Jumat, 24 November 2017

FARMAKOTERAPI
HIPERTENSI

Arief Rahman Hakim

arief.h1@gmail.com

Pendahuluan
TD = CO x TPR
Hipertensi
Jarang menunjukkan simptom
Silent killer
Uncontrolled penyakit jantung, stroke,
gagal ginjal, penyakit arteri perifier dan
retinopati

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Epidemiologi
Prevalensi di dunia 31% populasi
sebelum 45 tahun pria >> wanita
Antara 45-54 th wanita > pria
Setelah umur 55 th wanita >> pria
Di Indonesia hipertensi sekitar 15 juta
orang 4% hipertensi terkontrol
Prevalensi di Indonesia 6-15% 50%
tidak menyadari penderita HPT
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ETIOLOGI
Hipertensi esensial/primer
Tidak diketahui penyebabnya
> 90% penderita masuk kategori ini
Beberapa faktor yang berkontribusi :
hiperinsulinemia, gangguan natriuresis, autoregulasi
neural dan perifer abnormal, gangguan pada sistem
RAA (renin angiotensin aldosteron)
Hipertensi sekunder
<5% penderita
Penyebabnya diketahui (lihat tabel)
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Penyebab hipertensi sekunder

Penyebab Resistensi Kardiak
Perifer Output
Ginjal
Kerusakan glomerular ↓ GFR retensi cairan - +
Sekresi renin ↑ angiotensin ↑ (peny arteri ginjal) + +
Endokrin
Feokromositoma adrenalin (epinefrin) ↑ + +
Cushing’s/Conn’s sindrom aldosteron ↑ - +
Vasomotor
Tekanan intrakranial ↑ (trauma, tumor) + -
Anatomik
Koarktasio aorta (kontriksi) + -
Obat
NSAID, kortikosteroid, kontrasepsi , simpatomimetik, + +
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MAOI (antidepresi fenelzin)

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Classification based on the average of two or more properly measured

seated blood pressure measurements from two or more clinical encounters
If systolic and diastolic blood pressure values yield different classifications,
the highest category is used for the purpose of determining a classification.
For patients with diabetes mellitus, significant chronic kidney disease,
known coronary artery disease (myocardial infarction, stable angina,
unstable angina), noncoronary atherosclerotic vascular disease (ischemic
stroke, transient ischemic attack, peripheral arterial disease, abdominial
aortic aneurism), or a Framingham risk score of 10% or greater, values
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≥130/80 mm Hg; patients with left ventricular dysfuction values ≥ 120/80
mm Hg.

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Klasifikasi TD 2017

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PRESENTASI KLINIK
Umum
Pasien yang terlihat sehat atau memiliki faktor-faktor
resiko :
Umur (≥ 55 th untuk pria, ≥ 65 th untuk wanita)
Diabetes melitus
Dislipidemi (LDL, kolesterol, trigliserid ↑)
Riwayat keluarga
Obesitas
Merokok
Simptom : asimptomatik
Tanda : TD prehipertensi or hipertensi

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PRESENTASI KLINIK
Laboratory test :
BUN dan serum kreatinin
Kadar lipid puasa
Kadar glukosa puasa
Serum kalium
Urinalisis
Diagnostik lain :
EKG (deteksi gangguan jantung)

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Tujuan, Sasaran, & Strategi Terapi

Tujuan : mencegah morbiditas dan

mortalitas peny kardiovaskular
Sasaran : TD
Strategi : menurunkan TD sampai target

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Target Terapi HPT 2017

Atherosclerotic cardiovascular disease (ASCVD)

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Algoritme Terapi Hipertensi

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• Lifestyle modification alone appropriate therapy for patients

with prehypertension
• Patients diagnosed with stage 1 or 2 hypertension should be
placed on lifestyle modifications and drug therapy concurrently
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HTN pada Wanita Hamil

Preeklamsia komplikasi life-threating
untuk ibu dan fetus dan muncul setelah 20
mgg kehamilan
Ditandai TD >140/90 dan proteinuria
Dapat menjadi eklamsia bila ada kejang
Manajemen terapi :
Dilarang beraktivitas, bed rest, monitoring ketat
Hidralazin iv atau labetalol iv
HTN kronis pada wanita hamil
metildopa
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HTN pada lansia

Biasanya htn sistolik terisolasi
Data epidemiologi mengindikasikan mortalitas
lebih besar terjadi pada TDS dp TDD pada
pasien umur 50 th atau lebih
Terapi :
Diuretik tiazid terapi awal (HCT 12,5 mg)
ACEI

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Hiperlipidemi
Major CV risk factor, and should be controlled in
hypertensive patients.
Thiazide diuretics and β-blockers without ISA may
affect serum lipids, but no clinical consequence.
α-blockers have favorable effects (decreased LDL-
cholesterol and increased HDL-cholesterol levels).
However, not reduce CV risk not clinically
applicable.
ACE inhibitors and CCB have no effect on serum
cholesterol.

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Hypertensive Urgencies And Emergencies

Hypertensive crisis (BP >180/120 mm Hg) :

hypertensive emergency (extreme BP elevation
with acute or progressing target organ damage)
or
hypertensive urgency (severe BP elevation
without acute or progressing target organ injury)
Hypertensive urgencies ideally managed by
adjusting maintenance therapy by adding a new
antihypertensive and/or increasing the dose of a
present medication
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Hypertensive Urgencies And

Emergencies
Hypertensive emergencies require
immediate BP reduction to limit new or
progressing target-organ damage.
the initial target reduction in BP up to 25%
within minutes to hours.
Nitroprusside is the agent of choice for
minute-to-minute control in most cases.
given as continuous IV infusion at a rate of 0.25 to
10 mcg/kg/min.

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