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• Hypertension is one of the
most common worldwide
diseases afflicting humans
• Hypertension is the most
important modifiable risk factor
for coronary heart disease (the
leading cause of death in
North America), stroke (the
third leading cause),
congestive heart failure, end-
stage renal disease, and
peripheral vascular disease
• Approximately 50 million people
in the United States are affected
by hypertension
• Approximately 30% of adults are
still unaware of their
hypertension; up to 40% of
people with hypertension are not
receiving treatment; and, of those
treated, up to 67% do not have
their blood pressure (BP)
controlled to less than 140/90
mm Hg
• Di Indonesia, penderita Hipertensi
diperkirakan 15 juta orang tetapi
hanya 4% yang merupakan
hipertensi terkontrol.
• Prevalensi 6-15% pada orang
dewasa, 50% diantaranya tidak
menyadari sebagai penderita
hipertensi sehingga
mereka cenderung untuk menjadi
hipertensi berat karena tidak
menghindari dan tidak mengetahui
factor risikonya, dan 90%
merupakan hipertensi esensial.
• Hypertension is defined as an abnormal elevation
in diastolic pressure and/or systolic pressure.
• Multiple etiologies
• Identifiable underlying cause:
a. kidney disease
b. renal artery stenosis
c. hyperaldosteronism
d. pheochromocytoma
• Represents approximately 10% of all
hypertension
• Has specific therapy, and is potentially curable
• Often distinguishable from essential hypertension
on clinical grounds
Chronic Renal Disease
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• catecholamines (both
epinephrine and
norepinephrine)
– This leads to alpha-
adrenoceptor mediated
systemic
vasoconstriction
and beta-
adrenoceptor mediated
cardiac stimulation
arterial pressure.
Pre-eclampsia
• 3rd trimester of
pregnancy
• blood volume and
tachycardia
• The former increases
cardiac output by
the Frank-Starling
mechanism
Aortic coarctation
• Elevated pressures proximal to the coarctation (i.e.,
elevated arterial pressures in the head and arms)
• Distal pressures are not necessarily reduced
• Reduced systemic blood flow and reduced renal blood
flow renin and an activation of the renin-angiotensin-
aldosterone system blood volume and arterial
pressure
• Baroreceptor reflex in blunted due to structural changes
in the walls of vessels where the baroreceptors are
located
– Baroreceptors become desensitized to chronic
elevation in pressure and become "reset" to the
higher pressure
Isolated Systolic Hypertension
• Defined as SBP 140mmHG and
DBP 90mmHG
• 60% of hypertensives > 80 years old
• From age 35/40 many people have
elevated systolic or diastolic
pressure and this elevation leads to
the widening and stiffening of the
aorta
• elasticity and compliance of the
large blood vessels SBP and
DBP
Prognosis
• Untreated hypertension silent killer
• Mild-to-moderate Ht, if left untreated, is associated with a risk
of atherosclerotic disease in 30% of people and organ damage
in 50% of people after only 8-10 years of onset.
• Death from both ischemic heart disease and stroke increase
progressively as BP increases. For every 20 mm Hg S or 10
mm Hg diastolic D increase in BP above 115/75 mm Hg, the
mortality rate for both ischemic heart disease and stroke
doubles.
• The morbidity and mortality of Ht emergencies depend on the
extent of end-organ dysfunction on presentation and the
degree to which BP is controlled subsequently. With BP
control and medication compliance, the 10-year survival rate
of patients with hypertensive crises approaches 70%
Patient Education