Tatalaksana Hipertensi Terkini

di
Fasilitas Kesehatan Tingkat Pertama
(FKTP)

dr. Muhadi SpPD KKV M.Epid FINASIM

Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia
Cabang Jakarta Raya
(PAPDI Jaya)
27 November 2020
1. American College of Cardiology (ACC)/American Heart
Association (AHA) tahun 2017
2. European Society of Cardiology (ESC)/European Society of
Hypertension (ESH) tahun 2018
3. Konsensus Penatalaksanaan Hipertensi Perhimpunan Dokter
Hipertensi Indonesia (PerHI) tahun 2019
4. International Society of Hypertension (ISH) tahun 2020
Epidemiologi : The prevalence of hypertension is increasing

23.5 million
newly diagnosed hypertensive patients per year

Kearney PM et al. Lancet. 2005;365(9455):217-223.

 WHO 2013, Hypertension

1 dari 3 org dewasa menyandang Hipertensi

1 dari 3 org dewasa dgn Hipertensi

TIDAK tau bila mereka Hipertensi

1 dari 3 org dewasa yg dapat obat,

Hipertensi tetap tidak terkontrol < 140/90

World Health Organization: World Health Day 2013. http://www.paho.org/hipertension/?lang=en

Annual Number of Death by Cause and by Risk Factor,
World 2016
ABPM=ambulatory blood pressure monitoring; HBPM=home
blood pressure monitoring; TD=tekanan darah.
Berdasarkan pengukuran TDS dan TDD di klinik, pasien digolongkan menjadi :
Modifiable risk factors* Relatively fixed risk factors†
• Current cigarette smoking, second-hand • CKD
smoking • Family history
• Diabetes mellitus • Increased age
• Dyslipidaemia/hypercholesterolaemia • Low socioeconomic/educational
• Overweight/obesity status
• Physical inactivity/low fitness • Male sex
• Unhealthy diet • Obstructive sleep apnoea
• Psychosocial stress
*Factors that can be changed and, if changed, may reduce CVD risk.
†Factors that are difficult to change (CKD, low socioeconomic/educational status, obstructive sleep apnea), cannot be

changed (family history, increased age, male sex), or, if changed through the use of current intervention techniques, may
not reduce CVD risk (psychosocial stress).

CKD, chronic kidney disease; CVD, cardiovascular disease.

Adapted from Whelton PK, et al. Hypertension 2018;71(6):1269-324.
CVD=cardiovascular disease; DM=diabetes melitus; HMOD=Hypertension-mediated organ damage;
PGK=penyakit ginjal kronik
Catatan:
Diagram ini adalah diagram SCORE untuk negara-negara risiko
rendah.
Etnis Asia Timur masih dianggap memiliki risiko lebih rendah
dibanding Kaukasia, data Asia Tenggara saat ini belum ada.
Penilaian komplikasi
hipertensi khususnya
penyakit jantung dan
pembuluh darah di FKTP
dengan menggunakan
Carta Prediksi Risiko yang
merupakan adopsi dari
World Health Organization
Routine Laboratory Tests
Haemoglobin and/or haematocrit

Fasting blood glucose and glycated HbA1c

Blood lipids: total cholesterol, LDL cholesterol, HDL cholesterol

Blood triglycerides

Blood potassium and sodium

Blood uric acid

Blood creatinine and eGFR

Blood liver function tests

Urine analysis : microscopic examination; urinary protein by dipstick test or, ideally,
albumin:creatinine ratio

12-lead ECG

1. ESC/ESH. European Heart Journal 2018; 39:3021-3104

Hypertension causes end-organ damage

Cushman WC. J Clin Hypertens. 2003;5(suppl 2):14-22.

 Fornas Fornas
2020 2020
-
25 mg -
-
- -
-
12,5-50 mg
-
- -
5-20 mg 5-10 mg
-
-
- -
-
-
-
-

ACC/AHA Guideline of Hypertension 2017

Fornas 2020 Fornas
40 mg 2020
10 mg
- -
-
- -
-
-
25 mg -
50 mg -
- -
-
-
-
-
-

ACC/AHA Guideline of Hypertension 2017