Hipertensi masih menjadi penyebab kematian tertinggi di dunia.

Pada jangka waktu lama

bila hipertensi tidak dapat turun stabil pada kisaran normal tensi maka dapat merusak organ-
organ terkait. Komplikasi hipertensi dapat mengenai beberapa organ target seperti pada jantung
(penyakit jantung iskemik, hipertrofi ventrikel kiri, gagal jantung), otak (stroke), ginjal (gagal
ginjal), mata (retinopati), dan artei perifer (klaudikasio intermiten). Kerusakan organ-organ
tersebut bergantung pada tingginya tekanan darah yang dialami pasien dan berapa lama tekanan
darah tinggi tersebut tidak diobati dan tidak terkontrol.
The world's leading cause of death is still hypertension. In the long run, hypertension can
harm associated organs if it is unable to consistently decrease into the normal range of tension.
Several target organs, including the heart (ischemic heart disease, left ventricular hypertrophy,
and heart failure), brain (stroke), kidneys (kidney failure), eyes (retinopathy), and peripheral
arteries (PA), can be affected by complications of hypertension (intermittent claudication).
Depending on the patient's high blood pressure and how long it remains untreated and
uncontrolled, various organs may suffer damage.
Manajemen atau tatalaksana untuk menurunkan tekanan darah melalui dua cara yang
saling berkesinambungan dan tidak bisa dipisahkan agar dapat menurunkan tekanan darah secara
optimal, yaitu dengan tatalaksana non farmakologis atau dengan modifikasi gaya hidup dan
dengan tatalaksana farmakologis berdasarkan algoritma yang berlaku pada setiap guideline.
Modifikasi gaya hidup sehat telah banyak terbukti dapat menurunkan tekanan darah, dan juga
secara umum sangat menguntungkan dalam menurunkan risiko permasalahan kardiovaskular.
Pada pasien yang menderita hipertensi derajat 1 dan tanpa faktor risiko kardiovaskular lain, maka
strategi modifikasi gaya hidup sehat merupakan tatalaksana tahap awal yang harus dijalani
setidaknya selama 4-6 bulan. Bila setelah itu tidak didapatkan penurunan tekanan darah yang
diharapkan atau didapatkan faktor risiko kardiovaskular yang lain, maka dianjurkan untuk
memulai terapi farmakologi.
Management or management to reduce blood pressure through two ways that are
mutually sustainable and inseparable to reduce blood pressure optimally, namely by non-
pharmacological management or by lifestyle modification and with pharmacological
management based on algorithms that apply to each guideline. Healthy lifestyle modifications
have been widely proven to lower blood pressure, and are also generally very beneficial in
lowering the risk of cardiovascular problems. In patients suffering from 1st-degree hypertension
and without other cardiovascular risk factors, the strategy of modifying a healthy lifestyle is an
early-stage treatment that must be carried out for at least 4-6 months. If after that there is no
expected decrease in blood pressure or other cardiovascular risk factors are obtained, then it is
recommended to start pharmacological therapy.
Management or management to reduce blood pressure through two mutually sustainable
and inseparable methods, namely non-pharmacological management or lifestyle modification
and pharmacological management based on algorithms that apply to each recommendation, to
reduce blood pressure optimally. Healthy lifestyle changes are generally highly helpful in
reducing the risk of cardiovascular issues and have a strong track record of lowering blood
pressure. The approach of altering a healthy lifestyle is an early-stage treatment that must be
carried out for at least 4-6 months in patients with 1st-degree hypertension and without other
cardiovascular risk factors. It is advised to begin pharmaceutical therapy if the projected drop in
blood pressure or other cardiovascular risk factors is not seen after that.
Penatalaksanaan untuk menurunkan tekanan darah melalui dua metode yang saling
berkelanjutan dan tidak terpisahkan, yaitu manajemen non farmakologis atau modifikasi gaya
hidup dan manajemen farmakologis berdasarkan algoritma yang berlaku pada masing-masing
rekomendasi, agar dapat menurunkan tekanan darah secara optimal. Perubahan gaya hidup sehat
umumnya sangat membantu dalam mengurangi risiko masalah kardiovaskular dan memiliki
rekam jejak yang kuat dalam menurunkan tekanan darah. Pendekatan mengubah gaya hidup
sehat adalah pengobatan tahap awal yang harus dilakukan setidaknya selama 4-6 bulan pada
pasien dengan hipertensi derajat 1 dan tanpa faktor risiko kardiovaskular lainnya. Disarankan
untuk memulai terapi farmasi jika proyeksi penurunan tekanan darah atau faktor risiko
kardiovaskular lainnya tidak terlihat setelah itu.
Modifikasi gaya hidup yang dianjurkan oleh JNC 7 dan oleh beberapa guidelines lain.
1. Penurunan berat badan. Rekomendasi penurunan berat badan meliputi pengurangan
asupan kalori dan juga meningkatkan aktivitas fisik. Memperbanyak asupan sayuran dan
buah-buahan dapat memberikan manfaat lain selain penurunan tekanan darah seperti
menghindari diabetes dan dislipidemia. Penurunan berat badan dapat mengurangi tekanan
darah sistolik 5-20 mmHg/penurunan 10 kg. Ukuran pinggang yang dianjurkan yaitu pria
<94 cm dan perempuan <80cm, indeks massa tubuh 25 kg/m2.
2. Menerapkan pola makan DASH (Dietary Approaches to STOP Hypertension) dapat
menurunkan tekanan darah sistolik 8-14 mmHg. Diet ini menganjurkan lebih banyak
makan buah, sayur-sayuran, dan produk susu rendah lemak dengan kandungan lemak
jenuh dan total lebih sedikit, kaya potassium dan calcium.
3. Mengurangi asupan garam. Rekomendasikan makanan rendah garam sebagai bagian dari
pola makan sehat. Dianjurkan untuk asupan garam tidak melebihi 2 gr/ hari. Pengurangan
garam harian dapat menurunkan tekanan darah sistolik 2-8 mmHg. Pada pasien hipertensi
derajat ≥2, diet rendah garam juga bermanfaat untuk mengurangi dosis obat hipertensi.
4. Olah raga atau aktivitas fisik. Melakukan aktivitas fisik intensitas sedang secara teratur
sebanyak 30- 60 menit/ hari, minimal 3 hari/ minggu, dapat menurunkan tekanan darah
sistolik 4-9 mmHg.
5. Mengurangi konsumsi alcohol. Pembatasan konsumsi alcohol dapat menurunkan tekanan
darah sistolik 2-4 mmHg. Maksimum 2 minuman standard/ hari (1 oz atau 30 ml ethanol;
misalnya bir 24 oz, wine 10 oz, atau 3 oz 80-proof whiskey) untuk pria, dan 1 minuman
standard/ hari untuk wanita. Konsumsi alcohol lebih dari 2 gelas per hari pada pria atau 1
gelas per hari pada wanita dapat meningkatkan tekanan darah. Maka dengan demikian
membatasi atau menghentikan konsumsi alcohol akan sangat membantu dalam
menurunkan tekanan darah.
 6. Berhenti merokok. Meskipun sampai saat ini merokok belum terbukti dapat menurunkan
tekanan darah, tetapi merokok merupakan salah satu faktor risiko utama penyakit
kardiovaskular sehingga anjuran berhenti merokok untuk mengurangi risiko
kardiovaskular secara keseluruhan.
Lifestyle modifications are recommended by JNC 7 and by several other guidelines.
1. Weight loss. Weight loss recommendations include reducing caloric intake and also
increasing physical activity. Increasing the intake of vegetables and fruits can provide
other benefits besides lowering blood pressure such as avoiding diabetes and
dyslipidemia. Weight loss can reduce systolic blood pressure by 5-20 mmHg/decrease by
10 kg. The recommended waist size is <94 cm for men and women <80cm, body mass
index is 25 kg/m2.
2. Applying a DASH (Dietary Approaches to STOP Hypertension) diet can lower systolic
blood pressure by 8-14 mmHg. This diet recommends eating more fruits, vegetables, and
low-fat dairy products with less saturated and total fat content, rich in potassium and
calcium.
3. Reduces salt intake. Recommend low-salt foods as part of a healthy diet. It is
recommended for salt intake not exceed 2 gr/day. The daily salt reduction can lower
systolic blood pressure by 2-8 mmHg. In hypertensive patients of ≥2 degrees, a low-salt
diet is also useful for reducing the dose of hypertension drugs.
4. Sports or physical activity. Doing regular moderate-intensity physical activity of 30-60
minutes/day, at least 3 days/week, can lower systolic blood pressure by 4-9 mmHg.
5. Reduce alcohol consumption. Limiting alcohol consumption can lower systolic blood
pressure by 2-4 mmHg. Maximum 2 standard drinks/ day (1 oz or 30 ml of ethanol; e.g.
24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) for men, and 1 standard drink/ day for
women. Alcohol consumption of more than 2 glasses per day in men or 1 glass per day in
women can increase blood pressure. Thus, limiting or stopping alcohol consumption will
be very helpful in lowering blood pressure.
6. Quit. Although until now smoking has not been shown to lower blood pressure, smoking
is one of the main risk factors for cardiovascular disease so the recommendation to quit
smoking is to reduce overall cardiovascular risk.
JNC 7 and several additional recommendations advise making lifestyle changes.

1. Loss of weight. Reducing calories consumed and simultaneously increasing physical

activity are both recommended for weight loss. In addition to decreasing blood pressure,
increasing the consumption of fruits and vegetables can help prevent diabetes and
dyslipidemia. Systolic blood pressure can drop by 5–20 mmHg for every 10 kg of weight
lost. With a body mass index of 25 kg/m2, the ideal waist sizes for men and women are
94 cm and 80 cm, respectively.
2. Systolic blood pressure can be lowered by 8–14 mmHg by following a DASH (Dietary
Approaches to STOP Hypertension) diet. This diet advises consuming more fruits,
vegetables, and low-fat dairy foods that are high in potassium and calcium and low in
saturated and total fat.
3. lowers salt consumption. Promote low-salt foods as a component of a balanced diet. It is
advised that daily salt intake not exceed 2 gr. Systolic blood pressure can be lowered
daily by reducing salt intake by 2 to 8 mmHg. A low-salt diet is also helpful for lowering
the dose of hypertension medication in patients with hypertension of fewer than 2
degrees.
4. physical activities or sports. Systolic blood pressure can be lowered by 4–9 mmHg by
engaging in frequent moderate-intensity physical activity for 30–60 minutes per day, at
least three days per week.
5. Reduce your alcohol intake. Systolic blood pressure can be reduced by 2-4 mmHg by
limiting alcohol consumption. Men may only have two standard drinks per day (1 oz or
30 ml of ethanol; for example, 24 oz of beer, 10 oz of wine, or 3 oz of 80-proof whiskey)
and women may only have one standard drink per day. Blood pressure can rise if a
person drinks more than 2 glasses of alcohol per day (for men) or 1 glass per day (for
women). Thus, reducing or quitting alcohol use will significantly help to lower blood
pressure.
6. Quit. Smoking is one of the leading causes of high blood pressure, despite no evidence to
the contrary to date.

Diet DASH (Dietary Approaches to Stop Hypertension) merupakan suatu modifikasi gaya hidup
untuk penderita hipertensi dengan memakan makanan yang kaya akan buah-buahan, sayuran,
susu dan produk-produk susu tanpa lemak atau rendah lemak, biji-bijian, ikan, ungags, kacang-
kacangan. Diet DASH juga mengandung sedikit natrium, makanan manis, gula, lemak, dan
daging merah. Desain dari diet DASH ini juga mengandung lebih sedikit lemak jenuh, lemak
trans, dan kolesterol serta kaya akan nutrisi yang berhubungan dengan penurunan tekanan darah,
terutama kalium, magnesium, kalsium, protein, dan serat.
The DASH (Dietary Approaches to Stop Hypertension) diet is a lifestyle modification for people
with hypertension by eating foods rich in fruits, vegetables, milk, and lean or low-fat dairy
products, whole grains, fish, ungags, nuts. The DASH diet also contains a small amount of
sodium, sweets, sugar, fat, and red meat. The design of the DASH diet also contains fewer
saturated fats, trans fats, and cholesterol and is rich in nutrients associated with lowering blood
pressure, especially potassium, magnesium, calcium, protein, and fiber.
The DASH diet (Dietary Approaches to Stop Hypertension) encourages people with
hypertension to change their eating habits by consuming more foods high in fruits, vegetables,
milk, lean or low-fat dairy products, whole grains, seafood, nuts, and other healthy fats.
Additionally, the DASH diet includes a small quantity of sodium, sugar, fat, sweets, and red
meat. Less saturated fats, trans fats, and cholesterol are also present in the DASH diet's
composition, which is also high in minerals like potassium, magnesium, calcium, protein, and
fiber which are known to decrease blood pressure.

The DASH diet does not require special foods or recipes that are difficult to follow. This diet
requires only a certain number of daily servings of different food groups. The number of daily
servings depends on the number of calories needed each day. The calorie level depends on age,
especially how much physical activity is carried out daily. The level of physical activity is
divided into three categories, namely:
Not moving, only doing light physical activity that is part of the daily routine;
Moderately active, doing physical activity equivalent to walking about 1 to 3 miles a day at a
speed of 3 to 4 miles per hour, plus light activity;
Active, doing physical activity equivalent to walking more than 3 miles per day at a speed of 3 to
4 miles per hour, plus light physical activity.

The DASH diet does not call for any unusual foods or challenging-to-follow recipes. Only a
specific amount of daily servings from various food groups are necessary for this diet. The
amount of servings per day is determined by the daily caloric requirements. Age and, in
particular, the amount of daily physical activity affect calorie intake. Three categories are used to
categorize the level of physical exercise, including:
1. not moving, merely engaging in regular activities' minimal physical exercise;
2. moderate activity, which consists of mild exercise and walking 1 to 3 miles per day at a
speed of 3 to 4 miles per hour;
3. Active means engaging in physical activity that would equate to traveling at a pace of 3
to 4 miles per hour while walking more than 3 miles per day.

There are several steps to change daily dietary habits recommended by DASH:
Add a serving of vegetables at lunch on the first day and at dinner the next day, and add fruit to
food or as a snack.
Increase the use of fat-free and low-fat dairy products to three servings a day.
Limit lean meat to 6 ounces a day or 3 ounces per meal. If you usually eat large amounts of meat,
reduce meat consumption in a few days, for example, half or a third of each meal.
Include two or more vegetarian, or meatless, eating styles each week.
Add portions of vegetables, brown rice, wholemeal pasta, and cooked dried beans. Try stir-fried
dishes that contain less meat and more vegetables, seeds, and dried beans.
For snacks and desserts, use fruits or other foods that are low in saturated fats, trans fats,
cholesterol, sodium, sugar, and calories, for example, rice cakes without salt, Nuts without salt,
raisins, crackers, free or low-fat yogurt or frozen yogurt, popcorn without salt or butter added, or
raw vegetables.
Use fresh vegetables or low-sodium canned vegetables and fruits.

DASH advises taking the following measures to modify daily eating patterns:
Add fruit to food or as a snack, and include a portion of veggies at lunch on day one and dinner
on day two.
Increase daily consumption of dairy products with reduced or no fat to three servings.
3 ounces of lean meat every meal or no more than 6 ounces per day. If you typically consume a
lot of meat, try cutting back in a few days, perhaps to half or a third of each meal.
Each week, incorporate at least two vegetarian or meatless eating patterns.
Include quantities of cooked dried beans, brown rice, whole-wheat pasta, and veggies. Aim for
stir-fried foods that are higher in veggies, nuts, and dried beans rather than meat.
Use fruits or other low-calorie, low-saturated-fat, low-trans-fat, low-sodium, low-sugar, low-
calorie items for snacks and sweets, such as raw vegetables, rice cakes without salt, nuts without
salt, raisins, crackers, free or low-fat yogurt, or frozen yogurt.
Utilize fresh veggies or fruits and vegetables in low-sodium canned goods.

The Institute for Health Metrics and Evaluation (IHME) said in 2017 that of the 53.3 million
deaths worldwide, cardiovascular disease accounted for 33.1 percent, cancer 16.7 percent,
diabetes, and endocrine disorders 6 percent, and respiratory infections 6 percent. 4,8%.
Indonesia's cause of death data in 2016 showed a total of 1.5 million deaths, with the most causes
being cardiovascular disease 36.9%, cancer 9.7%, diabetes and endocrine diseases 9.3%, and
tuberculosis 5.9%. IHME also said that out of a total of 1.7 million deaths in Indonesia, the risk
factors for death were blood pressure (hypertension) at 23.7%, high blood sugar at 18.4%,
smoking at 12.7%, and obesity at 7.7%.

According to the Institute for Health Metrics and Evaluation (IHME), of the 53.3 million
fatalities recorded globally in 2017, cardiovascular disease was responsible for 33.1% of cases,
cancer for 16.7%, diabetes and endocrine disorders for 6%, and respiratory infections for 6%. 4,8
percent According to Indonesia's cause of death statistics from 2016, there were 1.5 million
fatalities overall, with the leading causes being cardiovascular disease (36.1%), cancer (9.7%),
diabetes, and endocrine illnesses (9.3%), and tuberculosis (5.9%). IHME also reported that out of
a total of 1.7 million deaths in Indonesia, the risk factors for mortality were high blood sugar
(18.4%), smoking (12.7%), and obesity (7.7%). Blood pressure (hypertension) was responsible
for 23.7% of these deaths.

Dietary approaches to stop hypertension (DASH) is a dietary pattern recommended in the

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC 7) for all hypertensive patients. This DASH pattern of
diets includes high fruits, vegetables, low-fat dairy products, low fat intake and low saturated fat,
cholesterol, whole grains, fish, poultry, and nuts; reduces red meat, sugar, as well as sugary
drinks. This DASH-compliant dietary pattern is rich in potassium, magnesium, calcium, and
fiber, and is slightly high in protein.

For all hypertensive patients, the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (JNC 7) recommends following the dietary pattern known
as Dietary Approaches to Stop Hypertension (DASH). This DASH pattern of eating eliminates
red meat, sugar, and sugary drinks while increasing fruits, vegetables, low-fat dairy products,
whole grains, fish, chicken, and nuts. It also includes low fat intake and low saturated fat and
cholesterol. This DASH-compliant eating plan is moderately high in protein and high in
potassium, magnesium, calcium, and fiber.