Dr Zainal Safri SpPD, SpJP, FIHA Dept. Cardiology, Fac. of Medicine USU Adam Malik Hospital
Prevalence (%)
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Gu DF, et al. Hypertension 2002;40:920-927; Singh RB, et al. J Hum Hypertens 2000;14:749-763; Janus ED. Clin Exp Pharmacol Physiol 1997;24:987-988; National Health Survey 1998, Singapore. Epidemiology and Disease Department, Ministry of Health, Singapore.; Lim TO, et al. Singapore Med J 2004;45:20-27; Tatsanavivat P, et al. Int J Epidemiol 1998;27:405-409; Muhilal H. Asia Pacific J Clin Nutr 1996;5:132-134; Gupta R. J Hum Hypertens 2004;18:73-78; Asai Y, et al. Nippon Koshu Eisei Zasshi 2001;48:827-836 [in Japanese]
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1 0 115/75 135/85 155/95 175/105 SBP/DBP (mm Hg)
*Individuals aged 40-70 years, starting at BP 115/75 mm Hg. CV, cardiovascular; SBP, systolic blood pressure; DBP, diastolic blood pressure Lewington S, et al. Lancet. 2002; 60:1903-1913. JNC 7. JAMA. 2003;289:2560-2572.
CHD
Stroke
CHF
10
0
>180
Obesity
HYPERTENSION
Neurohormonal Dysfunction
Kannel WB. JAMA. 1996;275:1571-1576. Weber MA et al. J Hum Hypertens. 1991;5:417-423. Dzau VJ et al. J Cardiovasc Pharmacol. 1993;21(suppl 1):S1-S5.
Hypertension risk
Aortic and other arterial aneurysm Peripheral arterial diseases Coronary Artery Disease Heart failure Ventricular hypertrophy Ventricular systolic dysfunction
Renal impairment End Stage Renal Disease Proteinuria modified from : Campbell, et al. CMAJ 2002 Williams B, et al.. BMJ 2004
KLASIFIKASI HIPERTENSI
Klasifikasi Hipertensi pada orang dewasa :
JNC 7 (The Seventh Report of The Joint National Committee on Prevention Detection, Evaluation, and Treatment of High Blood Pressure)
WHO (World Health Organization) ; ISH (International Society of Hypertension); ESH (European Society of Hypertension); BSH (British Hypertension Society); CHEP (Canadian Hypertension Education Program)
High normal
Grade 1 Hypertension (mild) Grade 2 Hypertension (moderate) Grade 3 Hypertension (severe) Isolated Systolic Hypertension
130-139 / 85-89
140-159 / 90-99 160-179 /100-109 > 180 / >110 140-159 / 90-99 >160 / >100 Stage 1 Hypertension Stage 2 Hypertension
>> 140
< 90
ESH-ESC BP Classification
80 70 60
73 68 51 55 54
70
59
Adults, %
50 40 30 20 10 0
31
29
34
27
Control
10
NHANES II 19761980
19992000*
*Computed by M. Wolz (unpublished data cited by Chobanian et al.) Adapted from Chobanian AV, et al. JAMA. 2003;289:2560-2572.
Canada
16
Spain
20
Australia
19
England 6
France
24
Germany
22.5
> 65 years
Scotland
17.5
India
9
USA: JNC VI. Arch Intern Med 1997 Canada: Joffres et al. Am J Hypertens 1997 England: Colhoun et al. J Hypertens 1998 France: Chamontin et al. Am J Hypertens 1998
Hipertensi Resisten
Prevalensi sekitar : 20 sampai 30% Faktor risiko : Usia tua, Obesitas
Caused of Hipertension :
I. Primer / essential / idiopathic (: 90-95%) II. Sekunder : (5-10%) A. Renal
B. Endocrine
C. Coartation of the aorta D. Pregnancy induced hypertension E. Neurological disorder F. Drug and other abused substancen
Patogenesis Hipertensi
MULTIFAKTORIAL
Tekanan Darah
Blood pressure
Hypertension
Vasoconstriction
Reninangiotensinaldosterone system
Stroke
Hypertension DEATH
HTN
Heart failure MI
Renal failure
LV = left ventricular; MI = myocardial infarction; GFR = glomerular filtration rate Adapted from Willenheimer R et al Eur Heart J 1999;20(14):997-1008; Dahlf B J Hum Hypertens 1995;9(suppl 5):S37-S44; Daugherty A et al J Clin Invest 2000;105(11):1605-1612; Fyhrquist F et al J Hum Hypertens 1995;9(suppl 5):S19-S24; Booz GW, Baker KM Heart Fail Rev 1998;3:125-130; Beers MH, Berkow R, eds. The Merck Manual. 17th ed. Whitehouse Station, NJ: Merck Research Laboratories, 1999:1682-1704; Anderson S Exp Nephrol 1996;4(suppl 1):34-40; Fogo AB Am J Kidney Dis 2000;35(2):179-188.
Elevated BP
Endothelial Dysfunction
Vascular Dysfunction
Elevated BP LVH
Angina Pectoris
Stroke
Therapeutic options
Masalah hipertensi :
Meningkatnya prevalensi Hipertensi Pasien Hipertensi : terapi (-) ; target (-) Komplikasi Hipertensi (HTN) keberhasilan penanganan HTN tergantung edukasi pasien & komunikasi thd kepatuhan minum obat
KESIMPULAN
Hipertensi esensial merupakan penyakit multifaktorial yang timbul karena interaksi : faktor risiko, sistim saraf simpatis, keseimbangan antara modulator vasodilatasi dan vasokonstriksi, pengaruh sistem renin-angiotensin-aldosteron Disfungsi endotel dan vaskular menyebabkan hipertensi, yg selanjutnya menyebabkan kerusakan target organ : jantung, otak, penyakit ginjal kronis, penyakit arteri perifer, retinopati Prevalensi hipertensi makin meningkat (15-25%), Pendekatan yang baik terhadap hipertensi akan meningkatkan angka pengendalian hipertensi dan mengurangi komplikasi
Thank You