MUZAKKIR AMIR
Category
Optimal
Normal
High-normal
Hypertension*
Stage 1
Stage 2
Stage 3
Systolic
(mm Hg)
Diastolic
(mm Hg)
<120
dan
<80
<130
130-139
dan
atau
<85
85-89
140-159
160-179
180
atau
atau
atau
90-99
100-109
110
*Based on the average of two or more readings taken at each of two or more visits after an initial screening.
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. November 1997. NIH
publication 98-4080
WHO-ISH (1999)
Klasifikasi Derajat Tekanan Darah menurut WHO-ISH
1999 yang diadaptasi dari JNC VI 1997
1
2
3
4
5
6
7
Kategori
Sistolik
(mmHg)
Diastolik
(mmHg)
Optimal
Normal
Normal Tinggi
Hipertensi derajat 1 (ringan)
Subgrup : perbatasan
Hipertensi derajat 2 (sedang)
Hipertensi derajat 3 (berat)
Hipertensi Sistolik
(Isolated Systolic Hypertension)
120
130
130 - 139
140 - 159
140 - 149
160 - 179
180
140
80
85
85 - 89
90 - 99
90 - 94
100 - 109
110
90
Category
Systolic
(mm Hg)
Diastolic
(mm Hg)
Normal
Pre Hipertensi
Hipertensi
Stage 1
Stage 2
<120
120-139
dan
atau
<80
80-89
140-159
> 160
atau
atau
90-99
>100
70
60
65
70-79
80+
54
50
44
40
30
20
64
21
4
11
18-29
30-39
10
0
age (yrs)
40-49
50-59
60-69
Prevalensi :
Berdasar kriteria Hipertensi WHO 1968 (tekanan darah > 160/95
mmHg), prevalensi hipertensi di dunia sekitar 5-18 %. Prevalensi
hipertensi di Indonesia tidak jauh berbeda yaitu sekitar 6-15 %,
walaupun dilaporkan adanya prevalensi yang rendah yaitu :
- Ungaran
1,8 %
- Lembah Balim
0,6 %
serta adanya prevalensi yang tinggi :
- Silungkang
19,4 %
- Talang
17,8 %
Prevalensi Hipertensi di Jawa Timur hampir sama yaitu :
- Sumberpucung (1976)
10 %
- Lawang
(1987)
11 %
- Kampak
(1987)
17 %
England
6
Canada
16
France
24
Spain
20.5
20
Germany
22.5
Scotland
Australia
19
India
17.5
> 65 years
5
4
2
1
< 140
mm Hg
mm Hg
140-159 160-179 180-199 200+
< 80
80-89
90-99
100-109
110+
10
5
MI
Stroke
0
0
100
200
300
Stage 2+ hypertension
15
CHF
Cumulative
Incidence 10
(%)
Stage 1+ hypertension
5
Normal BP
5
10
Years From Baseline Exam
15
Benefits of Lowering BP
Average Percent Reduction
Stroke incidence
3540%
Myocardial infarction
2025%
Heart failure
50%
Hipertensi
Berdasarkan penyebabnya dapat dibedakan :
Primer (essential)
tidak ada penyebab yang spesifik yang dapat
diidentifikasi
95% dari kasus hipertensi
Sekunder
diketahui penyebabnya
5% dari kasus hipertensi
penyakit ginjal merupakan penyebab dari 90%
kasus hipertensi sekunder
Hypertension :
The Disease Continuum
Early Paradigm
Elevated BP
Vascular Dysfunction
A Proposed Future Paradigm
Endothelial
Dysfunction
Vascular
Dysfunction
Elevated BP
Target Organ
Damage
LVH
Renal
Damage
MI
Angina
Pectoris
Stroke
Etiology Hypertension
Secondary Hypertension :
Renal disease :
Renal arterial disease
Renal parenchymal disease
Renal tumors
Arteritis (polyarteritis nodosa, neurofibromatosis)
Endocrine Disorders
Cushings syndrome
Acromegaly
Primary aldosteronism
Pheochromocytoma
Coarctation of the aorta
Neurologic disorders
Increased intra cranial pressure (tumor)
Drug-induced hypertension
Corticosteroids
Amphetamines
Oral contraceptives
Psychogenic disorders
Komplikasi Hipertensi
Eyes
retinopathy
Kidneys
renal failure
Brain
stroke
Heart
ischaemic heart disease
left ventricular hypertrophy
heart failure
Besarnya peningkatan
tekanan darah
Symptoms
Headache
Dizziness
Fatigue
Pounding of the heart
Symptoms are not specific and no more frequent than
in patients with normotension.
Hipertensi
Hipertensi
dan
menentukan
2. Untuk
menyingkirkan
Hipertensi Sekunder
dan
menemukan
Riwayat Klinik :
Riwayat keluarga HT, DM, dislipidemia, PJK, stroke atau penyakit ginjal
Lama dan tingkat tekanan darah tinggi sebelumnya dan hasil pengobatan serta
efek samping obat antihipertensi sebelumnya
Riwayat atau gejala sekarang PJK dan gagal jantung, penyakit serebrovaskuler,
penyakit vaskuler perifer, DM, pirai, dislipidemia, asma bronkhiale, penyakit
ginjal, dan informasi obat yang diminum
Penilaian faktor risiko termasuk diet lemak, natrium dan alkohol, jumlah rokok,
tingkat aktifitas fisik, dan peningkatan berat badan sejak awal dewasa
Riwayat obat-obatan atau bahan lain yang dapat meningkatkan tekanan darah
Pemeriksaan Fisik :
Pemeriksaan fisik lengkap termasuk pengukuran tekanan
Pemeriksaan lain-lain
Pemeriksaan Laboratorium :
Urinalisis untuk darah, protein dan gula serta pemeriksaan mikroskopik urin
Serum kalium, kreatinin, gula darah puasa & 2 jam dan profil lemak, asam urat
Pemeriksaan tambahan :
Pemeriksaan hormonal seperti pengukuran aktifitas renin plasma, aldosteron
plasma dan katekolamin urine atas indikasi khusus (hipertensi sekunder)
Pemeriksaan EKG
Pemeriksaan foto polos dada
Ekhokardiografi diperiksa bila mencurigakan adanya keru-sakan organ
Goals of Therapy
(JNC-VII)
Reduce CVD and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg
in patients with diabetes or chronic kidney
disease.
Achieve SBP goal especially in persons >50 years
of age.
JNC VI
Uncomplicated HTN
< 140/90
Hypertension with
diabetes mellitus
< 130/85
< 130/80*
< 130/85
Heart failure
Hypertension with
renal impairment
< 125/75
*National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group.
Terapi Hipertensi
Terapi Non-farmakologis
Menurunkan berat badan (5-20 mmHg/10 kg)
Latihan dan olah raga (4-9 mmHg)
Menghindari alkohol yang berlebihan
Mengurangi asupan garam (2-8 mmHg)
Stop merokok
Menurunkan asupan lemak jenuh
Terapi Hipertensi
Terapi Farmakologis
tujuan terapi antihipertensi
Memperbaiki fx. Endothel (?)
untuk menurunkan resistensi vaskular sistemik
mempertahankan curah jantung
mempertahankan suplai darah ke organ dan
jaringan
Pengobatan diberikan seumur hidup
Kepatuhan yang buruk merupakan penyebab
kegagalan terapi antihipertensi yang paling besar
Risk Group B
(At Least 1 Risk
Risk Group A
Factor, Not Including
Blood Pressure Stages (No Risk Factors Diabetes; No
(mmHg)
No TOD/CCD)
TOD/CCD)
Risk Group C
(TOD/CCD and/or
Diabetes, With or
Without Other Risk
Factors)
High-normal
(130-139/89-89)
Lifestyle
modification
Drug therapy
Stage 1
(140-159/90-99)
Lifestyle
Lifestyle
modification
modification
(up to 12 months) (up to 6 months)
Drug therapy
Stages 2 and 3
(> 160/> 100)
Drug therapy
Drug therapy
Lifestyle
modification
Drug therapy
For example, a patient with diabetes and a blood pressure of 142/94 mmHg plus left ventricular
hypertrophy should be classified as having stage 1 hypertension with target organ disease (left
ventricular hypertrophy) and with another major risk factor (diabetes). This patient would be categorized
as Stage 1, Risk Group C, and recommended for immediate initiation of pharmacologic treatment.
Without Compelling
Indications
With Compelling
Indications
Stage 1 Hypertension
Stage 2 Hypertension
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension
specialist.
DBP*
mmHg
Lifestyle
modification
Normal
and <80
Encourage
<120
With compelling
indications
Prehypertension
120139 or 8089
Yes
No antihypertensive drug
indicated.
Stage 1
Hypertension
140159 or 9099
Yes
Stage 2
Hypertension
>160
or >100
Yes
Initial combined therapy should be used cautiously in those at risk for orthostatic
hypotension.
Postmyocardial
infarction
ACC/AHA Post-MI
Guideline, BHAT,
SAVE, Capricorn,
EPHESUS
ALLHAT, HOPE,
ANBP2, LIFE,
CONVINCE
Diabetes
NKF-ADA Guideline,
UKPDS, ALLHAT
ACEI, ARB
NKF Guideline,
Captopril Trial,
RENAAL, IDNT, REIN,
AASK
Recurrent stroke
prevention
THIAZ, ACEI
PROGRESS
Hipertensi
Secondary Hypertension :
Renal disease
Renal artery
stenosis
Endocrine disorders
Hyperaldosteronism
(Conns syndrome)
Cushings syndrome
Phaeochromocytoma
Pregnancy
Coarctation of the
aorta
Certain drugs,
e.g. corticosteroids,
oral contraceptives
and vasoconstrictors