Syafrizal Nst,Mked(PD),SpPDKGH
I . Pendidikan
IV. Keanggotaan
ANTI HYPERTENSIVE
DRUG: WHEN TO START
& COMBINATION
Syafrizal nasution
OUTLINE
OUTCOME HYPERTENSION
HOW TO DIAGNOSE
MANAGING HYPERTENSION
TIME TO START DRUG THERAPY
WHICH ONE DRUG?
WHEN TO COMBINE ?
COMBINATION STRATEGIES
OUTLINE
OUTCOME HYPERTENSION
HOW TO DIAGNOSE
MANAGING HYPERTENSION
WHY TREAT?
TIME TO START DRUG THERAPY
WHICH ONE DRUG?
WHEN TO COMBINED ?
COMBINATION STRATEGIES
Hypertension:
a major CV risk factor
High-normal BP
Men
Normal BP
Optimal BP
Women
High-normal BP
Normal BP
6
Years
10
12
Optimal BP
Not treated
BP
uncontrolled
BP controlled
48%
(n = 2,458)
35%
(n = 1,756)
17%
(n = 872)
Gu Q, et al. Am J Hypertens 2010;23(1):38-45
The challenge of BP
control
% Adults
Hypertension Awareness,
Treatment,
and Control:
-2000
73 US 1976
68
69
51
%
31
%
10
%
%
55
%
%
54
%
29
%
27
%
%
58 Awareness
%
Treatment
31
%
Control
*
* Threshold of SBP/DBP 140/90 mm Hg
CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease;
DM, diabetes mellitus; HTN, hypertension; PAD, peripheral arterial disease.
* Based on BP target <130/80 mmHg
Sumut
(-)
OUTLINE
OUTCOME HYPERTENSION
HOW TO DIAGNOSE
MANAGING HYPERTENSION
TIME TO START DRUG THERAPY
WHICH ONE DRUG?
WHEN TO COMBINED ?
COMBINATION STRATEGIES
Patient
1. No acute anxiety, stress or pain.
2. No caffeine, smoking or nicotine in the
preceding 30 minutes.
3. No use of substances containing adrenergic
stimulants such as phenylephrine or
pseudoephedrine (may be present in nasal
decongestants or ophthalmic drops).
4. Bladder and bowel comfortable.
5. No tight clothing on arm or forearm.
6. Quiet room with comfortable temperature
7. Rest for at least 5 minutes before
measurement
8. Patient should stay silent prior and during the
procedure.
HYPERTENSION
Diagnosis
BP (mmHg)
Sistolic
Diastolic
<130
and
<80
130-139 and/or
85-89
Classification
Normal
Pre Hypertension
140-159 and/or
90-99
Hypertension Stage 1
160
100
Hypertension Stage 2
and/or
WHO-ISH
WHO-ISH
Systolic
Diastolic
< 120
< 130
130 - 139
140 - 159
140 - 149
160 - 179
> 180
> 140
140 - 149
< 80
< 85
85 - 89
90 - 99
90 - 94
100 - 109
> 110
<90
< 90
OUTLINE
OUTCOME HYPERTENSION
HOW TO DIAGNOSE
MANAGING HYPERTENSION
TIME TO START DRUG THERAPY
WHICH ONE DRUG?
WHEN TO COMBINED ?
COMBINATION STRATEGIES
The Newest
Guideline!!!
OUTLINE
OUTCOME HYPERTENSION
HOW TO DIAGNOSE
MANAGING HYPERTENSION
TIME TO START DRUG THERAPY
WHICH ONE DRUG?
WHEN TO COMBINE ?
COMBINATION STRATEGIES
Low
(n = 46)
MPR = Medication possession
ratio
Medium
(n = 165)
High
Adherence (MPR)
(n = 629)
Low
(n = 9,666)
Medium
(n = 7,624)
High
Adherence (PDC)
(n = 1,516)
35
30
30
25
20
15
10
5
12
16
OUTLINE
OUTCOME HYPERTENSION
HOW TO DIAGNOSE
MANAGING HYPERTENSION
TIME TO START DRUG THERAPY
WHICH ONE DRUG?
WHEN TO COMBINE ?
COMBINATION STRATEGIES
JNC-7
JNC-8
<140/9
0
<140/9
0
<140/9
0
<130/8
0
<130/8
0
<140/9
0
<150/9
0
<150/9
0
<140/9
0
<140/9
0
ASH/IS
H
<140/9
0
<140/9
0
<150/9
0
<140/9
0
<140/9
0
ESC/ES
H
<140/9
0
<140/9
0
<150/9
0
<140/8
5
<130/9
0
CHEP
<140/9
0
<140/9
0
<150/9
0
<130/8
0
<140/9
0
Monotherapy
1.Monotherapy can effectively reduce BP in only a limited number of
hypertensive patients1
Combination Therapy
2.The most patiens require the combination of at least two drugs to
achieve BP control1
3.The advantage of initiating with combination therapy is potentially
beneficial in high-risk patients1
4.A greater probability of achieving the target BP in patients with
higher BP values and a lower probability of discouraging patient
adherence with many treatment changes1
5.Lower drop-out rate than patients given any monotherapy1
6.Fewer side effects and provide larger benefits thant those offered
by a single agent. (e.g : RAAS + CCB reduces oedema) 1
7.Convinient once-daily administration of a single tablet, with
potential compliance benefits2
8.Effectively lowers BP in patients with an inadequate response to
monotherapy2
Loose Combination or
Single-pill Combination ?
10/3
0/16
64
10/3
0/16
65
Jangan sampai
ya !!!
The Paradox of
Diseases
The majority of people
continuously complain of
allergic problems
are
frightened to
death of
cancer and
AIDSor
H1N1
and ultimately die
of cardiovascular
diseases
Thank You