HIPERTENSI

dr. Dewi Martalena Sp.PD, M.Kes

ESC/ESH guideline
The relationship between BP & risk of CVD events is continuous, consistent, &
independent of other risk factors.
The higher the BP, the greater the chance of heart attack, HF, stroke, and kidney
diseases.
Evaluation of hypertensive patients has 3
objectives:
1. To assess lifestyle & identify other
cardiovascular risk factors or
concomitant disorders that may affect
prognosis & guide treatment

2. To reveal identifiable causes of high BP

3. To assess the presence or absence of

target organ damage & CVD.
Terapi ESC/ESH 2013
JNC 8
JNC 8
JNC 8
JNC 8
Green continuous lines: preferred combinations; green dashed line: useful
combination (with some limitations); black dashed lines: possible but less well tested
combinations; red continuous line: not recommended combination.
 Hypertensive Crises:
Emergencies & Urgencies
Hypertensive emergencies

Severe elevations in BP (>180/120 mmHg)

Hypertensive urgencies
Complicated by evidence of impending or
progressive target organ dysfunction Severe elevations in BP
without progressive target
Require immediate BP reduction (not organ dysfunction.
necessarily to normal) to prevent or limit
target organ damage Examples: upper levels of
stage II hypertension
Examples: hypertensive encephalopathy, associated with severe
intracerebral hemorrhage, acute MI, acute headache, shortness of
left ventricular failure with pulmonary breath, epistaxis, or severe
edema, unstable angina pectoris, dissecting anxiety.
aortic aneurysm, or eclampsia.
 Hypertensive Emergencies

should be admitted to ICU: monitoring of BP

& parenteral administration BP : MAP <25%
(within minutes to 1 hour)
Excessive falls in pressure that may
precipitate renal, cerebral, or coronary Clinically stable
ischemia should be avoided short-acting
nifedipine is no longer considered BP 160/100110 mmHg
acceptable within the next 26 hours

Exceptions to the recommendation:

Clinically stable
ischemic stroke patients
aortic dissection who should have their
further gradual reductions
SBP lowered to <100 mmHg if tolerated
toward a normal BP in the
patients in whom BP is lowered to
next 2448 hours
enable the use of thrombolytic agents
 Hypertensive Urgencies

May benefit from treatment with an oral, short-

acting agent such as captopril, labetalol, or clonidine
followed by several hours of observation.

Should not leave the ER without a confirmed follow

up visit within several days.
TERIMA KASIH