STRATEGI PENANGANAN

HIPERTENSI
PADA FASKES PRIMER
ERA BPJS

I MD DWI SUMOHADI
SOSIALISASI BPJS
2015
SK MENTERI No; 5 tahun 2014

 155 PENYAKIT NON SPESIALISTIK

 FASKES PRIMER
FASKES PRIMER

 SUMBER DAYA MANUSIA

 SARANA PRASARANA
 STAKEHOLDER TERKAIT ERA BPJS DI FASKES PRIMER
HIPERTENSI

 Out line:
1. DEFINISI
2. ETIOPATOGENESIS
3. KLASIFIKASI DAN STRATIFIKASI
4. PENANGANAN TERAPI
5. KOMPLIKASI TARGET ORGAN
Batasan Hipertensi
1. Bila tekanan sistolik >= 140 mmHg, dan
atau tekanan diastolik >= 90 mmHg,
atau sedang mendapat obat antihipertensi.

2. Dilakukan dua kali atau lebih

pengukuran pada dua kali atau lebih
kunjungan.
MENGUKUR TEKANAN DARAH

Sphygmomanomet
er
Epidemiologi
Hipertensi diperkirakan menjadi penyebab kematian sekitar 7,1
juta orang di seluruh dunia, yaitu sekitar 13% dari total
kematian.
Blood Pressure Classification
BP SBP DBP
Classification mmHg mmHg
Normal <120 and <80

Prehypertension 120–139 or 80–89

Stage 1 140–159 or 90–99

Hypertension

Stage 2 >160 or >100

Hypertension
JNC 7
ESC/ESH 2003 .
PENYEBAB HIPERTENSI

1. Tidak diketahui, 90-95 % 2. Secondary Hypertension

kasus hipertensi tidak (5 to 10%)
diketahui penyebabnya
( Primary Hypertension)  Kidney Abnormalities
 Narrowing of certain
arteries
 Rare tumors
 Adrenalgland
abnormalities
 Pregnancy
PATOGENESIS

 HIPERTENSI: disease continuum (atherosclerotic

syndrome)
 Endothel dysfunction
 Vascular dysfunction
 Perubahan hemodinamik
 Perubahan biologi vascular
 Target organ demage
PATOGENESIS
PATOGENESIS: TARGET TERAPI
PATOGENESIS: ANGIOTENSIN II
PATOGENESIS: RAA SISTEM
RISK FAKTOR HIPERTENSI

1. Controllable Risk
Factors
Increased salt
intake
Obesity
Alcohol
Stress
Lack of
exercise
2. Uncontrollable Risk
Factors
 Heredity

 Age
 Men between age 35
and 50
 Women after
menopause

 Race
 1 out of every 3 African
Americans
 Higher incidence in
non-Hispanic blacks
and Mexican
Americans
 Risk of Hypertension

 Advancing age
 Positive family history of premature cardiovascular
disease
 Smoking
 Hypercholesterolemia
Laboratory Tests
 Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose, and hematocrit
• Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
 Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine ratio
 More extensive testing for identifiable causes is not generally indicated
unless BP control is not achieved
 PENATALAKSANAAN
A. penatalaksanaan nonfarmakologi
atau perubahan gaya hidup
 Penurunan berat badan
 penurunan asupan garam
 menghindari faktor resiko
(merokok, minum alkohol,
hiperlipidemia dan stres)
B. penatalaksanaan farmakologi
atau dengan obat
 Diuretik
 Golongan penghambat
simpatetik
 Penyekat Beta (β-blocker)
 Vasodilator
 Penghambat ACE
 Antagonis kalsium
Algoritma pengobatan hipertensi
Treatment
Overview
 Goals of therapy
 Lifestyle modification
 Pharmacologic treatment
• Algorithm for treatment of hypertension
 Classification and management of BP for adults
 Followup and monitoring
Goals of Therapy

 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.

 WHO-ISH Guidelines for Management of
Hypertension: Stratification of Cardiovascular
Risk
Blood Pressure (mm Hg)
Grade 1 Grade 2 Grade 3
Mild Moderate Severe
hypertension hypertension hypertension
Other risk factors and SBP 140–159 SBP 160–179 SBP  180
disease history or DBP 90–99 or DBP 100–109 or DBP  110
I No other risk factors Low risk Med risk High risk
II 1–2 risk factors Med risk Med risk Very high risk
III 3 or more risk factors High risk High risk Very high risk
or TOD or diabetes
IV ACC Very high risk Very high risk Very high risk

TOD = Target-organ damage Guidelines subcommittee. WHO-ISH

ACC = Associated clinical conditions Guidelines. J Hypertens 1999;17:151-183.
BP TARGETS:

WITHOUT COMPLICATION : <140/80 mmHg

DIABETES : < 130/80 mmHg

CKD : < 130/80 mmHg

PROTEINURIA > 1 g/d : <125/75 mmHg

Lifestyle Recommendations for
Hypertension: Physical Activity
Should be prescribed to reduce blood pressure

F Frequency - Four or five times per week

I Intensity - Moderate

T Time - 45-60 minutes

Type Dynamic exercise

- Walking
T - Cycling
- Non-competitive swimming

For patients who are prescribed pharmacological therapy: Exercise should be prescribed as adjunctive therapy
Treatment of Hypertension

 Diuretic
 ACE-Inh
 ARB
 Beta blocker
 Alpha blocker
 Direct renin inhibitor
Treatment Algorithm for Adults with Systolic-Diastolic
Hypertension without another compelling
indication
TARGET <140/90 mmHg

INITIAL TREATMENT AND MONOTHERAPY

Lifestyle modification
therapy

Long-acting Beta-
Thiazide ACE-I ARB
DHP-CCB blocker

Alpha-blocker
as initial
monotherapy
Indications for
Pharmacotherapy
 Strongly consider prescription if:
 Average DBP equal or over 90 mmHg and:
 Hypertensive Target-organ damage (or CVD) or
 Independant cardiovascular risk factors
 Elevated systolic BP
 Cigarette smoking
 Abnormal lipid profile
 Strong family history of premature CV disease
 Truncal obesity
 Sedentary Lifestyle

– Average DBP equal or over 80 mmHg and

diabetes
 Diuretics

-blockers AT1 receptor

blockers

α-blockers Ca Antagonist

ACE Inhibitors

2003 Guidelines for Management of Hypertension, J of Hypertension 2003

C.I. : Verapamil + ßBlocker ESH-ESC 2003

Hipertensi & Kerusakan Organ Target

34
Hypertension is thought to account for :

- One–half of all deaths due to stroke

- Up to one quarter of coronary heart
disease deaths
Isolated Systolic hypertension increase the risk of :

 stroke and coronary heart disease by about 40%

 cardiovascular death by about 50%
 heart failure by about 50%
 Consequences of Malignant HTN
End Organ Complications

Aorta Aortic disection

Brain Hipertensive encepahlopathy
Cerebral Infarction or Haemmorharge
Heart Cardiac failure
Myocardial ischemic or infarction

Kidney Renal failure

Haematuria
Gastrointestinal Anorexia,nausea,vomiting,abdominal
pain
Placenta Eclampsia
Other Micro-angiopathic haemolytic anemia
 Consequences of
hypertension
 Cardiac disease
Left ventricular failure
Angina
Myocardial infarction

 Cerebrovascular disease
Transient ischemic attacks
Stroke
Multi-infarct dementia
Hypertensive encephalopathy
Consequences of hypertension

 Vascular disease
Aortic aneurysm
Occlusive peripheral vascular disease
Arterial dissection

 Others
Progressive renal failure
Hypertensive retinopathy