Hypertension

Mohamad Subandrio

Pelita Anugrah
2 Juni 2016
 Epidemiology
• Affects 75 millions in USA, 1 billion worldwide
• Indonesia: 26,5% (Riskesdas 2013)
• Most common, readily identifible, and
reversible risk factor for MI, stroke, heart
failure, AFib, aortic dissection, and PAD
• Causes 2/3 of all strokes,
½ of all cases of IHD
 Indonesia Data
• Prevalence: 26,5%
• Diagnosed by a health worker: 9,4%
• Diagnosed by a health worker OR consume
drug(s) to treat hypertension: 9,5%
• Normal blood pressure with hypertension
medication: 0,7%

Data from: Riskesdas 2013

 Definition
• usual office blood pressure of 140/90 mm Hg
or higher
 Primary Hypertension
• 90% to 95% of hypertensive patients have no
apparent single reversible cause
• Non-identified
• Related with behaviors, calori, salt, alcohol,
genetic
 Secondary Hypertension
• 5 – 10%, has
identifible cause of
hypertension - Vasocontraction
– CKD
– Renovascular
- Renal retension of
hypertension salt and water
– Coarctation of aorta
– Primary aldosteronism
– Cushing syndrome
– Pheochromocytoma
 Intial Evaluation of BP
A. Office blood presure
o BP normally varies throughout 24-h period.
 HT should never be diagnose on the basis
of a single elevated reading.
o To minimize variability in reading:
 BP should be measured at least twice after 5
minutes of rest with the patient seated, the
back supported and the arm at heart level.
 The cuff should not be too small for the
arm
 Tobacco and coffein should be avoided
for at least 30 minutes.

B. BP stage
C. Home and ambulatory BP monitoring
JNC VII
 ETIOLOGY
PRIMARY HT
• Pathogenesis remains
unclear
• Angiotensin II &
mineralocorticoid activity
• Genetic factors (30%)
SECONDARY HT
• Primary kidney disease
• Oral contraceptives
• Drug induced
• Pheocromocytoma
• Primary aldosteronism
• Renovascular disease
• Cushing’s syndrome
• Endocrine disorders
(hyperthyroidsm)
• Obstructive sleep apnea
Pathogenesis and
Pathophysiology
 Basic Equation of Blood Pressure

Cardiac Peripheral
Blood Pressure = Output
X Resistance

And / Or
 Cardiac X  Peripheral
Hypertension = Output Resistance
PATHOPHYSIOLOGY
High Salt
Intake Renal Mechanism

Sodium
• Resetting of pressure natriuresis
Retention
• Low birth weight reduces
nephrogenesis
– Decreased total filtration area
Plasma
Volume
– salt dependent hypertension

Blood
Pressure
Diagnosis
 History Taking
• Duration and severity
• Assessment of other CV risk factor
• Assessment of target organ damage
• Symptom of identifiable cause of HTN
• Drug/substance that may BP
• Psychosocial and enviromental
• Family history of HTN and CVD
 MEASUREMENT TECHNIQUE
• In the office, BP should be measured at least twice
after 5 minutes of rest, with the patient seated in a
chair, the back supported, and the arm bare and at
heart level. Cuff width 80% of the upper arm.

• A large adult-sized cuff should be used to measure

BP in overweight adults because the standard-sized
cuff can spuriously elevate readings. Tobacco and
caffeine should be avoided for at least 30 minutes.
2019/7/3
Management
 Lifestyle modification
• Body weight reduction
• Physical activity
• Alcohol cessation
• Smoking cessation
• Sodium restriction
• Low fat food
JNC VIII
Preferred Drug