HIPERTENSI

Pembimbing :
dr. Reddy Ramundito, Sp. JP

Oleh : Dwi kurniawan s 20190420075

SMF JANTUNG
RSU HAJI SURABAYA
FAKULTAS KEDOKTERAN HANG TUAH SURABAYA
2019
 suatu keadaan dimana dijumpai tekanan darah 140/90 mmHg atau lebih
untuk usia 13 – 50 tahun dan tekanan darah mencapai 160/95 mmHg
untuk usia di atas 50 tahun.
 Pengukuran tekanan darah minimal sebanyak dua kali untuk lebih
memastikan keadaan tersebut (WHO, 2005).

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 Tekanan darah sistolik ≥ 140 mmHg dan atau tekanan darah diastolik ≥ 90
mmHg, pada pemeriksaan yang berulang
 Tekanan darah sistolik merupakan pengukuran utama yang menjadi dasar
penentuan diagnosis hipertensi.
(Pedoman Tatalaksana Hipertensi pada Penyakit Kardiovaskular, PERKI,
2015)

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 FAKTOR RESIKO (JNC VII)

• Umur
• Jenis kelamin
• Riwayat keluarga
• Genetik (faktor resiko yang tidak dapat diubah/dikontrol)
• Kebiasaan merokok
• Konsumsi garam
• Dislipidemi
• Obesitas
• Kurang aktifitas fisik
• Stres
• Penggunaan estrogen
 Etiologi
 Essential (95%)
 Sekunder  5%-10% kasus
- Renal : renal artery stenosis ; parenchymal disease
- Endocrine : Pheochromocytoma; Hyperaldosteronism;
hyperthyroidsm ; Cushing syndrom; Exogenous
agent
- Vascular: Coarctation of aorta, Aortic insufficiency
- Toxemia of pregnancy
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TARGET KERUSAKAN ORGAN

Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
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CLASSIFICATION (JNC VII)

Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
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• Lama menderita hipertensi
• Indikasi hipertensi sekunder
• Faktor resiko
• Gejala kerusakan organ
• Pengobatan antihipertensi sebelumnya
• Faktor-faktor pribadi, keluarga dan lingkungan.

The Canadian
Recommendation for The Management of Hypertension
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2014
• Tanda vital ( Tensi, Nadi, RR, Suhu)

• Cardiovascular

• Paru

• Neurologic

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• Gula darah dan kolesterol

• Natrium dan Kalium

• Thyroid function tests

• Kidney function tests

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Algoritme tatalaksana hipertensi secara umum, (Pedoman Tatalaksana
Hipertensi pada Penyakit Kardiovaskular, PERKI, 2015)
Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
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 Reduce cardiac output
 -adrenergic blockers
 Ca2+ Channel blockers
 Dilate resistance vessels
 Ca2+ Channel blockers
 Renin-angiotensin system blockers
 1 adrenoceptor blockers
 Reduce vascular volume
 Diuretics
 Direct vasodilators

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JNCVIII

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ANTI HYPERTENSION DRUGS (JNC VII)
Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
COMBINATION THERAPY
 FOLLOW UP dan MONITORING

• Monitor tekanan darah

• Monitor serum kalium dan kreatinin
• Setelah target tek darah dicapai dan stabil, pasien dapat kembali
tiap 3-6 bulan
• Risiko kardiovaskular lainnya harus diterapi
• Menyarankan pasien untuk berhenti merokok

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 KONDISI OBAT YANG DIANJURKAN

 Kehamilan  Nifedipine, labetalol, hydralazine,

beta-blockers, methyldopa,
prazosin
 Coronary heart
disease  Beta-blockers, ACE inhibitors,
Calcium channel blockers

 Congestive heart  ACE inhibitors, diuretik

failure beta-blockers

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2003 WHO-ISH
Krisis Hipertensi
Hipertensi Gawat (Emergency)
Hipertensi Daurat (Urgency)

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Hipertensi Emergensi
 Penatalaksanaan HT Emergensi

 TD harus turun dalam hitungan menit, ok ada ancaman kerusakan

target organ
 Obat parenteral (i.v):
- sodium nitroprussid
- nitrogliserin
- diltiazem HCl
- hidralazin
Hypertensive Emergency
Drug Dose Onset Duration Adverse Effects Special Indications
(min) (min)
Sodium 0.25–10 mcg/kg/min Immediate 1–2 Nausea, vomiting, muscle Most hypertensive
nitroprusside intravenous infusion twitching, sweating, emergencies; caution
(requires special thiocyanate and cyanide with high intracranial
delivery system) intoxication pressure, azotemia, or in
chronic kidney disease

Nicardipine 5–15 mg/h 5–10 15–30; may Tachycardia, headache, Most hypertensive
hydrochloride intravenous exceed 240 flushing, local phlebitis emergencies except
acute heart failure;
caution with coronary
ischemia
Clevidipine 1-2 mg/h intravenous 2-4 5-15 Headache, syncope, Most hypertensive
butyrate infusion; may double dyspnea, nausea, vomiting emergencies except
dose every 90 sec severe aortic stenosis;
initially; maximum: 32 caution with heart failure
mg/h; typical
maintenance dose: 4
to 6 mg/h

Fenoldopam 0.1–0.3 mcg/kg/min <5 30 Tachycardia, headache, Most hypertensive

mesylate intravenous infusion nausea, flushing emergencies; caution
with glaucoma 37
Hypertensive Emergency
Drug Dose Onset Duration Adverse Effects Special
(min) (min) Indications

Nitroglycerin 5–100 mcg/min 2–5 5–10 Headache, vomiting, Coronary

intravenous infusion methemoglobinemia, ischemia
tolerance with prolonged use

Hydralazine 12–20 mg intravenous 10–20 60–240 Tachycardia, flushing, Eclampsia

hydrochloride 10–50 mg intramuscular 20–30 240–360 headache vomiting,
aggravation of angina

Labetalol 20–80 mg intravenous 5–10 180–360 Vomiting, scalp tingling, Most

hydrochloride bolus every 10 min; 0.5– bronchoconstriction, hypertensive
2.0 mg/min intravenous dizziness, nausea, heart emergencies
infusion block, orthostatic except acute
hypotension heart failure

Esmolol 250–500 mcg/kg/min 1–2 10–20 Hypotension, nausea, Aortic dissection;

hydrochloride intravenous bolus, then asthma, first-degree heart perioperative
50–100 mcg/kg/min block, heart failure
intravenous infusion;
may repeat bolus after 5
min or increase infusion
to 300 mcg/min

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 Hipertensi Urgensi

Bersifat mendesak dengan TD Diastolik > 120 mmHg, tetapi dengan

minimal atau tanpa kerusakan organ sasaran dan tidak dijumpai
keadaan pada hipertensi emergensi
 Hipertensi post operasi.
 Hipertensi tak terkontrol / tanpa diobati pada perioperatif.

 Penanganan
- dalam hitungan jam
- Obat HT diberikan secara per oral, sublingual
 ONSET/DURATION OF
AGENT DOSE ACTION PRECAUTIONS
(AFTER
DISCONTINUATION)

Captopril 25 mg p.o., repeat as needed 15-30 min/6-8 h SL, Hypotension, renal

SL, 25 mg 15-30 min/2-6 h failure in bilateral
renal artery stenosis

Clonidin 0.1-0.2 mg p.o., repeat hourly 30-60 min/8-16 h Hypotension,

e as required to total dose of drowsiness, dry
0.6 mg mouth

Labetalo 200-400 mg p.o repeat every 30 min-2 h/2-12 h Bronchoconstriction,

l 2-3 h heart block,
orthostatic
hypotension

Amblodi 2,5-5 mg 1-2 hr/12-18 hr Tachycardia,

pin hypotension

Nifedipin 5 mg sl 5-20 min/2-6 hr Tachycardio,

hypotension

Adapted with permission from Vidt DG. Hypertensive crises: emergencies and urgencies. J Clin Hypertens
(Greenwich). 2004;6:520-525
• Memperbaiki atau melindungi organ target.

• Obat yang bekerja cepat dengan pilihan tergantung kerusakan organ

target.

• Diturunkan secepat dan seoptimal mungkin tanpa mengganggu perfusi

organ target (tidak perlu sampai normal).

• Penurunan tekanan darah sekiar 20-30% dalam 1 jam untuk untuk

hipertensi gawat darurat, 24 jam hipertensi gawat.

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Terima kasih 
 DAFTAR PUSTAKA
 American Society of Hypertension and the International Society of Hypertension2013
 DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM: Pharmacotherapy:A
Pathophysiologic Approach, 7th Edition: http://www.accesspharmacy.com/
 James PA, Ortiz E, et al. 2014 evidence-based guideline for the management of high blood
pressure in adults: (JNC8). JAMA. 2014 Feb 5;311(5):507-20
 Kasper, Braunwald, Fauci, et al. Harrison’s principles of internal medicine 17th edition. New
York: McGrawHill:2008
 McPhee SJ, Ganong WF: Pathophyisiology of Disease: An Introduction to Clinical Medicine,
5th edition.
 Pedoman Tatalaksana Hipertensi pada Penyakit Kardiovaskular, Edisi Pertama, PERKI 2015.
 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
 World Health Organization International Society of Hypertension stastement on
management of hypertension 2013
 Vidt, DG. Hypertensive crises: emergencies and urgencies. J Clin Hypertens (Greenwich),
2004;6;520-525

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