HIPERTENSI

dr. Edwina R. Monayo, M.Biomed

 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.
 Blood Pressure Classification

BP Classification SBP mmHg DBP mmHg

Normal <120 and <80

Prehypertension 120–139 or 80–89

Stage 1 Hypertension 140–159 or 90–99

Stage 2 Hypertension >160 or >100

HIPERTENSI

Jika Peningkatan Tekanan Darah :

• Rata-rata dari  2 kali pemeriksaan

• Pengukuran pada waktu yang berbeda
• Pengukuran pada waktu duduk

4
 Etiology

• Primary hypertension
– 95% of all cases
• Secondary hypertension
– 5% of all cases
– Chronic renal disease – most common
 Target Organ Damage
 Heart
• Left ventricular hypertrophy
• Angina or prior myocardial infarction
• Prior coronary revascularization
• Heart failure
 Brain
• Stroke or transient ischemic attack
 Chronic kidney disease
 Peripheral arterial disease
 Retinopathy
Hipertensi & Kerusakan Organ Target

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 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
 Treatment

• Non Pharmacotherapy
(lifestyle modification)
• Pharmacotherapy
Pengobatan

Tujuan:

ANGKA KESAKITAN
KERUSAKAN ORGAN TARGET
ANGKA KEMATIAN
 Strategi Penatalaksanaan Hipertensi

JNC:
• Preventif
• Deteksi
• Evaluasi
• Pengobatan
JNC VI, 1997

Ket : JNC →Joint National Committee

 Preventif

• Untuk mencegah atau memperlambat terjadinya

Hipertensi
• Merupakan solusi jangka panjang masalah hipertensi
• Mencegah terjadi komplikasi
• Dapat menghentikan atau mengurangi biaya pengobatan
dan komplikasi

NHBPEP Working Group Report on Primary Prevention of

Hypertension
 Preventif

• Upaya preventif primer:

Terhadap individu yang potensial hipertensi:
TD normal tinggi
Riwayat keluarga hipertensi
Obesitas
Konsumsi tinggi garam
Kurang aktifitas
Konsumsi tinggi alkohol

• Diharapkan prevalensi Hipertensi turun

 Deteksi
• Dilakukan di fasilitas kesehatan dengan alat ukur yang standar
dan cara yang benar
• Pasien diberitahu tentang makna TDnya
• Pasien dianjurkan melakukan pemeriksaan periodik sesuai
dengan TD pertama

• Diharapkan ditemukan kasus tahap awal

 Evaluasi

• Mencari penyebab hipertensi (sekunder)

• Memeriksa adanya kerusakan organ target dan

penyakit lain

• Mencari faktor risiko

• Mengetahui respon pengobatan, efek samping dan

kepatuhan pasien
 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.
 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

T - Walking
- 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