HIPERTENSI
PEMBIMBING
DR. REDDY RAMUNDITA, SP. JP
OLEH
M DENNYS SP
20170420109
MUHAMMAD FARID
20170420
SMF JANTUNG
RSU HAJI SURABAYA
FAKULTAS KEDOKTERAN
UNIVERSITAS HANG TUAH SURABAYA
2017
2
Suatu keadaan dimana tekanan sistolik berada pada 140 mmHg atau
lebih dan tekanan diastolik berada pada 90 mmHg atau lebih (JNC
VII, 2003)
Tekanan darah yang sama atau melebihi 140 mmHg sistolik dan atau
sama atau melebihi 90 mmHg diastolik pada seseorang yang tidak
sedang mengkonsumsi antihipertensi.
JNC VII
Etiologi 7
Essential (95%)
Sekunder 5%-10% kasus
- Renal : renal artery stenosis ; parenchymal disease
- Endocrine : Hyperaldosteronism; hyperthyroidsm ; Cushing
syndr;Exogenous agent
- Vascular: Coarctation of aorta, Aortic insufficiency
- Toxemia of pregnancy
CLASSIC UNDERSTANDING OF THE RENIN SYSTEM
8
Angiotensinogen
Renin
Ang I
ACE
Ang II Aldosterone
AT1 Receptor
Vasoconstriction
Na /H2O retention
+
Hypertension
Gibbons GH. 1998; Adapted from: Müller DN & Luft FC. 2006
9
Asupan Jumlah Bahan-bahan
Perubahan
garam nefron Stress Obesitas yang berasal
genetis dari endotel
berlebih berkurang
↑ Volume Konstriksi
cairan vena
Konstriksi Hipertrofi
↑ Preload ↑ Kontraktilitas struktural
fungsionil
Autoregulasi
TARGET KERUSAKAN 11
ORGAN
12
CLASSIFICATION 13
14
15
Cardiovascular
Neurologic
16
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.
18
DRUGS
20
21
22
23
COMBINATION THERAPY 24
COMBINATION THERAPY 25
26
27
JNC VIII
28
29
Two-drug combination
Other
for most (usually antihypertensive
Stage 2 drugs (diuretic,
≥160 or ≥100 Yes thiazide-type diuretic
hypertension ACEI, ARB, BB,
and ACEI or ARB or
BB or CCB). CCB) as needed.
JNC 7. May 2003. NIH publication 03-5233.
(JNC VIII) 31
32
JNC VIII 33
FOLLOW UP dan 34
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
35
Krisis Hipertensi
• HIPERTENSI GAWAT (EMERGENCY)
• HIPERTENSI DARURAT (URGENCY)
Hipertensi Emergensi 37
Penatalaksanaan HT Emergensi 38
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: caution with heart failure
32 mg/h; typical
maintenance dose: 4
to 6 mg/h
Penanganan
- dalam hitungan jam
- Obat HT diberikan secara per oral, sublingual
Table 5 : Management of Hypertensive Urgencies
42
ONSET/DURATION OF
AGENT DOSE ACTION PRECAUTIONS
(AFTER
DISCONTINUATION)
Captopril 25 mg p.o., repeat as needed SL, 15-30 min/6-8 h SL, Hypotension, renal
25 mg 15-30 min/2-6 h failure in bilateral renal
artery stenosis
Clonidine 0.1-0.2 mg p.o., repeat hourly as 30-60 min/8-16 h Hypotension,
required to total dose of 0.6 mg drowsiness, dry mouth
Labetalol 200-400 mg p.o repeat every 2-3 h 30 min-2 h/2-12 h Bronchoconstriction,
heart block, orthostatic
hypotension
Amblodipi 2,5-5 mg 1-2 hr/12-18 hr Tachycardia,
n 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
Sumber :
- Adaptec etc
- InaSH
- Hebert C.J Hypertensive Crises Prim Care 2008. 35 (3)
43
Memperbaiki atau melindungi organ target.
James PA, Oparil S, Carter BL, et al. (2013). 2014 Evidence-Based Guideline for the Management
of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint
National Committee (JNC 8). JAMA. doi:10.1001/jama.2013.284427.pp: E2-E15.
Kasper, Braunwald, Fauci, et al. Harrison’s principles of internal medicine 17 th edition. New York:
McGrawHill:2008
Masuyer G, S. S. (2012). Molecular recognition and regulation of human angiotensin-I converting
enzyme (ACE) activity by natural inhibitory peptides. Europe PubMed Central, 2:717.
Patofisiologi buku
National Institute of Health. (2003). The seventh report of the JointNational Commitee on:
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication. Pp:3-
20.
Jnc VII
Weber, MA, Schiffrin, EL, White, WB, et al. (2011). Clinical Practice Guidelines for the
Management of Hypertension in the Community: A Statement by the American Society of
Hypertension and the International Society of Hypertension. The journal of Clinical Hypertension.
Pp: 1-6
Riskesdas 2007, Riskesdas 2013, Balitbangkes, Kemenkes