Dr.irene HHD Hipertensi Dan PJH

8/16/2019 Dr.irene HHD Hipertensi Dan PJH

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HIPERTENSI DANPENYAKIT JANTUNG

HIPERTENSI

HIPERTENSI DANPENYAKIT JANTUNG

HIPERTENSI

Irene Gunawan, dr., SpPD

SMF Penyakit Dalam RSUD Waled


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LOGO

Hypertension JNC 7Guideines

T!e Se"ent! Report o# t!e

Joint N$tion$ Co%%ittee on Pre"entionwww.nhlbi.nih.gov/guidelines/hypertension

Hypertension JNC 7Guideines

T!e Se"ent! Report o# t!e

Joint N$tion$ Co%%ittee on Pre"entionwww.nhlbi.nih.gov/guidelines/hypertension

Europe$n So&iety o#Hypertension 'ESH(

)**7


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ETIOLOGI

Primary/

Essential

Hypertension

(95%)

Klasifikasi

Secondary

Hypertension

(5-10%)


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Etioo+i

Essential - Idiopatik. Peningkatan resistensi perifer (tonus simpatis)

stress, hormonal, neural.

Genetic, familial, life style.

Sekunder . Penyakit ginjal: Renin-Angiotensin, Retensi Soium,

A!", Alosterone.

#ushings, Pheochromocytoma,

Setiap peningkatan $! %&'& mm"g risiko #! %*

lipat mulai +'+ mm"g


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Se&ond$ry Hypertension ',-.*/( enal G, RAS, Renin tumors

Endocrine #ushing, $hyroto*icosis

/y*ema, Pheochromocytoma, Acromegaly.

!asc"lar #oarctation of Aorta, PA,

Aortic insufficiency.

#e"ro$enic Psychogenic, 0ntracranialpressure, olyneuritis etc.


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Re+u$si Te0$n$n D$r$!

1aktor 2nokrin :Renin, Angiotensin, AP, A!", Alosterone.1

aktor #e"ral : Simpatis an parasimpatis&

!ol"me dara' : mineralokortikoi, AP, soium

aktor Kardiak : "eart rate an kontraktilitas

*P + ,ardiac "tp"t . Perip'eral esistance


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Klasifikasi Tekanan DarahJ! - "

or#al $%&' and $('

)rehypertension %&'*%+, or ('*(,Stage % ypertension %'*%, or ,'*,,

Stage & ypertension 0%1' or 0%''

2) !lassifi3ation S2) ##g D2) ##g


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ESH-)**7 1 De#inisi d$n 0$si#i0$si TD '%%H+(

Kategori Sistolik Diastolik

Optimal

Normal

High normalGrade 1

hypertension

Grade 2hypertension

Grade 3hypertension

Isolated systolichypertension

< 120

120-129

130-139 140-159

10-1!9

" 1#0

" 140

and

and$or

and$orand$or

and$or

and$or

%nd

< #0

#0-#4

#5-#9 90-99

100-109

" 110

< 90

2S# an 2S" Guielines%&&3oi:&.&45'eurheartj'ehm%56


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T$r+et2 Su3&ini&$ or+$nd$%$+e

Jantung eft entric"lar 'ypertrop'y

Angina or /0A

Gagal jantung

4tak

Stroke' transient ischemia attack

!hroni3 kidney disease 5!KD6

)eripheral 7rterial Disease

8etinopathy


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A+orit%$ T$t$$0s$n$ HipertensiJNC 7 Guideines

#ot at oal *lood Press"re (210/90 mmH$)

(210/30 mmH$ for t'ose 4it' diaetes or c'ronic kidney disease)

6nitial 7r"$ ,'oices

7r"$(s) for t'e compellin$

indications

7ther antihypertensi8e rugs

(iuretics, A#20, AR9, 99, ##9)

as neee.

8it' ,ompellin$

6ndications

ifestyle odifications

Sta$e & Hypertension (S9P 6& or !9P && mm"g)

%-rug com;ination for most (usually

thia


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ESH-)**7 1 Str$ti#i0$si risi0o C4D d$$% 5 0$te+ori

2S# an 2S" Guielines %&&3 oi:&.&45'eurheartj'ehm%56


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6$0tor Risi0o

Tekanan darah sistolik dan diastolik

)ulse pressure 5tekanan nadi6 tinggi

9sia 5: 0 ys; < 0 1 ys6

:erokok

Dyslipide#ia

- T! 0 %,' #g/dl or

- =D=-! 0 %% #g/dl or- D=-!> :$ ' #g/dl? < $ 1 #g/dl atau

- T@ 0 %' #g/dl

2S# an 2S" Guielines3 oi:&.&45'eurheartj'ehm%56


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6$0tor risi0o

Kadar glukosa puasa 5%'&-%& #g/dl6

7bnor#al glu3ose toleran3e test

7bdo#inal obesity lingkar pinggang

0%'& 3# 5:6? 0 (( 3# 5A6

8iwayat !BD dini dala# keluarga 5: $ years? < $ 1 years6

2S# an 2S" Guielines3 oi:&.&45'eurheartj'ehm%56


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T$r+et ter$pi 'ESH-)**7(

Target uta#a

#enurunkan TDse#aksi#al #ungkin tuCuan >#enurunkan risiko !BD Cangka panCang .5*2* %%H+

Target TD 8.9*2:* %%H+ 1 pasien D:dan pasien risiko tinggi/ sangat tinggi5stroke? #yo3ardial infar3tion? renaldysfun3tion? proteinuria6.

Inisiasi terapi 7nti hipertensi sebelu#kerusakan signifikan kardiovaskuler.


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K$si#i0$si d$n t$t$$0s$n$ !ipertensi

2)3lassifi3ation

S2)##g

D2)##g

=ifestyle#odifi3atio

n

Initial drug therapy


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Co%pein+ Indi&$tions


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PE;ERIKSAAN 6ISIK

Keadaan u#u#Keadaan khusus > !ushingoid? obesitas

sentral

)engukuran tekanan darah tangan kiridan kanan

Aunduskopi > retinopati hipertensifKeith


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Kardio#egali

I#puls I3tus 3ordis/ 7pe pro#inen/#elebar

2unyi S& #eningkat akibat kerasnya

penutupan katup aortaS > akibat peningkatan tekanan atriu#

pada disfungsi diastolik gallop atrial

S+ > akibat peningkatan preload ventrikel

5diastoli3 overload6 gallop ventrikelS+ S Su##ation gallop


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)aru-paru > ronki basah

bila sudahdeko#pensasi

7bdo#en > hepato#egali? 3ari tandaaneuris#e

7uskultasi daerah periu#bili3al utk#endengarkan ada/tdk bruit a.renalis stenosis

Tekanan darah di kaki? teruta#a bilahipertensi usia #uda 5$ +' tahun6.


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EKG 1 Hipertro#i 4entri0e 0iri

ipertrofi Bentrikel kiri > R+ atau R6 %+ mm

S ? R+ atau S ?R6 5+ mm

Strain pattern : peru;ahan segmen S$ angelom;ang $ (!epresi S$ an in8ersi $)

R6 R+

R a@ 5 mm

R a1 %& mm


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Sokolow-Lyon Criteria for LVHS wave in lead V1 + R wave in lead V5 or V6 >

3.50 mV

or

R wave in lead V5 or V6 > 2.60 mV


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EKGL4H


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Dr.irene HHD Hipertensi Dan PJH

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