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HIPERTENSI Oleh: Divisi Humas MER-C
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HIPERTENSI
Oleh:Divisi Humas MER-C
Apa itu hipertensi?
Tekanan darah tinggi (hipertensi) adalah peningkatan tekanan darah di dalam arteri (pembuluh darah nadi) di atas angka normal. Seringkali hipertensi terjadi tanpa gejala, sehingga penderita tidak merasa sakit. Pada pemeriksaan tekanan darah (tensi) akan didapat 2 angka yakni angka yang atas diperoleh saat jantung berkontraksi (sistolik) sedangkan angka bawah diperleh saat jantung relaksasi (diastolik). Sehingga hasil pemeriksaan tensi menunjukkan sekian per sekian,
Klasifikasi Hipertensi : JNC VII
Hypertension is defined as blood pressure 140/90 mmHg
Kategori Systolic
(mmHg)
Diastolic
(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
JNC VII. JAMA 2003;289:2560-2572
Penyebabnya apa?• Sekitar 90 % penderita hipertensi tidak diketahui
penyebabnya, disebut sebagai hipertensi esensial atau hipertensi primer.
• Para ahli sependapat bahwa hipertensi esensial berhubungan dengan faktor keturunan (herediter).
Kalau yang sekunder?• Sekitar 5-10% penderita hipertensi berhubungan
dengan penyakit ginjal, 1-2% berhubungan dengan kelainan hormonal atau pemakaian obat tertentu (misalnya pil KB).
• Kegemukan (obesitas), • Gaya hidup yang tidak aktif (malas olah raga,• Stress,• alkohol • Garam (makanan yg asin banget)
Franklin, S.S., J Hypertens 1999; 17 (suppl 5): S29-S36
0
10
20
30
40
50
60
70
18-29 30-39 40-49 50-59 60-69 70-79 80+
SBP > 140 mm Hg DBP > 90 mm Hg
Usia)
Per
sen
tase
4 11
21
44
54
64 65
Usia Yang Paling RentanUsia Yang Paling Rentan
25% 12.5%
12.5%
50%
Berobat tapi tidak kontrol rutin
Berobat dan terkontrolYang tidak tahu
Pasien yang tidak berobat
dan tidak kontrol
Source : Joffres et al. (1997) Am. J. Hypertension 10: 1097-1102
RULE OF HALF
Komplikasi HipertensiKomplikasi Hipertensi
Kerusakan tergantung pada:
• seberapa tinggi tekanan darah
• Berapa lama tidak terkontrol dan tertangani
Target Gagal Organ
Mataretinopathy
GinjalGagal Jintang
Otakstroke
JantungPeny.Jantung Koroner
Pembesaran Jantung kiriGagal Jantung
Peripheral arterial disease
PENGOBATAN
• DIET. • MENURUNKAN BERAT BADAN. • OLAH RAGA AEROBIK.
ASK-DNC
PEDIATRIC
OBESE
ATP-III 2001 - Criteria
WORLD OBESITY TRENDS GLOBESITY – DIABESITYWORLD OBESITY TRENDS GLOBESITY – DIABESITY(Summarized : Tjokroprawiro 2005-2007)(Summarized : Tjokroprawiro 2005-2007)
Stage― 3 or the MetS will be "TIME-BOMB DISEASE” in Indonesia ?
PrePreccliniliniccalal : the MetS : the MetSIFG, IGT, Pedr.-ObeseIFG, IGT, Pedr.-Obese
Healthy LifestyleHealthy Lifestyle ““Westernized”Westernized”
Unhealthy LifestyleUnhealthy LifestyleObesitObesityy
(Abdominal Obesit(Abdominal Obesityy))
STAGESTAGE –– 0 0 STAGESTAGE –– 11 STAGESTAGE –– 22 STAGESTAGE –– 33 STAGESTAGE –– 44Clinical : CADClinical : CAD
T2DM, Pedr.-T2DM, StrokeT2DM, Pedr.-T2DM, Stroke
3 Blood Pressure
> 130/85 mmHg
4 GDS
> 100 mg/dl
1 Triglyceride
> 150 mg/dl
2 HDL-Chol
< 40 mg/dl < 50 mg/dlo+o
Lingkar Pinggang > 90 cm > 80 cm+oo PEDIATRIC
T2DM
IDF 2005 - Criteria
44
GULOH CISAR
ASK-DNC
TEN PRACTICAL GUIDELINES FOR HEALTHY LIFETEN PRACTICAL GUIDELINES FOR HEALTHY LIFE
GULOH-CISAR = SYNDROME-10GULOH-CISAR = SYNDROME-10
(Tjokroprawiro 1995-2007)(Tjokroprawiro 1995-2007)
34
G
U
L
O
H
1
2
3
4
5
C
I
S
A
R
6
7
8
9
10
Stop Smoking
Daily Regular Exercise : TAKE MINIMALLY 6-HOUR SLEEP/DAY
Stop Alcohol
Regular Check-Up Esp. > 40 Years Old : 3, 6 or 12 Months
Limit Sugar Consumption
Restrict Purine Intake : JAS-BUKET
Consume Low Fat Diet : TEK-KUK-CS2
Prevent Obesity (Target : BMI < 25)
Measure BP Regularly(Less than g Sodium/day)3
+300 kcal/day or 3 km walk+Sit up 50-100 x/day
JAS-BUKET : Jerohan, Alkohol, Sarden - Burung Dara, Unggas, Kaldu, Emping, Tape(Bowels, Alcohol, Sardines - Pigeon, Fowls, Meat-Broth, Beaten Nut, Fermented Cassava)
TEK-KUK-CS2 : Telor, Keju - Kepiting, Udang, Kerang - Cumi, Susu, Santen
(Egg, Cheese - Crab, Shrimp, Mussel - Squid, Milk, Coconut - Juice)
"MABUK" (Rich in Chromium) : Mrica, Apel, Brokoli, Udang, Kacang-kacangan; good for DM
Recommended Food Supplements : Green Bean, Onions, Green Tea, Pepper, ARGININE, TKW-PJKA-BK
G = Glucose U = Uric Acid L = Lipids O = Obesity H = HypertensionC = Cigarette I = Inactivity S = Stress A = Alcohol R = Regular Check Up
Initiation of Antihypertensive treatment : ESC 2OO7Other risk factors, OD, or disease
Normal SBP 120-129 or DBP 80-84
High normal SBP 130-139 or DBP 85-89
Grade 1 HT SBP 140-159 or DBP 90-99
Grade 2 HT SBP 160-179 or DBP 100-109
Grade 3 HT SBP 180 or DBP 110
No other risk factors
No BP intervention
No BP intervention
Lifestyle changes for several months then drug treatment if BP uncontrolled
Lifestyle changes for several weeks then drug treatment if BP uncontrolled
Lifestyle changes + immediate drug treatment
1-2 risk factors Lifestyle changes
Lifestyle changes
Lifestyle changes for several weeks then drug treatment if BP uncontrolled
Lifestyle changes for several weeks then drug treatment if BP uncontrolled
Lifestyle changes + immediate drug treatment
3 risk factors, MS or OD
Lifestyle changes
Lifestyle changes and consider drug treatment
Lifestyle changes + drug treatment
Lifestyle changes + drug treatment
Lifestyle changes + immediate drug treatment
Diabetes Lifestyle changes
Lifestyle changes + drug treatment
Lifestyle changes + drug treatment
Lifestyle changes + drug treatment
Lifestyle changes + immediate drug treatment
Established CV or renal disease
Lifestyle changes + immediate drug treatment
Lifestyle changes + immediate drug treatment
Lifestyle changes + immediate drug treatment
Lifestyle changes + immediate drug treatment
Lifestyle changes + immediate drug treatment
