Dr. Andrianto, Sp.JPDr. Andrianto, Sp.JP

HipertensiHipertensi

Tujuan

Pada akhir kuliah, mahasiswa akan memahami dan mampu menjelaskan

mengenai penyakit hipertensi secara tepat dan benar.

>>100100atauatau>> 160 160 Stage 2Stage 290-9990-99atauatau140-159140-159 Stage 1Stage 1

HipertensiHipertensi

80-8980-89atauatau120-139120-139Pre HipertensiPre Hipertensi

<80<80dandan<120<120NormalNormal

DiastolicDiastolic(mm Hg)(mm Hg)

SystolicSystolic(mm Hg)(mm Hg)CategoryCategory

Definisi Hipertensi (JNC VII)Definisi Hipertensi (JNC VII) Klasifikasi tekanan darah pada seseorang berumur 18 dan lebih

HipertensiHipertensi

Berdasarkan penyebabnya dapat dibedakan :

• Primer (essential)– tidak ada penyebab yang spesifik yang dapat

diidentifikasi– 95% dari kasus hipertensi

• Sekunder– diketahui penyebabnya– 5% dari kasus hipertensi– penyakit ginjal merupakan penyebab dari 90%

kasus hipertensi sekunder

Etiology Hypertension ( Primary Hypertension )

Etiology Hypertension ( Primary Hypertension )

Early Paradigm

Elevated BP Target Organ Damage

Natural History of CVD ProgressionNatural History of CVD Progression

More Recent Paradigm

Vascular Dysfunction Elevated BP Target Organ Damage

A Proposed Future Paradigm

EndothelialDysfunction

LVHRenal

DamageMI Stroke

AnginaPectoris

VascularDysfunction

Elevated BP Target OrganDamage

?

Etiology HypertensionEtiology Hypertension

– Renal disease :• Renal arterial disease• Renal parenchymal disease• Renal tumors• Arteritis (polyarteritis nodosa, neurofibromatosis)

– Endocrine Disorders• Cushing’s syndrome• Acromegaly• Primary aldosteronism• Pheochromocytoma

–Coarctation of the aorta–Neurologic disorders

•Increased intra cranial pressure (tumor)

–Drug-induced hypertension•Corticosteroids•Amphetamines•Oral contraceptives

–Psychogenic disorders

( Secondary Hypertension )

Komplikasi HipertensiKomplikasi Hipertensi

Kerusakan yang disebabkan oleh hipertensi tergantung :

• Besarnya peningkatan tekanan darah

• Lamanya kondisi tekanan darah yang tidak terdiagnosis dan tidak diobati

Kerusakan Target Organ!!Eyesretinopathy

Kidneysrenal failure

Brainstroke

Heartischaemic heart disease

left ventricular hypertrophyheart failure

Peripheral arterial disease

SymptomsSymptoms

• Headache

• Dizziness

• Fatigue

• Pounding of the heartSymptoms are not specific and no more frequent than in patients with normotension.

• Symptoms of complications : heart failure, chest pain, claudication, vision

Pemeriksaan Fisik :Pemeriksaan Fisik :

• Pemeriksaan fisik & TD yang teliti dan benar

• TB, BB

• Sistim kardiovaskuler : ukuran jantung, gagal jantung, arteri perifer (carotis, aorta, renal)

• Paru (ronkhi & wheezing), bising abdomen.

• Fundus optikus & sistim syaraf (mengetahui kerusakan serebro-vaskuler).

Technique of blood pressure measurement recommended by the British Hypertension Society

Technique of blood pressure measurement recommended by the British Hypertension Society

2.The patient should be relaxed and the arm must be supported. Ensure no tight clothing constricts the arm

3.The cuff must be level with the heart. If the circumference exceeds 33cm, a large cuff must be used . Place stethoscope diaphram over brachial artery

4.The column of mercury must be vertical. Inflate to occlude the pulse (>30 mmHg). Deflate at 2-3 mm/s. measure systolic ( first sound / Korotkoff I ) & diastolic (disappearence / Korotkoff IV or V ) .

(From British Hypertension Society 1985)

1.Several time, rest 5 minutes before

Pemeriksaan lain-lainPemeriksaan lain-lain

• Laboratorium :• Urinalisis & mikroskopik urin• Serum kalium, kreatinin, GDP & 2 jam, profil lemak & asam urat• Pemeriksaan tambahan :

– Hormonal seperti pengukuran aktifitas renin plasma, aldosteron plasma dan katekolamin urine atas indikasi khusus (hipertensi sekunder)

• EKG & Foto polos dada• Ekhokardiografi (curiga kerusakan organ target /LVH / lainnya)• Ultrasonografi vaskuler (curiga penyakit arteri karotis, aorta atau

perifer lain)• Ultrasonografi renal (curiga penyakit ginjal)• Angiografi

Minimal BP Goal of TherapyMinimal BP Goal of Therapy

Recommendations (SBP/DBP mmHg)

Patient Type

Uncomplicated HTN

Hypertension with diabetes mellitus

Heart failure

Hypertension with renal impairment†

JNC VI

< 140/90

< 130/85 < 130/80*

< 130/85

< 125/75

(Bakris GL, et al for the National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis. 2000) (JNC VI. Arch Intern Med. 1997)

*National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group.†Proteinuria > 1 g/24h.

Terapi HipertensiTerapi Hipertensi

• Terapi Non-farmakologis

– Menurunkan berat badan (5-20 mmHg/10 kg)

– Latihan dan olah raga (4-9 mmHg)

– Menghindari alkohol (2-4 mmHg)

– Mengurangi asupan garam (2-8 mmHg)

– Stop merokok

– Menurunkan asupan lemak jenuh

Possible combinations of different classes of antihypertensive agents. The most rational combinations are represented as thick lines. ACE, angiotensin-converting enzyme; AT1, angiotensin II type 1.

ACE inhibitorsACE inhibitors

DiureticsDiuretics

11-blockers-blockers

-blockers-blockersATAT11 receptor receptor

blockersblockers

CalciumCalciumantagonistsantagonists

Ringkasan

• Hipertensi adalah salah satu penyebab tersering penyakit kardiovaskuler

• 95 % kasus adalah Hipertensi Primer• Hipertensi menyebabkan kerusakan organ

target spt jantung, otak, ginjal dan mata• Pengobatan harus mencapai target tensi agar

kerusakan organ target dpt dicegah