CHAPTER I

INTRODUCTION

1.1. Background
High blood disease known as hypertension is a disease that gets attention from
all circles of society, considering its impact both short and long term and thus require
long-term response that fully. Hypertension cause morbidity (illness) and mortality
(death) is high.
Hypertension is a disease resulting from the interaction of various risk factors
a person has. Various studies have linked between the various risk factors on the
incidence of hypertension.
Based on the research that has been conducted poorer prevalence (incidence)
of hypertension increases with age.From various epidemiological studies conducted
in Indonesia showed 1.8 to 28.6% of the population aged over 20 years are
hypertensive.
Hypertension, currently there is a trend that more urban than rural communities
suffer from hypertension. This is partly attributed to the urban lifestyle associated with the
risk of hypertension such as stress, obesity (overweight), lack of exercise, smoking,
alcohol, and eating foods high in fat content.
Along with age, almost everyone has experienced an increase in blood
pressure, systolic blood pressure continues to increase until the age of 80 years and
diastolic pressures continue to increase until the age of 55-60 years, then decrease
slowly or even decreased dramatically.

1.2. Problem Formulation

a. How does the definition of hypertension?
b. How to measure blood pressure?
c. Explaining the causes of hypertension?
d. Explain the symptoms of hypertension?
e. Describe the effect of hypertension?
 f. How hypertension prevention?
g. Explain the treatment of hypertension?

1.3. The purpose

a. To find definitions of hypertension.
b. To learn how to measure blood pressure.
c. To determine the cause of hypertension.
d. To know the symptoms that caused.
e. To know the result of hypertension.
f. To know the prevention of hypertension.
g. To determine the treatment of hypertension.

CHAPTER II
DISCUSSION

2.1 Definitions
Hypertension or high blood pressure, is increased blood pressure or force of
blood pressing on the walls of the cavity where the blood was. High Blood Pressure
(hypertension) is an increase in blood pressure in the arteries. (Hiper means
Overrated, tension means pressure / t egangan; j adi, hipertensi is p system
disorders that cause blood eredaran rise in blood pressure above the normal value.
Blood pressure in a person's life varies naturally. Infants and children
normally have a blood pressure that is much lower than adults. Blood pressure is also
affected by physical activity, which will be higher at the time of the activity and
lower when resting. Blood pressure is also different in one day, the highest in the
morning and most re ndah during nighttime sleep.

2.2 Measuring Blood Pressure (pengukuran)

On examination the blood pressure will get two points. A higher figure
obtained when the heart contracts (systolic), a lower number obtained when the heart
 relaxes (diastolic).Blood pressure is written as systolic pressure diastolic pressure
slash, eg 120/80 mmHg, read a hundred and twenty eighty. Along with age, almost
everyone has experienced an increase in blood pressure , systolic blood pressure
continues to increase until the age of 80 years and diastolic pressures continue to
increase until the age of 55-60 years, then decrease slowly or even decreased
dramatically.
Blood pressure is written with two numbers, the number units mmHg
(millimeters ofMERCURY ) in blood pressure tool / tension meter, the systolic and
diastolic. Is the highest systolic blood pressure is when the heart is doing contract or
contraction. Diastolic is the lowest figure at the heart expands in the final relaxation.
For example, blood pressure 120/80 mmHg mean systolic pressure of 120 and
diastolic pressure of 80 mmHg.

Blood pressure is the pressure generated by:

a. Strength buds urgent cardiac left ventricle to insert the contents of the blood into the
arterial trunk.
b. Resistance in the arterial blood flow.
c. Autonomic nerves are made up of the sympathetic and the sympathetic system.

Classification of blood pressure

No Classification Systolic Diastolic

1 Optimal <120 mmHg <80 mmHg
2 Normal <130 mmHg <85 mmHg
3 Normal high 130-139 mmHg 85-89 mmHg
4 Mild hypertension 140-159 mmHg 90-99 mmHg
 5 Hypertension was 160-179 mmHg 100-109 mmHg
6 Severe hypertension > 180 mmHg > 110 mmHg

Normal blood pressure

Blood pressure varies per person per day, depending on the circumstances,
and are affected by the activities of a person, so normalpun blood pressure varies.
Adults when the blood pressure showed the number 140/90 mmHg is
considered normal upward. There is a perception of low blood pressure is not good, it
is less precise.Because statistics show that people with low blood pressure have the
same age with so-called normal. The best thing is to maintain normal blood pressure
and the assumption that increasing age is higher blood pressure is not a problem, is
the assumption that needs to be clarified, because based on statistics of parents whose
blood pressure in the normal range, the trend gets low stroke disorders. Check your
blood pressure regularly at least once every 6 months or whenever the doctor / health
facility.

2 classification known hypertension (by cause), namely:

a. primary hypertension (hypertension idiophatik), in which the cause is not
known with certainty. It also said that hypertension is the impact of lifestyle
and environmental factors.
b. secundary hypertension, is hypertension that occurs due to the disease from
other diseases such as abnormalities in the kidneys or keruskanan of the
hormone system.

WHO classifies hypertension based on the presence or absence of abnormalities

in other organs, namely:
a. hypertension without abnormalities in other organs.
b. hypertension with cardiac enlargement.
c. hypertension with abnormalities in other organs in addition to the heart.
Classification of hypertension by high blood pressure are:
a. borderline hypertension: blood pressure between 140/90 mmHg and 160/95
mmHg.
b. mild hypertension: blood pressure between 160/95 mmHg and 200/110
mmHg.
c. Moderate Hypertension: Blood pressure between 200/110 mmHg and
230/120 mmHg.
d. severe hypertension: blood pressure between 230/120 mmHg and 280/140
mmHg.

2.3 Causes of hypertension

There are 2 kinds of hypertension, essential and secondary.
a. hypertension Essential hypertension is the most not known cause. There are
10 - 16% of adults suffer from high blood pressure.
b. hypertension Secondary hypertension is a known cause and why.
Hypertension kind is only a small part, which is only about 10%.
Some of the causes of hypertension, among others:
· Because hormonal, for example, from the adrenal glands.
· The use of drugs.
· smoking because the nicotine contained in tobacco.
· Alcoholic beverages.
· Abnormalities in the kidneys.
· Intracranial Abnormalities resulting in increased intracranial pressure or
because of its location near the center of persyarafan that affect blood pressure.
· Abnormalities of the large blood vessels (aorta) that koartasio aorta where
the aortic arch aorta is continuous with decendens.

2.4. Anatomy
a. Heart
 Measuring about one fist and is located within the chest, the limit on the right is
right and apeksnya sternum in the fifth intercostalis space midclavicular left
linea.
Relation of heart is:
Above: large blood vessels
Bottom: diaphragm
Each side: lung - lung
Rear: the descending aorta, esophagus, vertebral Columna
b. Arteries
Is the tube through which the blood flow in tissues and organs.Consists of
layers of the arteries: a slippery layer, the middle layer of elastin tissue / muscle: the
aorta and major branches have laposan center consisting of a network of elastin (to
deliver blood to the organs), smaller arteries have a muscular middle layer (regulating
the amount of Blood delivered to an organ).
c. Arterioles
Are the blood vessels with smooth muscle wall is relatively thick. Arteriolar
wall muscles to contract. Contractions caused kontriksi diameter blood vessels. When
kontriksi localized, blood supply to the tissues/organs is reduced. If there kontriksi
general, blood pressure will increase.
d. Major blood vessels and capillaries
The main blood vessels are thin-walled vessels that run directly from
arterioles to venul. Capillaries are the network of small blood vessels open major
blood vessels.
e. Sinusoids
There are spleen, liver, bone marrow, and endocrine glands.Sinusoids three to
four times greater than in capillaries and partially coated with reticulo-endothelial
system cells. In places the sinusoid, having direct contact with the blood cells and the
exchange does not take place through the network space.
f. Vena and venul
 Venul is a combination of small veins formed capillaries. Veins formed by the
combined venul. Veins have three walls that are not adjacent to each other perfectly.
(Gibson, John. Issue 2 2002, p 110)

2.5. Physiology
The heart has the function as a pump oxygenated blood in the arterial system,
which was brought into the cell and the entire body to collect blood deoxygenation
(blood oxygen levels less) of the vein system are delivered to the lungs for
reoksigenasi (Black, 1997)

2.6. Pathophysiology of hypertension

The mechanisms that control the constriction and relaxation of blood vessels
located in the vasomotor center, the medulla of the brain.This stems from the central
vasomotor sympathetic nerve pathway, which continues down to the spinal cord and
the spinal cord out of the column to the sympathetic ganglia in the thorax and
abdomen.stimulation of the vasomotor center is delivered in the form of impulse
moves down through the sympathetic nerves to the sympathetic ganglia. At this point,
neurons release acetylcholine preganglion, which will stimulate post-ganglion nerve
fibers to the blood vessels, which resulted in the release of norepinephrine
constriction of blood vessels. Various factors such as anxiety and fear can affect
vascular response to stimuli vasokontriktor. Individuals with hypertension are very
sensitive to norepinephrine, although it is not clear why it could happen.
At the same time stimulate the sympathetic nervous system in which the blood
vessels in response to emotional stimuli, the adrenal glands are also stimulated
vasoconstriction resulting in additional activities. Secreting adrenal medullary
epinephrine causes vasoconstriction. Adrenal cortex secrete cortisol and other
steroids, which DAPT strengthen blood vessels vasokontriktor
response.vasoconstriction resulting in decreased blood flow to the kidneys, causing
the release of renin. Renin stimulates the formation of angiotensin I, which is then
converted to angiotensin II, a potent vasoconstrictor, which in turn stimulates
 aldosterone secretion by the adrenal cortex. hormone causes retention of sodium and
water by the kidney tubules, causing an increase in intravascular volume. All of these
factors tend to provoke a state of hypertension.
Structural and functional changes in the peripheral vascular system
responsible for the changes in blood pressure that occurs in the elderly. These
changes include atherosclerosis, loss of elasticity of the connective tissue, and a
decrease in vascular smooth muscle relaxation, which in turn lowers the ability of
tensile strength distension and blood vessels. Consequently, the aorta and large
arteries less able to accommodate the volume of blood pumped by the heart (volume
sekuncup), resulting in decreased cardiac output and increased peripheral resistance
(Smeltzer, Bare, 2002).

2.7. The symptoms of hypertension

The symptoms of hypertension, among others:
a. Much of no symptoms.
b. Pain in the back of the head.
c. stiff neck.
d. Fatigue.
e. Nausea.
f. Shortness of breath.
g. Restless.
h. Vomiting.
i. easily offended.
j. hard to sleep.
Complaints are not always going to be experienced by a patient with
hypertension. Often a person with symptoms of pain behind his head, irritability and
difficulty sleeping, when the blood pressure measured showed a normal blood
pressure numbers. The only way to determine the presence or absence of
hypertension only by measuring blood pressure.
2.5 The effects of hypertension
Hypertension if not controlled can lead to serious complications, such as:
a. kidney damage.
b. damages blood vessels.
c. brain hemorrhage / stroke.
d. Paralysis.
e. enlarged heart / heart trouble.
f. Narrowing of the coronary arteries / heart attack.

2.6 Prevention of hypertension

Person's risk for hypertension (except essential), can be reduced by:
a. Checking blood pressure regularly .
b. Maintain ideal weight .
c. Reducing salt intake .
d. Do not smoke .
e. Exercising regularly .
f. regular life .
g. Reducing stress .
h. Do not rush .
i. Avoid fatty foods.

Primary Prevention:
· Adequate sleep, between 6-8 hours per day.
· Reduce high cholesterol foods and multiply physical activity to lose weight.
· Reduce alcohol consumption.
· Consumption of fish oil.
· The supply of calcium, although only slightly lower blood pressure but calcium is also
quite helpful.

Secondary Prevention
 · Pattern whice food healthy.
· Reduce salt and sodium in your diet.
· Physical active.
· Reduce intake Alcohol.
· Stop smoking.

Tertiary Prevention
· Control of blood on a regular basis.
· Sports regularly and adjusted to body condition.

2.7 Treatment of hypertension

Treatment of hypertension is best:
a. Always control your blood pressure checked regularly by a doctor .
b. Always take medication regularly even without a complaint .
c. Reducing salt intake .
d. Increase consumption of vegetables and fruit .
e. Obeying doctor's advice.

The content of salt (Sodium or Sodium)

Someone who is suffering from hypertension should control themselves in salt
consumption. The meaning here is the sodium salt of salt present in almost all foods
derived from animals and plants.One major source of sodium is table salt. Therefore,
the recommended salt intake of no more than ¼ - ½ teaspoon / day or to use other
than the sodium salt.
Low salt diet goal is to help eliminate the salt or water retention in the body tissues
and lowers blood pressure in hypertensive patients.The terms of a low salt diet is:
· Enough energy, protein, minerals, and vitamins.
· Forms of foods according to the disease state.
· The amount of sodium adjusted to the severity of salt or water retention and / or
hypertension.
This diet contains enough nutrients. In accordance with the state of the disease can be
given different levels of Low Salt Diet.
· Low Salt Diet I (200-400 mg Na)
This diet was given to patients with edema, ascites, and / or severe hypertension. In
the food processing no salt added. Avoided the foods high in sodium.
· Low Salt Diet II (600-800 mg Na)
This diet was given to patients with edema, ascites, and / or hypertension are not too
heavy. Daily feeding with Low Salt Diet I. In the food processing may not use salt ½
tsp (2 g). Avoided the foods high in sodium.
· Low Salt Diet III (1000-1200 mg Na)
This diet is given to patients with edema and/or mild hypertension. Daily feeding
with Low Salt Diet I. In the food processing may use 1 teaspoon salt (4 g).

2.8. Content of Potassium or Potassium

Potassium suplements 2-4 grams per day can help lower blood
pressure. Potassium is generally fat found in some fruits and vegetables. Fruits and
vegetables that contain potassium and good for people with hypertension consumed
include watermelon, avocado, melon, bitter melon fruit, squash, bligo, machete
pumpkin / gourd, cucumber, aloe vera, celery, onion and garlic. In addition, foods
containing omega 3 sagat elements known to be effective in helping to decrease blood
pressure (hypertension).
In patients with hypertension where blood pressure> 160 / g mmHg, in
addition to the provision of anti-hypertensive drugs need dietetic therapy and lifestyle
changes. The objective of dietary management is to help lower blood pressure and
maintain blood pressure to normal. In addition, the diet is also intended to reduce risk
factors such as overweight, high cholesterol and fat levels of uric acid in the blood. It
should be noted also that accompanies other degenerative diseases such as high blood
pressure, heart, kidney and diabetes mellitus.
a. SETTING MENU FOODS
 Adjusting diet is recommended for patients with hypertension to avoid and
limit foods that can increase blood cholesterol levels and increase blood pressure, so
people do not have a stroke or cardiac infarction.
Foods to be avoided or restricted are:
1. The food is high in saturated fat (brain, kidney, lung, coconut oil, lard).
2. Food was prepared by using sodium salt (cookies, crakers, chips and dried foods are
salty).
3. Food and drinks in cans (sardines, sausage, korned, vegetables and fruits in cans, soft
drink ).
4. Preserved foods (jerky, pickled vegetables or fruit, shredded, salted, boiled, dried
shrimp, salted eggs, peanut butter).
5. Milk full cream , butter, margarine, cheese, mayonnaise, and other sources of animal
protein are high in cholesterol such as red meat (beef / mutton), egg yolk, chicken
skin).
6. Condiments such as soy sauce, maggi, shrimp paste, tomato sauce, chili sauce, tauco
and other flavorings generally contain sodium salt.
7. Alcohol and alcohol-containing foods such as durian, tape.

How to set up a diet for people with hypertension is to improve the taste by
adding sugar fresh red / white onion (red / white), ginger, and other spices kencur are
not salted or salt contains less sodium.Food can be sauteed to improve the taste. Put
salt at the table above can be taken to avoid excessive use of salt. It is recommended
to always use iodized salt and salt use no more than 1 teaspoon per day.
Increasing potassium intake (4.5 grams or 120-175 mEq / day) can give the
effect of a mild decrease in blood pressure. In addition, administration of potassium
also helps to replace lost sodium and low potassium result. Can generally used
medium size (50 grams) of apples (159 mg potassium), orange (250 mg potassium),
tomato (366 mg potassium), banana (451 mg potassium) baked potato (503 mg
potassium) and 1 cup skim milk (406 mg potassium). Adequacy of calcium is
important to prevent and treat hypertension: 2-3 glasses of skim milk or 40 mg / day,
115 grams of low-sodium cheese to meet the needs of calcium 250 mg / day. While
the needs of the average daily calcium 808 mg.
In pregnant women food enough protein, calories, calcium and sodium are
associated with a lower incidence of hypertension of pregnancy. However, pregnant
women are especially hypertension accompanied by swelling and urinary protein
(pre-eclampsia), other than medicines recommended to reduce salt intake and
increase food sources of Mg (vegetables and fruits).
b. SUPPLEMENTATION anti oxidant
Despite antioxidant supplementation still require further research, but today
many supplements are sold and consumed by the public. As medical personnel should
be careful giving advice supplement drink to avoid overdose.

1. Vitamins and Decrease Homocysteine

Folic acid, vitamin B6, vitamin B12 and riboflavin are enzyme co-factor
essential for the metabolism of homocysteine. Various studies have shown that
elevated levels of homocysteine in the blood increases the risk of coronary artery
disease. Low levels of folic acid are associated with an increased risk of coronary
disease and low vitamin levels are also associated with an increased risk of
atherosclerosis, although the risk of atherosclerosis associated with low levels of
vitamin B6 was not associated with a high concentration of homositein. while vitamin
B12 is not associated with vascular disease.
2. Soybeans and Isoflavones
Soy contains many isoflavones are estrogen-Phy, which have weak estrogen
activity. Research meta-analysis in 1995 concluded that isoflavones from soy protein more
significantly reduce total cholesterol, LDL cholesterol and triglycerides, without affecting
HDL cholesterol levels. So it is recommended to consume soy protein (20-50 grams / day)
and dietary modifications in patients with cholesterol (total and LDL) is high. Tempe is the
result of processing soybeans fermented with better nutritional content than soy. So that
tempeh is recommended for consumption by people with hypertension as a source of
vegetable protein.
3. Tempe
Tempe is one of the traditional food of Indonesia, fermented fungus Rhizopus
ohgosporis or rhizopusoryzal on soybean seed that has been boiled. There are various
kinds of tempeh, tempeh discussion is made of soy, which is a compact product,
wrapped flat by the mycelium fungus that appears white in color, and when sliced
pieces seem pale yellow soya beans, among the mycelium. Fermentation mold
produces a change in the texture of soy, are soft and nutritional value of tempeh better
than soybeans.
Nutritional value Tempe:
· Protein
Enzymes produced molds, producing free amino acids, so the level is increased to 85
times the levels of soy protein.
· Carbohydrates
Soybeans contain carbohydrates in the form of sakrosa and stakhiosa and rifinosa (the
latter two led to the formation of gas in the stomach). Fermented soybeans into
soybean producing carbohydrates.
· Fat
Enzymes in the mold can reduce the total fat content from 22.2% to 14.4% and
increased free fatty acid levels from 0.5% to 21%.
· Mineral
In the soybean contained phytic acid which is a compound forfose, which can not be
utilized by the body. With fermentation, molds produce the enzyme phytase which
outlines the phytic acid, so it can be utilized forfosenya body.
· Vitamin
The fermentation process can increase levels of vitamin B2 (Riboferum), Vitamin B6
(pyridoxine), folic acid, panthotenat, and nicotinic acid. While vitamin B1 levels
decreased due to the growth of mold and also vitamin B12 formed by bacteria that do
not exist in other vegetable products.
 Benefits Tempe:
Tempe is a good source of nutrients, especially for patients with hyper
kolesterolemia. From various studies it turns out tempeh can lower cholesterol levels
in the blood and prevent blood vessel constriction, because tempeh contains
polyunsaturated fatty acids. So that hypertensive patients are encouraged to eat
tempeh every day, in addition to a diet low in saturated fat.
Tempe also contains antibacterial substances that can inhibit the growth of
some gram-positive bacteria as well as cause diarrhea (Salmonella sp
and Shigella sp.) Therefore, tempeh is also recommended to be consumed under five
with diarrhea.
4. Omega 3 Fatty Acids
Eating one serving of high-fat fish (or fish oil) per day can be the intake of
omega 3 fatty acids (EPA and DHA) of approximately 900 mg / dl, and has been
reported to lower cholesterol and prevent coronary heart disease.
5. Fiber
Although sharing of studies show an association between some types of fibers
with decreased cholesterol or LDL and total cholesterol, but there is no direct
evidence showing the relationship between fiber supplements with decreased
cardiovascular disease.
· Name the dish, main ingredient, processing methods, and tools food diet
hypertension and dyslipidemia
Menu Ingredients
Food Processing Equipment Method Supplementary Material misstatement
soft rice
Sauteed Chicken + Rice - Boiling + steaming porcelain dish
skinless chicken stir-fry dishes porcelain salt
Carrots Carrots
boiled Nutmeg Bowl
Coffee Milk Glass Milk Sugar Water +
Sugar Pudding Fruit Jelly boiled Saucer
Mango Mango
Milk cups low fat Milk
Rice Boiled Rice + Plato steamed
fish Pepes Fish Plato saffron steamed
soy chicken sauteed chicken red sugar Plato
Glass Milk Skimmed milk powder
Sugar
Watercress Oseng + carrots + green beans stir-fried salt Plato Carrots
Watercress
Beans
Diet
Breakfast Menu
• Nasi software
• Sauté chicken + carrots
soy milk • Coffee
(E: 225 Cal, KH: 30 g, L: 6.5 g, P: 30 g
Interlude 1 and 2
• Mango Pudding
• low fat milk
(E: 330 Cal, KH: 59 g, L: 7 g, P: 7 g)
Lunch
• White rice
• Pepes know
• Soup beans + carrots
• Papaya fruit
(E: 325 Cal, KH: 44 g, L: 7.5 g, P: 18.5 g)
Dinner
• White Rice
• Sauteed Spinach
• Pepes Fish
 • Fruit Papaya
(E: 360Kal, KH: 57 g, L: 3 g, P: 12g)

CHAPTER III
CLOSING

3.1 Conclusion
Hypertension or high blood pressure, is increased blood pressure or force of
blood pressing on the walls of the cavity where the blood was.
Blood pressure in a person's life varies naturally. Infants and children
normally have a blood pressure that is much lower than adults. Blood pressure is also
affected by physical activity, which will be higher at the time of the activity and
lower when resting. Blood pressure is also different in one day, the highest in the
morning and lowest at night during sleep.

3.2. Suggestion
How to set up a diet for people with hypertension is to improve the taste by
adding sugar fresh red / white onion (red / white), ginger, and other spices kencur are
not salted or salt contains less sodium. Food can be sauteed to improve the taste. Put
salt at the table above can be taken to avoid excessive use of salt. It is recommended
to always use iodized salt and salt use no more than 1 teaspoon per day.