Hipertensi

Definisi Hipertensi

JNC 7-2003 ESC-2007

Diukur dalam kondisi duduk, minimal pada 2 kali pemeriksaan

pada 2 kunjungan yang berbeda
2
 3.
1. The cuff must be level with
Several time, rest 5 the heart. If the circumference
minutes before exceeds 33cm, a large cuff 4.
must be used . Place The column of mercury
stethoscope diaphram over must be vertical. Inflate
brachial artery to occlude the pulse
(>30 mmHg). Deflate at
2-3 mm/s. measure
systolic ( first sound /
Korotkoff I ) & diastolic
2. (disappearence /
The patient should be Korotkoff IV or V ) .
relaxed and the arm
must be supported.
Ensure no tight clothing
constricts the arm
(From British Hypertension Society 1985)
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
 Early Paradigm

Natural History of CVD Progression

Elevated BP Target Organ Damage

More Recent Paradigm

Vascular Dysfunction Elevated BP Target Organ Damage

A Proposed Future Paradigm

Endothelial Vascular Elevated BP Target Organ

Dysfunction Dysfunction Damage Angina
? LVH Pectoris
Renal MI Stroke
Damage
 ( Secondary 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
Failure of

8
▪ Headache
▪ Dizziness
▪ Fatigue
▪ Pounding of the heart
▪Symptoms are not specific and no more
frequent than in patients with normotension.
▪ Symptoms of complications : heart failure,
chest pain, claudication, vision
Recommendations (SBP/DBP mmHg)

Patient Type
Uncomplicated HTN < 140/90
Hypertension with < 130/85
diabetes mellitus < 130/80*
Heart failure < 130/85
Hypertension with < 125/75
renal impairment†
 Diuretics

AT1 receptor
-blockers blockers

Calcium
1-blockers
antagonists

ACE inhibitors
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.