2. hipertensi.ppt

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HIPERTENSIHIPERTENSI

&&KESEHATANKESEHATANJANTUNGJANTUNG

Pusat Jantung Nasional Harapan KitaPusat Jantung Nasional Harapan KitaUPF Prev-Rehailitasi !e"i#UPF Prev-Rehailitasi !e"i#

Ja#artaJa#arta



DefinisiDefinisiHiper Hiper : Berlebihan: Berlebihan

TensiTensi : Tekanan/Tegangan: Tekanan/Tegangan

Hipertensi :Hipertensi :

Gangguan sistem peredaran darah yangGangguan sistem peredaran darah yang

menyebabkan kenaikan tekanan darahmenyebabkan kenaikan tekanan darahdiatas nilai normal.diatas nilai normal.



Tekanan DarahTekanan Darah

Terdiri dari 2 komponen :Terdiri dari 2 komponen :

1.1. Tekanan Sistolik Tekanan Sistolik : Tekanan tertinggi saat jantung: Tekanan tertinggi saat jantung

memompa (menguncup)memompa (menguncup)

2.2. Tekanan Diastolik Tekanan Diastolik : Tekanan terendah saat jantung: Tekanan terendah saat jantung

istirahat (mengembang)istirahat (mengembang)

Mis : 2!/"! # 2! : $istolikMis : 2!/"! # 2! : $istolik

"! : %iastolik"! : %iastolik

Milyar penduduk dunia Milyar penduduk dunia

Silent killer !! Silent killer !!



Kapan disebut Hipertensi ?Kapan disebut Hipertensi ?

Bila tekanan darah & '!/! mmgBila tekanan darah & '!/! mmg

dari * kali pemeriksaan terpisahdari * kali pemeriksaan terpisah

(jarak + 2 minggu)(jarak + 2 minggu) %iperiksa dalam keadaan%iperiksa dalam keadaan

santaisantai

Bila tinggi sekaliBila tinggi sekali tidaktidak

perlu beberapa kaliperlu beberapa kali



Faktor Risiko Utama Penyakit Kardiovaskular Faktor Risiko Utama Penyakit Kardiovaskular

ipertensiipertensi

,egemukan,egemukan ,urang akti-itas isik,urang akti-itas isik

MerokokMerokok

eminum alkohol ( & * gelas perhari )eminum alkohol ( & * gelas perhari )

%islipidemia ( ,olestrol tinggi )%islipidemia ( ,olestrol tinggi )

%iet tinggi kandungan garam%iet tinggi kandungan garam

,encing manis + %M,encing manis + %M

0bat1obatan ( mis : steroid )0bat1obatan ( mis : steroid )

MikroalbuminuriaMikroalbuminuria

sia ( 3anita & 44 thn 5 pria & '4 tahun )sia ( 3anita & 44 thn 5 pria & '4 tahun )

6i3ayat keluarga : hipertensi 7 stroke6i3ayat keluarga : hipertensi 7 stroke



PenyebabPenyebab

ipertensi rimer ipertensi rimer

88 !9!9 Tidak diketahui penyebabnyaTidak diketahui penyebabnya

ipertensi $ekunder ipertensi $ekunder

88 !9!9 Berhubungan dengan:Berhubungan dengan:,elainan Ginjal,elainan Ginjal

,elainan ormonal,elainan ormonal

,elainan embuluh %arah,elainan embuluh %arah

%ll.. : 1 ,ehamilan%ll.. : 1 ,ehamilan

1 lat kontrasepsi1 lat kontrasepsi

1 6okok1 6okok



Klasifikasi T.DKlasifikasi T.D SistolikSistolik DiastolikDiastolik

;ormal;ormal <2!<2! dandan <"!<"!

rehipertensirehipertensi 2!1*2!1* atauatau "!1""!1"

ipertensi $T. ipertensi $T. '!14'!14 atauatau !1!1

ipertensi $T. 2ipertensi $T. 2 &=>!&=>! atauatau &=!!&=!!

Klasifikasi HipertensiKlasifikasi Hipertensi

?;@ A 2!!*



e!ala Hipertensie!ala Hipertensi

CC (1)(1)

6asa berat/sakit bagian belakang kepala6asa berat/sakit bagian belakang kepala

$ulit tidur $ulit tidur

Mudah tersinggungMudah tersinggung

DDia"nosis pasti # $en"ukur tekanan darah %ia"nosis pasti # $en"ukur tekanan darah %Dia"nosis pasti# $en"ukur tekanan darah %%Dia"nosis pasti# $en"ukur tekanan darah %%



e!ala laine!ala lain

(+ Penyakit lain)(+ Penyakit lain)

DemahDemah

englihatan kabur englihatan kabur

$akit dada$akit dada

;apas pendek;apas pendek

Mual/muntahMual/muntah

Berdebar Berdebar

MimisanMimisan

Gelisah/perubahanGelisah/perubahan

mentalmental ,esadaran turun,esadaran turun

,elumpuhan,elumpuhan



KomplikasiKomplikasi

,erusakan berbagai organ tubuh,erusakan berbagai organ tubuh

?antung?antung

DA (serambi kiri jantungDA (serambi kiri jantung CC)) ngina 1 inark otot jantung ngina 1 inark otot jantung

6e-askularisasi koroner 6e-askularisasi koroner

Gagal jantungGagal jantung



KomplikasiKomplikasi

0tak0tak $troke$troke

TT

GinjalGinjal enyakit ginjal kronisenyakit ginjal kronis

embuluh darah perier embuluh darah perier

MataMata

6etinopati6etinopati



Pembuluh darah

Ginjal

HipertensiHipertrofi ventrikel kiri

a"al !antun" kronik

&nfark miokard

Penyakit !antun"

kon"estif

'ritmia

'rteriosklerosis

Penyakit pembuluh darah perifer

Penyakit !antun" koroner

&nsufisiensi "in!al

Jantung Otak

Stroke



Faktor risiko

Disfungsi endotel

aterosklerosis

&nfark miokard akut

Disfungsi sistolik

ventrikel kiri

remodelling

Gagal jantung

kongestif

Gagal jantung

tahap akhir

KEM!"#

Disritmia

mati mendadak Disfungsi diastolik

Hipertrofi

ventrikel kiri

Disfungsi endotel

Tekanan

glomerulusGagal ginjal

tahap akhir Disfungsi mesangial

sitokin

Proteinuria

sklerosis & fibrosis

Paradigma Perjalanan Pen$akit Kardiovaskular

plak tidak stabil

Pen$akit jantung koroner

Hipertensi

Dislipidemia

MerokokDiabetes % dll

P&D

'!(OKE

Hipertensi



PenatalaksanaanPenatalaksanaan

erubahan gaya hidup

Gagal mencapai target tekanan darah

Medikamentosa : 0bat

Tu!uan # Mengurangi morbiditas dan mortalitas akibat penyakit

kardiovaskular dan ginjal



Perubahan "aya hidupPerubahan "aya hidup

.. Memperbaiki gaya hidupMemperbaiki gaya hidup elihara agar berat badan dalam rentang normalelihara agar berat badan dalam rentang normal BM : "74 1 2'7BM : "74 1 2'7

2.2. engaturan pola makanengaturan pola makan erbanyak sayur 5 buaherbanyak sayur 5 buah

Makanan rendah lemak kurangi makananMakanan rendah lemak kurangi makananberkolesterol/kalori naikberkolesterol/kalori naik

*.*. ,urangi konsumsi garam,urangi konsumsi garam

'.'. 0lahraga0lahraga

Berolahraga teratur7 minimal *!E perhariBerolahraga teratur7 minimal *!E perhari Mis : ?alan7 renang7 bersepedaMis : ?alan7 renang7 bersepeda

4.4. indari minuman beralkoholindari minuman beralkohol

>.>. Berhenti merokokBerhenti merokok

F.F. indari stress dan emosiindari stress dan emosi



Perubahan "aya hidupPerubahan "aya hidup (umlah rata)rata penurunan(umlah rata)rata penurunan

tekanan darahtekanan darah

Penurunan berat badanPenurunan berat badan **––+,+, mmH"-, k" //mmH"-, k" //

Peren0anaan makanPeren0anaan makan 11––2 mmH"2 mmH"

Diet rendah "aramDiet rendah "aram ++––1 mmH"1 mmH"

'ktivitas fisik'ktivitas fisik 22––3 mmH"3 mmH"

$en"uran"i konsumsi$en"uran"i konsumsialkoholalkohol

++––2 mmH"2 mmH"

Hubun"an perubahan "aya hidupHubun"an perubahan "aya hidup

den"an tekanan darahden"an tekanan darah



Strate"i Dasar Strate"i Dasar Penurunan Tekanan DarahPenurunan Tekanan Darah

Distribusi TD

Sebelum intervensiSesudah intervensi

Penurunan TD Sistol

(mmHg)

2

3

5

penurunan

TD

Pengurangan mortalitas (%)

Stroke PJ Total

!" !# !3

!$ !5 !#

!# !& !'



Keuntun"an menurunkanKeuntun"an menurunkan

tekanan darahtekanan darah

Persentase pengurangan insidens

Stroke 35!#%

Infark miokard 2!25%

Gagal jantung 5%



P456/'T'5 D'7'$ R'5K'8..P4594'H'5 PR&$4R

P4594'H'5 S4KU5D4R

$4$4R7UK'5 K6$/&5'S& 6/'T

D'7'$ :'KTU 7'$'8/4RT'HU5)T'HU5

K'R45' &TU 6/'T)6/'T H'RUS ; D'P'T

D&T674R'5S& D'5 T4R('5K'U



Kapan minum obat ?Kapan minum obat ?

Bila tekanan darah & >!/!! mmgBila tekanan darah & >!/!! mmg

Terapi biasanya seumur hidupTerapi biasanya seumur hidup

,onsultasikan dengan dokter mengenai,onsultasikan dengan dokter mengenaiobat hipertensi anda HHHobat hipertensi anda HHH

Tar"et tekanan darah < 2,-3, mmH"



?angan lupa?angan lupaHHHH

,ontrol tekanan darah secara teratur dan minum,ontrol tekanan darah secara teratur dan minum

obat secara teratur obat secara teratur

Tekanan darah hanya dapat diketahui denganTekanan darah hanya dapat diketahui dengan

mengukurnya dan bukan sekedar dengan keluhanmengukurnya dan bukan sekedar dengan keluhan

ataupun perasaanataupun perasaan



T H A N K Y O U

...It is nice to be an important person but it is important to be a nice person...

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lgorithm or Treatment o lgorithm or Treatment o

ypertensionypertension

5ot at oal /lood Pressure =<2,-3, mmH">

=<,-1, mmH" for those @ith diabetes or 0hroni0 kidney disease>

&nitial Dru" 9hoi0es

Dru"=s> for the 0ompellin"

indi0ations

0ther antihypertensi-e drugs

(diuretics7 @I7 6B7 BB7 @@B)

as needed.

:ith 9ompellin"&ndi0ations

7ifestyle $odifi0ations

Sta"e + Hypertension ($B &>! or %B &!! mmg)

21drug combination or most

(usually thiaJide1type diuretic and

@I7 or 6B7 or BB7 or @@B)

Sta"e Hypertension($B '!+4 or %B !+

mmg)

ThiaJide1type diuretics or most.

May consider @I7 6B7 BB7 @@B7

or combination.

:ithout 9ompellin"&ndi0ations

5ot at oal

/lood Pressure

0ptimiJe dosages or add additional drugs

until goal blood pressure is achie-ed.

@onsider consultation 3ith hypertension

specialist.



@lassiication and Management@lassiication and Management

o B or adultso B or adults

/P 0lassifi0ation/P 0lassifi0ation S/PAS/PA

mmH"mmH" D/PAD/PA

mmH"mmH" 7ifestyle7ifestyle

modifi0ationmodifi0ation

&nitial dru" therapy&nitial dru" therapy

:ithout 0ompellin" indi0ation:ithout 0ompellin" indi0ation :ith 0ompellin":ith 0ompellin"

indi0ationsindi0ations

;ormal;ormal <2!<2! and <"!and <"! IncourageIncourage

rehypertensionrehypertension 2!+*2!+* or "!+"or "!+" KesKes ;o antihypertensi-e drug;o antihypertensi-e drugindicated.indicated.

%rug(s) or compelling%rug(s) or compellingindications.indications. LL

$tage $tage

ypertensionypertension

'!+4'!+4 or !+or !+ KesKes ThiaJide1type diuretics or most.ThiaJide1type diuretics or most.

May consider @I7 6B7 BB7May consider @I7 6B7 BB7@@B7 or combination.@@B7 or combination.

%rug(s) or the compelling%rug(s) or the compelling

indications.indications.LL

0ther antihypertensi-e0ther antihypertensi-edrugs (diuretics7 @I7drugs (diuretics7 @I7

6B7 BB7 @@B) as 6B7 BB7 @@B) asneeded.needed.

$tage 2$tage 2ypertensionypertension

&&>!>! oror &&!!!! KesKes T3o1drug combination or mostT3o1drug combination or most (usually thiaJide1type diuretic and(usually thiaJide1type diuretic and

@I or 6B or BB or @@B). @I or 6B or BB or @@B).

NTreatment determined by highest B category.nitial combined therapy should be used cautiously in those at risk or orthostatic hypotension.LTreat patients 3ith chronic kidney disease or diabetes to B goal o <*!/"! mmg.



H;P4RT45S&B4 9R&S&S

is determined #

) by the rate of /P)riseC rather than a0tual /PC

1 by vas0ular and or"an status.

Form # H;P4RT45S&B4 4$4R459;

= 7ife threatenin"C un0ontrolled hypertension@ith a0ute end)or"an dama"e >

H;P4RT45S&B4 UR459;

= Severe but not live threatenin" >

DefinitionDefinition



D4F&5&T&65 #D4F&5&T&65 #

H;P4RT45S&B4 9R&S&S

' severe elevation in /PC "enerally a S/P ++, mm H" and - or

D/P +, mm H". =(59)B&&C +,,2>

. H;P4RT45S&B4 4$4R459&4S

Severe elevation in /P 0ompli0ated by a0ute tar"et or"an

dysfun0tionC su0h as 0oronary is0hemiaC strokeC intra0erebral

hemorrha"eC pulmonary edemaC or a0ute renal failure.

+. H;P4RT45S&B4 UR459&4S

Severe elevations in /P @ithout eviden0e of tar"et or"an

deterioration. 9olhum D'. 6paril SC 5e@ 4n"l. (. $edC + # EEC 33,



6isk actor :6isk actor :@haracteristics that related to ncreasing@haracteristics that related to ncreasing

6isk Become $ick / llness6isk Become $ick / llness

@ardio-ascular 6isk Oactor :@ardio-ascular 6isk Oactor :

@haracteristics that related to increasing@haracteristics that related to increasing6isk become @ardio-ascular %isease/6isk become @ardio-ascular %isease/

bnormality bnormality



6$, O@T06$ 0O @060;6K6$, O@T06$ 0O @060;6K

I6T %$I$II6T %$I$IThe Oramingham eart $tudy7 '" : theThe Oramingham eart $tudy7 '" : the

pre-alence o @% is associated 3ith thepre-alence o @% is associated 3ith the

ollo3ing modiiable or immutable risk actors :ollo3ing modiiable or immutable risk actors :

1 d-anced aged1 d-anced aged 1 Tobacco use1 Tobacco use1 Male gender Male gender 1 ypertension1 ypertension

1 Oamily history o @%Oamily history o @% 1 %iabetes mellitus1 %iabetes mellitus

1 ypercholesterolemiaypercholesterolemia 1 $edentary liestyel1 $edentary liestyel1 Do3 le-els o %D cholesterolDo3 le-els o %D cholesterol



TI60GI;I$$ TI60GI;I$$

Risk Fa0tors

$moking

ypertension

yperlipidemia

0thers (diabetes7 coagulation

abnormalities7

hemocysteinemia7etc)

Oatty streak



6isk Oactors or therothrombosis6isk Oactors or therothrombosis

omocysteinemia

ypercoagulable states

%iabetes

0besity

Die1style (e.g7 smoking7

diet7 lack o ePercise) yperlipidemia

ypertension

nectionQ

ge

Gender

Genetics'therotromboti0 $anifestations

=$&C &s0hemi0 strokeC Bas0ular death merican eart ssociation7 eart and $troke acts: F $tatistical supplementR

Sol $troke !R2 ($D 2):1'1>RDaurila et al. arterioscle TrombAasc bio FRF:2!12*RGrau et

al. $troke FR2>RF2'1F2R Graham et al ?M FR2FF: FF41F"RBrigden ostgrad

MedR!(4)R2'12>2



M?06 6$, O@T06$ O06 @%M?06 6$, O@T06$ O06 @%The ;@I dult (treatment panel identiies ositi-e 6isk Oactors (6O)The ;@I dult (treatment panel identiies ositi-e 6isk Oactors (6O)

or @%or @%

Risk Fa0torsRisk Fa0tors

Oamily history o early @%Oamily history o early @%

parent or sibling <44 years o age i male7 <>4 years o age i emaleparent or sibling <44 years o age i male7 <>4 years o age i emale

ge : ge :

male &'4 yearsmale &'4 years

Oemale &44 years or premature menopause 3ithout estrogen replacementOemale &44 years or premature menopause 3ithout estrogen replacementtherapy (I6T)therapy (I6T)

ypertensi-e (Bypertensi-e (B && '!/! mmg or taking antihypertensi-e medication)'!/! mmg or taking antihypertensi-e medication)

@urent smoker @urent smoker

Type 2 diabetesType 2 diabetes

Do3 %D1cholesterol (<*4 mg/dl)Do3 %D1cholesterol (<*4 mg/dl) ;egati-e 6isk actor ;egati-e 6isk actor

%D1@ is &>! mg/dl substract one risk actor %D1@ is &>! mg/dl substract one risk actor



;on traditional 6isk actors;on traditional 6isk actors

'l0ohol =moderate 0onsumsumption>'l0ohol =moderate 0onsumsumption>

lcohol raises %D7 stimulates ibrinolysis7 reduces ibrinogen le-els7 lcohol raises %D7 stimulates ibrinolysis7 reduces ibrinogen le-els7and inhibits aggregation o plateletsand inhibits aggregation o platelets

'ntioidants'ntioidants

$tudies ha-e generally sho3n reduced @% risk in indi-iduals$tudies ha-e generally sho3n reduced @% risk in indi-idualsconsuming oods high in antioPidant -itaminsRconsuming oods high in antioPidant -itaminsR

Fibrino"enFibrino"en

Oactors associated 3ith ele-ated ibrinogen include cigarette smoking7Oactors associated 3ith ele-ated ibrinogen include cigarette smoking7sedentary liestyle7 and high triglyceride le-els. Oibric acidsedentary liestyle7 and high triglyceride le-els. Oibric acidderi-ati-es7 estrogen administration7 cigarette smoking cessation7deri-ati-es7 estrogen administration7 cigarette smoking cessation7and aerobic reduce ibrinogen le-els.and aerobic reduce ibrinogen le-els.



Homo0ysteine

%eiciencies in olate intake and reduced serum le-els ele-atedhomocystein

De-els. Oolate therapy sho3n to reduce homocysteine le-els and impro-e

Indothelial unction. $ome hyperhomocysteinemic patients 3ith other

enJyme abnormalities reuire pyridoPine or -itamin b2

&nfe0tious a"ents

Docal arterial inection (include @hlamydia pneumonia7 elicobacter

pylori7 @ytomegalo-irus and other herpes -irus) cause coronary

atherosclerosis and postangioplasty restenosis.

@ausati-e mechanism include endothelial injury7 local inlammation7

smooth muscle prolieration 3ith p4* inacti-ation7 and autoimmunity



@oronary eart %isease 6isk Oactors@oronary eart %isease 6isk Oactors scientiic position scientiic position

5on modifiable ma!or risk fa0tors #5on modifiable ma!or risk fa0tors #

&n0reasin" a"e&n0reasin" a"e : bout our out o i-e people 3ho die o: bout our out o i-e people 3ho die o

@% are >4 or older. t older age7 3omen 3ho has heart@% are >4 or older. t older age7 3omen 3ho has heart

attacks are more likely than men to die rom them 3ithinattacks are more likely than men to die rom them 3ithin

a e3 3eeks.a e3 3eeks.

$ale se ="ender>$ale se ="ender> : Men ha-e greater risk o heart attack: Men ha-e greater risk o heart attack

than 3omen7 and they ha-e attacks earlier in lie. I-enthan 3omen7 and they ha-e attacks earlier in lie. I-en

ater menopause 3hen 3omanUs death rate rom heartater menopause 3hen 3omanUs death rate rom heart

diseases increass7 it is not as great as menUs.diseases increass7 it is not as great as menUs.



Heredity =in0ludin" ra0e>

rican mericans ha-e more se-erehypertension than @aucasians and a higher risk

o heart disease. eart disease risk is also

higher among MePican mericans7 merican

ndians7 nati-e a3aiians and some sian mericans. Most people 3ith a strong amily

history o heart disease ha-e one or more other

risk actors.



The Major risk actors that can be modiied7 treatedThe Major risk actors that can be modiied7 treated

or controlledor controlled

Toba00o smoke.Toba00o smoke. $mokerUs risk o heart attack is &2 that$mokerUs risk o heart attack is &2 that

o nonsmokers. @igarette smoking is the biggest risko nonsmokers. @igarette smoking is the biggest risk

actor or sudden cardiac death. $mokers ha-e 2 + 'actor or sudden cardiac death. $mokers ha-e 2 + '

times the risk o non smokers. @igarette smoking alsotimes the risk o non smokers. @igarette smoking also

acts 3ith other risk actors to greatly increase the risk oracts 3ith other risk actors to greatly increase the risk or

@%.@%.

Hi"h /lood 9holesterolHi"h /lood 9holesterol. Ile-ated blood cholesterol. Ile-ated blood cholesterol

rises the risk o @%. cholesterol le-el is also aectedrises the risk o @%. cholesterol le-el is also aected

by age7 seP7 heredity7 and diet.by age7 seP7 heredity7 and diet.



Hi"h blood pressure.Hi"h blood pressure. igh blood pressure increasesigh blood pressure increases

heartUs 3orkload7 causing the heart to enlarge andheartUs 3orkload7 causing the heart to enlarge and

3eaken. t also increases your risk o stroke7 heart3eaken. t also increases your risk o stroke7 heart

attack7 kidney ailure and congesti-e heart ailure.attack7 kidney ailure and congesti-e heart ailure.

Physi0al ina0tivityPhysi0al ina0tivity. n inacti-e liestyle is a risk actor or. n inacti-e liestyle is a risk actor or

@%. 6egular7 moderate1to1-igorous physical acti-ity@%. 6egular7 moderate1to1-igorous physical acti-ity

helps pre-ent heart and blood -essel disease. IPercisehelps pre-ent heart and blood -essel disease. IPercise

helps controlling blood cholesterol7 diabetes7 and obesity7helps controlling blood cholesterol7 diabetes7 and obesity7

as 3ell as help lo3ering the blood pressureas 3ell as help lo3ering the blood pressure



6besity and over@ei"ht6besity and over@ei"ht. IPcess 3eight increases the. IPcess 3eight increases the

strain on the heart. t also raises blood pressure andstrain on the heart. t also raises blood pressure andblood cholesterol and Triglyceride le-els7 and lo3ersblood cholesterol and Triglyceride le-els7 and lo3ers

%D le-els.%D le-els.

Diabetes mellitusDiabetes mellitus. %iabetes increases your risk o. %iabetes increases your risk ode-eloping cardio-ascular disease. I-en 3hen glucosede-eloping cardio-ascular disease. I-en 3hen glucose

le-els are under control7 diabetes greatly increases thele-els are under control7 diabetes greatly increases the

risk o heart disease and stroke. bout t3o third orisk o heart disease and stroke. bout t3o third o

people 3ith diabetes die o some orm o heart or bloodpeople 3ith diabetes die o some orm o heart or blood

-essel disease.-essel disease.



0ther actors contribute to heart disease risk0ther actors contribute to heart disease risk

&ndividual response to stress&ndividual response to stress may be a contributingmay be a contributing

actor. $ome scientis ha-e noted a relationship bet3eenactor. $ome scientis ha-e noted a relationship bet3een

coronary heart disease risk and stress in a personUs lie7coronary heart disease risk and stress in a personUs lie7

their health beha-iours and socioeconomic status.their health beha-iours and socioeconomic status.

Se hormonesSe hormones play a role in heart disease. Men ha-eplay a role in heart disease. Men ha-e

more heart attacts than 3omen do beore 3omen reachmore heart attacts than 3omen do beore 3omen reach

the age o menopause. menopause is caused bythe age o menopause. menopause is caused by

surgery remo-ing the uterus and o-aries7 the risk osurgery remo-ing the uterus and o-aries7 the risk o

heart attack rises sharply.heart attack rises sharply.



ormones also aect blood cholesterol. Oemaleormones also aect blood cholesterol. Oemale

hormones tend to raise %D cholesterol andhormones tend to raise %D cholesterol and

lo3er total blood cholesterol. Male hormones dolo3er total blood cholesterol. Male hormones do

the opposite.the opposite. you ha-e had a natural or surgical menopause7 you ha-e had a natural or surgical menopause7

you may be considering estrogen replacementyou may be considering estrogen replacement

therapy(I6T) or hormone replacement therapytherapy(I6T) or hormone replacement therapy

(6T). I6T and 6T may increase your risk o(6T). I6T and 6T may increase your risk osome diseases and heath conditions.some diseases and heath conditions.

The Cardiovascular ContinuumThe Cardiovascular Continuum



Risk factors:Risk factors:

diabetesdiabetes

hypertensionhypertension

VascularVascular

dysfunctiondysfunction

Vascular diseaseVascular disease

Tissue injuryTissue injury

(MI, stroke)(MI, stroke)

PatholoicalPatholoical

re!odelinre!odelin

Taret oran dysfunctionTaret oran dysfunction

(H", renal)(H", renal)

#ndothelial$ysfunction

Taret %ra $a!ae

Mild &e'ere

niotensinniotensin IIII

The Cardiovascular Continuum:The Cardiovascular Continuum:

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