Download - hipertensi kuliah
HIPERTENSI
Tekanan Darah (TD): refleksi kardiovaskular
TD sistolik : dipengaruhi oleh curah jantung (CO),dapat berubah dalam waktu singkat (aktifitas fisik ringan, emosi)
TD diastolik : refleksi dari resistensi perifer, bila vasokonstriksi arteriol → TD diastolik ↑sukar dipengaruhi faktor emosi dan aktifitas fisik ringan
HIPERTENSI : kondisi abnormal hemodinamik (fungsi pengaturan/kontrol)
→ batasan hipertensi dipakai kriteria TD sistolik dan/atau TD diastolik
DEFINISI
Consequences of Hypertension
Consequences of Hypertension
http://www.massgeneral.org/vascularcenter/body/stroke.jpg
Hypertensive nephropathy
http://www.ndt-educational.org/images/Marcantonifig1.jpg
Fundoscopy/ Vascular
• Tekanan nadi (pulse pressure) = TD sistolik – TD diastolik
• Tekanan arteri rata-rata (mean arterial pressure/MAP) = (TD sistolik + 2xTD diastolik)
DEFINISI
3
BP = CO x SVR
SV x HR BP : blood pressure SVR: systemic vascular-resistance SV : stroke volume HR : heart rate
Blood PressureDetermining Factors
BP
Cardiac Output: Stroke Volume Heart Rate Force of Contraction
Peripheral Resistance **
Blood Volume **
Diuretics
Beta BlockersCalcium Channel Blockers
Vasodilators
ACE Inhibitors
ACE Inhibitors
• HIPERTENSI PRIMER (90 – 95%) hipertensi yang tidak diketahui penyebabnya
• HIPERTENSI SEKUNDER (5 – 10%) hipertensi yang diketahui penyebabnya
DEFINISI
Patogenesis Hipertensi
MULTIFAKTORIAL
BP Measurement Techniques
Method Brief Description
In-office Two readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm.
Ambulatory BP monitoring
Indicated for evaluation of “white-coat” HTN. Absence of 10–20% BP decrease during sleep may indicate increased CVD risk.
Self-measurement Provides information on response to therapy. May help improve adherence to therapy and evaluate “white-coat” HTN.
JNC 7 2003
……… sphygmomanometer
Patient should be seated and relaxed, preferably for several minutes prior to to the measurement and in a quiet room.
Appropriate cuff size.
Average the readings. If the first two readings differ by more than 10 mmHg systolic or 6 mmHg diastolic or if the initial readings are high, take several readings after five minutes of quiet rest, until consecutive readings do not vary by greater than these amounts.
Ideally, patients should not take caffeine-containing beverages or smoke for at least two hours before blood pressure is measured, …………………..
How to measure blood pressure accurately
Australia, 2004
Preparation for measurement• Patient should
abstain from eating, drinking, smoking and taking drugs that affect the blood pressure one hour before measurement.
Preparation for measurement
• Because a full bladder affects the blood pressure it should have been emptied.
Preparation for measurement
• BP take in quiet room and comfortable temperature, must record room temperature and time of day.
BLOOD PRESSURE: MEASUREMENT
Nokolai Korotkoff, 1905
Ascultatory method ofblood pressure measurement
Blood Pressure Assessment:Patient preparation and posture
Standardized Preparation:
Patient√ 1. No acute anxiety, stress or pain. 2. No caffeine, smoking or nicotine in the preceding 30 minutes. 3. No use of substances containing adrenergic stimulants such as phenylephrine or pseudoephedrine (may be present in nasal decongestants or ophthalmic drops).√ 4. Bladder and bowel comfortable. 5. No tight clothing on arm or forearm. 6. Quiet room with comfortable temperature 7. Rest for at least 5 minutes before measurement√ 8. Patient should stay silent prior and during the
procedure.
Benefits of Lowering BP
Average Percent Reduction
Stroke incidence 35–40%
Myocardial infarction 20–25%
Heart failure50%
700
600
500
400
300
200
100
8 Ye
ar P
roba
bilit
y Pe
r 1,0
00
Systolic BP:Cholesterol:Glucose Intol.:Cigaretes:ECG-LVH:
105 >>> 185185000
105 >>> 185335000
105 >>> 185335+00
105 >>> 185335++0
105 >>> 185335+++
Kannel, 1983
Framingham Heart Study (1983)
CV Risk Profile703
459
326
210
46
CXR:
Cardiomegalypleural effusions
interstitial edemaPulmonary venous redistribution
Hypertension SBP > 140 mmHg DBP> 85 mmHg
Heart
23
Vital organs risk
Coronary factors
Myocardium factors
CHD LVH
Congestive heart failure
Arrhythmia cordis Sudden death
• Stroke• Multi infarct dementia• Peripheral vascular
disease• Aortic aneurysm• Renal failure
Disability
R. Boedhi Darmojo, 2000, WHO-ISH, 1999
Target Organ Damage
Heart• Left ventricular hypertrophy• Angina or prior myocardial infarction• Prior coronary revascularization• Heart failure
Brain• Stroke or transient ischemic attack
Chronic kidney disease
Peripheral arterial disease Retinopathy
Laboratory Tests Routine Tests
• Electrocardiogram • Urinalysis • Blood glucose, and hematocrit • Serum potassium, creatinine, or the corresponding estimated GFR, and
calcium• Lipid profile, after 9- to 12-hour fast, that includes high-density and low-
density lipoprotein cholesterol, and triglycerides
Optional tests • Measurement of urinary albumin excretion or albumin/creatinine ratio
More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved
Lifestyle ModificationModification Approximate SBP
reduction(range)
Weight reduction 5–20 mmHg/10 kg weight loss
Adopt DASH eating plan
8–14 mmHg
Dietary sodium reduction
2–8 mmHg
Physical activity 4–9 mmHg
Moderation of alcohol consumption
2–4 mmHg