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