tabel hipertensi

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Tabel 1 Klasifikasi Tekanan Darah TDS (mmHg) TDD (mmHg) Normal < 120 dan < 80 Prehipertensi 120 - 139 atau 80 - 89 Hipertensi Derajat 1 140 - 159 atau 90 - 99 Hipertensi Derajat 2 ≥ 160 atau 100

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Page 1: Tabel hipertensi

Tabel 1

Klasifikasi Tekanan Darah TDS (mmHg) TDD (mmHg)Normal < 120 dan < 80Prehipertensi 120 - 139 atau 80 - 89Hipertensi Derajat 1 140 - 159 atau 90 - 99Hipertensi Derajat 2 ≥ 160 atau 100

Page 2: Tabel hipertensi

Tabel 2

Faktor Risiko Utama- Hipertensi- Usia (>55 tahun untuk pria dan >65 tahun untuk wanita- Diabetes melitus- Peningkatan kolesterol LDL (atau total) atau penurunan kolesterol HDL- Laju filtrasi glomerulus (LFG) <60 ml/menit- Riwayat penyakit jantung dalam keluarga (<55 tahun pada pria atau <65 tahun pada wanita)- Mikroalbuminuria-- Aktivitas fisik kurang-

Kerusakan Target OrganJantung

- hipertrofi ventrikel kiri- infark miokard angina- riwayat revaskularisasi koroner- gagal jantung

Otak-- demensia

Penyakit Ginjal KronikPenyakit arteri periferRetinopati

Obesitas (body mass index > 30 kg/m2)

Merokok, terutama cigarette

stroke atau translent ischemic attack

Page 3: Tabel hipertensi

Faktor Risiko Utama

Riwayat penyakit jantung dalam keluarga (<55 tahun pada pria atau <65 tahun pada wanita)

Kerusakan Target Organ

Page 4: Tabel hipertensi

Tabel 3 tabel 4

Penyebab Prevalensi Tekanan Darah Inisial (mmHg)Penyakit parenkim ginjal 5 NormalPenyakit renovaskular 0,5 - 5 PrehipertensiAldosteronisme 0,5 - 1 Hipertensi Derajat 1Penyakit tiroid 0,5 - 1

Hipertensi Derajat 2

Feokromositoma < 0,2Sindrom Cushing < 0,2Obat 0,1 - 1Kehamilan 0,1 - 1

Page 5: Tabel hipertensi

tabel 5

Follow-Up Basic Test For Initial EvaluationCek ulang dalam 2 tahun 1. Always includedCek ulang dalam 1 tahun aKonfirmasi dalam 2 bulan b

cdef

gh

2. Usually included, depending on cost and other factorsabcde

Special Studies to Screen for Secondary Hypertension

4. Primary aldosteronism

Evaluasi dalam 1 bulan. Untuk tekanan darah yang lebih tinggi (>180/110 mmHg), evaluasi dan tatalaksana secepatnya atau dalam 1 minggu tergantung klinik dan komplikasi

1. Renovascular disease: angiotensin-converting enzyme inhibitor radionuclide renal scan, renal duplex, Doppler flow studies and MRI angiography

2. Pheochromocytoma : 24-h urine assay for creatinine, metanephrines, and calecholamines

3. Cushing's syndrome: overweight dexamethasone suppression test or 24-h urine cortisol and creatinine

Note : HDL, High Density Lipoprotein; LDL, Low Density Lipoprotein; MRI, Magnetic Resonance Imaging

Page 6: Tabel hipertensi

Basic Test For Initial Evaluation1. Always included

Urine for protein, blood and glucoseMicroscopic urinalysisHematocritSerum potasslumSerum creatinine and/or blood urea nitrogenFasting glucoseTotal cholesterolElectrocardiogram

2. Usually included, depending on cost and other factorsThyroid-stimulating hormoneWhite blood cell countHDL and LDL cholesterol and triglyceridesSerum calcium and phospateChest x-ray; limites echocardiogram

Special Studies to Screen for Secondary Hypertension

4. Primary aldosteronism

1. Renovascular disease: angiotensin-converting enzyme inhibitor radionuclide renal scan, renal duplex, Doppler flow studies and MRI angiography

2. Pheochromocytoma : 24-h urine assay for creatinine, metanephrines, and calecholamines

3. Cushing's syndrome: overweight dexamethasone suppression test or 24-h urine cortisol and creatinine

Note : HDL, High Density Lipoprotein; LDL, Low Density Lipoprotein; MRI, Magnetic Resonance Imaging

Page 7: Tabel hipertensi

Stage 1Hypertension

(SBP 140 - 159 or DBP90 - 99 mmHg)

Thiezide type diureticsfor most May consider

ACEI, ARB, BB, CCB,or combination

Life Style Modification

Initial Drug Choices

Stage 2Hypertension

(SBP ≥ 160 or DBP≥ 100 mmHg)

2 drug combination formost (usually thiazide-type diuretic and ACEIor ARB, or BB, or CCB)

Not at Goal Blood Pressure

Optimize dosages or add additional drugs untill goal blood pressure is achieved. Consider consultation with hypertension specialist

See Stretegies for Improving to Theraphy

Page 8: Tabel hipertensi

Life Style Modification

Initial Drug Choices

Drug(s) fot thecompelling indications

See CompellingIndications for individual

Drug Classes

Other antihypertensivedrugs (diuretics, ACEI,

ARB, BB, CCB) as needed

Not at Goal Blood Pressure

Optimize dosages or add additional drugs untill goal blood pressure is achieved. Consider consultation with hypertension specialist

See Stretegies for Improving to Theraphy

Page 9: Tabel hipertensi

Recommended Drugs**

Compelling Indication* Diu

retic

BB

AC

E-I

AR

B

CC

B

ALD

O A

NT

Heart failure x x x x x

Postmyocardial Infarction x x x

High coronary disease risk x x x x

Diabetes x x x x x

Chronic Kidney Disease x x

Recurrent Stroke Prevention x x

* Compelling indications for antihypertensive drugs are based on benefits from outcome studies or existing clinical guidelines; the compelling indication is managed in parallel with

the BP.** Drug abbreviations: ACEI, angiotensin converting enzyme inhibitor, ARB, angiotensin

receptorblocker, Aldo ANT, aldosterone antagonist, BB, beta-blocker, CCB, calcium channel blocker

*** Conditions for which clinical trials demonstrate benefit of specific classes of antihypertensive drugs

Page 10: Tabel hipertensi

Clinical Trial Basis***

ACC/AHA Heart FailureGuideline, MERIT - HFCOPERNICUS, CIBIS,SOLVD, AIRE, TRACE,ValHEFT, RALES

ACC/AHA Post-MIGuideline, BHAT, SAVE,Capricorn, EPHESUS

ALLHAT, HOPE, ANBP2LIFE, CONVINCE

NFK-ADA GuidelineUKpds, ALHAT

NFK Guideline, CapTOPRILTrial, RENAAL, IDNTREIN, AASK

PROGRESS

* Compelling indications for antihypertensive drugs are based on benefits from outcome studies or existing clinical guidelines; the compelling indication is managed in parallel with

** Drug abbreviations: ACEI, angiotensin converting enzyme inhibitor, ARB, angiotensin receptorblocker, Aldo ANT, aldosterone antagonist, BB, beta-blocker, CCB, calcium

channel blocker

*** Conditions for which clinical trials demonstrate benefit of specific classes of antihypertensive drugs