Oleh : Eli Halimah

Hipertensi
Hipertensi atau tekanan darah (TD) tinggi adalah

keadaan dimana TD lebih tinggi dari normal

Hipertensi bukan penyakit melainkan suatu kelainan,
gejala dari gangguan pada mekanisme regulasi
tekanan darah
Gejala-gejala hipertensi :
- Nyeri kepala pagi hari sebelum bangun dari
pembaringan dan akan lenyap setelah bangun
- Gejala yg khas tidak ada - silent disease
- Hipertensi hanya dapat diketahui dari pengukuran
tekanan darah

Evolution in Understanding Cardiovascular

Disease: Total Risk Perspective

Dyslipidemia
Age

Smoking

Hypertension

Gender
Diabetes
Mellitus

Cardiovascular Disease Is an Interplay of Risk Factors

Kannel WB. Am J Hypertens. 2000;13:3S-10S; Poulter N. Am J Hypertens. 1999;12:92S-95S.
4

Hypertension

Dyslipidemia

Impaired Bioavailability
of Nitric Oxide

Smooth Muscle
Cell Contraction

Impaired
Vasodilation
Endothelial
Dysfunction

Atherosclerosis

CVD

Partners in Healthcare Education, LLC 2009

Hypertension Remains One of the Most

Important Multipliers of CV Risk
BP >140/90 mm Hg is associated with:

277,000 deaths in 2003

BP, blood pressure; CHF, congestive heart failure; MI, myocardial infarction.
Rosamond W et al. Circulation. 2007;115:1-103.

Klasifikasi Hipertensi berdasarkan

Tingginya Tekanan Darah
Kisaran TD (mmHg)
Diastolik :
< 90
90 104
105 - 114
> 115

Kategori
TD Normal
HT ringan
HT sedang
HT berat

Sistolik, bila TD diastolik < 90

< 140
TD Normal
140 159
HT sistolik perbatasan
> 160
HT sistolik

Classification of Blood Pressure for Adults

(JNC 7, May 2003)

Systolic
Normal
Prehypertensio
n
Stage 1
Stage 2

<120
120
139
140 159
> 160

Diastoli
c
An <80
d
80 89
Or
Or

90 99

Or

> 100

Prehypertension
Individuals with a

systolic BP of 120139 mm HG or a
diastolic BP or 80-89
mm HG should be
considered as prehypertensive and
lifestyle
modification
initiated.
JAMA. 2003:289:2560-2577.
9

Table 3. Lifestyle Modifications to Manage Hypertension*

Aetiology of Hypertension
Primary 90-95% of cases also termed essential of

idiopathic
Secondary about 5% of cases
Renal or renovascular disease
Endocrine disease
Phaeochomocytoma
Cusings syndrome
Conns syndrome
Acromegaly and hypothyroidism
Coarctation of the aorta
Iatrogenic
Hormonal / oral contraceptive
NSAIDs

Klasifikasi HT berdasarkan Etiologi

1. Hipertensi esensial, primer atau idiopatik
- HT ini tidak jelas etiologinya ( 90%)
- Ciri-ciri : ada riwayat HT pada keluarga
terjadi peningkatan reaktivitas
vaskuler
- Penyebab multifaktorial :
genetik
Lingkungan : masukan garam, obesitas,
pekerjaan /
jabatan, kepadatan penduduk
- HT esensial merupakan kelainan kronik & biasanya
progresif

2. Hipertensi Sekunder (6-8%)

Disebabkan oleh penyakit lain atau obat tertentu
a.

b.

c.

HT Renal ( HT Renovaskuler)
Terjadi karena penyakit pada ginjal :
- penyempitan pembuluh darah ginjal
- kerusakan arteri ginjal
HT Endokrin
- Kelainan korteks adrenal (Cushing syndrom)
- tumor di medula adrenal (Feokromositoma)
Obat-obatan :
- Kontraseptif hormonal
- Kortikosteroid
- Antidepresan trisiklik

Target Organ Damage

Heart
LVH, Angina, CHF, MI

Brain
Stroke or TIA
Dementia

Chronic Kidney Disease

Peripheral Vascular Disease
Retinopathy

JAMA. 2003:289:2560-2577.

This left ventricle is very thickened (slightly over 2 cm

in thickness), but the rest of the heart is not greatly
enlarged. This is typical for hypertensive heart
disease. The hypertension creates a greater pressure
load on the heart to induce the hypertrophy.
Kieran McGlade Nov 2001

Department of General Practice QUB

The left ventricle is markedly thickened in

this patient with severe hypertension that was
untreated for many years. The myocardial
fibers have undergone hypertrophy.

Kerusakan Organ Akibat Hipertensi

Kerusakan jantung
- Jantung bekerja lebih keras dan pembuluhpembuluh mengeras (menahan TD yang tinggi)
- Infark Jantung
- Infark otak, dengan kelumpuhan separuh badan
(pecah pembuluh darah otak)
- Kerusakan ginjal
- Kerusakan selaput jala mata

If HTN diagnosed
Evaluate for Cardiovascular Risk Factors
Age,Fm Hx, Lipids, Obesity, microalbuminuria,
Inactivity,Smoking
Evaluate for Target Organ Damage
LVH or reduced EF,
Angina,stroke,dementia,Kidney disease,
PAD,retinopathy
Think about Secondary Hypertension with any new
onset Hypertension or uncontrolled hypertension

Physiology of
the Renin Angiotensin System
Activation of
Baroreceptor
Reflexes

Renal Sympathetic
Nerve Activity

BLOOD PRESSURE
BLOOD VOLUME

Beta-adrenergic
Stimulation

RENIN
SECRECTION

Renal Artery
Pressure

Renal
Baroreceptor

Plasma
Ang I

Plasma
Ang II

Systemic
Vasoconstriction

Aldosterone
Secretion

Ang, angiotensin.
Reid IA. Adv Physiol Edu. 1998;20:S236-S245.

BLOOD PRESSURE
BLOOD VOLUME

Hypertension produces several types of structural change in the

blood vessel wall

Blood vessel walls in hypertension may be narrowed in two ways: structural

hypertrophy increase smooth muscle contraction producing vasoconstriction

Development of fibrinoid necrosis in malignant hypertension

CHARACTERISTICS of the
HYPERTENSION SYNDROME

2.
3.
4.

Blood Pressure
Dislipidemia
Insulin Resistance (IGT)
Central Obesity
Coagulation Factors
( Fibrinolysis)
1. Renal Changes (Microalbuinuria)
2. Arterial and Ventricular
Compliance (LVH)
All contribure Cardiovascular Risk

Panel Pemeriksaan Hipertensi

(Evaluasi Awal)
Tipe penyakit, etiologi, stratifikasi prognostik, Faktor risiko,

Target Organ Damage (Sebagai dasar u/ menentukan

pengobatannya)

Parameter :
Hematologi rutin, Hematokrit
Urinalisis rutin, ureum , kreatinin, asam urat, Mikroalbumin
(urin)
Glukosa puasa + 2 jam pp
Kolesterol, HDL/LDL, TrigliseridaApoA1/Apo B
K, Na (serum/ urin 24 jam)
Renin (PRA)
Tambahan : Foto toraks
EKG

Panel Pengelolaan Hipertensi

(Pemantauan)
Panel ini berguna u/ melihat adanya efek samping obat maupun

u/ deteksi dini adanya kerusakan organ akibat hipertensi

Parameter :
Urinalisis Rutin
Ureum
Kreatinin
Asam urat
Glukosa puasa
Mikroalbumin (urin)
Kolesterol, HDL/LDL
Trigliserida
Apo A1/Apo B
K, Na (serum)