BAB I

INTRODUCTION

A. Background
Cardiovascular disease typically attacks middle age and above. But
cardiovascular disease is the result of a process throughout human life. The incidence
of cardivascular disease in adulthood is inseparable from continuous interactions from
childhood to adolescence. Some risk factors that might be the cause of cardiovascular
disease in adolescents are definitely not known, however in general it is known that
various risk factors for someone to suffer from cardiovascular disease, for example
hypertension is determined through the interaction of two or more risk factors (Brian,
dkk. 2005)
Hypertension is one of the main causes of mortality-morbidity in Indonesia, so
the management of this disease is a very common intervention carried out at various
levels of health facilities (PERKI, 2015). High blood pressure / hypertension is a
medical condition where there is an increase in chronic blood pressure (long-term). This
disease is one type of disease that is very dangerous. Hypertension is defined as an
increase in blood pressure of more than 140/90 mmHg, is a silent killer and its role in
heart and brain disorders is undoubted. Symptoms of hypertension can vary between
individuals and are almost the same as the symptoms of other diseases. The symptoms
are headache / severe feeling in the neck, vertigo, palpitations, fatigue, blurred vision,
ringing in the ears (tinnitus) and nosebleeds (INFODATIN).

B. Formulation of The Problem

1. What is definition about Hypertension?
2. What kind of Hypertension?
3. What are the causes of Hypertension?
4. What are the risk factors for Hypertension?
5. How is the pathophysiology of Hypertension?
6. What are sign and symptoms of Hypertension?
7. What are the complications of Hypertension?
8. How are treatments for Hypertension?
C. The Purpose
1.
 BAB II

DISCUSS

A. Definition of Hypertension
Blood pressure is the force that a person's blood exerts against the walls of their
blood vessels. This pressure depends on the resistance of the blood vessels and how hard
the heart has to work. Hypertension is blood pressure a system where the systolic pressure
is above 140 mmHg and the diastolic pressure above 90 mmHg.
Essential hypertension occurs primarily in people between the ages of 25 and 55.
It is reported as being responsible for over 30.000 deaths each year and is often called the
“silent killer”, because individuals have no manifestations of illness prior to sudden death.
Although there is greater awareness of the causes and effects of hypertension, only about
20% of the people with this disorder have satisfactory blood pressure control.
Hypertension is also related to increased severity of atherosclerosis, stroke,
nephropathy, peripheral vascular disease, aortic aneurysms, and heart failure. If
hypertension is left untreated, nearly half of hypertension clients will die of heart disease,
one third will die of stroke, and the remaining 10% to 15% will die of renal failure.

Classification of Blood Pressure for adults age 18 and older

Category Systolic (mmHg) Diastolic (mmHg)

Optimal < 120 and < 80
Normal < 135 and/or < 85
High - normal 120 – 139 and/or 85 – 89
Hypertension
Stage 1 140 – 159 and/or 90 – 99
Stage 2 160 – 179 and/or 100 – 109
Stage 3 ≥ 180 and.or ≥ 110

B. Type of Hypertension
1. Primary hypertension
- Primary hipertension encompasses 90 to 95 percent of all cases of hypertension.
- At least 25 percent of the hypertensive population remain undiagnosed.
- Hypertension is considered to be the most significant predictor of developing
coronary artery disease.
 - Hypertension is the major risk factor for the coronary, cerebral, renal, and
peripheral vascular diseases that account for more than half of all deaths in the
United States.
- Incidence is greater in Blacks and in males.
2. Secondary hypertension
- Secondary hypertension affects 5 to 10 percent of the hypertension population.
- The most common causes of secondary hypertension include estrogen use, renal
disease, vascular disease, endocrine disorders, coarctation of the aorta, stress, and
pregnancy.
C. Causes of Hypertension
The cause of hypertension is often not known. In many cases, it is the result of an
underlying condition. Doctors call high blood pressure that is not due to another condition
or disease primary or essential hypertension. If an underlying condition is the cause of
increasing blood pressure, doctors call this secondary hypertension. Each type has a
different cause.
1. Primary hypertension
Primary hypertension is also called essential hypertension. This kind of
hypertension develops over time with no identifiable cause. Most people have this
type of high blood pressure. Researchers are still unclear what mechanisms cause
blood pressure to slowly increase. A combination of factors may play a role. These
factors include:
a. Genes : Some people are genetically predisposed to hypertension. This may be
from gene mutations or genetic abnormalities inherited from your parents.
b. Physical changes : If something in your body changes, you may begin
experiencing issues throughout your body. High blood pressure may be one of
those issues. For example, it’s thought that changes in your kidney function due
to aging may upset the body’s natural balance of salts and fluid. This change
may cause your body’s blood pressure to increase.
c. Environment : Over time, unhealthy lifestyle choices like lack of physical
activity and poor diet can take their toll on your body. Lifestyle choices can lead
to weight problems. Being overweight or obese can increase your risk for
hypertension.
 d. Older age : The older you are, the more likely you are to have high blood
pressure. But this can not be used as a benchmark, because now hypertension
can strike a young age.
2. Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This
type of high blood pressure, called secondary hypertension, tends to appear suddenly
and cause higher blood pressure than does primary hypertension.
Secondary hypertension has specific causes and is a complication of another
health problem. Chronic kidney disease (CKD) is a common cause of high blood
pressure, as the kidneys no longer filter out fluid. This excess fluid leads to
hypertension. Various conditions and medications can lead to secondary hypertension,
including:
a. Obstructive sleep apnea : where the walls of the throat relax and narrow during
sleep, interrupting normal breathing.
b. Kidney problems : diabetes, due to kidney problems and nerve damage.
c. Congenital heart defects.
d. Pregnancy.
e. Adrenal gland tumors.
f. Thyroid problems.
g. Certain defects you're born with (congenital) in blood vessels.
h. Certain medications, such as birth control pills, cold remedies, decongestants,
over-the-counter pain relievers and some prescription drugs.
i. Illegal drugs, such as cocaine and amphetamines.
j. Alcohol abuse or chronic use.
D. Risk Factor
A number of factors increase the risk of hypertension.
1. Age. Hypertension is more common in people who are more than 60 years of age.
Blood pressure can increase steadily with age as the arteries stiffen and narrow due to
plaque buildup.
2. Ethnicity. Some ethnic groups are more prone to hypertension than others. African
Americans have a higher risk than other ethnic groups, for example. · Size and weight:
Being overweight or obese is a primary risk factor.
 3. Alcohol and tobacco use. Regularly consuming large quantities of alcohol or tobacco
can increase blood pressure.
4. Sex. According to a 2018 review, males have a higher risk of developing hypertension
than females. However, this is only until after women reach menopause.
5. Existing health conditions. Cardiovascular disease, diabetes, chronic kidney disease,
and high cholesterol levels can lead to hypertension, especially as people age.
6. Sedentary lifestyle
7. Salt rich, high fat diet
8. Low potassium intake
9. Poorly managed stress and a family history of high blood pressure can also contribute
to the risk of developing hypertension.
E. Pathophysiologi
Hypertension is a chronic elevation of blood pressure that, in the long-term, causes
end-organ damage and results in increased morbidity and mortality. Blood pressure is the
product of cardiac output and systemic vascular resistance. It follows that patients with
arterial hypertension may have an increase in cardiac output, an increase in systemic
vascular resistance, or both. In the younger age group, the cardiac output is often elevated,
while in older patients increased systemic vascular resistance and increased stiffness of the
vasculature play a dominant role. Vascular tone may be elevated because of increased α-
adrenoceptor stimulation or increased release of peptides such as angiotensin or
endothelins. The final pathway is an increase in cytosolic calcium in vascular smooth
muscle causing vasoconstriction. Several growth factors, including angiotensin and
endothelins, cause an increase in vascular smooth muscle mass termed vascular
remodelling. Both an increase in systemic vascular resistance and an increase in vascular
stiffness augment the load imposed on the left ventricle; this induces left ventricular
hypertrophy and left ventricular diastolic dysfunction.
In youth, the pulse pressure generated by the left ventricle is relatively low and the
waves reflected by the peripheral vasculature occur mainly after the end of systole, thus
increasing pressure during the early part of diastole and improving coronary perfusion.
With ageing, stiffening of the aorta and elastic arteries increases the pulse pressure.
Reflected waves move from early diastole to late systole. This results in an increase in left
ventricular afterload, and contributes to left ventricular hypertrophy. The widening of the
pulse pressure with ageing is a strong predictor of coronary heart disease.
 The autonomic nervous system plays an important role in the control of blood
pressure. In hypertensive patients, both increased release of, and enhanced peripheral
sensitivity to, norepinephrine can be found. In addition, there is increased responsiveness
to stressful stimuli. Another feature of arterial hypertension is a resetting of the
baroreflexes and decreased baroreceptor sensitivity. The renin–angiotensin system is
involved at least in some forms of hypertension (e.g. renovascular hypertension) and is
suppressed in the presence of primary hyperaldosteronism. Elderly or black patients tend
to have low-renin hypertension. Others have high-renin hypertension and these are more
likely to develop myocardial infarction and other cardiovascular complications.
In human essential hypertension, and experimental hypertension, volume
regulation and the relationship between blood pressure and sodium excretion (pressure
natriuresis) are abnormal. Considerable evidence indicates that resetting of pressure
natriuresis plays a key role in causing hypertension. In patients with essential hypertension,
resetting of pressure natriuresis is characterized either by a parallel shift to higher blood
pressures and salt-insensitive hypertension, or by a decreased slope of pressure natriuresis
and salt-sensitive hypertension.
F. Sign and Symptoms of Hypertension
Most people with high blood pressure will not experience any symptoms. People
often call hypertension the "silent killer" for this reason. However, once blood pressure
reaches about 180/120 millimeters of mercury (mm Hg), it becomes a hypertensive crisis,
which is a medical emergency.
Symptoms that do occur, if present, may indicate temporary fluctuations or
elevations in blood pressure, and can be related to the timing of medication doses.
Generally, the symptoms of hypertension can happen at any time, do not last for long, and
may recur. They include:
1. Recurrent headaches
Headaches are fairly common among people with or without hypertension.
Some people with hypertension notice changes or worsening of headaches when
medications are skipped or when the blood pressure becomes higher than usual.
Headaches associated with hypertension can be mild, moderate, or severe and can be
of a throbbing nature.
 2. Dizziness
People with hypertension may notice dizziness in relation to medication doses
and blood pressure fluctuations. The dizziness of very high blood pressure is described
as vertigo (a sensation that the room is spinning).
3. Shortness of breath
Hypertension can cause shortness of breath as a result of the effect on the heart
and lung function. Shortness of breath is more noticeable with physical exertion or
exercise.
4. Nosebleed
You may be more prone to nosebleeds if you have hypertension, although, in
general, nosebleeds are not a classic sign of high blood pressure.
5. Nausea, vomiting or loss of appetite
Nausea associated with severe hypertension can develop suddenly and may be
associated with dizziness.
G. Complication
Untreated hypertension causes serious complications, including organ damage.
Less commonly, a condition called hypertensive emergency, which may also be called
hypertensive crisis or malignant hypertension can occur.
1. Hypertensive Emergency
A hypertensive emergency, unlike the similar sounding hypertensive urgency,
is characterized by serious, life-threatening complications. A hypertensive emergency
means that the blood pressure is >180 mm Hg or the diastolic pressure is >120 mm
Hg, and that end-organ damage is occurring. Signs and symptoms can include
shortness of breath, anxiety, chest pain, irregular heart rate, confusion, or fainting.
2. Aneurysm Rupture
An aneurysm, which is a bulge in the wall of an artery, can form due to a number
of causes. Aneurysms can occur in the aorta, brain, and kidneys. Hypertension
contributes to aneurysm formation, and sudden elevations of blood pressure can
increase the risk of an aneurysm rupture—a serious event that can be fatal.
3. Vascular Disease
Hypertension increases the risk of vascular disease, characterized by
atherosclerosis (hardening and stiffening of the blood vessels) and narrowing of the
arteries. Vascular disease can involve the blood vessels in the legs, heart, brain,
kidneys, and eyes, causing a range of disabling or life-threatening symptoms.
 4. Heart Disease
Hypertension contributes to the development and worsening of coronary artery
disease, cardiac arrhythmias, and heart failure.
5. Kidney Failure
Hypertension can affect the kidneys, as their blood vessels become less able to
function effectively; permanent damage is possible.
6. Respiratory Disease
Respiratory disease can develop as a consequence of heart disease, manifesting
as shortness of breath with exertion.
H. Treatment for Hypertension
1. Non-pharmacological management for hypertension
Non pharmacological methods to lower blood pressure allow the patient to
participate actively in the management of his or her disease. Reduction of weight,
restriction of salt, and moderation in the use of alcohol may be reduced blood pressure
and improve the effect of drug treatment. In addition, regular isotonic exercise also
lowers blood pressure in hypertensive patients.
a. Life style modification
Life style modification are recommended for clients with high normal
blood pressure or stage 1, 2, or 3 hypertension who do not have other risk factors
for cardiovascular disease or evidence of damage to target organs such as the
heart, blood vessels, or kidneys. Life style modification to reduce blood pressure
include weight loss, dietary changes, restricted alcohol use adn cigarette smoking,
increased physical activity, and stress reduction. These management strategies are
discussed below and summarized in the accompanying box.
b. Dietary fat modification
Modification of dietary intake of fat by decreasing the fraction of saturated
fat and increasing that of polyunsaturated fat has little, if any, effect on decreasing
blood pressure but can decrease the cholesterol level significantly. Because
dyslipidemio is a major risk factor in the development of atherosclerosis, diet
therapy aimed at reducing lipids is an important adjust to any total dietary
regimen. In addition to the usual recommendations for sensible eating following
the food pyramid, the Dietary Approaches to Stop Hypertension diet, which is
rich in fruits, vegetables, nuts, and low-fat dairy foods with reduced saturated and
 total fats, shoould be recommended for clients who need a more structured, fat-
limite dietary intervention.
c. Exercise
A regular program of aerobic exercise adequate to achieve at least a
moderate level of physical fitness facilitiates cardiovascular conditioning and can
aid the obese risk for cardiovascular disease and all-cause mortality. Blood
pressure can be reduced with moderate-intensity physycal activity, such as a brisk
walk for 30 to 45 minutes most days of the week. Advise hypertension clients to
initiate exercise program gradually, slowly body adjusts and becomes more
conditioned with on going professional surveillance.
d. Smoking cessation
Although smoking has not been statistically linked to the development of
hypertension, nicotine definitely increases the heart rate and produces peripheral
vasoconstriction, which does raise arterial blood pressure for a short time during
and after smoking. Smoking cessation is strongly recommended, however, to
reduce the client’s risk for cancer, pulmonary disease, and cardiovascular disease.
e. Relaxation technique
Some studies have shown that certain relaxation techniques, including
yoga, meditation, and guided breathing, can have a short-term and low-level
impact on blood pressure. The AHA issued a statement noting that there is modest
evidence to support the efficacy of some meditation techniques in reducing blood
pressure.
A 2014 review found some evidence in support of yoga as a way to
manage hypertension. However, the authors noted that yoga was no more
beneficial for hypertension than regular exercise. Relaxation techniques may be
more effective at an earlier stage of elevated blood pressure.

2. Pharmacological management for hypertension

For many years, researchers have been searching for the ideal antihypertension
drug; that is, a drug that would use a physiologic method to lower blood pressure, have
no long-term toxic or unpleasant side effects, could be prescribed as a dailu medication,
would not require complex dosing formulas and trial periods, would decrease the
number of hypertension-related serious illness and deaths, and be modrately priced
(Tierney et al, 1998).
 Although no such single agent has been found, significant progress has beed
made, and drug treatment plans can be tailored to the needs of clients. Current
pharmacologic treatment of hypertension involves the use of one or more of the
following categories of drugs : diuretics, beta-adrenergic blockers, centrally acting
sympatholytics, vasodilators, angiotensin-converting enzyme (ACE) inhibitors, and
calcium channel blockers.
a. Beta-Adrenergic Blocking Agents
Beta blockers reduce blood pressure by preventing stimulation of the beta
receptors in the heart by epinephrine and norepinephrine, thereby decreasing heart
rate and cardiac output. Beta-blockers also interfere with the release of renin by
the kidneys to decrease the renin-engiotensin mechanism. The side effects of all
beta blockers include bronchospasm, fatigue, sleep disturbance, nightmare,
bradycardia, heart block, worsening of congestive heart failure, gastrointestinal
disturbances, impotance, and increased triglyceride levels.
Beta blockers drug class is acebutolol, atenolol, betaxolol, carteolol,
labetalol, metroprolol tartrate, nadolol, penbutolol, pindolol, propranolol
hydrochloride, timolol.
b. Centrally Acting Sympatholytics
The centrally acting sympatholytics stimulate the alpha2 receptors in the
central nervous system to inhibitor the sympathetic cardioaccelerator and
vasoconstrictor centers. They also decrease sympathetic outflow from the central
nervous system. These actions lower the arterial pressure. These drugs may be
administered in combination with a diuretic. Centrally acting sympatholytics drug
is clonidine (Catapres), guanabenz (Wytensin), guanfacine (Tenex), methyldopa
(Aldomet).
c. Alpha – Adrenergic Blockers
Alpha – adrenergic blocking agents decrease vasomotor tone to cause
vasodilataion and thus reduce blood pressure; they also decrease the level low –
density and very low density lipoproteins. However, reflex stimulation of the
heart as a result of the vasodilatation causes tachycardia and palpitations. The
drugs also produce many unwanted side effects. For these reasons, the drugs are
primiraly used to control acute hypertensive states.
The one drug from this category that is used consistently is prazosin
(Minipress), which is often usef in combination with a diuretic and a beta –
 blockers. Alpha – adrenergic blockers drug is doxazosin (Cardura), prazosin
(Minipress), Terazosin (Hytrin).
d. Angiotensin – Converting Enzyme (ACE) Inhibitor
The ACE inhibitors inhibit the renin – angiotensin – aldosteron
mechanism, but they also stimulate vasodilation and reduce sympathetic nervous
system activity. These drugs have relatively few side effects in clients with
essential hypertension. They are often used in combination with a diuretic or
calcium channel blocker.
The ACE inhibitors drug is benazepril (Letonsin), captopril (Capoten),
enalapril (Vasotec), fosinopril (Monopril), lisinopril (Zestril), moexipril
(Univasc), quinapril (Accupril), ramipril (Altace).
 BAB III

CLOSING

A. Conclusion
Hypertension or high blood pressure, is increased blood pressure or force of blood
pressing on the walls of the cavity where the blood was. Hypertension is blood pressure a
system where the systolic pressure is above 140 mmHg and the diastolic pressure above
90 mmHg.
Hypertension is also related to increased severity of atherosclerosis, stroke,
nephropathy, peripheral vascular disease, aortic aneurysms, and heart failure. If
hypertension is left untreated, nearly half of hypertension clients will die of heart disease,
one third will die of stroke, and the remaining 10% to 15% will die of renal failure.

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https://www.verywellhealth.com/symptoms-of-hypertension-1763965, Access on 26
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