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HIPERTENSI EMERGENSI
PENYAKIT
KARDIO
HIPERTENSI VASKULAR
Prevalensi : 1 milyar
Mortalitas : + 7.1 juta
MONICA-JAKARTA
1993-2000 :
16.9 % 17.9 %
Peningkatan TD sistolik sebesar 20 mm Hg
atau 10 mm Hg TD diastolic) 2 X mortalitas
kardiovaskular.
Terapi Farmakologi
PENYAKIT
HIPERTENSI KARDIO
VASKULAR
Penurunan berat badan
Fluid Venous
volume Constriction
Autoregulation
Hipertensi emergensi
Merupakan suatu keadaan yang jarang dijumpai, yang
memerlukan penurunan tekanan darah sesegera
mungkin untuk membatasi atau menghindari kerusakan
organ target lebih lanjut.
Hipertensi urgensi
Keadaan dimana tidak terdapat tanda-tanda kerusakan
organ target dan memerlukan penurunan tekanan darah
secara bertahap dengan terapi oral dalam 24-48 jam.
Keadaan-keadaan yang dapat timbul pada
hipertensi emergensi :
Hipertensi ensefalopati
Kejadian intrakranial akut
Diseksi aorta akut
Sindroma koroner akut (angina tidak
stabil/infark miokard akut)
Gagal jantung akut
Eklamsia
Manifestasi Klinis
Krisis Hipertensi
Decompensated Acute
Heart Failure Coronary
Syndrome
Eclampsia
Acute Renal
Failure
Severe Hypertension
BP > 180/120 mm Hg
Yes No
HT 1st Episode Frequent Episodes
Emergency HT Urgency Uncontrolled HT
Di ruang ICU/ICCU
Bed rest
Menggunakan antihipertensi intra vena
Menurunkan tekanan arteri rata-rata (mean
arterial pressure/MAP) tidak lebih dari 25 %
dalam beberapa menit sampai 2 jam
Menurunkan tekanan darah sampai + 160/100
mm Hg dalam 2-6 jam
Ideal Pharmacologic Agents for
Hypertensive Crises
- Fast acting, stable
- Rapidly reversible
- Titratable without significant effect
- Parenteral administration
JNC 7, 2003
JNC 7 Recommendation for
Hypertensive Emergency
Drugs Dosage Onset Duration
Labetolol HCl 20-80 mg every 10-15 min or 5-10 minutes 3-6 minutes
0.5-2 mg/min
Fenoldopan 0.1-0.3 ug/kg/min <5 minutes 30=60 minutes
HCl
Nicardipine 5-15 mg/h 5-10 minutes 15-90 minutes
HCl
Esmolol HCl 250-500 ug/kg/min IV bolus, 1-2 minutes 10-30 minutes
then 50-100 ug/kg/min by
infusion; may repeat bolus after
5 minutes or increase infusion
to 300 ug/min
JNC 7, 2003
CHEST 2007 Recommendation for
Hypertensive Emergency
Acute Pulmonary edema / Nicardipine, fenoldopam, or nitropruside combined with
Systolic dysfunction nitrogliceryn and loop diuretic
Acute Pulmonary edema/ Esmolol, metoprolol, labetalol, verapamil, combined with
Diastolic dysfunction low dose of nitrogliceryn and loop diuretics
Acute Ischemia Coroner Labetalol or esmolol combined with diuretics
Hypertensive encephalopaty Nicardipine, labetalol, fenoldopam
Acute Aorta Dissection Labetalol or combined Nicardipine and esmolol or combine
nitropruside with esmolol or IV metoprolol
Preeclampsia, eclampsia Labetalol or nicardipine
Acute Renal failure / Nicardipine or fenoldopam
microangiopathic anemia
Sympathetic crises/ cocaine Verapamil, diltiazem, or nicardipine combined with
oveerdose benzodiazepin
Acute postoperative Esmolol, Nicardipine, Labetalol
hypertension
Acute ischemic stroke/ Nicardipine, labetalol, fenoldopam
intracerebral bleeding
CHEST, 2007
AHA / ASA 2007 Recommendation for
Hypertensive Emergency
CHEST, 2007
Nitroglycerin