Hipertensi

Pembimbing: dr Noer Saelan Tadjudin, SpKJ

Oleh: Kelompok Geriatri Hana
 Definisi dan Klasifikasi

 TDD ≥90 mmHg atau TDS ≥140 mmHg.

 Hipertensi primer (esensial)

 Hipertensi sekunder

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
Lee CT, Williams GH, Lilly LS. Hypertension. In: Lilly LS. Patophysiology of heart disease. 5th ed. 2011. Philadelphia: Wolters Kluwer. P. 301-23.
 Regulasi Tekanan Darah Sistemik

Lee CT, Williams GH, Lilly LS. Hypertension. In: Lilly LS. Patophysiology of heart disease. 5th ed. 2011. Philadelphia: Wolters Kluwer. P. 301-23.
 Penyebab Hipertensi Sekunder
 kadar gula darah tinggi;  sindrom Cushing
(kelebihan gukokortikoid
 GGK; termasuk terapi steroid
jangka panjang);
 koarktasio aorta;
 uropati obstruktif;
 sleep apnea;
 feokromositoma;
 penyakit tiroid/paratiroid aldosteronisme primer;
 HT renovaskular;

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
Lee CT, Williams GH, Lilly LS. Hypertension. In: Lilly LS. Patophysiology of heart disease. 5th ed. 2011. Philadelphia: Wolters Kluwer. P. 301-23.
 Faktor Genetik Penyebab Hipertensi

 angiotensinogen,

 alfa-adducin,

 reseptor adrenerdik beta dan DA,

 protein G subunit beta-3.

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
Lee CT, Williams GH, Lilly LS. Hypertension. In: Lilly LS. Patophysiology of heart disease. 5th ed. 2011. Philadelphia: Wolters Kluwer. P. 301-23.
 Pengukuran Tekanan
Darah
Diagnosis hipertensi harus
ditegakkan berdasarkan pengukuran
tekanan darah sebanyak minimal 2x,
dengan jarak 1 atau bbrp minggu,
atau lebih cepat jika hipertensi
berat.

National Heart Foundation of Australia. Guideline for the diagnosis and

management of hypertension in adults – 2016. Melbourne: National Heart
Foundation of Australia, 2016.
 Evaluasi Pasien
JNC 7:

JNC 8: mencapai target TD dalam 1 bulan

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel
members appointed to the eighth Joint National Committee (JNC 8) [published online December 18, 2013]. JAMA. doi:10.1001/jama.2013.284427.
 Faktor resiko
kardiovaskular
Sindrom metabolik ditandai dengan:
• lingkar pinggang >102cm pada laki-
laki atau >88cm pada perempuan
• TDS ≥130 mmHg dan atau TDD ≥85
mmHg
• Gula darah puasa ≥110mg/dL
• Trigliserid ≥150mg/dL
• HDL <40mg/dL pada laki-laki atau
<50mg/dL pada perempuan

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA.

2003;290(10):1313-1314; author reply 1314-1315.
 Kerusakan target organ

Lee CT, Williams GH, Lilly LS. Hypertension. In: Lilly LS. Patophysiology of heart disease. 5th ed. 2011. Philadelphia: Wolters Kluwer. P. 301-23.
 Pemeriksaan penunjang
 EKG 12 lead;

 urinalisa;

 gula darah;

 hematokrit;

 kalium,

 kreatinin (atau eGFR),

 kalsium serum;

 profil lipid.

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
 Tatalaksana

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
 JNC 7

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
 JNC 8

James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the
eighth Joint National Committee (JNC 8) [published online December 18, 2013]. JAMA. doi:10.1001/jama.2013.284427.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the
eighth Joint National Committee (JNC 8) [published online December 18, 2013]. JAMA. doi:10.1001/jama.2013.284427.
 Krisis Hipertensi

 Kenaikan TD akut

 TDS >180 mmmHg, TDD >120 mmHg

Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
Muiesan ML, et al. An update on hypertensive emergencies and urgencies. J Cardovasc Med 2014; 00(00).
Varounis C, Katski V, Nihoyannopoulos P, Lekakis J, and Tousoulis D. Cardiovascular hypertensive crisis: recent evidence and review of the literature.
Front. Cardiovasc. Med. 2017; 3(51).
 Hipertensi Urgensi

 Asimtomatik

 Gejala minimal: sakit kepala, epistaksis, pingsan, malaise,

agitasi, mual, muntah.

 Turunkan TD dalam 24-48 jam

Lagi A, Cencetti S. Hypertensive emergencies: a new clinical approach. Clinical hypertension 2015; 21:20.
Campos CL, et al. Pharmacologic treatment of hypertensive urgency in the outpatient setting: a systematic review. J Gen Intern Med 2018 Jan 16; 33(4):539-
50.
 Hipertensi Emergensi

 Turunkan 15-25% dalam 1-2 jam, jika stabil lanjut turunkan

TD sampao 160/100-110 mmHg dalam 2-6 jam kemudian
secara bertahap hingga <140/90 mmHg

 Maksimal turunkan 25% MAP/jam

Aronow WS. Treatment of hypertensive emergencies. Ann Transl Med 2017; 5(Suppl 1):S5.
Brotman DJ, Frost SD. The JNC 7 hypertension guidelines. JAMA. 2003;290(10):1313-1314; author reply 1314-1315.
THANK YOU