CHAPTER II

DISCUSSION

2.1 Definitions
Hypertension or high blood pressure, is increased blood pressure or force of
blood pressing on the walls of the cavity where the blood was. High Blood Pressure
(hypertension) is an increase in blood pressure in the arteries. (Hiper means
Overrated, tension means pressure / t egangan; j adi, hipertensi is p system disorders that
cause blood eredaran rise in blood pressure above the normal value.
Blood pressure in a person's life varies naturally. Infants and children normally
have a blood pressure that is much lower than adults. Blood pressure is also affected by
physical activity, which will be higher at the time of the activity and lower when
resting. Blood pressure is also different in one day, the highest in the morning and most
re ndah during nighttime sleep.

2.2 Measuring Blood Pressure

On examination the blood pressure will get two points. A higher figure obtained
when the heart contracts (systolic), a lower number obtained when the heart relaxes
(diastolic).Blood pressure is written as systolic pressure diastolic pressure slash, eg
120/80 mmHg, read a hundred and twenty eighty. Along with age, almost everyone has
experienced an increase in blood pressure , systolic blood pressure continues to increase
until the age of 80 years and diastolic pressures continue to increase until the age of 55-
60 years, then decrease slowly or even decreased dramatically.
Blood pressure is written with two numbers, the number units mmHg
(millimeters of mercury) in blood pressure tool / tension meter, the systolic and
diastolic. Is the highest systolic blood pressure is when the heart is doing contract or
contraction. Diastolic is the lowest figure at the heart expands in the final relaxation.
For example, blood pressure 120/80 mmHg mean systolic pressure of 120 and
diastolic pressure of 80 mmHg.

Blood pressure is the pressure generated by:

a. Strength buds urgent cardiac left ventricle to insert the contents of the blood into the
arterial trunk.
b. Resistance in the arterial blood flow.
c. Autonomic nerves are made up of the sympathetic and the sympathetic system.

Classification of blood pressure

No Classification Systolic Diastolic
1 Optimal <120 mmHg <80 mmHg
2 Normal <130 mmHg <85 mmHg
3 Normal high 130-139 mmHg 85-89 mmHg
4 Mild hypertension 140-159 mmHg 90-99 mmHg
5 Hypertension was 160-179 mmHg 100-109 mmHg
6 Severe hypertension > 180 mmHg > 110 mmHg

Normal blood pressure

Blood pressure varies per person per day, depending on the circumstances, and
are affected by the activities of a person, so normalpun blood pressure varies.
Adults when the blood pressure showed the number 140/90 mmHg is considered
normal upward. There is a perception of low blood pressure is not good, it is less
precise.Because statistics show that people with low blood pressure have the same age
with so-called normal. The best thing is to maintain normal blood pressure and the
assumption that increasing age is higher blood pressure is not a problem, is the
assumption that needs to be clarified, because based on statistics of parents whose blood
pressure in the normal range, the trend gets low stroke disorders. Check your blood
pressure regularly at least once every 6 months or whenever the doctor / health facility.

2 classification known hypertension (by cause), namely:

a. primary hypertension (hypertension idiophatik), in which the cause is not known with
certainty. It also said that hypertension is the impact of lifestyle and environmental
factors.
 b. secundary hypertension, is hypertension that occurs due to the disease from other
diseases such as abnormalities in the kidneys or keruskanan of the hormone system.

WHO classifies hypertension based on the presence or absence of abnormalities in other

organs, namely:
a. hypertension without abnormalities in other organs.
b. hypertension with cardiac enlargement.
c. hypertension with abnormalities in other organs in addition to the heart.

Classification of hypertension by high blood pressure are:

a. borderline hypertension: blood pressure between 140/90 mmHg and 160/95 mmHg.
b. mild hypertension: blood pressure between 160/95 mmHg and 200/110 mmHg.
c. Moderate Hypertension: Blood pressure between 200/110 mmHg and 230/120 mmHg.
d. severe hypertension: blood pressure between 230/120 mmHg and 280/140 mmHg.

2.3 Causes of hypertension

There are 2 kinds of hypertension, essential and secondary.
a. hypertension Essential hypertension is the most not known cause. There are 10 - 16% of
adults suffer from high blood pressure.
b. hypertension Secondary hypertension is a known cause and why. Hypertension kind is
only a small part, which is only about 10%.
Some of the causes of hypertension, among others:
Because hormonal, for example, from the adrenal glands.
The use of drugs.
smoking because the nicotine contained in tobacco.
Alcoholic beverages.
Abnormalities in the kidneys.
Intracranial Abnormalities resulting in increased intracranial pressure or because of its
location near the center of persyarafan that affect blood pressure.
Abnormalities of the large blood vessels (aorta) that koartasio aorta where the aortic
arch aorta is continuous with decendens.
2.4. Anatomy
a. Heart
Measuring about one fist and is located within the chest, the limit on the right is
right and apeksnya sternum in the fifth intercostalis space midclavicular left linea.
Relation of heart is:
Above: large blood vessels
Bottom: diaphragm
Each side: lung - lung
Rear: the descending aorta, esophagus, vertebral Columna
b. Arteries
Is the tube through which the blood flow in tissues and organs.Consists of layers
of the arteries: a slippery layer, the middle layer of elastin tissue / muscle: the aorta and
major branches have laposan center consisting of a network of elastin (to deliver blood
to the organs), smaller arteries have a muscular middle layer (regulating the amount of
Blood delivered to an organ).
c. Arterioles
Are the blood vessels with smooth muscle wall is relatively thick. Arteriolar
wall muscles to contract. Contractions caused kontriksi diameter blood vessels. When
kontriksi localized, blood supply to the tissues/organs is reduced. If there kontriksi
general, blood pressure will increase.
d. Major blood vessels and capillaries
The main blood vessels are thin-walled vessels that run directly from arterioles
to venul. Capillaries are the network of small blood vessels open major blood vessels.
e. Sinusoids
There are spleen, liver, bone marrow, and endocrine glands.Sinusoids three to
four times greater than in capillaries and partially coated with reticulo-endothelial
system cells. In places the sinusoid, having direct contact with the blood cells and the
exchange does not take place through the network space.
f. Vena and venul
 Venul is a combination of small veins formed capillaries. Veins formed by the
combined venul. Veins have three walls that are not adjacent to each other perfectly.
(Gibson, John. Issue 2 2002, p 110)

2.5. Physiology
The heart has the function as a pump oxygenated blood in the arterial system,
which was brought into the cell and the entire body to collect blood deoxygenation
(blood oxygen levels less) of the vein system are delivered to the lungs for reoksigenasi
(Black, 1997)

2.6. Pathophysiology of hypertension

The mechanisms that control the constriction and relaxation of blood vessels
located in the vasomotor center, the medulla of the brain.This stems from the central
vasomotor sympathetic nerve pathway, which continues down to the spinal cord and the
spinal cord out of the column to the sympathetic ganglia in the thorax and
abdomen.stimulation of the vasomotor center is delivered in the form of impulse moves
down through the sympathetic nerves to the sympathetic ganglia. At this point, neurons
release acetylcholine preganglion, which will stimulate post-ganglion nerve fibers to the
blood vessels, which resulted in the release of norepinephrine constriction of blood
vessels. Various factors such as anxiety and fear can affect vascular response to stimuli
vasokontriktor. Individuals with hypertension are very sensitive to norepinephrine,
although it is not clear why it could happen.
At the same time stimulate the sympathetic nervous system in which the blood
vessels in response to emotional stimuli, the adrenal glands are also stimulated
vasoconstriction resulting in additional activities. Secreting adrenal medullary
epinephrine causes vasoconstriction. Adrenal cortex secrete cortisol and other steroids,
which DAPT strengthen blood vessels vasokontriktor response.vasoconstriction
resulting in decreased blood flow to the kidneys, causing the release of renin. Renin
stimulates the formation of angiotensin I, which is then converted to angiotensin II, a
potent vasoconstrictor, which in turn stimulates aldosterone secretion by the adrenal
cortex. hormone causes retention of sodium and water by the kidney tubules, causing an
 increase in intravascular volume. All of these factors tend to provoke a state of
hypertension.
Structural and functional changes in the peripheral vascular system responsible
for the changes in blood pressure that occurs in the elderly. These changes include
atherosclerosis, loss of elasticity of the connective tissue, and a decrease in vascular
smooth muscle relaxation, which in turn lowers the ability of tensile strength distension
and blood vessels. Consequently, the aorta and large arteries less able to accommodate
the volume of blood pumped by the heart (volume sekuncup), resulting in decreased
cardiac output and increased peripheral resistance (Smeltzer, Bare, 2002).

2.7. The symptoms of hypertension

The symptoms of hypertension, among others:
a. Much of no symptoms.
b. Pain in the back of the head.
c. stiff neck.
d. Fatigue.
e. Nausea.
f. Shortness of breath.
g. Restless.
h. Vomiting.
i. easily offended.
j. hard to sleep.
Complaints are not always going to be experienced by a patient with
hypertension. Often a person with symptoms of pain behind his head, irritability and
difficulty sleeping, when the blood pressure measured showed a normal blood pressure
numbers. The only way to determine the presence or absence of hypertension only by
measuring blood pressure.

2.5 The effects of hypertension

Hypertension if not controlled can lead to serious complications, such as:
a. kidney damage.
 b. damages blood vessels.
c. brain hemorrhage / stroke.
d. Paralysis.
e. enlarged heart / heart trouble.
f. Narrowing of the coronary arteries / heart attack.

2.6 Prevention of hypertension

Person's risk for hypertension (except essential), can be reduced by:
a. Checking blood pressure regularly .
b. Maintain ideal weight .
c. Reducing salt intake .
d. Do not smoke .
e. Exercising regularly .
f. regular life .
g. Reducing stress .
h. Do not rush .
i. Avoid fatty foods.

Primary Prevention:
Adequate sleep, between 6-8 hours per day.
Reduce high cholesterol foods and multiply physical activity to lose weight.
Reduce alcohol consumption.
Consumption of fish oil.
The supply of calcium, although only slightly lower blood pressure but calcium is also
quite helpful.

Secondary Prevention
Pattern whice food healthy.
Reduce salt and sodium in your diet.
Physical active.
Reduce intake Alcohol.
 Stop smoking.

Tertiary Prevention
Control of blood on a regular basis.
Sports regularly and adjusted to body condition.

2.7 Treatment of hypertension

Treatment of hypertension is best:
a. Always control your blood pressure checked regularly by a doctor .
b. Always take medication regularly even without a complaint .
c. Reducing salt intake .
d. Increase consumption of vegetables and fruit .
e. Obeying doctor's advice.

The content of salt (Sodium or Sodium)

Someone who is suffering from hypertension should control themselves in salt
consumption. The meaning here is the sodium salt of salt present in almost all foods
derived from animals and plants.One major source of sodium is table salt. Therefore,
the recommended salt intake of no more than - teaspoon / day or to use other than
the sodium salt.
Low salt diet goal is to help eliminate the salt or water retention in the body tissues and
lowers blood pressure in hypertensive patients.The terms of a low salt diet is:
Enough energy, protein, minerals, and vitamins.
Forms of foods according to the disease state.
The amount of sodium adjusted to the severity of salt or water retention and / or
hypertension.
This diet contains enough nutrients. In accordance with the state of the disease can be
given different levels of Low Salt Diet.
Low Salt Diet I (200-400 mg Na)
This diet was given to patients with edema, ascites, and / or severe hypertension. In the
food processing no salt added. Avoided the foods high in sodium.
 Low Salt Diet II (600-800 mg Na)
This diet was given to patients with edema, ascites, and / or hypertension are not too
heavy. Daily feeding with Low Salt Diet I. In the food processing may not use salt tsp
(2 g). Avoided the foods high in sodium.
Low Salt Diet III (1000-1200 mg Na)
This diet is given to patients with edema and/or mild hypertension. Daily feeding with
Low Salt Diet I. In the food processing may use 1 teaspoon salt (4 g).

2.8. Content of Potassium or Potassium

Potassium suplements 2-4 grams per day can help lower blood
pressure. Potassium is generally fat found in some fruits and vegetables. Fruits and
vegetables that contain potassium and good for people with hypertension consumed
include watermelon, avocado, melon, bitter melon fruit, squash, bligo, machete
pumpkin / gourd, cucumber, aloe vera, celery, onion and garlic. In addition, foods
containing omega 3 sagat elements known to be effective in helping to decrease blood
pressure (hypertension).
In patients with hypertension where blood pressure> 160 / g mmHg, in addition
to the provision of anti-hypertensive drugs need dietetic therapy and lifestyle
changes. The objective of dietary management is to help lower blood pressure and
maintain blood pressure to normal. In addition, the diet is also intended to reduce risk
factors such as overweight, high cholesterol and fat levels of uric acid in the blood. It
should be noted also that accompanies other degenerative diseases such as high blood
pressure, heart, kidney and diabetes mellitus.
a. SETTING MENU FOODS
Adjusting diet is recommended for patients with hypertension to avoid and limit
foods that can increase blood cholesterol levels and increase blood pressure, so people
do not have a stroke or cardiac infarction.
Foods to be avoided or restricted are:
1. The food is high in saturated fat (brain, kidney, lung, coconut oil, lard).
2. Food was prepared by using sodium salt (cookies, crakers, chips and dried foods are
salty).
3. Food and drinks in cans (sardines, sausage, korned, vegetables and fruits in cans, soft
drink ).
4. Preserved foods (jerky, pickled vegetables or fruit, shredded, salted, boiled, dried shrimp,
salted eggs, peanut butter).
5. Milk full cream , butter, margarine, cheese, mayonnaise, and other sources of animal
protein are high in cholesterol such as red meat (beef / mutton), egg yolk, chicken skin).
6. Condiments such as soy sauce, maggi, shrimp paste, tomato sauce, chili sauce, tauco and
other flavorings generally contain sodium salt.
7. Alcohol and alcohol-containing foods such as durian, tape.

How to set up a diet for people with hypertension is to improve the taste by
adding sugar fresh red / white onion (red / white), ginger, and other spices kencur are
not salted or salt contains less sodium.Food can be sauteed to improve the taste. Put salt
at the table above can be taken to avoid excessive use of salt. It is recommended to
always use iodized salt and salt use no more than 1 teaspoon per day.
Increasing potassium intake (4.5 grams or 120-175 mEq / day) can give the
effect of a mild decrease in blood pressure. In addition, administration of potassium also
helps to replace lost sodium and low potassium result. Can generally used medium size
(50 grams) of apples (159 mg potassium), orange (250 mg potassium), tomato (366 mg
potassium), banana (451 mg potassium) baked potato (503 mg potassium) and 1 cup
skim milk (406 mg potassium). Adequacy of calcium is important to prevent and treat
hypertension: 2-3 glasses of skim milk or 40 mg / day, 115 grams of low-sodium cheese
to meet the needs of calcium 250 mg / day. While the needs of the average daily
calcium 808 mg.
In pregnant women food enough protein, calories, calcium and sodium are
associated with a lower incidence of hypertension of pregnancy. However, pregnant
women are especially hypertension accompanied by swelling and urinary protein (pre-
eclampsia), other than medicines recommended to reduce salt intake and increase food
sources of Mg (vegetables and fruits).
b. SUPPLEMENTATION anti oxidant
 Despite antioxidant supplementation still require further research, but today
many supplements are sold and consumed by the public. As medical personnel should
be careful giving advice supplement drink to avoid overdose.

1. Vitamins and Decrease Homocysteine

Folic acid, vitamin B6, vitamin B12 and riboflavin are enzyme co-factor
essential for the metabolism of homocysteine. Various studies have shown that elevated
levels of homocysteine in the blood increases the risk of coronary artery disease. Low
levels of folic acid are associated with an increased risk of coronary disease and low
vitamin levels are also associated with an increased risk of atherosclerosis, although the
risk of atherosclerosis associated with low levels of vitamin B6 was not associated with
a high concentration of homositein. while vitamin B12 is not associated with vascular
disease.
2. Soybeans and Isoflavones
Soy contains many isoflavones are estrogen-Phy, which have weak estrogen
activity. Research meta-analysis in 1995 concluded that isoflavones from soy protein more
significantly reduce total cholesterol, LDL cholesterol and triglycerides, without affecting
HDL cholesterol levels. So it is recommended to consume soy protein (20-50 grams / day)
and dietary modifications in patients with cholesterol (total and LDL) is high. Tempe is the
result of processing soybeans fermented with better nutritional content than soy. So that
tempeh is recommended for consumption by people with hypertension as a source of
vegetable protein.
3. Tempe
Tempe is one of the traditional food of Indonesia, fermented fungus Rhizopus
ohgosporis or rhizopusoryzal on soybean seed that has been boiled. There are various
kinds of tempeh, tempeh discussion is made of soy, which is a compact product,
wrapped flat by the mycelium fungus that appears white in color, and when slicedpieces
seem pale yellow soya beans, among the mycelium. Fermentation mold produces a
change in the texture of soy, are soft and nutritional value of tempeh better than
soybeans.
Nutritional value Tempe:
Protein
Enzymes produced molds, producing free amino acids, so the level is increased to 85
times the levels of soy protein.
Carbohydrates
Soybeans contain carbohydrates in the form of sakrosa and stakhiosa and rifinosa (the
latter two led to the formation of gas in the stomach). Fermented soybeans into soybean
producing carbohydrates.
Fat
Enzymes in the mold can reduce the total fat content from 22.2% to 14.4% and
increased free fatty acid levels from 0.5% to 21%.
Mineral
In the soybean contained phytic acid which is a compound forfose, which can not be
utilized by the body. With fermentation, molds produce the enzyme phytase which
outlines the phytic acid, so it can be utilized forfosenya body.
Vitamin
The fermentation process can increase levels of vitamin B2 (Riboferum), Vitamin B6
(pyridoxine), folic acid, panthotenat, and nicotinic acid. While vitamin B1 levels
decreased due to the growth of mold and also vitamin B12 formed by bacteria that do
not exist in other vegetable products.
Benefits Tempe:
Tempe is a good source of nutrients, especially for patients with hyper
kolesterolemia. From various studies it turns out tempeh can lower cholesterol levels in
the blood and prevent blood vessel constriction, because tempeh contains
polyunsaturated fatty acids. So that hypertensive patients are encouraged to eat tempeh
every day, in addition to a diet low in saturated fat.
Tempe also contains antibacterial substances that can inhibit the growth of some
gram-positive bacteria as well as cause diarrhea (Salmonella sp
and Shigella sp.) Therefore, tempeh is also recommended to be consumed under five
with diarrhea.
4. Omega 3 Fatty Acids
 Eating one serving of high-fat fish (or fish oil) per day can be the intake of
omega 3 fatty acids (EPA and DHA) of approximately 900 mg / dl, and has been
reported to lower cholesterol and prevent coronary heart disease.
5. Fiber
Although sharing of studies show an association between some types of fibers
with decreased cholesterol or LDL and total cholesterol, but there is no direct evidence
showing the relationship between fiber supplements with decreased cardiovascular
disease.
Name the dish, main ingredient, processing methods, and tools food diet
hypertension and dyslipidemia
Menu Ingredients
Food Processing Equipment Method Supplementary Material misstatement
soft rice
Sauteed Chicken + Rice - Boiling + steaming porcelain dish
skinless chicken stir-fry dishes porcelain salt
Carrots Carrots
boiled Nutmeg Bowl
Coffee Milk Glass Milk Sugar Water +
Sugar Pudding Fruit Jelly boiled Saucer
Mango Mango
Milk cups low fat Milk
Rice Boiled Rice + Plato steamed
fish Pepes Fish Plato saffron steamed
soy chicken sauteed chicken red sugar Plato
Glass Milk Skimmed milk powder
Sugar
Watercress Oseng + carrots + green beans stir-fried salt Plato Carrots
Watercress
Beans
Diet
Breakfast Menu
 Nasi software
Saut chicken + carrots
soy milk Coffee
(E: 225 Cal, KH: 30 g, L: 6.5 g, P: 30 g
Interlude 1 and 2
Mango Pudding
low fat milk
(E: 330 Cal, KH: 59 g, L: 7 g, P: 7 g)
Lunch
White rice
Pepes know
Soup beans + carrots
Papaya fruit
(E: 325 Cal, KH: 44 g, L: 7.5 g, P: 18.5 g)
Dinner
White Rice
Sauteed Spinach
Pepes Fish
Fruit Papaya
(E: 360Kal, KH: 57 g, L: 3 g, P: 12g)