Dr.

Ika Prasetya Wijaya SpPD-KKV, FINASIM, FACP, FICA

www.ipwijaya@gmail.com Samarinda: 5 Januari 1968

Pendidikan :
S1 : FKUI 1992
Spesialis 1 : FKUI 2003
Spesialis 2 : KIPD/FKUI 2011
FINASIM : PAPDI 2010
FACP : ACP 2015
FICA : ICA 2015
Pekerjaan:
KETUA Divisi Kardiologi, Departemen Ilmu Penyakit Dalam FKUI-RSUPNCM 2014
Editor Acta Medica Indonesiana/Indonesian Journal of Internal Medicine
Penulis Buku Ajar Ilmu Penyakit Dalam bidang Kardiologi
Organisasi:
Wakil Ketua Umum PB PAPDI 2015-sekarang
Wakil Ketua PAPDI Cabang Jakarta 2010- sekarang
Ketua I PB IKKI 2009-sekarang
Peminatan:

CRE/062/Aug10-Aug11/MF
Intervensi Kardiologi
Infeksi dan Aterosklerosis
Kardiologi dalam Onkologi
Kardiologi Klinis
Dr. Ika Prasetya Wijaya, SpPD, K-KV, FINASIM, FACP, FICA
HYPERTENSION IS…
◦ Hypertension is defined as a systolic
blood pressure (SBP) of 140 mm Hg
or more, or a diastolic blood pressure
(DBP) of 90 mm Hg or more, in
repetitive examination
Hypertension
in Indonesia
Nearly 1 in 4 Adults
(25.8%) in the
Indonesia Has
Hypertension
Why is this important?

Individuals with a normal BP

at age 55 yo have a
90% lifetime risk of developing hypertension.

Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in

middle-aged women and men: The Framingham Heart Study. JAMA. 2002;287:1003-10.
HYPERTENSION IS
ASSOCIATED WITH
VARIOUS
COMPLICATION
Global Leading Risks for Death,
2010

Systolic blood
pressure > 115
mmHg

Global Burden of Disease Study 2010 , Lancet 2012; 380: 2224–60

 Complications of Hypertension:
End-Organ Damage

Hypertension

Hemorrhage, LVH, CHD, CHF

Stroke

Peripheral
Vascular
Retinopathy Renal Failure,
Disease
CHD = coronary heart disease Proteinuria
CHF = congestive heart failure
LVH = left ventricular hypertrophy
Chobanian AV, et al. JAMA. 2003;289:2560-2572.
WHAT CAN WE DO?
Measuring blood pressure

Diagnosing hypertension

Assessing CV risk and Target Organ Damage

Lifestyle Intervention

Initiating and monitoring antihypertensive drug treatment

Choosing antihypertensive drug treatment

Patient education and adherence to treatment

 Measuring and confirm Blood
Pressure

A Statement by the American Society of

Hypertension and the International Society of Hypertension2013)
Algorithm
hypertension
diagnosis

Canadian Hypertension
Education Program. The
Canadian
Recommendation for The
Management of
Hypertension 2014
Assessing cardiovascular risk and target
organ damage: updated recommendations

For all people with hypertension offer

to:
– test urine for presence of protein
– take blood to measure glucose,
electrolytes, creatinine, estimated
glomerular filtration rate and
cholesterol
– examine fundi for hypertensive
retinopathy
– arrange a 12-lead ECG.
MANAGEMENT
◦Many guidelines exist for the management
of hypertension. Most groups, including the
JNC, American Heart Association/
American Stroke Association (AHA/ASA),
European Society of Hypertension (ESH)
recommend lifestyle modification as the
first step in managing hypertension
Lifestyle Intervention
Intake of vegetables, fruits, whole
grains (DASH dietary pattern) Lower sodium intake
•Low fat dairy products
•No more than 2,400 mg sodium/day
•Poultry, fish
•Further reduction of sodium intake to 1,500
•Legume mg/day
•Limits intake of sweet, sugar sweetened
and red meats

Physical Activity
•Aerobic physical activity 3-4 session a
week, lasting 40 min per session; moderate
to vigorous intensity
GUIDELINES FOR
HYPERTENSION
Algorithm
management
hypertension
in general
A Statement by the
American Society of
Hypertension and the
International Society of
Hypertension 2013
 JNC VIII

Algorithm management
of hypertension
JNC VII

Algorithm management
of hypertension
BRITISH
HYPERTENSION
SOCIETY 2004

Drug combination
therapy in hypertension
Treatment of
hypertension
according to
the NICE
guideline BHS
- 2011
EUROPEAN
SOCIETY OF
HYPERTENSION
2007
Selecting drugs
combinations to achieve
target of hypertension
Hypertension treatment
recommendations adjusted with
compelling indication,
according to WHO - ISH 2003
ESH - ESC 2007-2009
JNC 7 2003
INDONESIAN
GUIDELINES
PERHIMPUNAN DOKTER
SPESIALIS
KARDIOVASKULAR
INDONESIA, 2015
SUMMARY
◦ Guidlelines is just a guide, doctor could manage the patient according to
clinical manifestation on the patients
Blood
Pressure
Target
CASES
Case scenario 1
Presentation
38 year old, female, attending for routine appointment about her contraception, for
which she uses a IUD
Medical history
From her records you notice that Mary’s blood pressure has increased since her last
check twelve months ago. She does not smoke, doesn’t drink alcohol, and has no notable
medical history.
On examination
Mary’s first clinic blood pressure measurement is 158/94 mmHg. Her heart rate is
72 beats per minute and regular
You are considering a diagnosis of hypertension and therefore take another
reading in Mary’s other arm. There is no notable difference between readings.
Case scenario 1: Diagnosis
◦ How to diagnose a hypertension?

2 measurement BP Classification Systolic BP Diastolic BP

Normal < 120 < 80
Pre-hypertension 120-139 80-89
Stage 1 HTN 140-159 90-99
2 different occasion Stage 2 HTN > 160 > 100
(usual waking hours)
Case scenario 1: Assessing CV risk & TOD
◦How to assess CV risk and target organ damage?

• Creatinine clearance
Renal • Estimated GFR
• Presence of protein in urine
• Plasma Glucose
Metabolic • Electrolytes
• Serum total Cholesterol; HDL
Eyes • Funduscopy
• ECG
Heart
• CV risk assessment
Case scenario 1 : Assessing CV risk & TOD
◦The results of the investigations for target
organ damage and formal assessment of
cardiovascular risk are:
• no evidence of target organ damage
• 10-year cardiovascular risk less than 20%.

◦Nothing abnormal was detected in the other

investigations you organised.
Case scenario 1 : Lifestyle
Intervention

Before starting pharmacological

treatment, what would you advise to the
patient about the lifestyle intervention?
Lifestyle Intervention

DASH

Salt
Reduction

Physical
Exercise
Case scenario 1 : Drug Treatment

If the patients had been eligible to receive

antihypertensive drug treatment, what should you
consider when prescribing antihypertensive drugs for
a woman of child-bearing potential?
Case scenario 1 : Consideration?

◦There is an increased risk of congenital abnormalities if

women take angiotensin-converting enzyme (ACE)
inhibitors or angiotensin III receptor blockers (ARBs) during
pregnancy, and it is important that women of child-
bearing age know this. If the woman is planning a
pregnancy she should discuss this with you.

◦ If a woman taking ACE inhibitors or ARBs becomes

pregnant, these antihypertensive drugs should be stopped
and alternatives offered.
Case scenario 2
Presentation
65 year old male, came to your clinic for the first time. He was diagnosed by
his previous doctor with stage 2 hypertension for almost 5 years. His usual
blood pressure was 160/100 mmHg.
Medical history
From history taking you know that he also diagnosed with Diabetes with poor
adherence to the diabetes and hypertensive therapy.
On examination
He is moderately obese with waist circumference 100 cm. Current BP is
170/110. There is no previous laboratory data
Case scenario 2: Assessing CV risk & TOD

◦How to assess CV risk and target organ damage?

• Creatinine clearance
Renal • Estimated GFR
• Presence of protein in urine
• Plasma Glucose
Metabolic • Electrolytes
• Serum total Cholesterol; HDL
Eyes • Funduscopy
• ECG
Heart
• CV risk assessment
Case scenario 2 : Assessing CV risk & TOD

◦The results of the investigations for target organ

damage and formal assessment of cardiovascular
risk are: • Funduscopy: within normal limit
• Blood Glucose: 278
•Total cholesterol: 349
•LDL: 233
•HDL: 47
•Triglycerides: 297
•Ur/Creat: 49/2.0
•Urinalysis:
•Protein +
•Glucose +
◦ECG: Left ventricular hypertrophy
Case scenario 2

Before starting pharmacological

treatment, what would you advise to the
patient about the lifestyle intervention?
Lifestyle Intervention

DASH

Salt
Reduction

Physical
Exercise
Case scenario 2 : Drug Treatment

What do you consider when prescribing anti-hypertensive

drugs for a patient with diabetes mellitus and reduced
kidney function?