PAPER

HYPERTENSION

BY: GROUP 7

1. Andre Nugrahanto
2. Fatonah Eka Pratiwi
3. Heni Rohayati
4. Minarti Panjukang
5. Retno Wulandari
6. Rizka Ardania

Program Studi Sarjana Keperawatan

Stikes Kusuma Husada Surakarta
 CHAPTER I
INTRODUCTION

A. Background
High blood disease known as hypertension is a disease that gets attention
from all circles of society, considering its impact both short and long term and
thus require long-term response that fully. Hypertension cause morbidity
(illness) and mortality (death) is high.
Hypertension is a disease resulting from the interaction of various risk
factors a person has. Various studies have linked between the various risk
factors on the incidence of hypertension.
Based on the research that has been conducted poorer prevalence
(incidence) of hypertension increases with age.From various epidemiological
studies conducted in Indonesia showed 1.8 to 28.6% of the population aged
over 20 years are hypertensive.
Hypertension, currently there is a trend that more urban than rural
communities suffer from hypertension. This is partly attributed to the urban
lifestyle associated with the risk of hypertension such as stress, obesity
(overweight), lack of exercise, smoking, alcohol, and eating foods high in fat
content.
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.
B. Problem Formulation
1. How does the definition of hypertension?
2. How to measure blood pressure?
3. Explaining the causes of hypertension?
4. Explain the symptoms of hypertension?
5. Describe the effect of hypertension?
6. How hypertension prevention?
7. Explain the treatment of hypertension?

C. The purpose
1. To find definitions of hypertension.
2. To learn how to measure blood pressure.
3. To determine the cause of hypertension.
4. To know the symptoms that caused.
5. To know the result of hypertension.
6. To know the prevention of hypertension.
7. To determine the treatment of hypertension.
 CHAPTER II
DISCUSSION

A. 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.

B. 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.
 CHAPTER III
CLOSING

3.1 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.
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 lowest at night during sleep.

3.2. Suggestion
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.