Professional Documents
Culture Documents
Zainal
Musthafa
MSi. FS. SPjP. FIHA.
FAsCC
HIPERTEN
SI
Departemen Jantung
FK-UPN Veteran
JAKARTA . 2014
Cathepsin
Tonin
chymase
Aldosterone
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EP
ACE2
Angiotensin I
ACE-independent
ANG II formation
by Chymase, etc.
ACE
Inhibitor
Inactive fragments
Vasodilation
Tissue protection
Angiotensin II
Angiotensin II escape
Bradykinin?
ARB
AT1 RECEPTOR
Vasoconstriction
Sodium retention
SNS activation
Inflammation
Growth-promoting effects
Aldosterone
Apoptosis
NO?
AT2 RECEPTOR
Vasodilation
Natriuresis
Tissue regeneration
Inhibition of inappropriate cell growth
Differentiation
Anti-inflammation
Apoptosis
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Hypertension Treatments
Rules of Halves
Hypertension
50 % not diagnosed
50 % Diagnosis
50 % not treated
50 % Treated
50 %
7 million pts poorly controlled
Hypertension in practice 2nd, Beevers & MacGregor
50 % well treated
(12.5 % of all
hypertensives)
al :
Ensefalopathy,
Stroke emboli / infark, Stroke
perdarahan,
Cidera kepala,
Tumor,
Penyakit jantung / SKA /
Deseksi Aorta,
Edema paru,
Penyakit Ginjal,
Peningkatan katekolamin,
Peri operatif,
HIPERTENSI
PULMONAL
Resistensi meningkat A. Pulmonalis
Gagal Jantung Kanan
Kematian mendadak
Proses Seluler
HPA
Disfungsi Endothel
Keseimbangan bioaktif al :
Nitrous Oxide (NO)
Prostasiklin
Thromboxan A2
Endothelium 1
KLASIFIKASI HPA
1. Idiopatik
2. Familial
3. Berhubungan dengan
Penyakit Jaringan
PJB
Hipertensi Portal
Pengaruh obat / Toxin
Lain-lain
PPOM
Penyakit paru intrestitial
Gangguan tidur
Hipoventilasi alveoli
Ketinggian
Kelainan pertumbuhan
Emboli pulmonal
Emboli non thrombos (tumor,parasit,benda
asing)
7. Lain lain
PATOGENESIS HPA
Multifaktorial, a.l. :
vaso kontraksi
remodelling
obstruksi pbdr
inflamasi dan thrombosis
DETEKSI HPA
GANGGUAN
sesak tanpa kelainan yang lain
cepat lelah
lemah
angina
syncope
distensi abdomen
EKG
Foto Thorax
Ekhokardiography
Angiography
KLASIFIKASI KLINIS
Test fungsi paru
AGD
CT
Angiography
PENETUAN TYPE
LAB. DARAH / IMUNOLOGI
USG ABDOMEN
TREADMILL TES
AGIOGRAPHY
BIOPSY
Dx HPA
Ditegakkan
TATALAKSANA
UMUM
batasi aktifitas
hindari ketinggian
cegah inflasi
cegah anemia / Hb
obat-obatan /
Obat
ANTI KOAGULAN
DIURETIK
OKSIGENASI
INOTROPIK
CCB / VASODILATASI
VASO DILATASI
DLL
INTERVENSI
BALON
TRANSPLANTASI
Isolated Systolic
Hypertension (ISH)
Tekanan sistolik > 140 mmHg dan
tekanan diastolik < 90 mmHg 1)
Framingham study: 57.4% pria dan
65.1% wanita menderita ISH 2)
18% populasi usia > 65 tahun termasuk
ISH borderline (sistolik 140-159 mmHg,
diastolik > 90 mmHg) 2)
1). 1999 WHO - International Society of Hypertension Guidelines for the Management of Hypertension
2). Kaplan N.M., Isolated Systolic Hypertension in Difficult Hypertension: P
ractical Management and Decision Making, Martin Dunitz Ltd, 1995
elderly
Corticosteroid
Estrogen replacement
Non-steroidal anti-inflammatory
Alcohol
Ergotamine
Antihistamine/sympathomimetic decongestants
Liguorice
Renal
Endocrine
Conn's syndrome
Cushing's syndrome
Pheochromocytoma
Acromegaly
Hyperparathyroidism
Hypertension
in Pregnancy
BLOOD PRESSURE
Classification
Gestational hypertension
Preeclampsia-eclampsia
Chronic hypertension
Preeclampsia superimposed
upon chronic hypertension
Gestational Hypertension
Elevated BP first detected
after 20 weeks of gestation
without proteinuria
= transient hypertension
BP N
Proteinuria
()
Gestational
Hypertension
BP
20th week
of pregnancy
BP N
Proteinuria 12 weeks
()
postpartum
Preeclampsia
The syndrome of new onset of
hypertension & proteinuria after
20 weeks of gestation in a
previously normotensive woman
Preeclampsia Eclampsia
BP N
Proteinuria
()
BP
20th week
of pregnancy
BP N/
Proteinuria 12 weeks
(+)
postpartum
Chronic Hypertension
SBP > 140 mmHg and / or DBP > 90
mmHg that antedates pregnancy, is
present before the 20th week of
pregnancy, and persists longer than
12 weeks postpartum
Chronic Hypertension
BP
BP
BP
delivery
BP
12 weeks
postpartum
Superimposed Preeclampsia
Worsening HT w/ new onset
proteinuria in a woman w/
chronic HT
Superimposed preeclampsia upon
Underlying HT
BP
Proteinuria
()
BP
BP
12 weeks Proteinuria
postpartum ( - )/(+)
Pathomechanism
Functions of the endothelium
Regulate vascular permeability
Regulate vascular cell growth
Mediate inflammatory and
immune mechanism
Modulate lipid oxidation
( metabolic activity )
Endothelial dysfunction
An imbalance between relaxing and
contracting factors between
anti -and pro-coagulant mediators
or growth-inhibiting and growth
promoting factors.
HYPERTENSION
Uteroplacental
insufficiency
Vascular
dysfunction
Kidney
Proteinuria
Deficient
vascular
remodeling
Activation
of decidual
RAS
sFLT1
s EnG
Placental hypoxia
Elevated
subpressor
Ang II
Vascular
maladaptation
Figure 4 : Decidual RAS activation and the placental release of antiangiogenic factors may
explain the manifestations of human preeclampsia
Current Opinion in Nephrology and Hypertension 2007, 16:213220
Normal
SBP 120129
or DBP 8084
High Normal
SBP 130139
or DBP 8589
Grade 1
SBP 140159
or DBP 9099
Grade 2
SBP 160179
or DBP 100109
Grade 3
SBP >180
or DBP >110
Average risk
Average risk
Moderate added
risk
High added
risk
12 risk factors
Moderate added
risk
Moderate added
risk
Very high
added risk
Moderate added
risk
High added
risk
High added
risk
High added
risk
Very high
added risk
Associated clinical
conditions
High added
risk
Very high
added risk
1520%
2030%
30%
<4%
45%
58%
>8%
*90
Includes smoking, abdominal obesity and age
CVD = cardiovascular disease; SBP = systolic blood pressure; DBP = diastolic blood pressure
Guidelines Committee. J Hypertens 2003;21:10111053; J Hypertens 2007;21:11051187
< 55 years
aaaaaaaaaa
Step 1
Step 2
Step 3
Step 4
C or D
A
or
2006 update
Questions?
TERIMA KASIH