HIPERTENSI

DEFINISI

Tekanan Darah (TD): refleksi kardiovaskular

TD sistolik : dipengaruhi oleh curah jantung

(CO),
dapat berubah dalam waktu singkat (aktifitas fisik
ringan, emosi)

TD diastolik : refleksi dari resistensi perifer, bila

vasokonstriksi arteriol TD diastolik
sukar dipengaruhi faktor emosi dan aktifitas fisik
ringan

HIPERTENSI : kondisi abnormal hemodinamik

(fungsi pengaturan/kontrol)
batasan hipertensi dipakai kriteria TD sistolik

Consequences of
Hypertension

Consequences of
Hypertension

http://www.massgeneral.org/vascularcenter/body/stroke.jpg

Hypertensive nephropathy

http://www.ndt-educational.org/images/Marcantonifig1.jpg

Fundoscopy/ Vascular

DEFINISI
Tekanan nadi (pulse pressure) = TD sistolik TD
diastolik
Tekanan arteri rata-rata (mean arterial
pressure/MAP) = (TD sistolik + 2xTD diastolik)
3

BP = CO x SVR
SV x HR
BP : blood pressure
SVR: systemic vascular-resistance
SV : stroke volume
HR : heart rate

Blood Pressure
Determining Factors
Cardiac Output:

Peripheral
Resistance **

Stroke Volume
Heart Rate

Vasodilators

Force of Contraction
Beta Blockers
Calcium Channel
Blockers

BP

ACE Inhibitors

Blood Volume **
Diuretics

ACE Inhibitors

DEFINISI
HIPERTENSI PRIMER (90 95%)
hipertensi yang tidak diketahui penyebabnya
HIPERTENSI SEKUNDER (5 10%)
hipertensi yang diketahui penyebabnya

Patogenesis Hipertensi

MULTIFAKTORIAL

BP Measurement Techniques
Method

Brief Description

In-office

Two readings, 5 minutes apart, sitting

in chair. Confirm elevated reading in
contralateral arm.

Ambulatory BP
monitoring

Indicated for evaluation of white-coat

HTN. Absence of 1020% BP decrease
during sleep may indicate increased
CVD risk.

Self-measurement

Provides information on response to

therapy. May help improve adherence
to therapy and evaluate white-coat
HTN.
JNC 7 2003

How to measure blood pressure

accurately
sphygmomanometer
Patient should be seated and relaxed, preferably for several minutes
prior to to the measurement and in a quiet room.
Appropriate cuff size.
Average the readings. If the first two readings differ by more than 10 mmHg
systolic or 6 mmHg diastolic or if the initial readings are high, take several
readings after five minutes of quiet rest, until consecutive readings do not
vary by greater than these amounts.
Ideally, patients should not take caffeine-containing beverages or
smoke for at least two hours before blood pressure is measured,
..
Australia, 2004

Preparation for measurement

Patient should
abstain from
eating, drinking,
smoking and
taking drugs that
affect the blood
pressure one
hour before
measurement.

Preparation for measurement

Because a full
bladder affects the
blood pressure it
should have been
emptied.

Preparation for measurement

BP take in quiet
room and
comfortable
temperature, must
record room
temperature and
time of day.

BLOOD PRESSURE: MEASUREMENT

Ascultatory method of
blood pressure measurement

Nokolai Korotkoff, 1905

Blood Pressure Assessment:

Patient preparation and posture
Standardized Preparation:
Patient
1. No acute anxiety, stress or pain.
2. No caffeine, smoking or nicotine in the
preceding 30 minutes.
3. No use of substances containing
adrenergic
stimulants such as phenylephrine or
pseudoephedrine (may be present in
nasal
decongestants or ophthalmic drops).
4. Bladder and bowel comfortable.
5. No tight clothing on arm or forearm.
6. Quiet room with comfortable
temperature
7. Rest for at least 5 minutes before
measurement

Benefits of Lowering BP

Average Percent Reduction

Stroke incidence 3540%
Myocardial infarction 2025%
Heart failure50%

Framingham Heart Study (1983)

8 Year Probability Per 1,000

CV Risk Profile
703

700
600
500

459

400

326

300
210

200
100

46

Systolic BP: 105 >>> 185

Cholesterol: 185
Glucose Intol.:0
Cigaretes:
0
ECG-LVH:
0
Kannel, 1983

105 >>> 185

335
0
0
0

105 >>> 185

335
+
0
0

105 >>> 185

335
+
+
0

105 >>> 185

335
+
+
+

CXR:
Cardiomegaly
pleural effusions
interstitial edema
Pulmonary venous redistribution

Hypertension
SBP > 140 mmHg
DBP> 85 mmHg
Vital organs
risk

Heart
Coronary
factors

Myocardium
factors

CHD

LVH

Stroke
Multi infarct dementia
Peripheral vascular
disease
Aortic aneurysm
Renal failure

Congestive heart failure

Arrhythmia
cordis

Sudden death

Disability

23 WHO-ISH, 1999
R. Boedhi Darmojo, 2000,

Target Organ Damage

Heart
Left ventricular hypertrophy
Angina or prior myocardial infarction
Prior coronary revascularization
Heart failure
Brain
Stroke or transient ischemic attack
Chronic kidney disease
Peripheral arterial disease
Retinopathy

Laboratory Tests
Routine Tests
Electrocardiogram
Urinalysis
Blood glucose, and hematocrit
Serum potassium, creatinine, or the corresponding estimated GFR,
Lipid profile, after 9- to 12-hour fast, that includes high-density and
lipoprotein cholesterol, and triglycerides

and calcium
low-density

Optional tests
Measurement of urinary albumin excretion or albumin/creatinine ratio
More extensive testing for identifiable causes is not generally indicated unless BP control is not
achieved

Lifestyle Modification
Modification
Weight reduction
Adopt DASH eating
plan
Dietary sodium
reduction
Physical activity
Moderation of alcohol
consumption

Approximate SBP
reduction
(range)
520 mmHg/10 kg weight
loss
814 mmHg
28 mmHg
49 mmHg
24 mmHg