Professional Documents
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HIPERTENSI
Dr HARRIS HASAN SpJP(K),SpPD
DEPARTEMEN KARDIOLOGI
FK USU RS H.ADAM MALIK
II
(1976-80)
III(Phase 1
1988-91)
III(Phase 2
1991-94)
1999-2000
Awareness
51
73
68
70
Treatment
31
55
54
59
Control
10
29
27
34
JNC 7
Systolic
Diastolic
<120
120-129
130-139
140-159
160-179
180
<80
80-84
85-89
90-99
100-109
110
<90
140
When a patients systolic and diastolic blood pressure fall into different
categories, the higher category should apply. Isolated systolic hypertension
can also be graded (grades 1,2,3) according to systolic blood pressure
values in the ranges indicated, provided diastolic values are < 90.
Normal
SBP 120-129
Or DBP 80-84
High normal
SBP 130-139
Or DBP 85-89
Grade 1
SBP 140-159
Or DBP 90-99
Grade 2
SBP 160-179
Or DBP 100-109
Grade 3
SBP180
Or DBP 110
No other risk
factors
Average risk
Average risk
Low added
risk
Moderate added
risk
High added
risk
Low added
risk
Moderate
added risk
Moderate added
risk
Very high
added risk
3 or more risk
factors or TOD
or diabetes
Moderate added
risk
High added
risk
High added
risk
Very high
added risk
ACC
Very high
added risk
Very high
added risk
Very high
added risk
ACC, associated clinical conditions; TOD, target organ damage; SBP, systolic blood
pressure; DBP, diastolic blood pressure.
SBP* mmHg
DBP* mmHg
Lifestyle
modification
<120
And < 80
Encourage
Pre
hypertension
120-139
Or 80-89
Yes
Stage 1
hypertension
140-159
Or 90-99
Yes
Stage 2
hypertension
160
0r 100
Yes
Normal
Without compelling
indication
No antihypertensive drug
indicated.
With compelling
indications
Drug(s) for
compelling
indications.
Drug(s) for the
compelling
indications.
Other
antihypertensive
drugs (diuretics,
ACEI, ARB, BB,
CCB) as needed.
DBP, diastolic blood pressure; SBP, systolic blood pressure. Drug abbreviations:ACEI, angiotensin converting enzyme
inhibitor; ARB, angiotensin receptor blocker; BB, beta-blocker; CCB, calcium channel blocker.
*treatment determined by highest BP category
initial combined therapy should be used cautiously in those risk for orthostatic hypotension
treat patients with chronic kidney disease or diabetes to BP goal of < 130/80 mmHg
JNC 7
Smoking
Dyslipidaemia (total cholesterol > 6.5 mmol/l, >250 mg/dl, or LDL-cholesterol > 4.0
mmol/l, > 155 mg/dl, or HDL-cholesterol M<1.0, W<1.2 mmol/l, M<40, W<48 mg/dl)
Family history of premature cardiovascular disease (at age < 55 years M, < 65 years
W)
Diabetes mellitus
Fasting plasma glucose 7.0 mmol/l (126 mg/dl)
Postprandial plasma glucose > 11.0 mmol/l (198
mg/dl)
angina;
coronary
Investigation
Prescription
3. Risk factors:
a.
b.
c.
d.
Smoking habits
e.
Dietary habits
f.
g.
Personality
Laboratory investigations
Routine tests
Plasma glucose (preferably fasting)
Serum total cholesterol
Serum high-density lipoprotein (HDL)-cholesterol
Fasting serum triglycerides
Serum uric acid
Serum creatinine
Serum potassium
Haemoglobin and haematocrit
Urinalysis (dipstick test complemented by urinary
sediment examination)
Electrocardiogram
Recommended tests
Echocardiogram
Carotid (and femoral) ultrasound
C-reactive protein
Microalbuminuria (essential test in diabetics)
Quantitative proteinuria (if dipstick test positive)
Funduscopy (in severe hypertension)
Very high
Begin drug
treatment
High
Begin drug
treatment
Moderate
Monitor BP
frequently
Low
No BP
intervention
Very high
Begin drug
treatment
promptly
High
Begin drug
treatment
promptly
Moderate
Monitor BP and other
risk factors for at least
3 months
SBP 140 or
DBP 90
mmHg
Begin drug
treatment
Low
Monitor BP and other
risk factors for 3-12
months
LIFESTYLE MODIFICATIONS
Not at goal blood pressure (<140/90 mmHg) (<130/80 mmHg for patients with
diabetes or chronic kidney disease)
INITIAL DRUG CHOICES
Stage 1 Hypertension
(SBP 140-159 or DBP
90-99 mmHg)
Stage 2 Hypertension
(SBP 160 or DBP
100 mmHg)
Thiazide-type diuretics
for most. May consider
ACEI, ARB, BB,CCB,
or combination
JNC 7
Optimize dosages or add additional drugs until goal blood pressure is achieved.
Consider consultation with hypertension specialist
Heart failure
DIURETIC
BB
ACEI
ARB
.
.
.
.
.
.
.
.
.
.
Postmyocardial
infarction
High coronary
disease risk
Diabetes
Chronic kidney
diasease
Recurrent stroke
prevention
JNC 7
.
.
CCB
.
.
ALDO ANT
Oral contraceptives
Adrenal steroids
Cyclosporine and tacrolimus
Erythropoietin
Licorice (including some chewing tobacco)
Selected over-the-counter dietary supplements and
medicines (e.g.ephedra, ma haung, bitter orange)
Smoking cessation
Weight reduction
Reduction of excessive alcohol intake
Physical exercise
Reduction of salt intake
Increase in fruit and vegetable intake and decrease in
saturated and total fat intake
Isolated systolic
hypertension
Risk
reduction
Risk
reduction
-14%
-21%
-1%
<0.01
<0.001
NS
-13%
-18%
0.02
0.01
NS
-42%
-14%
<0.001
<0.01
-30%
-23%
<0.001
<0.001
Mortality
All Cause
Cardiovascular
Non-cardiovascular
Diuretics
-blockers
AT1-receptor
blockers
-blockers
Calcium
antagonists
ACE inhibitors