PRIMARY CARE

IN HYPERTENSION
Oleh:
Edda Rachmadenawanti
122011101018
Pembimbing:
dr. Dandy Hari Hartono,
Sp.JP. FIHA

HIPERTENSI
Klasifikasi Hipertensi menurut JNC VII untuk
usia lebih dari 18 tahun
Category
Normal

Systolic
(mm Hg)

Diastolic
(mm Hg)

<120

dan

<80

120-139

atau

80-89

Stage 1

140-159

atau

90-99

Stage 2

> 160

atau

>100

Pre Hipertensi
Hipertensi

DIAGNOSIS HIPERTENSI
Tekanan darah lebih dari 140/90 mmHg
Selama 1-5 kali kunjungan
Rata-rata dari dua kali atau lebih pengukuran
yang diambil pada setiap kunjungan
Jika tekanan darah sistol dan diastole pasien
termasuk ke dalam dua kategori yang berbeda,
maka klasifikasi yang dipilih adalah berdasarkan
kategori yang lebih tinggi.

(ISHIB, 2003; PERKI,2015)

ABPM : Ambulatory Blood Pressure Monitoring

HBPM : Home Blood Pressure Monitoring

ABMP
(AMBULATORY BLOOD PRESSURE
MONITORING)
Pengukuran tekanan darah selama 24 jam
Indikasi :

Adanya variasi tekanan darah yang besar

Office hypertension (white coat hypertension)
Dicurigai adanya episode hipotensi
Hipertensi yang resisten terhadap pengobatan

TECHNIQUE
TECHNIQUE OF
OF BLOOD
BLOOD PRESSURE
PRESSURE MEASUREMENT
MEASUREMENT
RECOMMENDED
RECOMMENDED BY
BY THE
THE BRITISH
BRITISH HYPERTENSION
HYPERTENSION SOCIETY
SOCIETY

1.
Several time, rest 5
minutes before

3.
The cuff must be level with
the heart. If the circumference
exceeds 33cm, a large cuff
must be used (2/3 of arm).
Place stethoscope diaphram
over brachial artery

2.
The patient should be relaxed
and the arm must be
supported. Ensure no tight
clothing constricts the arm

4.
The column of mercury
must be vertical. Inflate
to occlude the pulse
(>30 mmHg). Deflate at
2-3 mm/s. measure
systolic ( first sound /
Korotkoff I ) & diastolic
(disappearence /
Korotkoff IV or V ) to
nearest 2 mmHg

To exclude possibility of
auscultatory gap,
increase cuff pressure
rapidly to 30 mmHg
above level of
diseappearance of radial
pulse
(From British Hypertension Society 1985)

Neurohormonal control of blood pressure

Blood pressure
Hypertension

= Cardiac output (CO) x Peripheral resistance (PR)

=

Increased CO

Preload

and/or

Contractility
Fluid volume

Increased PR

Vasoconstriction

Fluid volume

Renal sodium
retention
Excess
sodium
intake

Sympathetic
nervous
system

Genetic
factors

Reninangiotensinaldosterone
system

Age

-stress
-birth control /
contraception
-drugs

(Adapted from Kaplan, 1994)

TATA LAKSANA TERAPI NON

FARMAKOLOGI

DASH
(DIETARY APPROACHES TO STOP
HYPERTENSION)

Diuretics

-blockers

AT1 receptor
blockers

1-blockers

Calcium
antagonists

ACE inhibitors

Possible combinations of different classes of antihypertensive agents.

The most rational combinations are represented as thick lines. ACE,
angiotensin-converting enzyme; AT1, angiotensin II type 1.

The Renin-Angiotensin System

Alternate Pathway
Circulating
Liver
Renin inhibitors
-B blocker
-Aliskiren

ACE inhibitor

Angiotensinogen
Renin
Angiotensin I
Converting enzyme
Angiotensin II

ARBs

Angiotensin
receptors

DIABETIC NEPHROPHATY
ACE-inhibitor dan ARBs dapat digunakan untuk
hipertensi pada pasien Nefropathi diabetikum,
karena dapat mencegah mikroalbuminuria
menjadi progresif (makroalbuminuria) dan
meningkatkan aktivasi insulin.
ALISKIREN