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Hipertensi

Definisi

Peningkatan tekanan darah sistolik lebih dari 130 mmHg atau diastolik lebih
dari 80 mmHg pada ≥2 kali pembacaan pada ≥2 kali pengukuran

10.1093/geront/gnr084
Klasifikasi

10.1093/geront/gnr084
Klasifikasi

10.1093/geront/gnr084
Manajemen Non Farmakologis Hipertensi

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More Than 2 Drug Required to Control BP

>2 drugs
Trial (SBP achieved) 44.4%
2 drugs
ASCOT-BPLA (136.9 mmHg)
55.6%
ALLHAT (138 mmHg)
IDNT (138 mmHg) Controlled Hypertension
RENAAL10.1093/geront/gnr084
(141 mmHg) Saifur Rohman et al. APCH 2009
UKPDS (144 mmHg)
ABCD (132 mmHg)
MDRD (132 mmHg)
HOT (138 mmHg)
AASK (128 mmHg)

1 2 3 4
Number of medications
More Than 2 Drug Required
to Control BP
>2 drugs
Trial (SBP achieved) 44.4%
2 drugs
ASCOT-BPLA (136.9 mmHg)
55.6%
ALLHAT (138 mmHg)
IDNT (138 mmHg) Controlled Hypertension
RENAAL (141 mmHg) Saifur Rohman et al. APCH 2009
UKPDS (144 mmHg)
ABCD (132 mmHg)
MDRD (132 mmHg)
HOT (138 mmHg)
AASK (128 mmHg)

1 2 3 4
Number of medications
THE ROLE OF RENIN ANGIONTENSIN
SYSTEM IN HYPERTENSION
Excess sodium Reduced Stress Genetic Endothelium Obesity
intake Nephron number Alteration derived factors
Renal Decreased Sympathetic Renin
Sodium Filtration nervous Angiotensin
retention surface overactivity Excess
Cell membrane Hyperinsulinemia
alteration
Venous
Fluid Volume 10.1093/geront/gnr084
Constriction

Preload Contractility Functional Constriction Structural Hypertrophy

Blood Pressure = Cardiac Output (CO) X Peripheral Resistance (PR)


Hypertension Increased CO and/or Increased PR
Poor adherence Autoregulation

Kaplan NM, Clinical Hypertension 7th ed. 2002; 63


Gagal Jantung
Definisi

Sindroma klinis yang terjadi akibat ketidakmampuan jantung


mempertahankan cardiac output yang adekuat untuk memenuhi kebutuhan
metabolik dan mengakomodasi venous return

10.1093/geront/gnr084
Tanda dan Gejala
• Dispnea
• Batuk
• PND
• Edema ekstremitas dan atau asites
• Fatigue
• Mual dn kehilangan nafsu makan
• Palpitasi
10.1093/geront/gnr084
Gagal Jantung Kiri Gagal Jantung Kanan
Klasifikasi

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Patofisiologi
Pump fails → decreased stroke volume /CO.
Compensatory mechanisms kick in to increase CO
SNS stimulation → release of epinephrine/nor-epinephrine
Increase HR
Increase contractility
Peripheral vasoconstriction (increases afterload)
Myocardial 10.1093/geront/gnr084
hypertrophy: walls of heart thicken to provide more muscle
mass → stronger contractions
Hormonal response: ↓’d renal perfusion interpreted by juxtaglomerular
apparatus as hypovolemia. Thus:
Kidneys release renin, which stimulates conversion of antiotensin I
→ angiotensin II, which causes:
Aldosterone release → Na retention and water retention (via
ADH secretion)
Peripheral vasoconstriction
Patofisiologi
Compensatory mechanisms may restore CO to near-normal.
But, if excessive the compensatory mechanisms can worsen heart failure
because . . .

• Vasoconstriction: ↑’s the resistance against which heart has to pump


(i.e., ↑’s afterload), and may therefore ↓ CO
• Na and water10.1093/geront/gnr084
retention: ↑’s fluid volume, which ↑’s preload. If too much
“stretch” (d/t too much fluid) → ↓ strength of contraction and ↓’s CO
• Excessive tachycardia → ↓’d diastolic filling time → ↓’d ventricular filling
→ ↓’d SV and CO
Acute Congestive Heart Failure
Nursing and Collaborative Management

Primary goal is to improve LV function by:


Decreasing intravascular volume
Decreasing afterload
Improving gas exchange and oxygenation
Improving cardiac function
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Reducing anxiety
Acute Congestive Heart Failure
Nursing and Collaborative Management

Decreasing intravascular volume


Improves LV function by reducing venous return
Loop diuretic: drug of choice
Reduces preload
High Fowler’s position
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Acute Congestive Heart Failure
Nursing and Collaborative Management

Decreasing afterload
Drug therapy:
vasodilation, ACE inhibitors
Decreases pulmonary congestion
10.1093/geront/gnr084
Acute Congestive Heart Failure
Nursing and Collaborative Management

Improving cardiac function


Positive inotropes
Improving gas exchange and oxygenation
Administer oxygen, sometimes intubate and ventilate
Reducing anxiety
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Morphine
Self Care in Chronic Heart Failure

• Kepatuhan minum obat


• Kepatuhan diet
• Kepatuhan rstriksi cairan
• Pengnelan tanda dan gejala kekambuhan gagal jantung
• Pengukuran10.1093/geront/gnr084
berat badan setiap hari
• Aktifitas fisik

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