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HIPERTENSI Oleh: Divisi Humas MER-C
Apa itu hipertensi?  Tekanan darah tinggi (hipertensi) adalah peningkatan tekanan darah di dalam arteri (pembuluh darah nadi) di atas angka normal. Seringkali hipertensi terjadi tanpa gejala, sehingga penderita tidak merasa sakit. Pada pemeriksaan tekanan darah (tensi) akan didapat 2 angka yakni angka yang atas diperoleh saat jantung berkontraksi (sistolik) sedangkan angka bawah diperleh saat jantung relaksasi (diastolik). Sehingga hasil pemeriksaan tensi menunjukkan sekian per sekian,
Klasifikasi Hipertensi : JNC VII ,[object Object],JNC VII.  JAMA  2003;289:2560-2572 Kategori Systolic (mmHg) Diastolic (mmHg) Normal <120 and <80 Prehypertension 120-139 or 80-89 Stage 1 hypertension 140-159 or 90-99 Stage 2 hypertension  160 or   100
Penyebabnya apa? ,[object Object],[object Object]
Kalau yang sekunder? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Usia Yang Paling Rentan Franklin, S.S., J Hypertens 1999; 17 (suppl 5): S29-S36 0 10 20 30 40 50 60 70 18-29 30-39 40-49 50-59 60-69 70-79 80+ SBP  >  140 mm Hg  DBP  >   90 mm Hg  Usia) Persentase 4 11 21 44 54 64 65
25% 12.5% 12.5% 50% Berobat tapi tidak kontrol rutin Berobat dan terkontrol Yang tidak tahu Pasien yang tidak berobat dan tidak kontrol Source : Joffres et al. (1997) Am. J. Hypertension 10: 1097-1102 RULE OF HALF
Komplikasi Hipertensi ,[object Object],[object Object],[object Object],Target Gagal Organ Mata retinopathy Ginjal Gagal Jintang Otak stroke Jantung Peny.Jantung Koroner Pembesaran Jantung kiri Gagal Jantung Peripheral arterial disease
PENGOBATAN ,[object Object],[object Object],[object Object]
ASK-DNC ATP-III 2001 - Criteria IDF 2005 - Criteria GULOH CISAR PEDIATRIC OBESE WORLD OBESITY TRENDS GLOBESITY   –  DIABESITY (Summarized : Tjokroprawiro 2005-2007) Stage―  3  or the MetS  will be  &quot;TIME-BOMB DISEASE ”  in Indonesia ? Pre c lini c al  : the MetS IFG, IGT, Pedr.-Obese Healthy Lifestyle   “ Westernized” Unhealthy Lifestyle Obesit y (Abdominal Obesit y ) STAGE   –   0 STAGE   –   1 STAGE   –   2 STAGE   –   3 STAGE   –   4 Clinical : CAD T2DM, Pedr.-T2DM, Stroke 3  Blood Pressure >  130/85 mmHg 4  GDS >  100 mg/dl 1  Triglyceride > 150 mg/dl 2  HDL-Chol < 40 mg/dl < 50 mg/dl o + o Lingkar Pinggang >  90 cm  >  80 cm + o o PEDIATRIC T2DM 44
ASK-DNC TEN  PRACTICAL  GUIDELINES FOR HEALTHY LIFE GULOH-CISAR = SYNDROME-10 (Tjokroprawiro 1995-2007) 34 G U L O H 1 2 3 4 5 C I S A R 6 7 8 9 10 Stop  Smoking Daily Regular Exercise : TAKE MINIMALLY 6-HOUR SLEEP/DAY Stop Alcohol Regular Check-Up  Esp. > 40 Years Old : 3, 6 or 12 Months Limit Sugar Consumption Restrict Purine Intake : JAS-BUKET Consume Low Fat Diet : TEK-KUK-CS 2 Prevent Obesity  (Target : BMI < 25) Measure BP Regularly (Less than  g Sodium/day) 3  +300 kcal/day or 3 km walk +Sit up 50-100 x/day JAS-BUKET :  Jerohan, Alkohol, Sarden - Burung Dara, Unggas, Kaldu, Emping, Tape (Bowels, Alcohol, Sardines - Pigeon, Fowls, Meat-Broth, Beaten Nut, Fermented Cassava) TEK-KUK-CS2 :  Telor, Keju - Kepiting, Udang, Kerang - Cumi, Susu, Santen (Egg, Cheese - Crab, Shrimp, Mussel - Squid, Milk, Coconut - Juice) &quot;MABUK&quot; (Rich in Chromium) :  M rica,  A pel,  B rokoli,  U dang,  K acang-kacangan; good for DM Recommended Food Supplements : Green Bean, Onions, Green Tea, Pepper, ARGININE, TKW-PJKA-BK G  = Glucose U  = Uric Acid L  = Lipids O  = Obesity H  = Hypertension C  = Cigarette  I  = Inactivity S  = Stress A  = Alcohol R  = Regular Check Up
Initiation of Antihypertensive treatment : ESC 2OO7 Other risk factors, OD, or disease Normal SBP 120-129 or DBP 80-84 High normal SBP 130-139 or DBP 85-89 Grade 1 HT SBP 140-159 or DBP 90-99 Grade 2 HT SBP 160-179 or DBP 100-109 Grade 3 HT SBP   180 or DBP    110  No other risk factors No BP intervention No BP intervention Lifestyle changes for several months then drug treatment if BP uncontrolled Lifestyle changes for several weeks then drug treatment if BP uncontrolled Lifestyle changes + immediate drug treatment 1-2 risk factors Lifestyle changes Lifestyle changes Lifestyle changes for several weeks then drug treatment if BP uncontrolled Lifestyle changes for several weeks then drug treatment if BP uncontrolled Lifestyle changes + immediate drug treatment    3 risk factors, MS or OD Lifestyle changes Lifestyle changes and consider drug treatment Lifestyle changes + drug treatment  Lifestyle changes + drug treatment  Lifestyle changes + immediate drug treatment Diabetes Lifestyle changes Lifestyle changes + drug treatment  Lifestyle changes + drug treatment  Lifestyle changes + drug treatment  Lifestyle changes + immediate drug treatment Established CV or renal disease Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment

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Hipertensi

  • 2. Apa itu hipertensi? Tekanan darah tinggi (hipertensi) adalah peningkatan tekanan darah di dalam arteri (pembuluh darah nadi) di atas angka normal. Seringkali hipertensi terjadi tanpa gejala, sehingga penderita tidak merasa sakit. Pada pemeriksaan tekanan darah (tensi) akan didapat 2 angka yakni angka yang atas diperoleh saat jantung berkontraksi (sistolik) sedangkan angka bawah diperleh saat jantung relaksasi (diastolik). Sehingga hasil pemeriksaan tensi menunjukkan sekian per sekian,
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  • 6. Usia Yang Paling Rentan Franklin, S.S., J Hypertens 1999; 17 (suppl 5): S29-S36 0 10 20 30 40 50 60 70 18-29 30-39 40-49 50-59 60-69 70-79 80+ SBP > 140 mm Hg DBP > 90 mm Hg Usia) Persentase 4 11 21 44 54 64 65
  • 7. 25% 12.5% 12.5% 50% Berobat tapi tidak kontrol rutin Berobat dan terkontrol Yang tidak tahu Pasien yang tidak berobat dan tidak kontrol Source : Joffres et al. (1997) Am. J. Hypertension 10: 1097-1102 RULE OF HALF
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  • 10. ASK-DNC ATP-III 2001 - Criteria IDF 2005 - Criteria GULOH CISAR PEDIATRIC OBESE WORLD OBESITY TRENDS GLOBESITY – DIABESITY (Summarized : Tjokroprawiro 2005-2007) Stage― 3 or the MetS will be &quot;TIME-BOMB DISEASE ” in Indonesia ? Pre c lini c al : the MetS IFG, IGT, Pedr.-Obese Healthy Lifestyle “ Westernized” Unhealthy Lifestyle Obesit y (Abdominal Obesit y ) STAGE – 0 STAGE – 1 STAGE – 2 STAGE – 3 STAGE – 4 Clinical : CAD T2DM, Pedr.-T2DM, Stroke 3 Blood Pressure > 130/85 mmHg 4 GDS > 100 mg/dl 1 Triglyceride > 150 mg/dl 2 HDL-Chol < 40 mg/dl < 50 mg/dl o + o Lingkar Pinggang > 90 cm > 80 cm + o o PEDIATRIC T2DM 44
  • 11. ASK-DNC TEN PRACTICAL GUIDELINES FOR HEALTHY LIFE GULOH-CISAR = SYNDROME-10 (Tjokroprawiro 1995-2007) 34 G U L O H 1 2 3 4 5 C I S A R 6 7 8 9 10 Stop Smoking Daily Regular Exercise : TAKE MINIMALLY 6-HOUR SLEEP/DAY Stop Alcohol Regular Check-Up Esp. > 40 Years Old : 3, 6 or 12 Months Limit Sugar Consumption Restrict Purine Intake : JAS-BUKET Consume Low Fat Diet : TEK-KUK-CS 2 Prevent Obesity (Target : BMI < 25) Measure BP Regularly (Less than g Sodium/day) 3 +300 kcal/day or 3 km walk +Sit up 50-100 x/day JAS-BUKET : Jerohan, Alkohol, Sarden - Burung Dara, Unggas, Kaldu, Emping, Tape (Bowels, Alcohol, Sardines - Pigeon, Fowls, Meat-Broth, Beaten Nut, Fermented Cassava) TEK-KUK-CS2 : Telor, Keju - Kepiting, Udang, Kerang - Cumi, Susu, Santen (Egg, Cheese - Crab, Shrimp, Mussel - Squid, Milk, Coconut - Juice) &quot;MABUK&quot; (Rich in Chromium) : M rica, A pel, B rokoli, U dang, K acang-kacangan; good for DM Recommended Food Supplements : Green Bean, Onions, Green Tea, Pepper, ARGININE, TKW-PJKA-BK G = Glucose U = Uric Acid L = Lipids O = Obesity H = Hypertension C = Cigarette I = Inactivity S = Stress A = Alcohol R = Regular Check Up
  • 12. Initiation of Antihypertensive treatment : ESC 2OO7 Other risk factors, OD, or disease Normal SBP 120-129 or DBP 80-84 High normal SBP 130-139 or DBP 85-89 Grade 1 HT SBP 140-159 or DBP 90-99 Grade 2 HT SBP 160-179 or DBP 100-109 Grade 3 HT SBP  180 or DBP  110 No other risk factors No BP intervention No BP intervention Lifestyle changes for several months then drug treatment if BP uncontrolled Lifestyle changes for several weeks then drug treatment if BP uncontrolled Lifestyle changes + immediate drug treatment 1-2 risk factors Lifestyle changes Lifestyle changes Lifestyle changes for several weeks then drug treatment if BP uncontrolled Lifestyle changes for several weeks then drug treatment if BP uncontrolled Lifestyle changes + immediate drug treatment  3 risk factors, MS or OD Lifestyle changes Lifestyle changes and consider drug treatment Lifestyle changes + drug treatment Lifestyle changes + drug treatment Lifestyle changes + immediate drug treatment Diabetes Lifestyle changes Lifestyle changes + drug treatment Lifestyle changes + drug treatment Lifestyle changes + drug treatment Lifestyle changes + immediate drug treatment Established CV or renal disease Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment Lifestyle changes + immediate drug treatment