Definition

Hypertension is defined as an increase in blood pressure continuously exceeding the normal

limit. Normal blood pressure is <120mmHg and diastolic pressure <80 mmHg. Hypertension is
defined as persistent blood pressure where the systolic pressure is above 140 mmHg and diastolic
pressure above 90 mmHg. Hypertension is a product of peripheral vascular resistance and
cardiac output.(Weber et al., no date)

Etiologi

Hypertension depends on the rate of heart rate, stroke volume and Total Peripheral Resistance
(TPR). Then the increase of one of the three uncompensated variables can cause hypertension.
Increased heart rate may occur due to abnormal stimulation of the nerve or hormone in the SA
node. Increased chronically elevated heart rate often accompanies hyperthyroidism. However,
the rate of heart rate increase is usually compensated by a decrease in stroke volume or TPR, so
as not to cause hypertension.(Specialists, 2008) There are risk factor that can cause hypertension,
Blood pressure tends to rise as people get older and thus everyone’s risk for hypertension
increases with age, Behavior and lifestyle-related factors can put people at a giher risk for
developing high blood pressure. This includes eating too much salt (sodium), not eating enough
potassium (from fruits and vegetables), being overweight, not getting enough exercise, as well as
drinking too much alcohol and smoking, About 60% of people who have diabetes also have high
blood pressure, Hypertension can be heredity. People can inherit genes that make them more
likely to develop the condition. The risk for high blood pressure can increase even more when
heredity is combined with unhealthy lifestyle choices.(Asia and Region, no date)

Pathogenesis

Hypertension is a complex, multifactorial disease, and its development is determined by a

combination of genetic susceptibility and environmental factors. Several mechanisms have been
implicated in the pathogenesis of hypertension: increased activity of the sympathetic nervous
system, overactivation of the renin-angiotensin aldosterone system (RAAS), dysfunction of
vascular endothelium, impaired platelet function, thrombogenesis, vascular smooth muscle and
cardiac hypertrophy, and altered angiogenesis.(B??tkai and Thum, 2012) Blood pressure is
regulated by the integrated function of the kidneys, central nervous system, and vasculature. The
central role of the kidneys in long-term blood pressure control through the regulation of body fluid
and salt homeostasis.(Ryan, 2013) The activation of renin-angiotensin-aldosterine system (RAAS)
is one of the established pathogenesis of hypertension. All the components of RAAS are present
inthe kidneys at higher concentrations compared to plasma levels, and intrarenal formation of
angiotensin II (Ang II) is independent of the systemic RAAS. Ang II elevates blood pressure by
activating symphathetic nerve activity and arteriolar vasoconstriction.(Moon, 2013) The central
control of blood pressure is achieved through a balance of sympathetic and parasympathetic
innervation of vasculature and kidneys, in addition to hypothalamic hormones that regulate thirst,
renal sodium handling, and peripheral and renal vascular function.(Ryan, 2013) Impaired vascular
function is common in human and experimental hypertension. Vascular can be an important
mechanism to promote the pathogenesis of hypertension, particularly if that impaired function
restricts flow to the kidney and impairs the normal natriuretic response to changes in blood
pressure.(Ryan, 2013) Endothelial dysfunction may be defined as impairment characterized by a
shift of the actions of the endothelium toward reduced vasodilation, a proinflammatory state, and
prothrombotic setting. These events lead to a state of vascular inflammation, which may be
mediated, partly, by ROS formed by activated mononuclear cells.(González et al., 2014)

Classification
The recommended classification is unchanged from the 2003 and 2007 ESH/ESC guidelines.
Hypertension is defined as value 140 mmHg SBP (Sistolic Blood Pressure) and/or 90 mmHg DBP
(Diastolic Blood Pressure), based on the evidence from RCTs that in patients with these BP values
treatment-induced BP reductions are beneficial. The same classification is used in young,
middleaged and elderly subjects, whereas different criteria, based on percentiles, are adopted in
children and teenagers for whom data from interventional trials are not available.(Mancia et al.,
2013)
Table I. Definitions and classification of office blood pressure levels (mmHg).(Mancia et al., 2013)

Category Systolic Diastolic

Optimal <120 and <80
Normal 120-129 and/or 80-84
 High normal 130-139 and/or 85-89
Grade 1 hypertension 140-159 and/or 90-99
Grade 2 hypertension 160-179 and/or 100-109
Grade 3 hypertension ≥ 180 and/or ≥110

The blood pressure (BP) category is defined by the highest level of BP, whether systolic or
diastolic. Isolated systolic hypertension should be graded 1, 2, or 3 according to systolic BP values
in the ranges indicated.
Daftar Pustaka

Asia, S. and Region, S. E. A. (no date) ‘Hypertension Fact sheet’.

B??tkai, S. and Thum, T. (2012) ‘MicroRNAs in hypertension: Mechanisms and therapeutic

targets’, Current Hypertension Reports, 14(1), pp. 79–87. doi: 10.1007/s11906-011-0235-6.

González, J., Valls, N., Brito, R. and Rodrigo, R. (2014) ‘Essential hypertension and oxidative
stress: New insights.’, World journal of cardiology, 6(6), pp. 353–66. doi:
10.4330/wjc.v6.i6.353.

Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., Christiaens, T.,
Cifkova, R., De Backer, G., Dominiczak, A., Galderisi, M., Grobbee, D. E., Jaarsma, T.,
Kirchhof, P., Kjeldsen, S. E., Laurent, S., Manolis, A. J., Nilsson, P. M., Ruilope, L. M.,
Schmieder, R. E., Sirnes, P. A., Sleight, P., Viigimaa, M., Waeber, B. and Zannad, F. (2013)
‘2013 ESH/ESC Guidelines for the management of arterial hypertension’, Blood Pressure, 22(4),
pp. 193–278. doi: 10.3109/08037051.2013.812549.

Moon, J. Y. (2013) ‘Recent update of renin-angiotensin-aldosterone system in the pathogenesis

of hypertension’, Electrolyte and Blood Pressure, 11(2), pp. 41–45. doi:
10.5049/EBP.2013.11.2.41.

Ryan, M. J. (2013) ‘An update on immune system activation in the pathogenesis of

hypertension’, Hypertension, 62(2), pp. 226–230. doi:
10.1161/HYPERTENSIONAHA.113.00603.

Specialists, K. (2008) ‘Hypertension Guidelines : Revisiting the JNC 7 Recommendations’, 3(3),

pp. 91–97.

Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G., Flack,
J. M., Carter, B. L., Pharm, D., Materson, B. J. and Ram, C. V. S. (no date) ‘Clinical Practice
Guidelines for the Management of Hypertension in the Community A Statement by the
American Society of Hypertension and the International Society of Hypertension’, pp. 1–13. doi:
10.1111/jch.12237.