HYPERTENSION

Presented By:
Mahendra Yudha Negara 15.1.152

PROGRAM STUDI KEPERAWATAN

POLITEKNIK KESEHATAN RS. dr. SOEPRAOEN MALANG
TAHUN AKADEMIK 2016/2017
 PREFACE

Thanks to Almighty God who has given Hiss bless to the writer for finishing
the paper entitled “Hypertension” . The writer also wish to express his deep and
sicere gratitude for those who have guided in completing this paper.
This paper contains about hypertension, Hopefully, this paper can help the
readers to expand their knowledge about hypertension.

Malang, July 5th, 2017

Author

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 Contents
PREFACE ........................................................................................................................................ 2
BAB I............................................................................................................................................. 4
PRELIMINARY ............................................................................................................................ 4
1.1 Background ............................................................................................................... 4
1.2 Formulation of The Problem.................................................................................. 5
1.3 Aim ............................................................................................................................... 5
BAB II ........................................................................................................................................... 6
LITERATURE REVIEW ............................................................................................................. 6
2.1 Definitions Hypertension........................................................................................ 6
2.2 Measuring Blood Pressure .................................................................................... 6
2.3 Cause Of Hypertension ........................................................................................... 9
2.4 Anatomy and Physiology ....................................................................................... 9
2.5 Pathophysiology Of Hypertension .................................................................... 11
2.6 The Symptoms Of Hypertension ........................................................................ 12
2.7 The Effect Of Hypertension ................................................................................. 12
2.8 Prevention Of Hypertention ................................................................................. 13
2.9 Treatment Of Hypertention .................................................................................. 14
CHAPTER III ............................................................................................................................. 20
CLOSING ................................................................................................................................... 20
3.1 Conclusion ............................................................................................................... 20
3.2 Suggestion ............................................................................................................... 20
BIBLIOGRAPHY ....................................................................................................................... 21

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 BAB I

PRELIMINARY

1.1 Background
High blood disease known as hypertension is a disease that gets
attention from all circles of society, considering its impact both short and
long term and thus require long-term response that fully. Hypertension
cause morbidity (illness) and mortality (death) is high.
Hypertension is a disease resulting from the interaction of various
risk factors a person has. Various studies have linked between the
various risk factors on the incidence of hypertension.
Based on the research that has been conducted poorer
prevalence (incidence) of hypertension increases with age. From various
epidemiological studies conducted in Indonesia showed 1.8 to 28.6% of
the population aged over 20 years are hypertensive. Hypertension,
currently there is a trend that more urban than rural communities suffer from
hypertension. This is partly attributed to the urban lifestyle associated with the
risk of hypertension such as stress, obesity (overweight), lack of exercise,
smoking, alcohol, and eating foods high in fat content.
Along with age, almost everyone has experienced an increase in
blood pressure, systolic blood pressure continues to increase until the
age of 80 years and diastolic pressures continue to increase until the age
of 55-60 years, then decrease slowly or even decreased dramatically.

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1.2 Formulation of The Problem
1. How about definition of hypertension?
2. How to measure blood pressure?
3. Explaining the causes of hypertension?
4. Explain the symptoms of hypertension?
5. How hypertension prevention
6. Explain the treatment of hypertension?

1.3 Aim
1. To find definition of hypertension..
2. To learn how to measure blood pressure.
3. To determine the cause of hypertension.
4. To know the symptomps that caused.
5. To know the result of hypertension.
6. To kknow the prevention of hypertension.
7. To determine the treatment of hypertension.

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 BAB II

LITERATURE REVIEW

2.1 Definitions Hypertension

Hypertension or high blood pressure, is increased blood pressure or
force of blood pressing on the walls of the cavity where the blood was. High
Blood Pressure (hypertension) is an increase in blood pressure in the
arteries. Hiper means Overrated, tension means pressure hipertensi is
system disorders that cause blood rise in blood pressure above the normal
value.
Blood pressure in a person's life varies naturally. Infants and children
normally have a blood pressure that is much lower than adults. Blood
pressure is also affected by physical activity, which will be higher at the time
of the activity and lower when resting. Blood pressure is also different in one
day, the highest in the morning and most re ndah during nighttime sleep.

2.2 Measuring Blood Pressure

On examination the blood pressure will get two points. A higher figure
obtained when the heart contracts (systolic), a lower number obtained when
the heart relaxes (diastolic).Blood pressure is written as systolic pressure
diastolic pressure slash, eg 120/80 mmHg, read a hundred and twenty
eighty. Along with age, almost everyone has experienced an increase in
blood pressure , systolic blood pressure continues to increase until the age
of 80 years and diastolic pressures continue to increase until the age of 55-
60 years, then decrease slowly or even decreased dramatically.
Blood pressure is written with two numbers, the number units mmHg
(millimeters of mercury) in blood pressure tool / tension meter, the systolic
and diastolic. Is the highest systolic blood pressure is when the heart is

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 doing contract or contraction. Diastolic is the lowest figure at the heart
expands in the final relaxation.
For example, blood pressure 120/80 mmHg mean systolic pressure of
120 and diastolic pressure of 80 mmHg.
Blood pressure is the pressure generated by:
a. Strength buds urgent cardiac left ventricle to insert the contents of the
blood into the arterial trunk.
b. Resistance in the arterial blood flow.
c. Autonomic nerves are made up of the sympathetic and the
sympathetic system.

Classification of blood pressure

No Classification Systolic Diastolic
1 Optimal <120 mmHg <80 mmHg
2 Normal <130 mmHg <85 mmHg
3 Normal high 130-139 mmHg 85-89 mmHg
4 Mild hypertension 140-159 mmHg 90-99 mmHg
5 Hypertension was 160-179 mmHg 100-109 mmHg
6 Severe hypertension > 180 mmHg > 110 mmHg

Normal blood pressure

Blood pressure varies per person per day, depending on the
circumstances, and are affected by the activities of a person, so normalpun
blood pressure varies.
Adults when the blood pressure showed the number 140/90 mmHg is
considered normal upward. There is a perception of low blood pressure is not
good, it is less precise.Because statistics show that people with low blood
pressure have the same age with so-called normal. The best thing is to maintain
normal blood pressure and the assumption that increasing age is higher blood
pressure is not a problem, is the assumption that needs to be clarified, because
based on statistics of parents whose blood pressure in the normal range, the

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trend gets low stroke disorders. Check your blood pressure regularly at least
once every 6 months or whenever the doctor / health facility.

2 classification known hypertension (by cause), namely:

a. primary hypertension (hypertension idiophatik), in which the cause is not
known with certainty. It also said that hypertension is the impact of
lifestyle and environmental factors.
b. secondary hypertension, is hypertension that occurs due to the disease
from other diseases such as abnormalities in the kidneys or keruskanan
of the hormone system.
WHO classifies hypertension based on the presence or absence of
abnormalities in other organs, namely:
a. hypertension without abnormalities in other organs.
b. hypertension with cardiac enlargement.
c. hypertension with abnormalities in other organs in addition to the heart.
Classification of hypertension by high blood pressure are:
a. borderline hypertension: blood pressure between 140/90 mmHg and
160/95 mmHg.
b. mild hypertension: blood pressure between 160/95 mmHg and 200/110
mmHg.
c. Moderate Hypertension: Blood pressure between 200/110 mmHg and
230/120 mmHg.
d. severe hypertension: blood pressure between 230/120 mmHg and
280/140 mmHg.

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2.3 Cause Of Hypertension
There are 2 kinds of hypertension, essential and secondary.
a. hypertension Essential hypertension is the most not known
cause. There are 10 - 16% of adults suffer from high blood
pressure.
b. hypertension Secondary hypertension is a known cause and why.
Hypertension kind is only a small part, which is only about 10%.

Some of the causes of hypertension, among others:

a. Because hormonal, for example, from the adrenal glands.
b. The use of drugs.
c. smoking because the nicotine contained in tobacco.
d. Alcoholic beverages.
e. Abnormalities in the kidneys.
f. Intracranial Abnormalities resulting in increased intracranial pressure or
because of its location near the center of persyarafan that affect blood
pressure.
g. Abnormalities of the large blood vessels (aorta) that koartasio aorta
where the aortic arch aorta is continuous with decendens.

2.4 Anatomy and Physiology

1) Heart
Measuring about one fist and is located within the chest, the limit on the
right is right and apeksnya sternum in the fifth intercostalis space
midclavicular left linea.
Relation of heart is:
- Above: large blood vessels
- Bottom: diaphragm
- Each side: lung – lung
- Rear: the descending aorta, esophagus, vertebral Columna
2) Arteries

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 Is the tube through which the blood flow in tissues and organs.Consists
of layers of the arteries: a slippery layer, the middle layer of elastin tissue
/ muscle: the aorta and major branches have laposan center consisting
of a network of elastin (to deliver blood to the organs), smaller arteries
have a muscular middle layer (regulating the amount of Blood delivered
to an organ).
3) Arterioles
Are the blood vessels with smooth muscle wall is relatively
thick. Arteriolar wall muscles to contract. Contractions caused kontriksi
diameter blood vessels. When kontriksi localized, blood supply to the
tissues/organs is reduced. If there kontriksi general, blood pressure will
increase.
4) Major blood vessels and capillaries
The main blood vessels are thin-walled vessels that run directly from
arterioles to venul. Capillaries are the network of small blood vessels
open major blood vessels.
5) Sinusoids
There are spleen, liver, bone marrow, and endocrine glands.Sinusoids
three to four times greater than in capillaries and partially coated with
reticulo-endothelial system cells. In places the sinusoid, having direct
contact with the blood cells and the exchange does not take place
through the network space.
6) Vena and venul
Venul is a combination of small veins formed capillaries. Veins formed by
the combined venul. Veins have three walls that are not adjacent to each
other perfectly. (Gibson, John. Issue 2 2002, p 110)
The heart has the function as a pump oxygenated blood in the arterial
system, which was brought into the cell and the entire body to collect blood
deoxygenation (blood oxygen levels less) of the vein system are delivered to
the lungs for reoksigenasi (Black, 1997).

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2.5 Pathophysiology Of Hypertension
The mechanisms that control the constriction and relaxation of blood
vessels located in the vasomotor center, the medulla of the brain.This stems
from the central vasomotor sympathetic nerve pathway, which continues
down to the spinal cord and the spinal cord out of the column to the
sympathetic ganglia in the thorax and abdomen.stimulation of the vasomotor
center is delivered in the form of impulse moves down through the
sympathetic nerves to the sympathetic ganglia. At this point, neurons
release acetylcholine preganglion, which will stimulate post-ganglion nerve
fibers to the blood vessels, which resulted in the release of norepinephrine
constriction of blood vessels. Various factors such as anxiety and fear can
affect vascular response to stimuli vasokontriktor. Individuals with
hypertension are very sensitive to norepinephrine, although it is not clear
why it could happen.
At the same time stimulate the sympathetic nervous system in which the
blood vessels in response to emotional stimuli, the adrenal glands are also
stimulated vasoconstriction resulting in additional activities. Secreting
adrenal medullary epinephrine causes vasoconstriction. Adrenal cortex
secrete cortisol and other steroids, which DAPT strengthen blood vessels
vasokontriktor response.vasoconstriction resulting in decreased blood flow
to the kidneys, causing the release of renin. Renin stimulates the formation
of angiotensin I, which is then converted to angiotensin II, a potent
vasoconstrictor, which in turn stimulates aldosterone secretion by the
adrenal cortex. hormone causes retention of sodium and water by the kidney
tubules, causing an increase in intravascular volume. All of these factors
tend to provoke a state of hypertension.
Structural and functional changes in the peripheral vascular system
responsible for the changes in blood pressure that occurs in the
elderly. These changes include atherosclerosis, loss of elasticity of the
connective tissue, and a decrease in vascular smooth muscle relaxation,
which in turn lowers the ability of tensile strength distension and blood

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 vessels. Consequently, the aorta and large arteries less able to
accommodate the volume of blood pumped by the heart (volume sekuncup),
resulting in decreased cardiac output and increased peripheral resistance
(Smeltzer, Bare, 2002).

2.6 The Symptoms Of Hypertension

The symptoms of hypertension, among others:
1. Much of no symptoms.
2. Pain in the back of the head.
3. stiff neck.
4. Fatigue.
5. Nausea.
6. Shortness of breath.
7. Restless. Vomiting.
8. easily offended.hard to sleep.
Complaints are not always going to be experienced by a patient with
hypertension. Often a person with symptoms of pain behind his head,
irritability and difficulty sleeping, when the blood pressure measured showed
a normal blood pressure numbers. The only way to determine the presence
or absence of hypertension only by measuring blood pressure.

2.7 The Effect Of Hypertension

Hypertension if not controlled can lead to serious complications, such as:
a. kidney damage.
b. damages blood vessels.
c. brain hemorrhage / stroke.
d. Paralysis.
e. enlarged heart / heart trouble.
f. Narrowing of the coronary arteries / heart attack.

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2.8 Prevention Of Hypertention
Person's risk for hypertension (except essential), can be reduced by:
a. Checking blood pressure regularly .
b. Maintain ideal weight .
c. Reducing salt intake .
d. Do not smoke .
e. Exercising regularly .
f. regular life.
g. Reducing stress.
h. Do not rush
i. Avoid fatty foods.

1) Primary Prevention:
a. Adequate sleep, between 6-8 hours per day.
b. Reduce high cholesterol foods and multiply physical activity to lose
weight.
c. Reduce alcohol consumption.
d. Consumption of fish oil.
e. The supply of calcium, although only slightly lower blood pressure but
calcium is also quite helpful.
2) Secondary Prevention
a. Pattern whice food healthy.
b. Reduce salt and sodium in your diet.
c. Physical active.
d. Reduce intake Alcohol
e. Stop smoking.
3) Tertiary Prevention
a. Control of blood on a regular basis.
b. Sports regularly and adjusted to body condition.

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2.9 Treatment Of Hypertention
Treatment of hypertension is best:
a. Always control your blood pressure checked regularly by a doctor .
b. Always take medication regularly even without a complaint .
c. Reducing salt intake .
d. Increase consumption of vegetables and fruit .
e. Obeying doctor's advice.

1. The content of salt (Sodium or Sodium)

Someone who is suffering from hypertension should control themselves in salt
consumption. The meaning here is the sodium salt of salt present in almost all
foods derived from animals and plants.One major source of sodium is table
salt. Therefore, the recommended salt intake of no more than ¼ - ½ teaspoon /
day or to use other than the sodium salt.
Low salt diet goal is to help eliminate the salt or water retention in the
body tissues and lowers blood pressure in hypertensive patients.The terms of a
low salt diet is:
a. Enough energy, protein, minerals, and vitamins.
b. Forms of foods according to the disease state.
c. The amount of sodium adjusted to the severity of salt or water
retention and / or hypertension.
This diet contains enough nutrients. In accordance with the state of the
disease can be given different levels of Low Salt Diet.
a. Low Salt Diet I (200-400 mg Na)
This diet was given to patients with edema, ascites, and / or severe
hypertension. In the food processing no salt added. Avoided the foods high in
sodium.
a. Low Salt Diet II (600-800 mg Na)
This diet was given to patients with edema, ascites, and / or hypertension
are not too heavy. Daily feeding with Low Salt Diet I. In the food processing may
not use salt ½ tsp (2 g). Avoided the foods high in sodium.

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 a. Low Salt Diet III (1000-1200 mg Na)
This diet is given to patients with edema and/or mild hypertension.
Daily feeding with Low Salt Diet I. In the food processing may use 1 teaspoon
salt (4 g).

2. Content of Potassium or Potassium

Potassium suplements 2-4 grams per day can help lower blood
pressure. Potassium is generally fat found in some fruits and
vegetables. Fruits and vegetables that contain potassium and good for
people with hypertension consumed include watermelon, avocado, melon,
bitter melon fruit, squash, bligo, machete pumpkin / gourd, cucumber, aloe
vera, celery, onion and garlic. In addition, foods containing omega 3 sagat
elements known to be effective in helping to decrease blood pressure
(hypertension).
In patients with hypertension where blood pressure> 160 / g mmHg,
in addition to the provision of anti-hypertensive drugs need dietetic therapy
and lifestyle changes. The objective of dietary management is to help lower
blood pressure and maintain blood pressure to normal. In addition, the diet
is also intended to reduce risk factors such as overweight, high cholesterol
and fat levels of uric acid in the blood. It should be noted also that
accompanies other degenerative diseases such as high blood pressure,
heart, kidney and diabetes mellitus.
3. Setting Menu Foods
Adjusting diet is recommended for patients with hypertension to
avoid and limit foods that can increase blood cholesterol levels and
increase blood pressure, so people do not have a stroke or cardiac
infarction.
Foods to be avoided or restricted are:
1. The food is high in saturated fat (brain, kidney, lung, coconut oil, lard).
2. Food was prepared by using sodium salt (cookies, crakers, chips and
dried foods are salty).

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 3. Food and drinks in cans (sardines, sausage, korned, vegetables and
fruits in cans, soft drink ).
4. Preserved foods (jerky, pickled vegetables or fruit, shredded, salted,
boiled, dried shrimp, salted eggs, peanut butter).
5. Milk full cream , butter, margarine, cheese, mayonnaise, and other
sources of animal protein are high in cholesterol such as red meat
(beef / mutton), egg yolk, chicken skin)
6. Condiments such as soy sauce, maggi, shrimp paste, tomato sauce,
chili sauce, tauco and other flavorings generally contain sodium salt.
7. Alcohol and alcohol-containing foods such as durian, tape.
How to set up a diet for people with hypertension is to improve the taste
by adding sugar fresh red / white onion (red / white), ginger, and other spices
kencur are not salted or salt contains less sodium.Food can be sauteed to
improve the taste. Put salt at the table above can be taken to avoid excessive
use of salt. It is recommended to always use iodized salt and salt use no more
than 1 teaspoon per day.
Increasing potassium intake (4.5 grams or 120-175 mEq / day) can give
the effect of a mild decrease in blood pressure. In addition, administration of
potassium also helps to replace lost sodium and low potassium result. Can
generally used medium size (50 grams) of apples (159 mg potassium), orange
(250 mg potassium), tomato (366 mg potassium), banana (451 mg potassium)
baked potato (503 mg potassium) and 1 cup skim milk (406 mg
potassium). Adequacy of calcium is important to prevent and treat hypertension:
2-3 glasses of skim milk or 40 mg / day, 115 grams of low-sodium cheese to
meet the needs of calcium 250 mg / day. While the needs of the average daily
calcium 808 mg.
In pregnant women food enough protein, calories, calcium and sodium
are associated with a lower incidence of hypertension of pregnancy. However,
pregnant women are especially hypertension accompanied by swelling and
urinary protein (pre-eclampsia), other than medicines recommended to reduce
salt intake and increase food sources of Mg (vegetables and fruits).

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4. SUPPLEMENTATION anti oxidant
Despite antioxidant supplementation still require further research,
but today many supplements are sold and consumed by the public. As
medical personnel should be careful giving advice supplement drink to
avoid overdose.
5. Vitamins and Decrease Homocysteine
Folic acid, vitamin B6, vitamin B12 and riboflavin are enzyme co-
factor essential for the metabolism of homocysteine. Various studies
have shown that elevated levels of homocysteine in the blood increases
the risk of coronary artery disease. Low levels of folic acid are associated
with an increased risk of coronary disease and low vitamin levels are
also associated with an increased risk of atherosclerosis, although the
risk of atherosclerosis associated with low levels of vitamin B6 was not
associated with a high concentration of homositein. while vitamin B12 is
not associated with vascular disease.
6. Soybeans and Isoflavones
Soy contains many isoflavones are estrogen-Phy, which have weak
estrogen activity. Research meta-analysis in 1995 concluded that isoflavones
from soy protein more significantly reduce total cholesterol, LDL cholesterol
and triglycerides, without affecting HDL cholesterol levels. So it is
recommended to consume soy protein (20-50 grams / day) and dietary
modifications in patients with cholesterol (total and LDL) is high. Tempe is the
result of processing soybeans fermented with better nutritional content than
soy. So that tempeh is recommended for consumption by people with
hypertension as a source of vegetable protein.
7. Tempe
Tempe is one of the traditional food of Indonesia, fermented
fungus Rhizopus ohgosporis or rhizopusoryzal on soybean seed that has
been boiled. There are various kinds of tempeh, tempeh discussion is
made of soy, which is a compact product, wrapped flat by the mycelium
fungus that appears white in color, and when slicedpieces seem pale

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yellow soya beans, among the mycelium. Fermentation mold produces a
change in the texture of soy, are soft and nutritional value of tempeh
better than soybeans.
Nutritional value Tempe:
- Protein
Enzymes produced molds, producing free amino acids, so the level is
increased to 85 times the levels of soy protein.
- Carbohydrates
Soybeans contain carbohydrates in the form of sakrosa and stakhiosa
and rifinosa (the latter two led to the formation of gas in the
stomach). Fermented soybeans into soybean producing
carbohydrates.
- Fat
Enzymes in the mold can reduce the total fat content from 22.2% to
14.4% and increased free fatty acid levels from 0.5% to 21%.
- Mineral
In the soybean contained phytic acid which is a compound forfose,
which can not be utilized by the body. With fermentation, molds
produce the enzyme phytase which outlines the phytic acid, so it can
be utilized forfosenya body.
- Vitamin
The fermentation process can increase levels of vitamin B2
(Riboferum), Vitamin B6 (pyridoxine), folic acid, panthotenat, and
nicotinic acid. While vitamin B1 levels decreased due to the growth of
mold and also vitamin B12 formed by bacteria that do not exist in
other vegetable products.
- Benefits Tempe:
Tempe is a good source of nutrients, especially for patients with
hyper kolesterolemia. From various studies it turns out tempeh can
lower cholesterol levels in the blood and prevent blood vessel
constriction, because tempeh contains polyunsaturated fatty

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 acids. So that hypertensive patients are encouraged to eat tempeh
every day, in addition to a diet low in saturated fat.
Tempe also contains antibacterial substances that can inhibit the
growth of some gram-positive bacteria as well as cause diarrhea
(Salmonella sp and Shigella sp.) Therefore, tempeh is also
recommended to be consumed under five with diarrhea.
- Omega 3 Fatty Acids
Eating one serving of high-fat fish (or fish oil) per day can be the
intake of omega 3 fatty acids (EPA and DHA) of approximately 900
mg / dl, and has been reported to lower cholesterol and prevent
coronary heart disease.
- Fiber
Although sharing of studies show an association between some types
of fibers with decreased cholesterol or LDL and total cholesterol, but
there is no direct evidence showing the relationship between fiber
supplements with decreased cardiovascular disease.

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 CHAPTER III

CLOSING

3.1 Conclusion
Hypertension or high blood pressure, is increased blood pressure or
force of blood pressing on the walls of the cavity where the blood was. Blood
pressure in a person's life varies naturally. Infants and children normally
have a blood pressure that is much lower than adults. Blood pressure is also
affected by physical activity, which will be higher at the time of the activity
and lower when resting. Blood pressure is also different in one day, the
highest in the morning and lowest at night during sleep.

3.2 Suggestion
How to set up a diet for people with hypertension is to improve the taste
by adding sugar fresh red / white onion (red / white), ginger, and other
spices kencur are not salted or salt contains less sodium. Food can be
sauteed to improve the taste. Put salt at the table above can be taken to
avoid excessive use of salt. It is recommended to always use iodized salt
and salt use no more than 1 teaspoon per day.

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Altman, G.B. 2010. Fundamental and advanced nursing skills. Clifton park. NY.
Delmar.

Potter, Patricia A. Fundamental Of Nursing: Concepts, Process, and Practice

Ed-4. Jakarta. EGC.

Caple, C. 2011. Physical assesment: Performing-cultural considerations.

Glendale, CA. Cinahl Information System.

Jarvis, C. 2012. Physical Examination and Health Assesment. St. Louis. W.B
Saunders.

Smeltzer, Suzanne C. 2001. Brunner & Suddarth’s textbook of medical-surgical

nursing, 8.e. Jakarta. EGC.

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