1.

Hypertension

1.1 Definition of Hypertension

Hypertension is defined as blood pressure that persistent systolic pressure above 140 mmHg and
diastolic blood pressure above 90 mmHg. In the elderly population, hypertension is defined as systolic
pressure of 160 mmHg and a diastolic pressure of 90 mmHg (Sheps, 2005).

Hypertension is defined as blood pressure continuously so as to exceed the normal limits. Normal blood
pressure is 110/90 mmHg. Hypertension is a product of peripheral vascular resistance and cardiac
output (Wexler 2002)

1.2 Classification of Hypertension

1.2.1 Based on the known causes of hypertension are two types, namely:

Primary hypertension (essential) is a persistent increase in arterial pressure produced by the irregularity
of normal homeostatic control mechanisms, Hypertension
unknown cause and includes a + 90% of cases of hypertension (Wibowo, 1999).

Secondary hypertension is a disorder of persistent hypertension second base in addition to essential

hypertension. Hypertension is the cause is known, and this concerns the + 10% of cases of hypertension.
(Sheps, 2005).

1.2.2 Based on the form of hypertension, the diastolic hypertension, mix, and systolic.

Diastolic hypertension (diastolic hypertension) is an increase in diastolic blood pressure without a

subsequent increase in systolic pressure. Usually found in children and adults muda.Hipertensi mixture
(systole and diastole are rising), namely an increase in blood pressure in systole and diastole. Systolic
hypertension (isolated systolic hypertension) is an increase in systolic pressure without a subsequent
increase in the diastolic pressure. Commonly found in the elderly. (Gunawan, 2001)
1.3 The etiology of hypertension

Corwin (2000) explained that hypertension depends on heart rate, stroke volume and Total Peripheral
Resistance (TPR). Then an increase in one of the three variables that are not compensated can cause
hypertension.

Increase in heart rate can occur due to abnormal neural or hormonal stimulation in the SA node.
Increase in heart rate which lasts often accompanies chronic state of hyperthyroidism. However,
increase in heart rate is usually compensated by a decrease in stroke volume or TPR, so it does not
meninbulkan hypertension (Astawan, 2002)

An increase in stroke volume that lasts longer may occur if there is a prolonged increase in plasma
volume, due to disruption of salt and water handling by the kidney or excessive salt intake. Increased
renin release, or aldosterone and decreased blood flow to the kidneys can alter water and salt handling
by the kidneys. Increased plasma volume will lead to an increase in end-diastolic volume resulting in an
increase in stroke volume and blood pressure. Peningkata preload is usually associated with an increase
in systolic pressure (Amir, 2002)
Total increase in long-lasting periperial Resistance can occur in an increase in nerve stimulation or
hormone on arteriolar or excessive responsiveness of arterioles are normal stimuli. Both of these will
cause constriction of blood vessels. On improving periperial Total Resistance, the heart must pump more
powerfully and thus produce greater pressure to push blood passing narrowed blood vessels. It is called
an increase in cardiac afterload and is usually associated with an increase in diastolic pressure. If the
increased afterload lasts longer, then left ventricle may begin to experience hipertrifi (enlarged). With
hypertrophy, ventricular need for oxygen increased so that the ventricle should be able to pump blood
harder to meet proficiency level. Hypertrophy, cardiac muscle fibers also began to tense exceeds the
normal length, which in turn causes a decrease in contractility and stroke volume. (Hayens, 2003)

1.4 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 pathways,
which continues down to the spinal cord and out of the columns of the spinal cord to the sympathetic
ganglia in the thorax and abdomen. Vasomotor center stimulation is delivered in the form of an impulse
that travels down through the sympathetic nerves to the sympathetic ganglia. At this point, the
preganglionic neurons release acetylcholine, which will stimulate the post-ganglion nerve fibers to the
blood vessels, where the release of norepinephrine lead to constriction of blood vessels.
Various factors such as anxiety and fear can affect the response of blood vessels to stimuli
vasokontriktor. Individuals with hypertension are very sensitive to norepinephrine, although it is not
clear why it could happen (Corwin, 2001)
At the same time that the sympathetic nervous system stimulates the blood vessels in response to
emotional stimuli, the adrenal glands also lead to additional activity stimulated vasoconstriction. The
adrenal medulla secretes epinephrine causes vasoconstriction. The adrenal cortex secretes cortisol and
other steroids, which dapt vasokontriktor strengthen the response of blood vessels. Vasoconstriction
resulting in decreased blood flow to the kidneys, causing release of renin. Renin stimulates the
formation of angiotensin I, which is then converted into angiotensin II, a potent vasoconstrictor, which
in turn stimulates aldosterone secretion by the adrenal cortex. This hormone causes the 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 (Dekker, 1996)

Structural and functional changes in the peripheral vascular system responsible for blood pressure
changes that occur in the elderly. The changes cover i atherosclerosis, loss of elasticity of the connective
tissue, and decrease in vascular smooth muscle relaxation, which in turn lowers the ability of distension
and tensile strength of blood vessels. Consequently, the aorta and large arteries diminished ability to
accommodate the volume of blood pumped by the heart (stroke volume), resulting in decreased cardiac
output and increased peripheral resistance (Corwin, 2001).

1.5 Signs and Symptoms of Hypertension

On physical examination, may not find any abnormalities in addition to high blood pressure, but can also
be found changes in the retina, such as bleeding, exudate (fluid collection), narrowing of blood vessels,
and in severe cases, the pupil edema (edema of the optic disc).

Individuals who suffer from hypertension, sometimes not show symptoms until many years. Symptoms
when there showed the presence of vascular damage, with typical manifestations corresponding organ
systems divaskularisasi by blood vessels concerned. Pathological changes in the kidneys may manifest as
nocturia (increased urination at night) and azetoma [increase in blood urea nitrogen (BUN) and
creatinine]. The involvement of the blood vessels of the brain can cause a stroke or transient ischemic
attack which manifests as temporary paralysis on one side (hemiplegia) or sharp vision disturbances
(Wijayakusuma, 2000).

Crowin (2000: 359) states that the majority of clinical symptoms arise after experiencing hypertension
the years include: headache when awake, sometimes accompanied by nausea and vomiting, as a result
of increased blood pressure intracranial, blurred vision due to damage to the retina caused by
hypertension, swing step unstable due to damage to the central nervous system, Nocturia due to an
increase in renal blood flow and filtration glomerolus, dependent edema and swelling due to increased
capillary pressure.

Other symptoms that commonly occur in patients with hypertension, dizziness, flushing, headache,
output of blood from the nose of a sudden, neck sore and others (Wiryowidagdo, 2002).
1.6 Risk Factors Hypertension

Hypertension risk factors include:

The age factor is very influential on hypertension because with age, the higher the risk of hypertension
received. Incidence of hypertension increased with increasing age. This is often caused by natural
changes in the body that affect the heart, blood vessels and hormones. Hypertension in aged less than
35 years will increase the incidence of coronary artery disease and premature death (Julianti, 2005).
Gender is also a very close relation to the occurrence of hypertension where the youth and middle-aged
hypertensive disease is higher in men and in women were higher after the age of 55 years, when a
woman experiences menopause.
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Comparisons between men and women, it turns more women suffer from hypertension. From the
reports sugiri in Central Java found the prevalence rate of 6% of men and 11% in women. Reports from
West Sumatra showed 18.6% in men and
17.4% of women. In urban areas Semarang gained 7.5% in men and 10.9% in women. Whereas in urban
areas of Jakarta obtained 14.6 in men and 13.7% in
women (Gunawan, 2001).

Family history is also an issue that triggered the problem of hypertension hypertension tends to be a
hereditary disease. If one of the parents we have a lifetime history of hypertension then we have the
possibility
25% of hypertension (Astawan, 2002)
Salt is a factor in the pathogenesis of hypertension. Hypertension is almost never found in tribes with
minimal salt intake. Salt intake of less than 3 grams per day lead to hypertension lower salt intake
between 5-15 grams per day, the prevalence of hypertension increased to 15-20%. The influence of salt
intake on the incidence of hypertension terjadai through increased plasma volume, cardiac output and
blood pressure (Basha, 2004).

Salt contains 40% sodium and 60% chloride. People sensitive to sodium increases sodium more easily,
leading to fluid retention and increased blood pressure (Sheps, 2000).

Salt is closely linked to the occurrence of high blood pressure, blood vessel disorders is hardly found in
tribal low salt intake. If the salt intake of less than 3 grams daily low prevalence of hypertension
presentation, but if the salt intake of 5-15 grams per day, will increase the prevalence of 15-20%
(Wiryowidagdo, 2004).

Salt has a water holding properties. Consuming more salt or pickled food eat- in itself will raise blood
pressure. Avoid using salt berkebih or pickled food. This does not mean to stop the use of salt altogether
role in food. Otherwise limit the amount of salt consumed (Wijayakusuma, 2000).
Smoking merupaka one of the factors that can be changed, while the association between smoking and
hypertension are the nicotine will cause an increase in blood pressures because nicotine is absorbed by
blood vessels smaller in the lungs and are transported by vessels dadarah up to the brain, the brain
reacts to nicotine by the member signals on
the adrenal glands to release epinephrine (adrenaline). This powerful hormone that constricts blood
vessels and force the heart to work harder because the more tinggi.Selain pressure, the carbon
monoxide in the smoke rokokmenggantikan iksigen in the blood. This will menagakibatkan blood
pressures because the heart is forced to pump enough oxygen to enter into the orga and tissues
(Astawan, 2002).

Activity is very mempengaruhiterjadinya hypertension, where the person who kuan aktvitas will tend to
have a heart rate that is higher up so that the heart muscle will have to work harder on each
kontraksi.Makin hard and often the heart muscle to pump the greater the pressure imposed on the
arteries (Amir, 2002).

Stress is also very closely the problems that triggered the occurrence of hypertension in which the
relationship between stress and hypertension presumably through an increase in neural activity of the
sympathetic nerves can raise blood pressure intermittently (erratic). Prolonged stress can lead to high
blood pressure persist. Although this has not been proven but the incidence is higher in urban
communities than in rural areas. This can be attributed to the influence of the stress experienced by
groups of people who live in cities (Dunitz, 2001).

1.7. Complications of Hypertension

Stroke can result from high pressure bleeding in the brain, or from an embolus that apart from non-
brain vessels exposed to high pressure. Stroke can occur in chronic hypertension when the arteries that
memperdarahi brain undergoes hypertrophy and thickened, so that blood flow to areas that
diperdarahinya reduced.
Brain arteries undergo atherosclerosis may weaken thereby increasing the possibility of the formation of
aneurysms (Corwin, 2000).

Symptoms of stroke include headache suddenly, like, people are confused, bewildered or behave like a
drunken man, one part of the body feels weak or difficult to set in motion (eg, face, mouth, or arm feels
stiff, can not speak clearly) and sudden unconsciousness (Santoso 2006).

Myocardial infarction can occur when a coronary artery atherosclerosis can not supply enough oxygen
to the myocardium or if formed thrombus that impedes the flow of blood through blood vessels. Due to
chronic hypertension and hypertension ventricle, the myocardial oxygen demand may not be met and
cardiac ischemia can occur that cause infarction. Similarly, ventricular hypertrophy can cause changes in
the electrical conductivity of time across the ventricles, causing dysrhythmias, cardiac hypoxia, and
increased risk of clot formation (Corwin, 2000).

Kidney failure can occur due to progressive deterioration due to high pressure in the capillary-kepiler
kidney, glomerolus. With glomerolus damage, blood will flow keunit-functional unit of the kidney, the
nephron will be disturbed and may progress to hypoxia and death. With glomerolus membrane rupture,
the protein will come out through the urine so that the plasma colloid osmotic pressure is reduced,
causing edema are often found in chronic hypertension (Corwin, 2000).

Heart failure or inability of the heart to pump blood that return kejantung quickly lead to fluid build up
in the lungs, legs and other tissues are often referred edma.Cairan in the lungs - lungs causing shortness
breath, fluid heap ditungkai cause leg swelling or edema is often said

(Amir, 2002)

Encephalopathy may occur occur mainly in malignant hypertension (hypertension fast). Pressure is high
on the disorder causes increased capillary pressure and push the fluid into the space intertisium
throughout the central nervous system. Neron Neron- surrounding collapse and occurs coma and death
(Corwin, 2000).

2. Treatment of Hypertension Patients at Home

Treatment of hypertensive patients in general carried out by the family by observing the pattern of life
and maintain the psychic from family members who suffer from hypertension. Setting healthy lifestyle is
very important to the client in order to lessen hypertension ill effects of hypertension. The coverage
pattern of life among others quit smoking, reduce excess weight, avoid alcohol, diet modification. And
which includes among other psychic reduce sres, exercise, and rest (Amir, 2002).

Smoking is huge perananya increase blood pressure, this is caused by the nicotine contained in
cigarettes Yag that trigger the hormone adrenaline which causes increased blood pressures. Nicotine is
absorbed by the blood vessels in the lungs and circulate to all other blood flow, causing constriction of
blood vessels. This leads to increased work of the heart to pump blood throughout the body via the
blood vessels narrow.

By quitting the blood pressure will drop slowly, besides that if they smoked the drug consumed will not
work optimally secar and by quitting smoking will increase the effectiveness of the drug (Santoso, 2001).
Losing weight also lowers the risk of diabetes, cardiovascular disease, and cancer .In general, the more
weight the higher the blood pressure, if applying a balanced diet, it can reduce weight and lower blood
pressure in a controlled way.
Of alcohol in the blood stimulates the hormone adrenaline and other HORMONES that makes blood
vessels constrict or cause a buildup of sodium and water. Drinking alcoholic excess can also lead to
malnutrition, namely kalsium.Mengurangi decreased levels of alcohol can lower systolic pressure of 10
mmHg and 7 mmHg diastolic.

Modification of diet or the diet is very important to the client hypertension, the main goal of diabetes
management of hypertension is set on healthy foods that can control high blood pressure and reducing
cardiovascular penyakiit. Broadly speaking, there are four kinds of diet to overcome, or at least maintain
a state of blood pressures, namely: a low-salt diet, a diet low in cholesterol, fat is limited and high in
fiber, and low in calories if overweight baadan (Astawan, 2002).

Low-salt diet given to patients with edema or ascites and hypertension. Low-salt diet the goal is to lower
blood pressure and to prevent edema and heart disease (weak heart). As for the so-called low-salt not
only limit consumption of salt but consume a diet low in sodium or sodium (Na) .Therefore it is very
important to consider in a diet low in salt is a food composition should contain enough substance -
nutrients, whether calories, protein, minerals and vitamins and low in sodium and sodium (Gunawan,
2001).
Sources of sodium include foods containing baking soda, baking powder, MSG (Mono Sodium
Glutamate), preservatives or sodium benzoate (usually contained in the sauce, ketchup, jam, jelly), food
made of butter and drugs that contain sodium (drug headache ). For patients with hypertension, a habit
of drug use in consultation with your doctor first. (Hayens, 2003).

A diet low in cholesterol and fat is limited. In the body there are three parts of fat, namely: cholesterol,
trigeserida, and pospolipid.Tubuh obtain cholesterol from food a day - day and of the results of the
synthesis in the liver. Cholesterol can be harmful if consumed more than required by the body, increase
in cholesterol can occur because of too many foods containing high cholesterol and body will consume
about 25-50% of every food (Amir, 2002).

High-fiber diet is very important in patients with hypertension, the fiber consists of two types of crude
fiber (crude fiber) and crude fiber found in many fruits and vegetables - fruits, while the dietary fiber
found in carbohydrate foods are: potatoes, rice, cassava and green beans , Crude fiber can serve to
prevent high blood pressure due to the crude fiber is able to bind cholesterol and bile acids and then
throw together dirt. This situation can be achieved if the food is consumed containing crude fiber is high
enough (Mayo, 2005).

Low-calorie diet is recommended for people who are overweight or obese weight badan.Kelebihan be at
high risk of developing hypertension. Likewise, people who are 40 years old are susceptible to
hypertension. In planning the diet, to note it - the following:
1. Calorie intake was reduced approximately 25% of the energy needs, or 500 calories for a decrease of
500 grams or 0.5 kg of body weight per week.
2. The food menu should be balanced and meet nutritional needs.
3. Need to do light exercise activities.
Stress does not cause persistent hypertension, but severe stress can cause an increase in blood pressure
while a very high nersifat. If the period of stress is often the case it will be damage to blood vessels,
heart and kidneys as well as sedentary (Amir, 2002).
Benefits of exercise are often called isotonic exercise such as walking, jogging, swimming and
cycling are very capable of reducing hypertension. On the sports isotonic capable of shrinking
hormone and hormone noradrenaline - another hormone causes increased blood pressure. Avoid
Isometric exercise such as lifting weights, because it can raise blood pressure (Mayer, 1980).

Break is an opportunity to obtain cellular energy in the body, rest can be done by taking time.
Take the time out for rest does not mean much more than on productive work samapai exceed
kepatuhan.Meluangkan Waku pitch breaks it needs to be done regularly between tension rush
hour working day - day. Relax also does not mean recreation exhaustive, but are meant to break
is an attempt to restore stamina and restore hormonal balance and body (Amir, 2002).