Tabel 1 Klasifikasi Tekanan Darah Normal Prehipertensi Hipertensi Derajat 1 Hipertensi Derajat 2 TDS (mmHg) < 120 120

- 139 140 - 159 160 TDD (mmHg) dan < 80 atau 80 - 89 atau 90 - 99 atau 100

Jantung Otak

Penyakit Ginjal Kroni Penyakit arteri perife Retinopati

Tabel 2 Faktor Risiko Utama Hipertensi Usia (>55 tahun untuk pria dan >65 tahun untuk wanita Diabetes melitus Peningkatan kolesterol LDL (atau total) atau penurunan kolesterol HDL Laju filtrasi glomerulus (LFG) <60 ml/menit Riwayat penyakit jantung dalam keluarga (<55 tahun pada pria atau <65 tahun pada wanita) Mikroalbuminuria Obesitas (body mass index > 30 kg/m2) Aktivitas fisik kurang Merokok, terutama cigarette Kerusakan Target Organ Jantung Otak - stroke atau translent ischemic attack - demensia Penyakit Ginjal Kronik Penyakit arteri perifer Retinopati hipertrofi ventrikel kiri infark miokard angina riwayat revaskularisasi koroner gagal jantung

Tabel 3 Penyebab Penyakit parenkim ginjal Penyakit renovaskular Aldosteronisme Penyakit tiroid Feokromositoma Sindrom Cushing Obat Kehamilan Prevalensi 5 0,5 - 5 0,5 - 1 0,5 - 1 < 0,2 < 0,2 0,1 - 1 0,1 - 1

tabel 4 Tekanan Darah Inisial (mmHg) Normal Prehipertensi Hipertensi Derajat 1

Hipertensi Derajat 2

tabel 5 Follow-Up Cek ulang dalam 2 tahun Cek ulang dalam 1 tahun Konfirmasi dalam 2 bulan Evaluasi dalam 1 bulan. Untuk tekanan darah yang lebih tinggi (>180/110 mmHg), evaluasi dan tatalaksana secepatnya atau dalam 1 minggu tergantung klinik dan komplikasi Basic Test For Initial Evaluation 1. Always included a b c d e f g h 2. Usually included, depending on cost and other factors a b c d e Special Studies to Screen for Secondary Hypertension 1. Renovascular disease: angiotensin-converting enzyme inhibitor radionuclide renal scan, renal duplex, Doppler flow studies and MRI angiography

2. Pheochromocytoma : 24-h urine assay for creatinine, metanephrin and calecholamines

3. Cushing's syndrome: overweight dexamethasone suppression test 24-h urine cortisol and creatinine 4. Primary aldosteronism

Note : HDL, High Density Lipoprotein; LDL, Low Density Lipoprotei MRI, Magnetic Resonance Imaging

Basic Test For Initial Evaluation 1. Always included Urine for protein, blood and glucose Microscopic urinalysis Hematocrit Serum potasslum Serum creatinine and/or blood urea nitrogen Fasting glucose Total cholesterol Electrocardiogram 2. Usually included, depending on cost and other factors Thyroid-stimulating hormone White blood cell count HDL and LDL cholesterol and triglycerides Serum calcium and phospate Chest x-ray; limites echocardiogram Special Studies to Screen for Secondary Hypertension 1. Renovascular disease: angiotensin-converting enzyme inhibitor radionuclide renal scan, renal duplex, Doppler flow studies and MRI angiography 2. Pheochromocytoma : 24-h urine assay for creatinine, metanephrines, and calecholamines 3. Cushing's syndrome: overweight dexamethasone suppression test or 24-h urine cortisol and creatinine 4. Primary aldosteronism Note : HDL, High Density Lipoprotein; LDL, Low Density Lipoprotein; MRI, Magnetic Resonance Imaging

Stage 1 Hypertension (SBP 140 - 159 or DBP 90 - 99 mmHg)

Stage 2 Hypertension (SBP 160 or DBP 100 mmHg)

Thiezide type diuretics for most May consider ACEI, ARB, BB, CCB, or combination

2 drug combination for most (usually thiazide type diuretic and ACEI or ARB, or BB, or CCB)

Optimize dosages or add additional drugs untill goal blood press

See Stretegies for Impro

Life Style Modification

Initial Drug Choices

pertension 160 or DBP 00 mmHg)

ombination for sually thiazideuretic and ACEI or BB, or CCB)

Drug(s) fot the compelling indications See Compelling Indications for individual Drug Classes Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed

Not at Goal Blood Pressure

nal drugs untill goal blood pressure is achieved. Consider consultation with hypertension specialist See Stretegies for Improving to Theraphy

Recommended Drugs** ALDO ANT x x Diuretic

ACE-I

ARB x x x

Compelling Indication* Heart failure

Postmyocardial Infarction

High coronary disease risk

Diabetes

Chronic Kidney Disease

Recurrent Stroke Prevention

* Compelling indications for antihypertensive drugs are based on benefits from outcome studies or existing clinical guidelines; the compelling indication is managed in parallel with the BP. ** Drug abbreviations: ACEI, angiotensin converting enzyme inhibitor, ARB, angiotensin receptorblocker, Aldo ANT, aldosterone antagonist, BB, beta-blocker, CCB, calcium channel blocker *** Conditions for which clinical trials demonstrate benefit of specific classes of antihypertensive drugs

CCB

BB

Clinical Trial Basis*** ACC/AHA Heart Failure Guideline, MERIT - HF COPERNICUS, CIBIS, SOLVD, AIRE, TRACE, ValHEFT, RALES ACC/AHA Post-MI Guideline, BHAT, SAVE, Capricorn, EPHESUS ALLHAT, HOPE, ANBP2 LIFE, CONVINCE NFK-ADA Guideline UKpds, ALHAT NFK Guideline, CapTOPRIL Trial, RENAAL, IDNT REIN, AASK PROGRESS

ugs are based on benefits from outcome g indication is managed in parallel with the

rting enzyme inhibitor, ARB, angiotensin t, BB, beta-blocker, CCB, calcium channel

nstrate benefit of specific classes of e drugs