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KESEHATAN
JANTUNG
Pusat Jantung Nasional Harapan Kita
UPF Prev-Rehabilitasi Medik
Jakarta
Definisi
Hiper : Berlebihan
Tensi : Tekanan/Tegangan
Hipertensi :
Gangguan sistem peredaran darah yang
menyebabkan kenaikan tekanan darah
diatas nilai normal.
Tekanan Darah
Terdiri dari 2 komponen :
1. Tekanan Sistolik : Tekanan tertinggi saat jantung
memompa (menguncup)
2. Tekanan Diastolik : Tekanan terendah saat jantung
istirahat (mengembang)
Mis : 120/80 ~ 120 : Sistolik
80 : Diastolik
1 Milyar penduduk dunia
Silent killer !!
Penyebab
Hipertensi Primer
90% Tidak diketahui penyebabnya
Hipertensi Sekunder
10% Berhubungan dengan:
Kelainan Ginjal
Kelainan Hormonal
Kelainan Pembuluh Darah
Dll.. : - Kehamilan
- Alat kontrasepsi
- Rokok
Klasifikasi Hipertensi
Klasifikasi T.D
Sistolik
Diastolik
Normal
<120
dan
<80
Prehipertensi
120-139
atau
80-89
Hipertensi ST. 1
140-159
atau
90-99
Hipertensi ST. 2
>=160
atau
>=100
JNC VII 2003
Gejala Hipertensi
(-)
Rasa berat/sakit bagian belakang kepala
Sulit tidur
Mudah tersinggung
Diagnosispasti:
pasti Mengukur
: Mengukurtekanan
tekanandarah
darah!!!
Diagnosis
Gejala lain
(+ Penyakit lain)
Lemah
Penglihatan kabur
Sakit dada
Napas pendek
Mual/muntah
Berdebar
Mimisan
Gelisah/perubahan
mental
Kesadaran turun
Kelumpuhan
Komplikasi
Kerusakan berbagai organ tubuh
Jantung
Komplikasi
Otak
Stroke
TIA
Ginjal
Penyakit ginjal kronis
Pembuluh darah perifer
Mata
Retinopati
Ginjal
Insufisiensi ginjal
Jantung
Hipertrofi ventrikel kiri
Hipertensi
Otak
Stroke
Pembuluh darah
Arteriosklerosis
Penyakit pembuluh darah perifer
Penyakit jantung koroner
PVD
Hipertensi
Dislipidemia
Merokok
Diabetes , dll
Hipertrofi
ventrikel kiri
remodelling
STROKE
Disfungsi endotel
Gagal jantung
kongestif
Disfungsi endotel
Faktor risiko
Disfungsi diastolik
Disfungsi sistolik
ventrikel kiri
Disritmia
mati mendadak
Gagal jantung
tahap akhir
KEMATIAN
Hipertensi
Gagal ginjal
tahap akhir
Tekanan
glomerulus
Disfungsi mesangial
sitokin
Proteinuria
sklerosis & fibrosis
Penatalaksanaan
Perubahan gaya hidup
Medikamentosa : Obat
Tujuan : Mengurangi morbiditas dan mortalitas akibat penyakit
kardiovaskular dan ginjal
Perencanaan makan
814 mmHg
28 mmHg
Aktivitas fisik
49 mmHg
Mengurangi konsumsi
alkohol
24 mmHg
Sesudah intervensi
Sebelum intervensi
penurunan
TD
Penurunan TD Sistol
(mmHg)
2
3
5
14
Keuntungan menurunkan
tekanan darah
Persentasepenguranganinsidens
Stroke
3540%
Infarkmiokard
2025%
Gagaljantung
50%
Jangan lupa!!
Kontrol tekanan darah secara teratur dan minum
obat secara teratur
Tekanan darah hanya dapat diketahui dengan
mengukurnya dan bukan sekedar dengan keluhan
ataupun perasaan
K A S I H
T E R I M A
T H
Y O
Without Compelling
Indications
With Compelling
Indications
Stage 1 Hypertension
Stage 2 Hypertension
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension
specialist.
SBP*
mmHg
DBP*
mmHg
Lifestyle
modification
<120
and <80
Encourage
Prehypertension
120139
or 8089
Yes
No antihypertensive drug
indicated.
Stage 1
Hypertension
140159
or 9099
Yes
Stage 2
Hypertension
>160
or >100
Yes
BP classification
Normal
Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.
Treat patients with chronic kidney disease or diabetes to BP goal of <130/80 mmHg.
With compelling
indications
Definition
HYPERTENSIVE CRISIS
is determined :
- by the rate of BP-rise, rather than actual BP,
- by vascular and organ status.
Form : HYPERTENSIVE EMERGENCY
( Life threatening, uncontrolled hypertension
with acute end-organ damage )
HYPERTENSIVE URGENCY
( Severe but not live threatening )
DEFINITION :
HYPERTENSIVE CRISIS
A severe elevation in BP, generally a SBP > 220 mm Hg and / or
DBP > 120 mm Hg. (JNC-VII, 2004)
1. HYPERTENSIVE EMERGENCIES
Severe elevation in BP complicated by acute target organ
dysfunction, such as coronary ischemia, stroke, intracerebral
hemorrhage, pulmonary edema, or acute renal failure.
2. HYPERTENSIVE URGENCIES
Severe elevations in BP without evidence of target organ
deterioration.
Risk factor :
Characteristics that related to Increasing
Risk Become Sick / Illness
Cardiovascular Risk Factor :
Characteristics that related to increasing
Risk become Cardiovascular Disease/
Abnormality
ATHEROGENESIS
Risk Factors
Smoking
Hypertension
Hyperlipidemia
Others (diabetes, coagulation
abnormalities,
hemocysteinemia,etc)
Fatty streak
Hyperlipidemia
Hypertension
Gender
Diabetes
Infection?
Obesity
Genetics
Age
Atherotrombotic Manifestations
(MI, Ischemic stroke, Vascular death
American Heart Association, Heart and Stroke facts: 1997 Statistical supplement;
Wolf Stroke 1990;21 (SUPPL 2):II-4II-6;Laurila et al. arterioscle TrombVasc bio 1997;17:2910-2913;Grau et
al. Stroke 1997;26;1724-1729; Graham et al JAMA 1997;277: 1775-1781;Brigden Postgrad
Med;101(5);249-262
parent or sibling <55 years of age if male, <65 years of age if female
Age :
male >45 years
Female >55 years or premature menopause without estrogen replacement
therapy (ERT)
Hypertensive (BP > 140/90 mmHg or taking antihypertensive medication)
Curent smoker
Type 2 diabetes
Low HDL-cholesterol (<35 mg/dl)
Negative Risk factor
If HDL-C is >60 mg/dl substract one risk factor
Homocysteine
Deficiencies in folate intake and reduced serum levels elevated
homocystein
Levels. Folate therapy shown to reduce homocysteine levels and improve
Endothelial function. Some hyperhomocysteinemic patients with other
enzyme abnormalities require pyridoxine or vitamin b12
Infectious agents
Local arterial infection (include Chlamydia pneumonia, Helicobacter
pylori, Cytomegalovirus and other herpes virus) cause coronary
atherosclerosis and postangioplasty restenosis.
Causative mechanism include endothelial injury, local inflammation,
smooth muscle proliferation with p53 inactivation, and autoimmunity
Sever
e
Vascular disease
Vascular
dysfunction
Target Organ
Damage
ACEI
ARB
Risk factors:
diabetes
hypertension
Angiotensin II
U.S. Department of
Health and Human
Services
National Institutes
of Health
The Seventh
Report of the
Joint National
Committee on
Prevention,
Detection,
Evaluation, and
Treatment of
High Blood
Pressure (JNC 7)
Stroke
Arrhythmia &
loss of muscle
Silent
Angina
Hibernation
CAD
Atherosclerosis
LVH
Risk factors
(CHOL, BP, DM, smoking)
platelets, fibrinogen
Sudden death
Remodelling
Ventricular
dilatation
Congestive
heart failure
End stage
heart
disease