HIPERTENSI

Rizki Ahmad Ferdian

Sri Kartini Pania Lumbantobing
Si Agung Bintang Triana Dewi
Zefanya Inggrid Margotje Rumuat
DEFINISI

Peningkatan tekanan darah ≥140/90 mmHg secara kronis.

Berdasarkan etiologinya :
• Hipertensi primer/esensial (insidens 80-95%) : hipertensi yang
tidak diketahui penyebabnya.
• Hipertensi sekunder : hipertensi akibat suatu penyakit atau
kelainan mendasari, seperti stenosis arteri renalis, penyakit
parenkim ginjal, feokromositoma, hiperaldosteronisme, dsb.
 BLOOD PRESSURE SBP (mmHg) DBP (mmHg)
CLASSIFICATION
NORMAL <120 <80
PREHYPERTENSION 120-139 Or 80-89
STAGE 1 140-159 0r 90-99
HYPERTENSION
STAGE 2 ≥ 160 Or ≥ 100
HYPERTENSION
(JNC VII)
PATOGENESIS
Mekanisme yang berperan dalam peningkatan tekanan darah :
– Mekanisme Neural : stress, aktivasi simpatis
– Mekanisme Renal : asupan natrium tinggi dengan retensi cairan
– Mekanisme Vaskular : disfungsi endotel, radikal bebas, remodeling pembuluh darah
– Mekanisme Hormonal : sistem renin, angiotensin, dan aldosteron.
DIAGNOSIS
 Diagnosis Hipertensi
• Anamnesis penderita harus dilakukan secara cermat: Riwayat Hipertensi (awal hipertensi,
jenis obat anti hipetensi, keteraturan konsumsi obat), disertai gejala
• Sakit kepala
• Rasa berat ditengkuk
• Pusing/migrain
• Mata kabur
• Epistaksis
• Sukar tidur
• Mata berkunang
• Lemah dan lelah

• Pemeriksaan fisik dilakukan sesuai dengan kecurigaan organ target yang terkena berdasarkan
anamnesis yang didapat:
• Pengukuran TD di kedua lengan.
• Palpasi denyut nadi di keempat ekstremitas.
• Auskultasi untuk mendengar ada/tidaknya bruit pembuluh darah besar, bising jantung dan ronki paru.
Pemeriksaan Fisik
• Nilai TD diambil dari rata-rata dua kali pengukuran pada setiap kali
kunjungan dokter.
• Apabila TD > 140/90 mmHg pada dua kali atau lebih kunjungan, maka
hipertensi dapat ditegakkan.
• Pemeriksaan TD harus dilakukan dengan alat dan ukuran yang baik.
Pemeriksaan Penunjang
• Pemeriksaan laboratorium awal:
• Urinalisis
• Hb, Ht, ureum, kreatinin, gula darah dan elektrolit

• Pemeriksaan lain:
• EKG
• Foto thorax
• CT Scan
• Echocardiogram
• Ultrasonogram
PENATALAKSANAAN
 JNC 8
2014 Evidence-Based Guidelines
for the Management of High
Blood Pressure in Adults
April 22, 2016
Why Do We Treat Hypertension?
• Hypertension can lead to:
• Myocardial infarction
• Stroke
• Renal failure
• Death
Blood Pressure Treatment Goals
• Persons 60 years or older without diabetes or CKD
• BP < 150/90 (based on strong evidence)
• Persons less than 60 years of age, with diabetes, and/or with CKD
• BP <140/90 (based on expert opinion)
Initial Therapy
• Non-black persons
• Angiotensin-converting enzyme inhibitor (ACEI)
• Angiotensin receptor blocker (ARB)
• Calcium channel blocker (CCB)
• Thiazide-type diuretic
• Black persons (including those with diabetes)
• CCB
• Thiazide-type diuretic
• Chronic kidney disease (regardless of race or diabetes status)
• ACEI or ARB as initial or add-on antihypertensive therapy
Strength of Recommendation
Recommendation 1
In the general population aged ≥60 years, initiate treatment at systolic
blood pressure (SBP) ≥150 or diastolic blood pressure (DBP) ≥90 and
treat to a goal SBP <150 and DBP <90.

Strong Recommendation – Grade A

Corollary Recommendation
In the general population aged ≥60 years, if treatment results in lower
achieved SBP (e.g. SBP <140) and treatment is well tolerated without
adverse effects on health or quality of life, treatment does not need to
be adjusted.

Expert Opinion – Grade E

Recommendation 2
In the general population <60 years, initiate treatment at DBP ≥90 and
treat to a goal DBP <90.

For ages 30-59 years, Strong Recommendation – Grade A

For ages 18-29 years, Expert Opinion – Grade E
Recommendation 3
In the general population <60 years, initiate treatment at SBP ≥140 and
treat to a goal SBP<140.

Expert Opinion – Grade E

Recommendation 4
In the population aged ≥18 with chronic kidney disease (CKD), initiate
treatment at SBP ≥140 or DBP ≥90 and treat to goal SBP <140 and DBP
<90.

Expert Opinion – Grade E

Based on the inclusion criteria used in the randomized controlled trials (RCTs) reviewed by the panel, this
recommendation applies to individuals <70 years with an estimated GFR or measured GFR <60 and in
people of any age with albuminuria defined as >30 mg of albumin/g of creatinine at any level of GFR.
Recommendation 5
In the population aged ≥18 years with diabetes, initiate treatment at
SBP ≥140 or DBP ≥90 and treat to a goal SBP <140 and DBP <90.

Expert Opinion – Grade E

Recommendation 6
In the general nonblack population, including those with diabetes, initial
antihypertensive treatment should include a thiazide-type diuretic, calcium
channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or
angiotensin receptor blocker (ARB).

Moderate Recommendation – Grade B

RCTs that were limited to specific nonhypertensive populations, such as those with coronary artery
disease (CAD) or heart failure (HF) were not reviewed for this recommendation. Therefore,
recommendation 6 should be applied with caution to these populations.

For more details regarding why other drug classes were not recommended for initial therapy please see
the notes for this slide.
Recommendation 7
In the general black population, including those with diabetes, initial
antihypertensive treatment should include a thiazide-type diuretic or
CCB.

For general black population: Moderate Recommendation – Grade B

For black patients with diabetes: Weak Recommendation – Grade C

For more information regarding why the other drug classes were not recommended as initial therapy for black
persons please see the notes for this slide.
Recommendation 8
In the population aged ≥18 years with CKD, initial (or add-on)
antihypertensive treatment should include an ACEI or ARB to improve
kidney outcomes. This applies to all CKD patients with hypertension
regardless of race or diabetes status.

Moderate Recommendation – Grade B

Recommendation 9
• The main objective of treatment is to attain and maintain goal BP.
• If goal BP is not reached within a month of treatment, increase the dose of the
initial drug or add a second drug from one of the classes in recommendation 6.
• The clinician should continue to assess BP and adjust the treatment regimen until
the goal BP is reached.
• If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the
list provided in recommendation 6.
• If goal BP cannot be reached using on the drugs in recommendation 6 because of
a contraindication or the need to use more than 3 drugs to reach goal BP,
antihypertensive drugs from other classes can be used.
• Referral to a hypertension specialist may be indicated for patients in whom goal
BP cannot be attained using the above strategy or for the management of
complicated patients for whom additional clinical consultation is needed.

Expert Opinion – Grade E

Figure continued on following slide.
KOMPLIKASI

• Serebrovaskular : stroke, transient ischemic attacks, demensia vaskular

• Mata : retinopati hipertensif
• Kardiovaskular : penyakit jantung hipertensif, disfungsi atau hipertrofi
ventrikel kiri, penyakit jantung koroner
• Ginjal : nefropati hipertensif, albuminuria, penyakit ginjal kronis
• Arteri perifer : klaudikasio intermitten