HIPERTENSI

Oleh:Divisi Humas MER-C

Apa itu hipertensi?

Tekanan darah tinggi (hipertensi) adalah peningkatan tekanan darah di dalam arteri (pembuluh darah nadi) di atas angka normal. Seringkali hipertensi terjadi tanpa gejala, sehingga penderita tidak merasa sakit. Pada pemeriksaan tekanan darah (tensi) akan didapat 2 angka yakni angka yang atas diperoleh saat jantung berkontraksi (sistolik) sedangkan angka bawah diperleh saat jantung relaksasi (diastolik). Sehingga hasil pemeriksaan tensi menunjukkan sekian per sekian,

Klasifikasi Hipertensi : JNC VII

Hypertension is defined as blood pressure 140/90 mmHg

Kategori Systolic

(mmHg)

Diastolic

(mmHg)

Normal <120 and <80

Prehypertension 120-139 or 80-89

Stage 1 hypertension 140-159 or 90-99

Stage 2 hypertension 160 or 100

JNC VII. JAMA 2003;289:2560-2572

Penyebabnya apa?• Sekitar 90 % penderita hipertensi tidak diketahui

penyebabnya, disebut sebagai hipertensi esensial atau hipertensi primer.

• Para ahli sependapat bahwa hipertensi esensial berhubungan dengan faktor keturunan (herediter).

Kalau yang sekunder?• Sekitar 5-10% penderita hipertensi berhubungan

dengan penyakit ginjal, 1-2% berhubungan dengan kelainan hormonal atau pemakaian obat tertentu (misalnya pil KB).

• Kegemukan (obesitas), • Gaya hidup yang tidak aktif (malas olah raga,• Stress,• alkohol • Garam (makanan yg asin banget)

Franklin, S.S., J Hypertens 1999; 17 (suppl 5): S29-S36

0

10

20

30

40

50

60

70

18-29 30-39 40-49 50-59 60-69 70-79 80+

SBP > 140 mm Hg DBP > 90 mm Hg

Usia)

Per

sen

tase

4 11

21

44

54

64 65

Usia Yang Paling RentanUsia Yang Paling Rentan

25% 12.5%

12.5%

50%

Berobat tapi tidak kontrol rutin

Berobat dan terkontrolYang tidak tahu

Pasien yang tidak berobat

dan tidak kontrol

Source : Joffres et al. (1997) Am. J. Hypertension 10: 1097-1102

RULE OF HALF

Komplikasi HipertensiKomplikasi Hipertensi

Kerusakan tergantung pada:

• seberapa tinggi tekanan darah

• Berapa lama tidak terkontrol dan tertangani

Target Gagal Organ

Mataretinopathy

GinjalGagal Jintang

Otakstroke

JantungPeny.Jantung Koroner

Pembesaran Jantung kiriGagal Jantung

Peripheral arterial disease

PENGOBATAN

• DIET. • MENURUNKAN BERAT BADAN. • OLAH RAGA AEROBIK.

ASK-DNC

PEDIATRIC

OBESE

ATP-III 2001 - Criteria

WORLD OBESITY TRENDS GLOBESITY – DIABESITYWORLD OBESITY TRENDS GLOBESITY – DIABESITY(Summarized : Tjokroprawiro 2005-2007)(Summarized : Tjokroprawiro 2005-2007)

Stage― 3 or the MetS will be "TIME-BOMB DISEASE” in Indonesia ?

PrePreccliniliniccalal : the MetS : the MetSIFG, IGT, Pedr.-ObeseIFG, IGT, Pedr.-Obese

Healthy LifestyleHealthy Lifestyle ““Westernized”Westernized”

Unhealthy LifestyleUnhealthy LifestyleObesitObesityy

(Abdominal Obesit(Abdominal Obesityy))

STAGESTAGE –– 0 0 STAGESTAGE –– 11 STAGESTAGE –– 22 STAGESTAGE –– 33 STAGESTAGE –– 44Clinical : CADClinical : CAD

T2DM, Pedr.-T2DM, StrokeT2DM, Pedr.-T2DM, Stroke

3 Blood Pressure

> 130/85 mmHg

4 GDS

> 100 mg/dl

1 Triglyceride

> 150 mg/dl

2 HDL-Chol

< 40 mg/dl < 50 mg/dlo+o

Lingkar Pinggang > 90 cm > 80 cm+oo PEDIATRIC

T2DM

IDF 2005 - Criteria

44

GULOH CISAR

ASK-DNC

TEN PRACTICAL GUIDELINES FOR HEALTHY LIFETEN PRACTICAL GUIDELINES FOR HEALTHY LIFE

GULOH-CISAR = SYNDROME-10GULOH-CISAR = SYNDROME-10

(Tjokroprawiro 1995-2007)(Tjokroprawiro 1995-2007)

34

G

U

L

O

H

1

2

3

4

5

C

I

S

A

R

6

7

8

9

10

Stop Smoking

Daily Regular Exercise : TAKE MINIMALLY 6-HOUR SLEEP/DAY

Stop Alcohol

Regular Check-Up Esp. > 40 Years Old : 3, 6 or 12 Months

Limit Sugar Consumption

Restrict Purine Intake : JAS-BUKET

Consume Low Fat Diet : TEK-KUK-CS2

Prevent Obesity (Target : BMI < 25)

Measure BP Regularly(Less than g Sodium/day)3

+300 kcal/day or 3 km walk+Sit up 50-100 x/day

JAS-BUKET : Jerohan, Alkohol, Sarden - Burung Dara, Unggas, Kaldu, Emping, Tape(Bowels, Alcohol, Sardines - Pigeon, Fowls, Meat-Broth, Beaten Nut, Fermented Cassava)

TEK-KUK-CS2 : Telor, Keju - Kepiting, Udang, Kerang - Cumi, Susu, Santen

(Egg, Cheese - Crab, Shrimp, Mussel - Squid, Milk, Coconut - Juice)

"MABUK" (Rich in Chromium) : Mrica, Apel, Brokoli, Udang, Kacang-kacangan; good for DM

Recommended Food Supplements : Green Bean, Onions, Green Tea, Pepper, ARGININE, TKW-PJKA-BK

G = Glucose U = Uric Acid L = Lipids O = Obesity H = HypertensionC = Cigarette I = Inactivity S = Stress A = Alcohol R = Regular Check Up

Initiation of Antihypertensive treatment : ESC 2OO7Other risk factors, OD, or disease

Normal SBP 120-129 or DBP 80-84

High normal SBP 130-139 or DBP 85-89

Grade 1 HT SBP 140-159 or DBP 90-99

Grade 2 HT SBP 160-179 or DBP 100-109

Grade 3 HT SBP 180 or DBP 110

No other risk factors

No BP intervention

No BP intervention

Lifestyle changes for several months then drug treatment if BP uncontrolled

Lifestyle changes for several weeks then drug treatment if BP uncontrolled

Lifestyle changes + immediate drug treatment

1-2 risk factors Lifestyle changes

Lifestyle changes

Lifestyle changes for several weeks then drug treatment if BP uncontrolled

Lifestyle changes for several weeks then drug treatment if BP uncontrolled

Lifestyle changes + immediate drug treatment

3 risk factors, MS or OD

Lifestyle changes

Lifestyle changes and consider drug treatment

Lifestyle changes + drug treatment

Lifestyle changes + drug treatment

Lifestyle changes + immediate drug treatment

Diabetes Lifestyle changes

Lifestyle changes + drug treatment

Lifestyle changes + drug treatment

Lifestyle changes + drug treatment

Lifestyle changes + immediate drug treatment

Established CV or renal disease

Lifestyle changes + immediate drug treatment

Lifestyle changes + immediate drug treatment

Lifestyle changes + immediate drug treatment

Lifestyle changes + immediate drug treatment

Lifestyle changes + immediate drug treatment