Hipertensi

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  • Hipertensi

    1. 1. HIPERTENSI Oleh: Divisi Humas MER-C
    2. 2. 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,
    3. 3. Klasifikasi Hipertensi : JNC VII <ul><li>Hypertension is defined as blood pressure  140/90 mmHg </li></ul>JNC VII. JAMA 2003;289:2560-2572 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
    4. 4. Penyebabnya apa? <ul><li>Sekitar 90 % penderita hipertensi tidak diketahui penyebabnya, disebut sebagai hipertensi esensial atau hipertensi primer . </li></ul><ul><li>Para ahli sependapat bahwa hipertensi esensial berhubungan dengan faktor keturunan (herediter). </li></ul>
    5. 5. Kalau yang sekunder? <ul><li>Sekitar 5-10% penderita hipertensi berhubungan dengan penyakit ginjal , 1-2% berhubungan dengan kelainan hormonal atau pemakaian obat tertentu (misalnya pil KB). </li></ul><ul><li>Kegemukan (obesitas), </li></ul><ul><li>Gaya hidup yang tidak aktif (malas olah raga, </li></ul><ul><li>Stress, </li></ul><ul><li>alkohol </li></ul><ul><li>Garam (makanan yg asin banget) </li></ul>
    6. 6. Usia Yang Paling Rentan 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) Persentase 4 11 21 44 54 64 65
    7. 7. 25% 12.5% 12.5% 50% Berobat tapi tidak kontrol rutin Berobat dan terkontrol Yang tidak tahu Pasien yang tidak berobat dan tidak kontrol Source : Joffres et al. (1997) Am. J. Hypertension 10: 1097-1102 RULE OF HALF
    8. 8. Komplikasi Hipertensi <ul><li>Kerusakan tergantung pada: </li></ul><ul><ul><li>seberapa tinggi tekanan darah </li></ul></ul><ul><ul><li>Berapa lama tidak terkontrol dan tertangani </li></ul></ul>Target Gagal Organ Mata retinopathy Ginjal Gagal Jintang Otak stroke Jantung Peny.Jantung Koroner Pembesaran Jantung kiri Gagal Jantung Peripheral arterial disease
    9. 9. PENGOBATAN <ul><li>DIET. </li></ul><ul><li>MENURUNKAN BERAT BADAN. </li></ul><ul><li>OLAH RAGA AEROBIK. </li></ul>
    10. 10. ASK-DNC ATP-III 2001 - Criteria IDF 2005 - Criteria GULOH CISAR PEDIATRIC OBESE WORLD OBESITY TRENDS GLOBESITY – DIABESITY (Summarized : Tjokroprawiro 2005-2007) Stage― 3 or the MetS will be &quot;TIME-BOMB DISEASE ” in Indonesia ? Pre c lini c al : the MetS IFG, IGT, Pedr.-Obese Healthy Lifestyle “ Westernized” Unhealthy Lifestyle Obesit y (Abdominal Obesit y ) STAGE – 0 STAGE – 1 STAGE – 2 STAGE – 3 STAGE – 4 Clinical : CAD T2DM, 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/dl o + o Lingkar Pinggang > 90 cm > 80 cm + o o PEDIATRIC T2DM 44
    11. 11. ASK-DNC TEN PRACTICAL GUIDELINES FOR HEALTHY LIFE GULOH-CISAR = SYNDROME-10 (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-CS 2 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) &quot;MABUK&quot; (Rich in Chromium) : M rica, A pel, B rokoli, U dang, K acang-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 = Hypertension C = Cigarette I = Inactivity S = Stress A = Alcohol R = Regular Check Up
    12. 12. Initiation of Antihypertensive treatment : ESC 2OO7 Other 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

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