This document discusses guidelines and recommendations for measuring and managing hypertension. It defines hypertension as a systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher based on the average of two or more readings. The goals of treatment are to reduce cardiovascular risk, end organ damage, and mortality. Treatment involves lifestyle modifications like weight loss, reduced sodium intake, exercise, and limiting alcohol as well as pharmacotherapy including diuretics, ACE inhibitors, ARB, beta blockers, calcium channel blockers, and other antihypertensive drugs.

1. MAIMUN SYUKRI
*

2. 1. Bila tekanan sistolik >= 140 mmHg, dan
atau tekanan diastolik >= 90 mmHg,
atau sedang mendapat obat
antihipertensi.
2. Dilakukan dua kali atau lebih
pengukuran pada dua kali atau lebih
kunjungan.
*

3. *
Normal <120 and <80
Prehypertension 120–139 or 80–89
Stage 1
Hypertension
140–159 or 90–99
Stage 2
Hypertension
>160 or >100
BP
Classification
SBP
mmHg
DBP
mmHg

4. WHO/ISH 2003.

5. ESC/ESH 2003 .

6. *
Category Systolic blood pressure Diastolic blood pressure
(mmHg) (mmHg)
Optimal <120 <80
Normal <130 <85
High-normal 130–139 85–89
Hypertension
Grade 1 (mild) 140–159 90–99
Grade 2 (moderate) 160–179 100–109
Grade 3 (severe) 180 110
Isolated Systolic Hypertension
Grade 1 140 - 159 <90
Grade 2 >160 <90
Brit Med J 2004 328:634-40.

7. AUSTRALIA 2003

8. Method Brief Description
In-office Two readings, 5 minutes apart,
*
sitting in chair. Confirm elevated
reading in contralateral arm.
Ambulatory BP
monitoring
Indicated for evaluation of “white-coat”
HTN. Absence of 10–20% BP
decrease during sleep may indicate
increased CVD risk.
Self-measurement Provides information on response
to therapy. May help improve
adherence to therapy and evaluate
“white-coat” HTN.
JNC 7 2003

9.  Use auscultatory method with a properly calibrated and validated
instrument.
 Patient should be seated quietly for 5 minutes in a chair
(not on an exam table), feet on the floor, and arm supported at heart
level.
 Appropriate-sized cuff should be used to ensure accuracy.
 At least two measurements should be made.
 Clinicians should provide to patients, verbally and in writing,
specific BP numbers and BP goals.
*
JNC 7 2003

10. *
 ……… sphygmomanometer
 Patient should be seated and relaxed, preferably for several
minutes prior to the measurement and in a quiet room.
 Appropriate cuff size.
 Average the readings. If the firsty two readings differ by more than 10
mmHg systolic or 6 mmHg diastolic or if the initial readings are high,
take several readings after five minutes of quiet rest, until consecutive
readings do not vary by greater than these amounts.
 Ideally, patients should not take caffeine-containing beverages or
smoke for at least two hours before blood pressure is measured,
…………………..
Australia, 2004

11. *
When measuring blood pressure, care should be taken to
* ……….. to sit for several minutes in a quiet room before beginning blood
pressure measurements.
* Take at least two measurements spaced by 1-2 min, ………….
* Use a standard bladder ……. but have a larger and a smaller bladder available
for fat and thin arms, respectively.
* Have the cuff at the heart level, whatever the position of the patient.
* Use phase I and V …………….
* Measure blood pressure in both arms at first visit to detect possible
differences ……………………..
*Measure blood pressure 1 and 5 min after assumption of the standing
position in elderly subjects, diabetic patients,……………..
*Measure heart rate by pulse palpation (30 s) after the second
measurement in the sitting position.
ESC/ESH 2003

12. HIPERTENSI
Tekanan Darah :
• Rata-rata dari  2 kali pemeriksaan
• Pengukuran pada waktu yang berbeda
• Pengukuran pada waktu duduk
12

13. TD  kekuatan darah ketika melewati
dinding arteri
Jenis Hipertensi
Hipertensi Resisten
Hipertensi Emergensi
Hipertensi Urgensi
Berdasarkan Penyebab
Hipertensi Primer  idiopatik 90-95%
Hipertensi Skunder  Sistemik

14. Prevalensi Hipertensi 
USA 50 Juta dari total Penduduk
( 1 dari 4 orang dewasa)
Indonesia Baliem 0,65%
Sukabumi 28,6%

15. *
*Primary hypertension
*95% of all cases
*Secondary hypertension
*5% of all cases
*Chronic renal disease – most common

16.  Sleep apnea
 Drug-induced or related causes
 Chronic kidney disease
 Primary aldosteronism
 Renovascular disease
 Chronic steroid therapy and Cushing’s syndrome
 Pheochromocytoma
*
 Coarctation of the aorta
 Thyroid or parathyroid disease

17. *
 Hypertension*
 Cigarette smoking
 Obesity* (BMI >30 kg/m2)
 Physical inactivity
 Dyslipidemia*
 Diabetes mellitus*
 Microalbuminuria or estimated GFR <60 ml/min
 Age (older than 55 for men, 65 for women)
 Family history of premature CVD
(men under age 55 or women under age 65)
*Components of the metabolic syndrome.

18. *
 Heart
• Left ventricular hypertrophy
• Angina or prior myocardial infarction
• Prior coronary revascularization
• Heart failure
 Brain
• Stroke or transient ischemic attack
 Chronic kidney disease
 Peripheral arterial disease
 Retinopathy

19. *Categories of
hypertensive
end-organ damage
Origin Category
Large arteries Loss of compliance
(Dissecting) aneurysm
Peripheral occlusive arterial disease
Kidney Nephrosclerosis
Birkenhäger and de Leeuw (1992)

20. 20
Hipertensi & Kerusakan Organ Target

21. *
 Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose, and hematocrit
• Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
 Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine ratio
 More extensive testing for identifiable causes is not generally indicated
unless BP control is not achieved

22. *
 Goals of therapy
 Lifestyle modification
 Pharmacologic treatment
• Algorithm for treatment of hypertension
 Classification and management of BP for adults
 Followup and monitoring

23. *
 Reduce CVD and renal morbidity and mortality.
 Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients
with diabetes or chronic kidney disease.
 Achieve SBP goal especially in persons >50 years of age.

24. *Essential HTN is usually
- asymptomatic
- undetected for many years
- headache, BP elevated systolic
beyond 200 mmHg or BP rising
rapidly (can occur in malignant
HTN)
*

25. *Headache
*Blurred vision
*Chest pain
*Breathlessness
*Nausea, vomiting
*Anxiety, confusion, coma
*Seizures
*

26. *
End Organ Complications
Aorta Aortic disection
Brain Hipertensive encepahlopathy
Cerebral Infarction or Haemmorharge
Heart Cardiac failure
Myocardial ischemic or infarction
Kidney Renal failure
Haematuria
Gastrointestinal Anorexia,nausea,vomiting,abdominal
pain
Placenta Eclampsia
Other Micro-angiopathic haemolytic anemia

27. *
*Cardiac disease
Left ventricular failure
Angina
Myocardial infarction
*Cerebrovascular disease
Transient ischemic attacks
Stroke
Multi-infarct dementia
Hypertensive encephalopathy

28. *
*Vascular disease
Aortic aneurysm
Occlusive peripheral vascular disease
Arterial dissection
*Others
Progressive renal failure
Hypertensive retinopathy

29. * *Advancing age
*Positive family history of premature
cardiovascular disease
*Smoking
*Hypercholesterolemia

30. Hypertension is thought to account for :
- One–half of all deaths due to stroke
- Up to one quarter of coronary heart disease deaths

31. Isolated Systolic hypertension increase the risk
of :
* stroke and coronary heart disease by about
40%
* cardiovascular death by about 50%
* heart failure by about 50%

32. *Essential hypertension
(primer/idiopathic hypertension
remain uncertain
(genetic and environmental factors
contribute to development of hypertension)
*
*Secondary hypertension

33. *Renal parenchymal disease, causes :
- the glomerulonephritides
- diabetic nephropathy
- analgesic nephropathy
- adult polycystic kidney disease
*Renal artery stenosis
*Primary hyperaldosteronism
*
*Phaeochromocytoma

34. *
*Aortic coarctation
*Cushing’s syndrome
*Drug induced hypertension
- the oral contraception pill
- steroids
- NSAID
- immunosuppressive
- sympathomimetics
- anabolic steroids
- erythropoieti n
- monoamin oxidase inhibitors
*Thyrotoxicosis
*Rare monogenic syndrome

35. *Sign and symptoms
*Pointers to secondary hypertension
*Features of malignant hypertension
*End organ damage
*Hypertensive nephropathy
*Left ventricular hypertrophy
*Hypertensive retinopathy
*

36. *
Grade Features
I Mild narrowing or sclerosis of the retinal
arteriole, no symptoms,
Good general health
II Venous compression at artriovenous
crossing (A-V nipping) no symptoms,
good general health
III Retinal oedema, cotton wool spots,
hemmorhages, often symptoms
IV All above
Papiloedema,Symptomatic
Cardiac and renal function often
impaired, reduced survival

37. *
*Non Pharmacotherapy
(lifestyle modification)
*Pharmacotherapy

38. *Pengobatan
Tujuan:
ANGKA KESAKITAN
KERUSAKAN ORGAN TARGET
ANGKA KEMATIAN

39. Sasaran Pengelolaan
Menilai gaya hidup dan identifikasi faktor
risiko kardiovaskular lain atau gangguan
yang menyertai yang dapat
mempengaruhi prognosis & pengobatan
Mengetahui penyebab tekanan darah
yang tinggi
Menilai adanya kerusakan organ dan
penyakit kardiovaskular
39

40. *
JNC:
*Preventif
*Deteksi
*Evaluasi
*Pengobatan
JNC VI, 1997

41. *Untuk mencegah atau memperlambat terjadinya Hipertensi
*Merupakan solusi jangka panjang masalah hipertensi
*Mencegah terjadi komplikasi
*Dapat menghentikan atau mengurangi biaya pengobatan dan
komplikasi
*Preventif
NHBPEP Working Group Report on Primary Prevention of Hypertension

42. *Preventif
*Upaya preventif primer:
Terhadap individu yang potensial hipertensi:
TD normal tinggi
Riwayat keluarga hipertensi
Obesitas
Konsumsi tinggi garam
Kurang aktifitas
Konsumsi tinggi alkohol
*Diharapkan prevalensi Hipertensi turun

43. *Intervensi Preventif
Primer
Terbukti Efektif
*Turunkan BB
*Kurangi Garam
*Kurangi Alkohol
*Olah Raga
Efektif terbatas
*Manajemen Stres
*Kalium
*Minyak Ikan (Fish oil)
*Kalsium
*Magnesium
*Serat
*Cegak makronutrien

44. *Dilakukan di fasilitas kesehatan
dengan alat ukur yang standar dan
cara yang benar
*Pasien diberitahu tentang makna
TDnya
*Pasien dianjurkan melakukan
pemeriksaan periodik sesuai dengan
TD pertama
*Diharapkan ditemukan kasus *
tahap
awal

45. *
*Mencari penyebab hipertensi (sekunder)
*Memeriksa adanya kerusakan organ target dan
penyakit lain
*Mencari faktor risiko
*Mengetahui respon pengobatan, efek samping
dan kepatuhan pasien

46. *
Blood Pressure (mm Hg)
Grade 1 Grade 2 Grade 3
Mild
hypertension
Moderate
hypertension
Severe
hypertension
Other risk factors and
disease history
SBP 140–159
or DBP 90–99
SBP 160–179
or DBP 100–109
SBP  180
or DBP  110
I No other risk factors Low risk Med risk High risk
II 1–2 risk factors Med risk Med risk Very high risk
III 3 or more risk factors
or TOD or diabetes
High risk High risk Very high risk
IV ACC Very high risk Very high risk Very high risk
TOD = Target-organ damage
ACC = Associated clinical conditions
Guidelines subcommittee. WHO-ISH
Guidelines. J Hypertens 1999;17:151-183.

47. BP TARGETS:
WITHOUT COMPLICATION : <140/80 mmHg
DIABETES : < 130/80 mmHg
CKD : < 130/80 mmHg
PROTEINURIA > 1 g/d : <125/75 mmHg

48. *
Modification Approximate SBP
reduction
(range)
Weight reduction 5–20 mmHg/10 kg weight loss
Adopt DASH
eating plan
8–14 mmHg
Dietary sodium
reduction
2–8 mmHg
Physical activity 4–9 mmHg
Moderation of
alcoholconsumption
2–4 mmHg

49. *
Should be prescribed to reduce blood pressure
F Frequency - Four or five times per week
I
Intensity - Moderate
T
Time - 45-60 minutes
Type Dynamic exercise
- Walking
- Cycling
- Non-competitive swimming
T
For patients who are prescribed pharmacological therapy: Exercise should be prescribed as adjunctive therapy

50. *
*Diuretic
*ACE-Inh
*ARB
*Beta blocker
*Alpha blocker
* Direct renin inhibitor

51. *
TARGET <140/90 mmHg
INITIAL TREATMENT AND MONOTHERAPY
Lifestyle modification
Beta-blocker
Long-acting
DHP-CCB
therapy
Thiazide ARB
ACE-I
Alpha-blocker
as initial
monotherapy

52. *
* Strongly consider prescription if:
* Average DBP equal or over 90 mmHg and:
* Hypertensive Target-organ damage (or CVD) or
* Independant cardiovascular risk factors
* Elevated systolic BP
* Cigarette smoking
* Abnormal lipid profile
* Strong family history of premature CV disease
* Truncal obesity
* Sedentary Lifestyle
– Average DBP equal or over 80 mmHg and
diabetes

53. Diuretics
-blockers AT1 receptor
blockers
α-blockers Ca Antagonist
ACE Inhibitors
2003 Guidelines for Management of Hypertension, J of Hypertension 2003
C.I. : Verapamil + ßBlocker ESH-ESC 2003

54. *
Initial Drug Therapy
With Compelling
Indication
No drug indicated Drug(s) for the compelling
indications
Drug(s) for the compelling
indications; other
antihypertensive drugs
(diuretics, ACE-I, ARB, BB,
CCB) as needed
Drug(s) for the compelling
indications; other
antihypertensive drugs
(diuretics, ACE-I, ARB,
BB, CCB) as needed
BP Classification
Lifestyle
Modification
Without Compelling
Indication
Normal
<120/80 mm Hg
Prehypertension
120-139/80-89 mm Hg
Stage 1 hypertension
140-159/90-99 mm Hg
Stage 2 hypertension
≥160/100 mm Hg
Encourage
Yes
Yes
Yes
Thiazide-type diuretics
for most; may consider
ACE-I, ARB, BB, CCB, or
combination
2-drug combination for most
(usually thiazide-type diuretic
and ACE-I, ARB, BB, or
CCB)
ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin-receptor blocker; BB = beta blocker;
CCB = calcium channel blocker.
Chobanian AV et al. JAMA. 2003;289:2560-2572.

55. Compelling
Indication
Diabetes
Chronic kidney
disease
*
Recurrent stroke
prevention
Initial Therapy
Options
Clinical Trial
Basis
NKF-ADA
Guideline, UKPDS,
ALLHAT
NKF Guideline,
Captopril Trial,
RENAAL, IDNT,
REIN, AASK
PROGRESS
THIAZ, BB, ACE,
ARB, CCB
ACEI, ARB
THIAZ, ACEI
JNC 7 2003

57. *HIPERTENSI

58. * Afrita Mahyuni
*Antoni Ardhi
*Ardhiansyah
*Arfaliza
*Delly Fadlianti
*Desi Diana
*Devit Aprizal
*Handi Hendra
*Jenny
*Khairussaadah
*Juniar Sianipar
*Lia Farista
*Muhammad Yusuf
Nasution
*Nurhanifah
*Pardamean
*Ramlah Melina
Harahap
*Ruth Marliani Silalahi
*Yola Safitri
*Yogi Sugianto
*Yuyun Nailupar

59. hipertensi
adalah kondisi medis
di mana terjadi
peningkatan tekanan
darah secara kronis
(dalam jangka waktu
lama)
*
Yaitu penderita yang
mempunyai tekanan
darah yang melebihi
140/90 mmHg saat
istirahat.

60. TEKANAN
DARAH
tekanan yang dialami
darah pada pembuluh
arteri darah ketika
darah di pompa oleh
jantung ke seluruh
anggota tubuh manusia

61. *
Sphygmomanometer

62. *
1. Tidak
diketahui, 90-
95 % kasus
hipertensi
tidak diketahui
penyebabnya
( Primary
Hypertension)
2. Secondary Hypertension (5 to
10%)
*Kidney Abnormalities
*Narrowing of certain
arteries
*Rare tumors
*Adrenal gland
abnormalities
*Pregnancy

63. *

64. *
Hipertensi diperkirakan menjadi penyebab kematian sekitar
7,1 juta orang di seluruh dunia, yaitu sekitar 13% dari total
kematian.

65. *

66. *

67. *
1. Controllable Risk
Factors
*Increased salt
intake
*Obesity
*Alcohol
*Stress
*Lack of exercise

68. 2. Uncontrollable Risk
Factors
* Heredity
* Age
* Men between age 35 and 50
* Women after menopause
* Race
* 1 out of every 3 African
Americans
* Higher incidence in non-
Hispanic blacks and
Mexican Americans

69. *
Penurunan berat badan
penurunan asupan garam
menghindari faktor resiko
(merokok, minum alkohol,
hiperlipidemia dan stres)
Diuretik
Golongan penghambat
simpatetik
Penyekat Beta (β-blocker)
Vasodilator
Penghambat ACE
Antagonis kalsium

70. *

71. *
*Diuterika
Obat yang dapat mempertinggi sekresi urin. Secara umum
obat dalam golongan ini bekerja menghambat reabsorpsi
elektrolit pada sistem tubulus, dengan begitu osmolalitas
lumen dipertinggi, sehingga pengambilan cairan ditekan. Obat
yang termasuk golongan ini umumnya dapat menurunkan
tekanan darah.
Contoh:
- Asetozolamida - Furosemida - Manitol
- Hidroklortiazid - Triamteren

72. *GOLONGAN PENGHAMBAT SIMPATETIK
Penghambatan aktifitas simpatetik dapat
terjadi pada pusat vasomotor otak (
metildopa dan klonidin) atau pada ujung
saraf perifer (reserpin dan guanetidin)
Metil dopa mempunyai efek antihipertensi
dengan menurunkan tonus simpatis secara
sentral, serta mengganti norefinefrin di
saraf perifer dengan metabolit metil dopa
yang kurang poten
Efek samping: anemia hemolitik, gangguan
faal hati dan kadang-kadang hepatitis kronik.

73. *PENYEKAT BETA (Β-BLOCKER)
Mekanisme kerja adalah melalui penurunan curah jantung dan
penekanan sekresi renin, dibedakan atas 2 jenis:
= yang menghambat reseptor β1
= yang menghambat reseptor β1 dan β2
Efek samping terjadi karena obat tidak selektif terhadap
reseptor β2 sehingga menimbulkan bradikardi.
Kontraindikasi pada pasien asma bronkial, gagal jantung, dan
blok atrioventrikular. Hati-hati pada pasien diabetes melitus.
Contoh: propanolol

74. *VASODILATOR
- Mekanisme obat dengan melepaskan nrogen oksida (NO)
akan mengaktifkan guanilat siklase dengan hasil akhir
defosforilasi berbagai protein termasuk protein kontraktil
dalam sel otot polos. Sehingga obat ini bisa merelaksasi
secara langsung otot polos arteriol atau vena, berakibat
penurunan resistensi pembuluh darah.
- Efek samping yang terjadi disebabkan oleh efek
antihipertensi yang berlebihan.
Contoh: Hidralazin

75. *PENGHAMBAT ACE
ACE (Angiotensin Converting Enzyme) mengubah
angiotensin I menjadi Angiotensin II yang aktif dan
mempunyai efek vasokontriksi pembuluh darah. Dengan
penghambat ACE maka Angiotensin II menurun. Yang
pertama digunakan dalam klinik adalah enalpril dan
kaptopril.

76. *
1. Ketahui tekanan darah anda
Apakah diperiksa secara teratur ?
2. Ketahui berat badan anda
Apakah proporsional?
3. Jangan gunakan garam yang berlebih pada makanan
Hindari makanan asin
4. Makan makanan yang diet rendah lemak
5. Jangan merokok

77. 6. Minum obat seperti yang sudah diresepkan
7. Sering berkonsultasi dengan dokter
8. Rutin berolahraga
9. Ajak anggota keluarga anda untuk mengontrol tekanan darah
secara teratur
10. Hiduplah secara normal dan bahagia.