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Hipertensi

Preface
• Elevated arterial blood Sistol  heart
contraction
pressure persistenly
Description (Dipiro et al, 2008)
Diastol  heart
dilatation

• TD : Sistol/diastol mmHg
Hypertension :
• Normal : 120/80 mmHg
Value • CV Function range till
Sistol ≥140 mmHg
Diastol ≥ 90mmHg
105/60 mmHg

WHO (2013) A Global Brief on Hypertension Silent Killer, Global Public Health Crisis
Classification
ETIOLOGY
Pathophysiology
Pathhysiology Scheme
RENIN ANGIOTENSIN
ALDOSTERON SYSTEM
• Renin  an enzyme that is stored in the juxtaglomerular cells,
which are located in the afferent arterioles of the kidney
• The release of renin is modulated by :
• Intrarenal factor: renal perfusion pressure, cathecolamin,
angiotensin II
• Extrarenal factor: level Na, K, dan Cl
Antidiuretic Hormone
Blood
Pressure ↑
Sympathetic Nerves
Response of Adrenergic Receptors
related Blood Pressure
• Vasoconstriction
α1
• Vasoconstriction
α2 • inhibit neurotransmitter release pra sinaps

• Heart contractility
β1
• vasodilatation
β2
Receptor β3 (hypothesis)

http://www.ncbi.nlm.nih.gov/pubmed/15170407
Mechanism
Induce
Sympathetic
Nerves

α1, α2 β1

Heart
vasoconstriction
Contractility ↑

Peripheral Cardiac output


Resistance ↑ ↑
Pregnancy
Pregnancy Induced Hypertension (PIH)
• Pregnancy Induced Hypertension = Gestational
Hypertension  hypertension with onset in the latter part
of pregnancy (>20 weeks' gestation) without any other
features of preeclampsia, and followed by normalization of
the blood pressure postpartum

• Cause 
Hypertension in Pregnancy

Pre eclampsia Gestational


Eclampsia Hypertension
BP ≥ 140/90 mmHg appears
after 20 weeks gestation the onset of new-onset hypertension
accompanied by convulsions in preeclampsia, arising after
new-onset proteinuria (≥300 is a medical emergency midpregnancy in the absence
mg/24 hours) of proteinuria

Chronic Hypertension Superimposed pre


elevated BP that is noted eclampsia dand chronic
before the pregnancy began hypertension
MANAGEMENT OF
HYPERTENSION
Non
Pharmacology
Blood
Pressure
Goal
Pharmacology
Non Pharmacology
Pharmacology
DIURETIC
• Diuretic diuresis ↑  fluid volume ↓  stroke volume ↓ 
cardiac output ↓

• Consists of :
• Thiazide diuretic,
• Loop diuretic,
• Potassium sparing diuretic (aldosteron antagonist &
triamterene-amiloride)
• Osmosis diuretic

• High Ceiling Diuretic = Loop Diuretic


Mechanism of action Diuretic
Central α
Agonis
β Blocker
α1 Blocker

Prazosin
Terazosin
Doxazosin
Minimal side effect, most happen
is “first dose” effect which is
orthostatic hypertension
Peripheral
adrenergic blocker

Guanetidin
Guanadrel
Vasodilator
Ca Channel
Blocker
Ion Ca2+ channel Type
ACE Inhibitor
Angiotensin II
Receptor Blocker
Potential Drug Interaction
Pharmacology
Alternative antihypertensive agent
Goal of Therapy
• Decrease mortality and morbidity risk related target organ
damage (CV events, heart failure, kidney disease, etc)
 Surrogate goal : BP goal  to lower risk
Guideline
Dirjen P2PL,
2006
Guideline 2014
(JAMA)
Dipiro,
2008

2014
JNC 7
Guideline Comparison
ANTIHYPERTENSIVE FOR PREGNANCY
ANTIHYPERTENSIVE FOR CHILDREN
AAFP. Vol
73, 2006
Emergency Hypertension Therapy
Resistance and Monitoring Therapy
Patient Education
• Hypertension Management Control BP  neep patient’s
compliance on lifestyle modification and pharmacology
therapy
• Uncontrolled hypertension  increase mortality and
morbidity risk related target organ damage
• Patient need to monitor their BP  monitor effectiveness of
therapy
• Give information about factors which will increase BP
• Sufficient drug information  what, how to use, effect, goal
therapy, side effect, drug interaction, and storage
Reference
• Dipiro J, et al. 2008. Pharmacotherapy A Pathophysiologic Approach 7th
Ed. McGrawHill
• Chisholm-Burns M, Wells B, Schwinghammer T, Malone P M, Kolesar J M,
Rotschafer J, Dipiro J. 2008.Pharmacotherapy Principles & Practice.
McGrawHill
• Reams G, Bauer J. Pharmacologic Treatment of Hypertension. Kidney
Atlas.
• Opie LH.2012. Drug Interactions of Antihypertensive Agents. S Afr Fam
Pract 2012;54(2)(Suppl 1):S23-S25
• WHO.2013. A Global Brief on Hypertension.
• Alldredge Brian et al(ed). 2013. Koda-Kimble & Young’s Applied
Theurapeutics The Clinical Use of Drugs 10th ED. Wolters Kluwer Lippincot
Wiliam & Wilkins
• James Paul et al. 2014. 2014 Evidence-Based Guideline for The
Management of High Blood Pressure in Adults Report From the Panel
Members Appointed to the Eighth Joint National Committee (JNC 8).
JAMA 311(5):507-520
• Vikrant S, Tiwari SC. 2001. Essential Hypertension-Pathogenesis and
Pathophysiology. Journal Indian Academy of Clinical Medicine (2) 141-
161
• Hipertensi pulmonal pada neonatal menggunakan sildenafil?
EBM-nya
• pengukuran tekanan darah yang optimal? Geriatri dberikan
nifedipin regimen dosisnya lebih kecil dari umumnya gimana
cara komunikasinya?
• Na nitropruside pada hipertensi emergensi?
FDA memberikan kategori
“WARNING” pada penggunaan
sildenafil di pasien anak dengan
usia 1-17 tahun dikarenakan
resiko mortalitas meningkat.
Jadi penggunaan sildenafil pada
pasien anak PAH harus disertai
monitoring