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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 ↑
• Cause
Hypertension in Pregnancy
• Consists of :
• Thiazide diuretic,
• Loop diuretic,
• Potassium sparing diuretic (aldosteron antagonist &
triamterene-amiloride)
• Osmosis diuretic
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