Hypertension management

with Chronic Kidney Disease

Terminologi
• Hypertension – tekanan darah tinggi diluar normal
• Reseptor - adalah struktur kimia, terdiri dari
protein, yang menerima dan menyalurkan sinyal
untuk diintegrasikan ke dalam sistem
• Vasodilator – pembesar pembuluh darah
• Arteri: arteriodilator
• Vein: venodilator
• Vasoconstriction – penyempit pembuluh darah
• Arteri: arterioconstrictor
• Vein: venoconstrictor
 Prevalence
World Data

https://www.who.int/images/default
-source/infographics/ncds/one-in-4-
men.jpg?sfvrsn=a28796ef_2
Local Data
• “Indonesia Family Life Survey (IFLS-5)
• >18yo
• Usia rata- 43.3
Di Ukur:
• Tekanan darah
• Tinggi badan
• Berat badan
• Pola Makan
• Aktivitas fisik
• Merokok
• Psychosocial variable
 Male Female AWARE UN AWARE

Hasil
Penelitian • Prevalence 33.4 %
• Laki-laki: 31.0%
35.4 51.1
• Perempuan: 35.4%
• 42.9% were aware
33.4 • 11.5% were treated
• 14.3% were controlled

31 42.9
Treated Controlled
11.5% 14.3%

hypertensive nonhypertensive
37.34M 614T
86.84M 4.2M
Epidemiology
hipertensi
RISKESDAS
Epidemiology
Hipertensi
RISKEDAS
 Diagnosis Hipertensi

Diagnosis hipertensi ditegakkan bila TDS ≥140 mmHg

dan/atau
TDD ≥90 mmHg pada pengukuran berulang di klinik
KATEGORI TDS TDD
Optimal < 120 mmHg dan <80 mmHg

Normal 120-129 mmHg dan/atau 80-84 mmHg

Normal-tinggi 130-139 mmHg dan/atau 85-89 mmHg

Hipertensi derajat 1 140-159 mmHg dan/atau 90-99 mmHg

Hipertensi derajat 2 160-179 mmHg dan/atau 100-109 mmHg

Hipertensi derajat 3 ≥ 180 mmHg dan/atau ≥ 110 mmHg

Hipertensi sistolik terisolasi ≥ 140 mmHg dan < 90 mmHg

Konsensus Penatalaksanaan Hipertensi 2019

 Chronic Kidney
Disease

• Chronic kidney disease

(CKD) is defined as
persistent kidney damage
accompanied by a reduction
in the glomerular filtration
rate (GFR) and the presence
of albuminuria
Epidemiology
(RISKEDAS)
Epidemiololgy
Pathophysology
Treatment Hypertension
with CKD
Ambang Batas TD untuk Inisiasi Obat

Konsensus Penatalaksanaan Hipertensi 2019

Strategi Penatalaksanaan
Hipertensi Tanpa Komplikasi

Konsensus Penatalaksanaan Hipertensi 2019

Strategi Pengobatan pada Hipertensi dan PGK

Konsensus Penatalaksanaan Hipertensi 2019

 Recommendations for Treatment of Hypertension in
COR LOE
Patients With CKD
SBP: Adults with hypertension and CKD should be treated to a
I B-RSR BP goal of less than 130/80 mm Hg.
DBP:
C-EO
Chronic In adults with hypertension and CKD (stage 3 or higher or
Kidney stage 1 or 2 with albuminuria [≥300 mg/d, or ≥300 mg/g
IIa B-R albumin-to-creatinine ratio or the equivalent in the first
Disease morning void]), treatment with an ACE inhibitor is
reasonable to slow kidney disease progression.
In adults with hypertension and CKD (stage 3 or higher or
stage 1 or 2 with albuminuria [≥300 mg/d, or ≥300 mg/g
IIb C-EO albumin-to-creatinine ratio in the first morning void]),
treatment with an ARB may be reasonable if an ACE
inhibitor is not tolerated.

SR indicates systematic review.

 Treatment of hypertension in patients with CKD

BP goal <130/80 mm Hg
(Class I)

Albuminuria
(≥300 mg/d or ≥300 mg/g
creatinine)

Management Yes No

of ACE inhibitor Usual “first-line”

(Class IIa) medication choices
Hypertension
in Patients
ACE inhibitor
With CKD intolerant

Yes No

ARB* ACE inhibitor*

(Class IIb) (Class IIa)

•Colors correspond to Class of Recommendation in Table 1.

•*CKD stage 3 or higher or stage 1 or 2 with albuminuria ≥300 mg/d or ≥300 mg/g
creatinine.
•ACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BP
blood pressure; and CKD, chronic kidney disease.
Hypertension After Renal Transplantation

Recommendations for Treatment of Hypertension

COR LOE
After Renal Transplantation
SBP: After kidney transplantation, it is reasonable to treat patients
IIa B-NR with hypertension to a BP goal of less than 130/80 mm Hg.
DBP:
C-EO
After kidney transplantation, it is reasonable to treat patients
with hypertension with a calcium antagonist on the basis of
IIa B-R improved GFR and kidney survival.