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OBAT HIPERTENSIdr. Hj. Darmiana, MM
Mencegah komplikasi Menurunkan kejadian vaskuler
Kardiovaskuler Serebrovaskuler Renovaskuler
Melalui penurunan dan pengendalian tekanan darah sesuai target serta pengobatan faktor-faktor risiko yang reversibel
TUJUAN PENGOBATAN
Management of hypertension
1. Non pharmacological
2. Pharmacological
MODIFIKASI GAYA HIDUP UNTUK PENGENDALIAN
HIPERTENSIMODIFI-KASI
REKOMEN-DASI
PENURUN-AN TDS
BB BMI 18,5-24,5 5-20mmHg , setiap turun BB10kg
DASH Konsumsi buah, sayur banyak, susu rendah lemak&lemak jenuh
8-14mmHg
Asupan garam
≤ 2,4gr/hari 2-8mmHg
Aktifitas fisik OR teratur 30meit perhari
4-9gr
Alkohol Batasi 2-4gr
Pharmacological
0BAT INDIVIDUAL SEUMUR HIDUP PRINSIP KENDALIKAN TEKANAN DARAH CEGAH KOMPLIKASI
Stratification of CV risk in four categories
Blood pressure (mmHg)
Other risk factors, TOD or disease
Normal SBP 120-129 or DBP 80-84
High normal SBP 130-139 or DBP 85-89
Grade 1 HTSBP 140-159 or DBP 90-99
Grade 2 HTSBP 160-179 or DBP 100-109
Grade 3 HT SBP ≥180 or DBP ≥110
No other risk factors
Average risk
Average risk
Low added risk
Moderate added risk
High added risk
1-2 risk factorsLow added risk
Low added risk
Moderate added risk
Moderate added risk
Very high added risk
3 or more risk factors, TOD, DM or MS
Moderate added risk
High added risk
High added risk
High added risk
Very high added risk
Established CV or renal disease
Very high added risk
Very high added risk
Very high added risk
Very high added risk
Very high added risk
Guidelines Committee of the 2003 ESH-ESC guidelines for the management of arterial hypertension. J Hypertens 2003;21:1011-53
FAKTOR RESIKO KARDIOVASKULER
Ada tidaknya Faktor Resiko Usia lanjut Male gender Merokok Riwayat keluarga prematur cardiovaskuler
disease ( laki-laki < 55 tahun dan perempuan < 65 tahun)
Gangguan lemak (kolesterol atau trigliseride tinggi)
Pola hidup tidak sehat Obesitas Gangguan metabolisme glukosa
Ada tidaknya Target Organ yang rusak Ginjal : laboratorium Jantung : rekam jantung (EKG) Mata : funduscopy Otak : stroke
Ada tidaknya Aterosklerotic Vasculer Disease
TIA / stroke Penyakit jantung koroner Penyakit arteri perifer
Initiation of antihypertensive treatmentOther risk factors, Target Organ Damage or disease
Normal SBP 120-129 or DBP 80-84
High normal SBP 130-139 or DBP 85-89
Grade 1 HTSBP 140-159 or DBP 90-99
Grade 2 HTSBP 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 TOD Lifestyle changes
Lifestyle changes and consider drug treatment Lifestyle changes +
drug treatmentLifestyle changes + drug treatment
Lifestyle changes + immediate drug treatment
Diabetes Lifestyle changesLifestyle changes + 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
Uncomplicated hypertension
High CAD risk, Stable Angina, STEMI,
UA/NSTEMI
< 140/90 mmHg
< 130/80 mmHg
Diabetes Mellitus (DM) and/orChronic Kidney Disease
< 130/80 mmHg
Renal Failure with Proteinuria > 1 gr/24 hours
< 125/75 mmHg
Goals of Therapy
LVD < 120/80 mmHg
JNC-7, 2003WHO-ISH/ESH-ESC, 2007
Mosher M, et al. J Clin Hypertens 2008;10(2):390-397
1-blockers
2007 ESH/ESC Guidelines
CCBs
Diuretics
ACE inhibitors
AT1-receptor blockersß-blockers
Mancia G, et al. 2007 ESH/ESC Guidelines for the Management of Arterial Hypertension. J Hypertens 2007;25:1105-1187
TERIMA KASIH
