HYPERTENSION

I.

DEFINITIONS
Hypertension is defined as persistent blood pressure where the systolic
pressure above 140 mmHg and a diastolic pressure above 90 mmHg.
(Tom Smith, 1995) According to the World Health Organization,
hypertension is an increase in systolic pressure greater than or equal to
160 mmHg and or diastolic pressure equal to or greater 95 mmHg
(Kodim Nasri, 2003). Categorized as mild hypertension if the diastolic
pressure between 95 104 mmHg, diastolic hypertension was if the
pressure is between 105 - 114 mmHg, and severe hypertension when
diastolic pressure of 115 mmHg or more. This division is based on an
increase in diastolic pressure is considered more serious because of the
increase in systolic (Tom Smith, 1995).
II. CAUSE
Hypertension based on the cause can be divided into two categories,
namely : (Lany Gunawan, 2001)
1. Essential hypertension (primary hypertension) that hypertension of
unknown cause.
2. Secondary hypertension is hypertension caused by other deseases.
Primary hypertension present in over 90% of patient with hypertension,
while the remaining 10% are caused by hypertension secondary. Although
hypertension primary cause is not knwn with certainty, data research has
found several factors that pften lead to hypertension. Factor is as follows :
1. Heredity
From the statistics prove that a person would have a greater chance to
get hypertension if their parents are hypertensive.
2. Individual traits
Characteristic of individuals that affect the incidence of hypertension
were age (if age whites).
3. Living habits
Living habits often cause hypertension is high salt intake (in excess of
30 g), obesity or overeating, stress, and other influences such as
smoking, drinking alcohol, taking drugs (ephedrine, prednisone,
epinephrine).

III. PATHOPHYSIOLOGY
The mechanism that control the contriction and relaxation of blood
vessels located centrally vasomotor, the medulla tmpered. This stems

from the central vasomotor sympathetic nerve pathway, wich continues

down to the spinal cord and exit the spinal cord colum sympathetic
At the same time stimulate the sympathetic nervous system in which
the blood vessels in response to emotional stimuli, the adrenal glands are
also stimulated, resulting in additional vasoconstriction activity. Adrenal
medulla scretes epinephrine, which causes vasoconstriction. The adrenal
cortex scretes cortisol and other steroids, wich can strengthen the
vasoconstriction response of blood vessels. Vasoconstriction resulting in
decreased flow to the kidneys, causing the release of renin. Stimulate the
formation of renin angiotensi I which is then converted to angiotensin II,
a potent vasoconstrictor, wich in turn stimulates aldosterone secretion by
the adrenal cortex. This hormone causes the retention of sodium and
water by the kidney tubules, causing an increase in intra-vascular volume.
All of these factors tend to trigger a state of hypertension.
For consideration of gerontology. Structural and functional changes in
the peripheral vascular system is responsible for the changes in blood
pressure that occurs in the elderly. These changes include atherosclerosis,
loss of elasticity of the connective tissue and a decrease in vascular
smooth muscle relaxation, wich in turn lowers the ability of tensile
strength distension and blood vessels. Consequently, the aorta and large
arteries less able to accommodate the volume of blood pumped by the
heart (volume sekuncup), resulting in decreased cardiac cheating and
increased peripheral resistance (Brunner and suddarth, 2002).
IV.

SIGNS AND SYMPTOMS

Signs and symptoms of hypertension can be divided into : (Edward K
Chung, 1995)
1. No symptoms
There are no specific symptoms that can be associated with increased
blood pressure, in addition to the determination of arterial pressure
checked by a doctor. This means that arterial hypertension will never
diagnosed when arterial pressure was not measured.
2. Symptoms commonly
It is often said that the common symptoms that accompany
hypertension include headache and fatigue. In fact this is a common
phenomenon that the majority of patients who seek medical help.

V.

DIAGNOSIS SUPPORT
A. History and thorough physical examination
B. Retinal examination

C. Laboratory test to determine damage to organs such as the kidneys

and heart
D. ECG to determine left ventricular hypertrophy
E. Urinalisa to determine protein in the urine, blood, glucose
F. Examination : renogram, intravenous pielogram renal anteriogram,
renal function test and determination of urine separately
G. Photos of the chest and CT scan

DAFTAR PUSTAKA

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Jakarta, Penerbit Hipokrates, 1999
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