Kusman Ibrahim, Ph.D.

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• Hypertension is one of the
most common worldwide
diseases afflicting humans
• Hypertension is the most
important modifiable risk factor
for coronary heart disease (the
leading cause of death in
North America), stroke (the
third leading cause),
congestive heart failure, end-
stage renal disease, and
peripheral vascular disease
• Approximately 50 million people
in the United States are affected
by hypertension
• Approximately 30% of adults are
still unaware of their
hypertension; up to 40% of
people with hypertension are not
receiving treatment; and, of those
treated, up to 67% do not have
their blood pressure (BP)
controlled to less than 140/90
mm Hg
• Di Indonesia, penderita Hipertensi
diperkirakan 15 juta orang tetapi
hanya 4% yang merupakan
hipertensi terkontrol.
• Prevalensi 6-15% pada orang
dewasa, 50% diantaranya tidak
menyadari sebagai penderita
hipertensi sehingga
mereka cenderung untuk menjadi
hipertensi berat karena tidak
menghindari dan tidak mengetahui
factor risikonya, dan 90%
merupakan hipertensi esensial.
• Hypertension is defined as an abnormal elevation
in diastolic pressure and/or systolic pressure.

The 7th Report of the Joint National Committee of Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure (JNC VII, 2003)

• The average of 2 or more readings taken at each of

2 or more visits after initial screening
• Severe hypertension is defined by a blood
pressure above 180/110 without
symptoms.
• Hypertensive urgency is defined as a BP
above 180/110 with mild end organ effects,
such as headache and dyspnea.
• Hypertensive emergency is a BP of
220/140 or greater with life-threatening
end-organ dysfunction
Other Classification
 Primary or “Essential” Hypertension

• Etiology - unknown (result of environmental or

genetic causes)
• Accounts for approximately 90% of hypertension
• Onset typically in the fifth or sixth decade of life
• Strong family history - 70-80% positive family history
- If hypertension in both parents, risk of
hypertension in off-spring is increased by 250%
- BP correlations are stronger among parent and
child than between spouses, suggesting that
environmental factors are less important than
genetic ones
- Certain races (e.g. African Americans) are at much
higher risk of hypertension
 Secondary Hypertension

• Multiple etiologies
• Identifiable underlying cause:
a. kidney disease
b. renal artery stenosis
c. hyperaldosteronism
d. pheochromocytoma
• Represents approximately 10% of all
hypertension
• Has specific therapy, and is potentially curable
• Often distinguishable from essential hypertension
on clinical grounds
 Chronic Renal Disease

• Diabetic nephropathy; glomerulonephritis

etc.
• Damage caused to the nephrons
– Impaired excretion of sodium
sodium retention and blood volume
cardiac output by Frank Starling
mechanism
– May also result in release of renin
Renal Artery Stenosis
• Activation of sympathetic nervous system
norepinephrine in heart and blood vessels
cardiac output and systemic vascular
resistance
• Adrenal medulla secretes catecholamines
(epinephrine and norepinephrine)
– angiotensin II, aldosterone and vasopressin
– Cardiac and vascular hypertrophy = sustained
blood pressure
• Higher incidence of
hypertension
• The mechanism of hypertension
may be related to sympathetic
activation and hormonal
changes associated with
repeated periods of apnea-
induced hypoxia and
hypercapnea, and from stress
associated with the loss of
sleep.
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• catecholamines (both
epinephrine and
norepinephrine)
– This leads to alpha-
adrenoceptor mediated
systemic
vasoconstriction
and beta-
adrenoceptor mediated
cardiac stimulation
arterial pressure.
 Pre-eclampsia

• 3rd trimester of
pregnancy
• blood volume and
tachycardia
• The former increases
cardiac output by
the Frank-Starling
mechanism
 Aortic coarctation
• Elevated pressures proximal to the coarctation (i.e.,
elevated arterial pressures in the head and arms)
• Distal pressures are not necessarily reduced
• Reduced systemic blood flow and reduced renal blood
flow renin and an activation of the renin-angiotensin-
aldosterone system blood volume and arterial
pressure
• Baroreceptor reflex in blunted due to structural changes
in the walls of vessels where the baroreceptors are
located
– Baroreceptors become desensitized to chronic
elevation in pressure and become "reset" to the
higher pressure
 Isolated Systolic Hypertension
• Defined as SBP 140mmHG and
DBP 90mmHG
• 60% of hypertensives > 80 years old
• From age 35/40 many people have
elevated systolic or diastolic
pressure and this elevation leads to
the widening and stiffening of the
aorta
• elasticity and compliance of the
large blood vessels SBP and
DBP
 Prognosis
• Untreated hypertension silent killer
• Mild-to-moderate Ht, if left untreated, is associated with a risk
of atherosclerotic disease in 30% of people and organ damage
in 50% of people after only 8-10 years of onset.
• Death from both ischemic heart disease and stroke increase
progressively as BP increases. For every 20 mm Hg S or 10
mm Hg diastolic D increase in BP above 115/75 mm Hg, the
mortality rate for both ischemic heart disease and stroke
doubles.
• The morbidity and mortality of Ht emergencies depend on the
extent of end-organ dysfunction on presentation and the
degree to which BP is controlled subsequently. With BP
control and medication compliance, the 10-year survival rate
of patients with hypertensive crises approaches 70%
 Patient Education

• Prevention and treatment of obesity

• Appropriate amounts of aerobic
physical activity
• Diets low in salt, total fat, and
cholesterol
• Adequate dietary intakes of
potassium, calcium, and magnesium
• Avoidance alcohol consumption
• Avoidance of cigarette smoking
• Avoidance of the use of illicit drugs,
such as cocaine