Pathophysiology of Hypertension

and
Hypertension Management

dr.YUDI FADILAH SPPD, KKV

RS MUHAMMADIYAH-FK MUHAMMADIYAH
 SAP
Pokok Bahasan : Hipertensi
Sub Bahasan : pengertian, penyebab, tanda dan gejala , diagnosis,
terapi
Tujuan : mampu memahami dan mengerti tentang hipertensi
Tujuan khusus : menjelaskan, menyebutkan penyebab, tanda gejala,
diagnosis dan terapi
Waktu :
Metode : ceramah dan tanya jawab
Media: power point , bahan kuliah.
 HIPERTENSI
DEFINISI
PATOGENESIS
KLASIFIKASI
JENIS HIPERTENSI
FAKTOR RISIKO
PENGUKURAN TEKANAN DARAH
PENGOBATAN
 EPIDEMIOLOGI

Di Indonesia
Prevalensi hipertensi sebesar 31,7%
Belum terjangkau oleh pelayanan kesehatan
(pedesaan)
Berobat kalau ada keluhan
Tidak makan obat teratur

4
 Hipertensi

Bila tekanan sistolik >= 140 mmHg,

dan atau
tekanan diastolik >= 90 mmHg,
atau sedang mendapat obat anti
hipertensi.
Patogenesis Hipertensi
Secara hemodinamik, tekanan darah arteri (TD)
merupakan resultan dari cardiac output (CO) dan
resistensi perifer
Heart Rate + Stroke
volume

Cardiac output + Peripheral

resistance

Blood
Pressure
Patogenesis  Hemodinamik Tekanan Darah

Tekanan Darah

Cardiac Output Resistensi perifer

Heart rate Stroke volume Resistensi Viskositas

Pembuluh darah Darah

Kontraktilitas Pre-load
miokard

Kapasitas
Volume darah
vena
8
Hipertensi
 Regulation of
o BP
Baroreceptor reflex – changes in arterial pressure – medulla
(brain stem)
◦ Location : left and right carotid sinuses, aortic arch

o Renin – angiotensin system (RAS)

◦ Long – term adjustment of arterial pressure

◦ Kidney - compensation
◦
Endogenous vasoconstrictor – angiotensin I

o Aldosterone release (adrenal cortex)

◦ Stimulates sodium retention and potassium excretion
by the kidney
◦ Increases fluid retention and indirectly arterial
pressure
Primary HTN

o No medical cause

o Risk factors :
o Sedentary
lifestyle
o Obesity ( body
mass index greater
than 25)
o Salt ( sodium)
sensitivity
o Alcohol, smoking
o Family history
Secondary HTN
Common Uncommon
◦Intrinsic renal ◦Pheochromocyto
disease ma

◦ Renovascular ◦ Glucocorticoid
disease excess

◦ Mineralocorticoid ◦ Coarctation of
excess Aorta

◦ Sleep Breathing ◦ Hyper/hypothyroi

disorder dism
Pathophysiology of HTN

oInability of the kidneys to excrete sodium

oAn overactive renin – angiotensin system,

vasoconstriction and retention of sodium and water
– hypertension
oAn overactive sympathetic nervous system
The ANS
o Increased production of
catecholamines (epinephrine and
norepinephrine) results in SNS
overactivity.

o This results in an increased

heart rate, increased peripheral
vascular resistance due to
systemic vasoconstriction, and
hypertension.
o Additionally, an overactive SNS
effects insulin resistance, vascular
remodeling, has procoagulant
effects, which can lead to neospasm
and narrowing of the blood vessels
The
RAAS
 Endotheli
al
•
Dysfunct
Oxidative stress upsets
ion
balance between
endothelin and Nitric
oxide

• leads to changes in the

endothelium and sets up a
“vicious cycle” that
contributes to the
maintenance of high blood
pressure

• Alterations in endothelial
function are a reliable
indicator of target organ
damage and
Genetics
o Caused by single gene mutations which leads to several
forms of high blood pressure

o Ten genes have been identified which cause these

monogenic forms of hypertension.

o HTN has been linked with several chromosomal regions,

including regions linked to familial combined
hyperlipidemia, was found.
Risk factors
o Non Modifiable: o
Modifiable:
o Age o Weight

o Sex o Physical fitness

o Race o Smoking and alcohol

o Family history o
Diet

o Stress

o diabetes

o
 Complications

o Changes in the vessel wall leading to vessel trauma and

arteriosclerosis throughout the vasculature

o Complications arise due to the “target organ” dysfunction

and ultimately failure.

o Damage to the blood vessels can be seen on fundoscopy.

Target Organs
o CVS (Heart and Blood
Vessels)

o The kidneys

o Nervous system

o The Eyes
Effects On CVS
o Ventricular hypertrophy, dysfunction
and failure

o Arrhithymias

o Coronary artery disease, Acute MI

o Arterial aneurysm, dissection, and

rupture
Effects on The Kidneys
oGlomerular sclerosis leading to
impaired kidney function and
finally end stage kidney disease

o Ischemic kidney disease

especially when
renal artery stenosis is the cause
of HTN
Nervous System
o Stroke

o intracerebral and subaracnoid

hemorrhage

o Cerebral atrophy and dementia

The Eyes
oRetinopathy, retinal hemorrhages and
impaired vision

o Vitreous hemorrhage, retinal

detachment

oNeuropathy of the nerves leading to

extraoccular muscle paralysis and
dysfunction
 SIGNS AND SYMPTOMS

oNo symptoms – many people

unaware they have hypertension until
accidentally found

o Non–specific symptoms – mild

symptoms
Headache, Morning headache,
Tinnitus, Dizziness, Confusion,
Fatigue, Shortness of breath,
Changes in vision – blindness,
Nausea
BP Classification Systolic Blood Pressure Diastolic Blood Pressure
ESH 2003
Optimal <120 <80
Normal 120-129 80-84
High Normal 130-139 85-89
Grade 1 HT (mild) 140-159 90-99
Grade 2 HT (moderate) 160-179 100-109
Grade 3 (severe) >180 >110
Isolated systolic HT >140 <90

JNC VII
Normal <120 and <80
Prehypertension 120-139 or 80-89
Stage 1 HT 140-159 or 90-99
Stage 2 HT >160 or >100
White coat hypertension

more commonly known as white coat

syndrome, is a phenomenon in which
patients exhibit elevated
blood pressure in a clinical setting but
not in other settings.
Saraf
Jantung
Ginjal
Mata
Pembuluh Darah
 Bagaimana mengukur tekanan darah yang
benar ?
 Alat pengukur tekanan darah yang mana yang paling
baik dipakai ?
 Sfigmomanometer ada 3 jenis: air raksa, aneroid,
dan digital.
 Yang paling ideal air raksa.
• Syarat : Penggunaannya harus benar.
Bagaimanakah posisi terbaik saat pengukuran
tekanan darah ?

Pemeriksaan TD sebaiknya dilakukan dalam posisi duduk dg

siku lengan menekuk di atas meja dg posisi telapak tangan
menghadap ke atas dan posisi lengan sebaiknya setinggi
jantung

PENGUKURAN TD YG TIDAK AKURAT AKAN MENIMBULKAN KESALAHAN

DIAGNOSIS DAN TERAPI HIPERTENSI !!
Bagaiamana prosedur pemeriksaan TD yg baik ?

1. Pasanglah manset pd lengan atas, dg

batas bawah manset 2-3 cm dari lipat siku
& perhatikan posisi manset ( lebar manset
sebaiknya 2/3 dari panjang lengan atas).
2. Letakkan stetoskop tepat di atas arteri
brakialis.
3. Rabalah pulsasi arteri pada pergelangan
tangan (arteri radialis).
4. Pompalah manset hingga tekanan manset
mencapai 30 mmHg setelah pulsasi arteri
radialis menghilang.
6. Bila bunyi pertama terdengar, ingatlah dan
catatlah sbg tekanan sistolik.
7. Bunyi terakhir yg masih terdengar dicatat sbg
tekanan diastolik.
8. Turunkan tekanan manset sampai 0 mmHg,
kemudian lepaskan manset.
9. Pengukuran TD sebaiknya dilakukan 2 kali, utk
mendapatkan nilai tekanan darah rerata.
 Pemeriksaan Penunjang
The diagnostic test include:
Electrolytes (sodium, potassium)
Glucose
Lipid profile : Cholesterol, HDL, LDL, Trigliseride
Creatinine (renal function), Testing of urine samples for proteinuria

Electrocardiogram (EKG/ECG)
May show (left ventricular hypertrophy) or the previous silent cardiac
disease even a myocardial infarction).
Chest X-ray - again for signs of cardiac enlargement or evidence of
cardiac failure.
Echocardiography (HHD)
Pengobatan Hipertensi RSMP
1. Pengobatan non farmakologik( modifikasi gaya hidup )

2. Pengobatan farmakologik (obat-obatan)

R eduction of weight, intake chol,salt
S top smoking
M odification of life
P harmacologic treatment
 Treatment of HTN
o Antihypertensive drugs – act by lowering blood pressure

o Aim of treatment - <140/ 90

o Reduction of blood pressure by 5-6 mm/Hg decreases the

risk of stroke by 40%, coronary heart disease by 15- 20%,
heart failure and mortality from vascular disease
 Treatment Options: Antihypertensives

ACE Inhibitors; ARBs

Beta blockers
Calcium cannel blockers; Centrally acting alpha-agonists
Diuretics ; Direct Vasodilators