STUDI PENGGUNAAN GOLONGAN CALCIUM CHANNEL BLOCKER (CCB) PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) (Penelitian Dilakukan di Instalasi Rawat Inap RS Muhammadiyah Lamongan)

SKRIPSI
Retno Aprillia Handayani
STUDI PENGGUNAAN GOLONGAN CALCIUM
CHANNEL BLOCKER (CCB) PADA PASIEN
CHRONIC KIDNEY DISEASE (CKD)
(Penelitian Dilakukan di Instalasi Rawat Inap RS
Muhammadiyah Lamongan)

PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2016

KATA PENGANTAR
Bismillahirrohmanirrohim
Assalamu’alaikum warohmatullahi wabarokatuh
Puji syukur tercurahkan kepada ALLAH SWT, Tuhan semesta alam
karena berkat rahmat dan ridhoNya, penulis dapat menyelesaikan skripsi yang
berjudul STUDI PENGGUNAAN GOLONGAN CALCIUM CHANNEL
BLOCKER (CCB) PADA PASIEN CHRONIC KIDNEY DISEASE (CKD)
(Penelitian Dilakukan di Instalasi Rawat Inap RS Muhammadiyah

Lamongan)
Skripsi ini diajukan untuk memenuhi syarat untuk mencapai gelar Sarjana
Farmasi pada Program Studi Farmasi Fakultas Ilmu Kesehatan Universitas
Muhammadiyah Malang. Dalam penyusunan skripsi ini penulis tidak terlepas dari
peranan pembimbing dan bantuan dari seluruh pihak. Oleh karena itu, dengan
segala kerendahan hati, penulis ingin mengucapkan banyak terima kasih kepada:
1.

ALLAH SWT, tuhan semesta alam yang memberkan rahmat, nikmat dan
Karunia-Nya, Nabi Muhammad SAW yang sudah menuntun kita menuju
jalan yang benar.

2.

Bapak Yoyok Bekti P., M.Kep., Sp.Kom.,,selaku Dekan Fakultas Ilmu
Kesehatan Universitas Muhammadiyah Malang yang telah memberikan
kesempatan penulis menuntut ilmu di Fakultas Ilmu Kesehatan Universitas
Muhammadiyah Malang.

3.

Ibu Nailis Syifa’, S.Farm., M.Sc., Apt., selaku Ketua Program Studi
Farmasi Universitas Muhammadiyah Malang yang telah memberi motivasi
dan kesempatan penulis menuntut ilmu di Program Studi Farmasi
Universitas Muhammadiyah Malang.

4.

Bapak Drs. Didik Hasmono, M.S., Apt., Ibu Nailis Syifa’, S.Farm., M.Sc.,
Apt. dan Ibu Rully Yuliandhari, S.Farm, M.Farm.Klin., Apt., Selaku
Dosen Pembimbing I, II dan III, disela kesibukan Bapak dan Ibu masih
bisa meluangkan waktu untuk membimbing dan memberi pengarahan dan
dorongan moral sampai terselesaikannya skripsi ini.

iii

5.

Ibu Hidajah Rachmawati, S.Si., Apt., Sp.FRS dan Ibu Lilik Yusetyani
Apt., Sp.FRS., selaku Dosen Penguji I dan II, yang telah banyak

memberikan saran dan masukan demi kesempurnaan skripsi ini.

6.

Ibu Siti Rofida, S.Si., Apt., M.Farm., selaku Dosen wali saya yang telah
banyak membantu dan membimbing saya selama masa perkuliahan.

7.

Orang Tuaku tercinta, Johansyah, S.E., dan Astuty Ambulyani, Amd.Kep.,
yang tiada hentinya memotivasi dan sabar mendoakan untuk kebaikan dan
kesuksesan anak-anaknya.

8.

Sahabat seperjuangan skripsi klinis maupun bidang lainnya Hafiz, Ovi,
Ivone, Viar, Pipit, Ana, Gitta, Uti, Delle, Aeny, Elok dan yang lainnya,
terima kasih atas kebersamaan, bantuan, dan semangat kerjasamanya
sehingga skripsi ini dapat terwujud.

9.

Teman-teman kost Veteran Dalam dek Yenny, dek Ria, Dek Kiki, Ayuni,
dek Laras, Lika dan yang lainnya terima kasih untuk selalu memangati
saya.

10. Teman-teman budak Bulungan yang selalu menanyakan saya kapan lulus,
terima kasih banyak atas motivasinya.
11. Untuk semua pihak yang belum disebutkan namanya, penulis mohon maaf
dan terimakasih yang sebesar-besarnya.
Penulis menyadari bahwa skripsi ini jauh dari kesempurnaan, oleh karena
itu penulis mengharapkan saran dan kritik yang membangun dari pembaca demi
kebaikan skripsi ini. Semoga penulisan ini dapat berguna bagi penelitian
berikutnya, amin.
Wassalamu’alaikum warohmatullohi wabarokatuh

Malang,
Penyusun

(Retno Aprillia Handayani)

iv

DAFTAR ISI
LEMBAR PENGESAHAN ............................................................................................. i
KATA PENGANTAR ........................................................................................... iii
RINGKASAN ......................................................................................................... v
ABSTRAK ............................................................................................................ vii
ABSTRACT ......................................................................................................... viii
DAFTAR ISI.................................................................................................................... ix
DAFTAR TABEL ......................................................................................................... xiii
DAFTAR GAMBAR .................................................................................................... xiv
DAFTAR LAMPIRAN ......................................................................................... xv
DAFTAR SINGKATAN ..................................................................................... xvi
BAB 1 PENDAHULUAN .............................................................................................. 1
1.1 Latar Belakang ............................................................................................... 1
1.2 Rumusan Masalah .......................................................................................... 4
1.3 Tujuan Penelitian ........................................................................................... 4
1.3.1 Tujuan Umum .............................................................................................. 4
1.3.2 Tujuan Khusus ............................................................................................. 4

1.4 Manfaat Penelitian ......................................................................................... 5
BAB II TINJAUAN PUSTAKA .................................................................................... 6
2.1 Hipertensi ....................................................................................................... 6
2.1.1 Definisi Hipertensi ............................................................................... 6
2.1.2 Epidemologi Hipertensi ....................................................................... 6
2.1.3 Manifestasi Klinis Hipertensi .............................................................. 7
2.1.4 Klasifikasi Hipertensi .......................................................................... 8
2.1.5 Etiologi Hipertensi ............................................................................... 9
2.1.5.1 Hipertensi Primer/Esensial ........................................................ 9

ix

2.1.5.2 Hipertensi Sekunder ................................................................ 10
2.1.6 Faktor Resiko Hipertensi ................................................................... 10
2.1.6.1 Faktor yang Tidak Dapat Dikontrol ........................................ 10
2.1.6.2 Faktor yang Dapat Dikontrol ................................................... 11
2.1.7 Patofisiologi Hipertensi ..................................................................... 13
2.1.8 Komplikasi Hipertensi ........................................................................ 15
2.2 Chronic Kidney Disease ................................................................................. 16
2.2.1 Tinjauan Tentang Ginjal .................................................................... 16

2.2.2 Anatomi dan Fisiologi Ginjal ............................................................ 17
2.2.3 Definisi Chronic Kidney Disease ...................................................... 19
2.2.4 Epidemologi Chronic Kidney Disease............................................... 19
2.2.5 Manifestasi Chronic Kidney Disease................................................. 21
2.2.6 Klasifikasi Chronic Kidney Disease .................................................. 22
2.2.7 Etiologi Chronic Kidney Disease ...................................................... 22
2.2.8 Faktor Resiko Chronic Kidney Disease ............................................. 23
2.2.9 Patofisiologi Chronic Kidney Disease ............................................... 23
2.2.10 Tanda dan Gejala Chronic Kidney Disease ..................................... 27
2.2.11 Komplikasi Chronic Kidney Disease............................................... 28
2.2.12 Penatalaksanaan Chronic Kidney Disease ....................................... 29
2.3 Tinjauan Terapi Antihipertensi pada Pasien Chronic Kidney Disease ...........35
2.3.1 Angiotensin Converting Enzyme Inhibitor (ACE-I) ......................... 35
2.3.2 Angiotensin Receptor Blocker (ARB) ............................................... 37
2.2.3 Diuretik .............................................................................................. 37
2.3.6 Calcium Channel Blocker (CCB) ...................................................... 38
2.3.6.1 Non-Dihidropiridin .................................................................. 40
2.3.6.1.1 Diltiazem ..................................................................... 41

x

2.3.6.1.2 Verapamil .................................................................... 42
2.3.6.2 Dihidropiridin .......................................................................... 45
2.3.6.2.1 Amlodipin ................................................................... 46
2.3.6.2.2 Nifedipin ..................................................................... 49
2.3.6.2.3 Nicardipin .................................................................... 51
BAB III KERANGKA KONSEPTUAL ..................................................................... 53
3.1 Kerangka Konseptual ..................................................................................... 53
3.2 Kerangka Operasional .................................................................................... 56
BAB IV METODE PENELITIAN .............................................................................. 57
4.1 Rancangan Penelitian................................................................................... 57
4.2 Bahan Penelitian .......................................................................................... 57
4.2.1 Kriteria Inklu dan Ekslusi .................................................................... 57
4.3Populasi dan Sampel ...................................................................................... 58
4.3.1 Populasi ................................................................................................ 58
4.3.2 Sampel.................................................................................................. 58
4.4 Instrumen Penelitian .................................................................................... 58
4.5 Lokasi dan Waktu Penelitian ....................................................................... 58
4.6 Definisi Operasional Parameter Penelitian .................................................. 58
4.7 Metode Pengumpulan Data .......................................................................... 59

4.8 Analisa Data ................................................................................................. 60
BAB V HASIL PENELITIAN ............................................................................. 62
5.1 Data Demografi ............................................................................................ 62
5.1.1 Jenis Kelamin ........................................................................................ 63
5.1.2 Usia ....................................................................................................... 63
5.1.3 Status Pasien ......................................................................................... 63
5.2 Faktor Resiko ................................................................................................ 64

xi

5.3 Diagnosa Penyerta ........................................................................................ 64
5.4 Klasifikasi Chronic Kidney Disease ............................................................. 65
5.5 Profil Tekanan Darah .................................................................................... 65
5.6 Terapi Antihipertensi yang diterima pasien Chronic Kidney Disease .......... 66
5.6.1 Distribusi Antihipertensi Tunggal......................................................... 66
5.6.2 Distribusi Kombinasi 2 Antihipertensi ................................................. 67
5.6.3 Distribusi Kombinasi 3 Antihipertensi ................................................. 68
5.6.4 Distribusi Kombinasi 4 Antihipertensi ................................................. 70
5.6.5 Distribusi Kombinasi 5 Antihipertensi ................................................. 71
5.7 Distribusi terapi penyerta yang diterima pasien Chronic Kidney Disease ... 71

5.8 Perubahan Dosis, Rute, Frekuensi, dan Sediaan ........................................... 72
5.9 Lama Terapi .................................................................................................. 73
5.10 Kondisi Saat Dipulangkan .......................................................................... 73
5.11 Pasien Meninggal........................................................................................ 73
BAB VI PEMBAHASAN ..................................................................................... 75
BAB VII KESIMPULAN DAN SARAN ............................................................. 88
7.1 Kesimpulan ................................................................................................... 88
7.2 Saran ............................................................................................................. 88
DAFTAR PUSTAKA .................................................................................................... 89

xii

DAFTAR TABEL
Tabel

Halaman

2.1

Klasifikasi Hipertensi .................................................................................... 8

2.2

Klasifikasi Chronic Kidney Disease ........................................................... 21

2.3

Karakteristik berbagai Calcium Channel Blocker....................................... 39

5.1

Distribusi jenis kelamin pasien Chronic Kidney Disease ........................... 63

5.2

Distribusi usia pasien Chronic Kidney Disease .......................................... 63

5.3

Distribusi jenis kelamin pasien Chronic Kidney Disease ........................... 63

5.4

Distribusi faktor resiko pasien Chronic Kidney Disease ............................ 64

5.5

Distribusi diagnosa penyerta pasien Chronic Kidney Disease .................... 64

5.6

Distribusi klasifikasi pasien Chronic Kidney Disease ................................ 65

5.7

Distribusi profil tekanan darah pasien Chronic Kidney Disease ................ 65

5.9

Distribusi antihipertensi yang diterima pasien Chronic Kidney Disease .... 66

5.10 Distribusi antihipertensi tunggal ................................................................. 66
5.11 Distribusi kombinasi 2 antihipertensi ......................................................... 67
5.12 Distribusi kombinasi 3 antihipertensi ......................................................... 68
5.13 Distribusi kombinasi 4 antihipertensi ......................................................... 70
5.14 Distribusi kombinasi 5 antihipertensi ......................................................... 71
5.15 Distribusi terapi penyerta yang diterima pasien Chronic Kidney Disease.. 71
5.16 Distribusi perubahan dosis, rute, frekuensi, dan sediaan ............................ 72
5.16 Distribusi kondisi saat dipulangkan pasien Chronic Kidney Disease ......... 73
5.16 Distribusi lama terapi pasien Chronic Kidney Disease ............................... 73
5.17 Pasien meninggal ........................................................................................ 73

xiii

DAFTAR GAMBAR
Gambar

Halaman

2.1

Etiologi penyebab Hipertensi ........................................................................ 9

2.2

Patofisiologi Hipertensi............................................................................... 13

2.3

Gambaran umum struktur ginjal ................................................................. 16

2.4

Prevalensi Chronic Kidney Disease ............................................................ 19

2.5

Patofisiologi Chronic Kidney Disease ........................................................ 25

2.6

Struktur Kimia Diltiazem ............................................................................ 40

2.7

Struktur Kimia Verapamil ........................................................................... 42

2.8

Struktur Kimia Amlodipin .......................................................................... 45

2.9

Struktur Kimia Nifedipin ............................................................................ 48

2.10 Struktur Kimia Nikardipin .......................................................................... 50
3.1

Kerangka Konseptual .................................................................................. 55

3.2

Kerangka Operasional ..................................................................................56

5.1

Skema Inklusi dan Ekslusi ...........................................................................62

xiv

DAFTAR LAMPIRAN
Lampiran .................................................................................................... Halaman
Lampiran 1 : Riwayat Hidup ................................................................................103
Lampiran 2 : Surat Pernyataan .............................................................................104
Lampiran 3 : Surat Etikal Klirens ...........................................................................105
Lampiran 4 : Tabel Induk.....................................................................................106
Lampiran 5 : Lembar Pengumpulan data .............................................................134

xv

DAFTAR SINGKATAN

ADH

: Anti Diuretik Hormone

ACE-I

: Angiotensin Converting Enzyme Inhibitor

ACR

: Albumin Creatinine Ratio

AKI

: Acute Kidney Injury

ARB

: Angiotensin Receptor Blocker

BPJS

: Badan Penyelenggara Jaminan Nasional

Ca

: Kalsium

CCB

: Calcium Channel Blocker

CERA

: Continue Erythropoesis Receptor Activator

CKD

: Chronic Kidney Disease

COX

: Cyclooxigenase

CVD

: Cardiovascular Disease

dL

: Desiliter

EPO

: Erythropoetin

ESA

: Erythropoesis Stimulating Agent

ESRD

: End Stage Renal Disease

GGK

: Gagal Ginjal Kronik

Hb

: Hemoglobin

HCO3

: Biakrbonat

HDL

: High Density Lipoprotein

IL 1β

: Interleukin 1β

IL 2

: Interleukin 2

IL 6

: Interleukin 6

IMT

: Indeks Massa Tubuh

LBP

: Lipopolysaccaarida binding protein

LDL

: Low Density Lipoprotein

LFG

: Laju Filtrasi Glomerulus

LVH

: Left Ventricular Hypertrophy

mmHg

: Mili Meter Raksa

NaCl

: Natrium Klorida

NSAID

: Non Steroid Anti Inflamatory Drugs

NH3

: Nitrogen Hidroksida

NO

: Nitric Oxide

xvi

NUD

: Nitrogen Urea Darah

OAT

: Obat Anti Hipertensi

PAF

: Platelet Activating Factor

PJK

: Penyakit Jamtung Koroner

PTH

: Parathyroid Hormone

RAAS

: Renin Angiotensin Aldosteron System

RMK

: Rekam Medik Kesahatan

SIRS

: Systemic Inflamatory Response Syndrome

TD

: Tekanan Darah

TNF α

: Tumor Necrosis Factor α

WBC

: White Blood Cell

xvii

88

DAFTAR PUSTAKA

Abdullah, M. 2005. Kejadian Penyakit Jantung Di Indonesia. Available From :
http://www.fkm.undip.ac.id/data/index.php?action=4&idx=2701
Alam, S., and Hadibroto, I., 2007. Gagal Ginjal. Jakarta : Gramedia Pustaka
Utama
Amin, N., Mahmood R. T., Asad M. J., Zafar M., and Raja A. M. 2014.
Evaluating Urea and Creatinine Levels in Chronic Renal Failure Pre
and

Post

Dialysis:

A

Prospective

Study.

Available

From

:

http://researchpub.org/journal/jcvd/number/early/22.pdf
Anggraini, A. D., Waren, A. A., Situmorang, E., Asputra, H., and Siahaan, S.S.
2009. Faktor-Faktor yang Berhubungan dengan Kejadian Hipertensi
pada Pasien yang Berobat di Poliklinik Dewasa Puskesmas
Bangkinang Periode Januari sampai Juni 2008
Ando, K., Isshiki, M., and Takahashi, K., 2009. Effect of switching from
amlodipine to combination therapy with telmisartan and low-dose
hydrochlorothiazide. Available From : http://www.nature.com/hr/journal/
v32/n9/pdf/hr2009101a.pdf
Andany, M. M. A, Fernández, C. F., Bayolo, D. M., Quintela, E. C., and Montero,
A. D., 2014.Sodium Bicarbonate Therapy in Patients with Metabolic
Acidosis. Available From : http://www.hindawi.com/journals/tswj/2014/
627673/
Antman, E. M., 2007. Cardiovascular Therapeutics: A Companion to
Braunwald's Heart Disease. Philadelphia : Elsevier
Arcangelo, V. P., and Peterson, A. M., 2006. Pharmacotherapeutics for
Advanced Practice : A Practical Approach. Philadelphia : Lippincott
Williams & Wilkins
Arici, M., 2014. Management of Chronic Kidney Disease : A Clinicians
Guide. Heidelberg : Springer

89

Aronson, J. K., 2009. Meyler’s Side Effect of Cardiovascular Drug. United
Kingdom : Elsevier
Arora, P., Vasa, P., Brenner, D., Iglar, K., McFarlane, P., Morrison H., and
Badawi, A., 2013. Prevalence Estimates of Chronic Kidney Disease in
Canada: Results of a Nationally Representative Survey. Available
From : http://www.cmaj.ca/content/185/9/E417.full.pdf+html
Ayub. W., and Fletcher, S., 2000. End-stage Renal Disease and Erectile
Dysfunction. Is There any Hope? Available From : http://ndt.
oxfordjournals.org/content/15/10/1525.full.pdf+html
Asnelia, D., 2014. Hipertensi Krisis. Available From : http://cme.medicinus.co/
file.php/1/LEADING_ARTICLE_Hipertensi_Kritis.pdf
Aziza, L., 2007. Peran Antagonis Kalsium dalam Penatalaksanaan
Hipertensi. Available From : http://mki.idionline.org/index.php?uPage=
mki.mkidl&smod=mki&sp=public&key= MTM2LTE0
Baradero, M., Dayrit, M. W., and siswadi Y., 2005. Klien Gangguan Ginjal.
Jakarta : Penerbit Buku Kedokteran EGC
Basha, A., 2004. Hipertensi: Faktor Resiko Dan Penatalaksanaan. Available
From : http://www.pjnhk.go.id
Bianchi, S., Bigazzi, R., and Campese, V. E., 2006. Long-Term Effects of
Spironolactone on Proteinuria and Kidney Function in Patients with
Chronic Kidney Disease. Available Ftom : http://www.nature.com/
ki/journal/v70/n12/pdf/5001854a.pdf
Bijvank S. W., and Duvekot, J. J., 2010. Nicardipine for the Treatment of
Severe Hypertension in Pregnancy: A Review of the Literature.
Available

From

:

http://academicdepartments.musc.edu/medicine/

divisions/pulmonary/fellowship_and_education/education/Critical%20Car

90

e%20Syllabus/critical_care_files/Obstetric%20Patients/nicardipine%2020
10.pdf
Bomback, A. S., and Bakris, G. L., 2011. Chronic Kidney Disease (CKD) and
Hypertension Essentials. Sudbury : Jones & Bartlett Learning
Braham-Grey, L., PhD, RD, CNSD; and Wiesen, K., MS, RD., 2004. A Clinical
Guide to Nutrition Care in Kidney Disease. US : American Dietetic
Association.
CDC, 2014. National Chronic Kidney Disease Fact Sheet 2014. Available From
: http://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf
Chandra, K. S., and Ramesh, G., 2013. The fourth-generation Calcium channel
blocker: Cilnidipine. Available From : http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3905258/pdf/main.pdf
Chen, W., and Abramowitz, M. K., 2014. Treatment of Metabolic Acidosis in
Patients With CKD. Available From : http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3946919/pdf/nihms514444.pdf
Chien, K., Chao, C., and Su, T., 2005. Bioavailability Study of Fixed-Dose
Tablet Versus Capsule Formulation of Amlodipine Plus Benazepril: A
Randomized, Single-Dose, Two-Sequence, Two-Period, Open-Label,
Crossover

Study

in

Healthy

Volunteers.

Available

From

:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964558/pdf/main.pdf
Chobanian, A.V., Bakris, G.L., Black, H.R., 2003. Seventh report of the Joint
National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure : Hypertension. Available From :
http://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf
Cikrikcioglu, M.A., Karatoprak, C., Cakirca, M., Kiskac, M., Zorlu, M., Cetin, G.,
Yildiz, K., Erkoc, R., Alay, M., Erkal, S., Erkal, S.N., Dogan, S.,
Kazancioglu,R., 2013. Association of calcium channel blocker use with
lower hemoglobin levels in chronic kidney disease. Available From :
http://www.europeanreview.org/wp/wp-content/uploads/2530-2537.pdf

91

Corwin, E. J., 2001. Buku Saku Patofisiologi. Jakarta : Penerbit Buku
Kedokteran EGC
Cole, R. T.,

Kalogeropoulos,

A. P., Georgiopoulou, V. V., Gheorghiade,

M., Quyyumi, A., Yancy, C., and
Isosorbide Dinitrate in
Mechanisms,

and

Butler, J., 2011. Hydralazine and

Heart Failure

Future

Directions.

Historical Perspective,
Available

From

:

http://circ.ahajournals.org/content/123/21/2414.full.pdf+html
Dallas, M. E., 2015. A High Salt and Potassium Diet May Accelerate Chronic
Kidney Disease. Available From : https://www.nlm.nih.gov/medlineplus
/news/fullstory154687.html
Decker, S.B., Mueller, A.B, and Sowinski, M.K., 2007. Drug Dosing
Considerations in Alternative Hemodialysis. Available from :
http://www.ackdjournal.org/article/ S1548-5595(07)00048-1/fulltext
Depkes RI., 2006. Pharmaceutical Care untuk Penyakit Hipertensi. Jakarta :
Depkes RI
Duru, O. K., Li, S., Jurkovitz, C., Bakris, G., Brown, W., Chen, S., Collins, A.,
Klag, M., McCullough, M. A., McGill, J., Narva, A., Pergola, A., Singh,
A., and Norris, K., 2008. Race and Sex Differences in Hypertension
Control in CKD: Results From the Kidney Early Evaluation Program.
Available From : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866650/
pdf/nihms150995.pdf
Elliott, W., J., and Ram, C., V., S. 2011. Calcium Channel Blocker. Available
From : http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7176.2011.
00513.x/epdf
Frandsen, G., and Pennington, S. S., 2013. Abram’s Clinical Drug Therapy :
Rationales for Nursing Practice. Philadelphia : Wolters Kluwer
Frank, J., 2008. Managing Hypertension Using Combination Therapy.
Available From : http://www.aafp.org/afp/2008/0501/p1279.pdf
Frishman, W. H., Cheng-Lai, A., and Chen, J., 2005. Current Cardiovascular
Drugs. New York : Springer Science-Business Media

92

Goroll, A. H., and Mulley, A. G., 2011. Primary Care Medicine : Office
Evaluation and Management of The Adult Patient, Sixth Edition.
Philadelphia : Lippincott Williams & Wilkins
Gradman, A. H., Basile, J. N., Carter, B. L., and Bakris, G. L., 2010.
Combination

Therapy

in

Hypertension.

Available

From

:

http://www.ashjournal.com/article/S1933-1711(10)00006-9/pdf
Gray, L. D. B., Burrowes, J. D., and Chertow, G. M., 2008. Nutrition in Kidney
Disease. Totowa : Humana Press
Grove, E. L., 2012. Antiplatelet Effect Of Aspirin In Patients With Coronary
Artery Disease. Available From : http://www.danmedj.dk/portal/pls/
portal/!PORTAL.wwpob_page.show?_docname=9206964.PDF
Gunawan, L., 2001. Hipertensi : Tekanan Darah Tinggi. Yogyakarta :
Percetakan Kanisus.
Guyton, A.C., and Hall John E., 2006. Textbook of Medical Physiology.
Philadelphia : Elsevier.
Hajjar, I., MD, MS; dan Kotchen, T.A., MD., 2000. Trends in Prevalence,
Awareness, Treatment, and Control of Hypertension in the United
States, 1988-2000.
Haller, H., 2008. Effective management of hypertension with dihydropyridine
calcium channel blocker-based combination therapy in patients at
high cardiovascular risk. Available From : http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC2324209/
Hsieh, M. F., Wu, I. W., Lee, C. C.,Wang, S. Y., Wu, M. S. 2010. Higher Serum
Potassium Level Associated with Late Stage Chronic Kidney Disease.
Available From : http://memo.cgu.edu.tw/cgmj/3404/340411.pdf
Hughes, S. C., Levinson, G., and Rosen, M. A., 2002. Shinder and Levinson’s
Anasthesia for Obstretrics. Philadelphia : Lippincott Williams & Wilkins
Hunts, W. A., 2011. Kidney Disease : A Guide For Living. Maryland : The
Johns Hopkins Unisersity Press

93

Iacobellis, G., 2006. Drug- Drug Interactions In The Metabolic Syndrome.
New York : Nova Science Publishers Inc
IAI, 2013. Informasi Spesialite Obat Indonesia Vol. 48. Jakarta : PT. ISFI
Penerbitan
Ismudiati, L., 2003. Buku Ajar Kardiologi. Jakarta : Balai Penerbit Fakultas
Kedokteran Universitas Indonesia
JNC7, 2003.Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure.

Available

From

:https://www.nhlbi.nih.gov/files/docs/

guidelines/express.pdf
Johnson, D., 2012. Diagnosis, Classification, and Staging of Chronic Kidney
Disease. Available From : http://www.cari.org.au/CKD/CKD%20early/
Diag_Classification_Staging_ECKD.pdf
Kalra, S., Kalra, B., and Agrawal, N., 2010. Combination Therapy in
Hypertension: An update. Available From : http://link.springer.com/
article/10.1186/1758-5996-2-44
Kasper, D. L., Fauci, A. S., Longo, D. N., Braunwald. E., Hauser, S., and
Jameson, J. L., 2012.Harrison’s Principles of Internal Medicine. Ed 18.
New York: Mc-Graw Hill
KDIGO, 2012. Clinical Practice Guideline for the Evaluation and
Management

of

Chronic

Kidney

Disease.

Available

From

:

http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_201
2_CKD_GL.pdf
Kizilirmak, P., Uresin Y., and Yildiz, O. B., 2012. The Efficacy and Safety of
Triple vs Dual Combination of Angiotensin II Receptor Blocker and
Calcium Channel Blocker and Diuretic: A Systematic Review and
Meta-Analysis. Available From : http://onlinelibrary.wiley.com/doi/
10.1111/jch.12040/full

94

Kovesdy, C. P., 2012. Metabolic Acidosis and Kidney Disease: Does
Bicarbonate Therapy Slow The Progression ff CKD. Available From :
http://ndt.oxfordjournals.org/content/27/8/3056.full.pdf+html
Kresnawan T., 2012. Diet Rendah Protein Dan Penggunaan Protein Nabati
Pada Penyakit Ginjal Kronik. Available From : http://gizi.depkes.go.id/
wp-content/uploads/2012/05/diet_rendah_prot-nabati.pdf
Krummel, D. A., 2004. Medical Nutrition Therapy in Cardiovascular Disease.
USA: Saunders co
Langman, C. B., and Cannata-Andia, J. B. 2010. Calcium in Chronic Kidney
Disease: Myths and Realities. Available From : http://cjasn.asnjournals.
org/content/5/Supplement_1/S1.full.pdf+html
Levey, A. S., Coresh, J., Balk, E., Kausz, A. T., Levin, A., Steffes, M. W., Hogg,
R. J., Perrone, R. D., Lau, J., and Eknoyan G., 2003. National Kidney
Foundation Practice Guidelines for Chronic Kidney Disease:
Evaluation, Classification, and Stratification. Available From :
http://annals.org/data/Journals/AIM/20044/0000605-200307150-00013.pdf
Lerma, E. V., 2013. Clinical Decision in Nephrology, Hypertension, and
Kidney Disease Transplantation. New York : Springer.
Lipowsky, R., Richter, D., and Kremer, K., 2013. The Structure and
Conformation of Amphiphilic Membranes : Proceedings of The
International Workshop. Berlin : Springer-Verlag
Lydtin, H., and Trenkwalder, P., 2002. Calcium Antagonist : A Critical
Review.Heidelberg : Springer-Verlag
Lopez-Novoa, J. M., Martinez-Salgado, C., Rodriguez-Pena, A. B., and
Hernandez, F. J. L., 2010. Common Pathophysiological Mechanism of
Chronic Kidney Disease : Therapeutic Perspectives. Available From :
https://www.researchgate.net/profile/Jose_LopezNovoa/publication/45091
427_Common_pathophysiological_mechanisms_of_chronic_kidney_disea
se_therapeutic_perspectives/links/0fcfd5062f18813c83000000.pdf

95

Lukela, J. R., Harrison, R. V., Jimbo, M., Mahallati, A., Saran, R., and Sy, A. Z.,
2014. Guidelines for Clinical Care Ambulatory : Management of
Chronic Kidney Disease. Available From : http://www.med.umich.edu/
1info/FHP/practiceguides/kidney/CKD.pdf
Mallat, S. G., 2012. What is a preferred angiotensin II receptor blocker-based
combination therapy for blood pressure control in hypertensive
patients with diabetic and non-diabetic renal impairment. Available
From : http://www.cardiab.com/content/pdf/1475-2840-11-32.pdf
Mahesa, D. R., 2010. Penyakit Ginjal Kronis (Chronic Kidney Disease).
Available From : http://pustaka.unpad.ac.id/wp-content/uploads/2014/01/
pustaka_unpad_penyakit_ginjal_kronis.pdf
Maria, G., Puspita, R. D., and Sulistyowati, Y., 2012. Hubungan Asupan
Natrium Dan Kalium Dengan Tekanan Darah Pada Pasien Hipertensi
Di Unit Rawat Jalan Di Rumah Sakit Guido Valadares Dili Timor
Leste. Available From : http://journal.respati.ac.id/index.php/medika/
article/viewFile/73/69
Marliani, L., and Tantan, S., 2007. 100 Question & Answer Hipertensi. Jakarta :
Elex Media Komputindo
Martin,

J.,

2008.

Hypertension

Guidelines:

Revisiting

the

JNC

7

Recommendations. Available From : http://www.jlgh.org/JLGH/media/
Journal-LGH-Media-Library/Past%20Issues/Volume%203%20-%20Issue
%203/JLGH_V3n3_p91-97.pdf
McPhee, S. J., Lingappa, V. R., and Ganong, W. F., 2003 Pathophysiology of
Disease: An Introduction to Clinical Medicine. Lange.
Ministry of Health and Kidney Health, 2014. Living with Kidney Disease : a
Comprehensive Guide For Coping With Chronic Kidney Disease,
Second Edition. Available From : https://www.health.govt.nz/system/
files/documents/publications/living-with-kidney-disease-2nd-ed-dec14.pdf

96

Miyagawa, K., Dohi, Y., Nakazawa, A., Sugiura, T., Yamashita. S., Sato,
K., Kimura, G., 2010. Renoprotective effect of calcium channel
blockers in combination with an angiotensin receptor blocker in
elderly patients with hypertension. A randomized crossover trial
between

benidipine

and

amlodipine.Available

From

:

http://www.tandfonline.com/doi/full/10.3109/10641960902929446
Moini, J., 2015. The Pharmacy Technician : A Comprehensive Approach,
Third Edition. Boston : Cengange Learning
Moorthy, A. V., Becker, B. N., and Djamali A., 2009. Pathophysiology of
Kidney Disease and Hypertension. Philadelphia : Elsevier
Muchtar, N.R., Tjitrosantoso, H., Bodhi, W., 2015. Studi Penggunaan Obat
Antihipertensi Pada Pasien Gagal Ginjal Kronik Yang Menjalani
Perawatan Di Rsup Prof. Dr. R. D. Kandou Manado Periode Juli 2013
- Juni 2014. Available From : http://ejournal.unsrat.ac.id/index.php/
pharmacon/article/viewFile/8833/8392
Muhammadun, 2010. Hidup Bersama Hipertensi Seringai Darah Tinggi Sang
Pembunuh Sejati. Jokjakarta: In-Books
Nahas, M. E., and Levin, A., 2009. Chronic Kidney Disease : A Practical Guide
to Understanding and Management. New York : Oxford University
Press
Neliya, S. W., 2012. Hubungan Pengetahuan tentang Asupan Cairan dan
Cara pengendalian Asupan cairan terhadap Penambahan Berat
Badan. Jurnal Nursing Studies. Available From : http://repository.unri.
ac.id/handle/123456789/1872
Nephrol, I. J., 2005. Clinical practice guidelines on hypertension and
antihypertensive agents in chronic kidney disease (CKD). Available
From : http://medind.nic.in/iav /t05/s1/iavt05s1p14.pdf

97

NKF, 2010. 2010 Annual Report : 60 years of Fighting Kidney Disease.
Availbale From : https://www.kidney.org/sites/default/files/docs/annual_
report_2010.pdf
Nurjanah, A., 2012. Hubungan Antara Lama Hipertensi Dengan Angka
Kejadian Gagal Ginjal Terminal Di Rsud Dr. Moewardi Surakarta.
Availabale

From

:

http://eprints.ums.ac.id/23959/10/NASKAH

PUBLIKASI.pdf
O’Mara, N. B. 2008. Anemia in Patients With Chronic Kidney Disease.
Available From : http://spectrum.diabetesjournals.org/content/21/1/12.full.
pdf
Opie, L. H., 2012. Clinical Use of Calcium Channel Antagonist Drugs.
Massachusetts : Kluwer Academic Publisher
Opie, L. H., and Gersh, B. J., 2013. Drug for The Heart, Eighth Edition.
Philadelphia : Elsevier Saunders
Opler, L. A., 2005. The Complete Pill Guide, Second Edition. New York :
Barnes & Noble Books
Owen, J., 2003. Drug Information Reference, 5th Edition. Available From :
http://dpic.org /sites/default/files/pdf/ DIR_CCBs.pdf
Panggabean, M. M., 2006. Penyakit Jantung Hipertensi. Buku Ajar Ilmu
Penyakit Dalam. Jilid 3. Edisi IV. Jakarta: Pusat Penerbitan Departemen
Ilmu Penyakit Dalam FK UI.
Papadopoulou, E., Varaouktsi, A., Lazaridis, A., Boutari, C., and Doumas M.,
2015. Erectile Dysfunction in Chronic Kidney Disease: From
Pathophysiology to Management. Available From : http://www.ncbi.
nlm.nih.gov/pmc/articles/PMC4491929/pdf/WJN-4-379.pdf
Pardo, M., and Sonner, J. M., 2007. Mannual of Anasthesia Practice. New York
: Cambridge University Press

98

Pearce, E. C., 2009. Anatomi dan Fisiologi untuk Paramedis. Jakarta : PT.
Gramedia
Perez-Lopez, F. R., Larrad-mur, L., Kallen, A., Chedraui, P., and Taylor, H. S.,
2010. Gender Differences in Cardiovascular Disease: Hormonal and
Biochemical Influences. Available From : http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3107852/pdf/nihms-293590.pdf
Pernefri, 2011. 4th Annual Report of Indonesian Renal Registry. Available
From

:http://www.pernefri-inasn.org/Laporan/4th%20Annual%20Report

%20Of%20IRR%202011.pdf
Phoon, R. K., 2012. Chronic Kidney Disease in The Elderly Assessment and
Management. Available From : http://www.racgp.org.au/download/
Documents/AFP/2012/December/201212phoon.pdf
Price, S., and Wilson L., 2005. Patofisiologi : Konsep Klinis Proses-Proses
Penyakit. Jakarta : EGC
Rahajeng, E.,

dan

Tuminah,

S.,

2009.

Prevalensi Hipertensi dan

Determinannya di Indonesia. Jakarta: Pusat Penelitian Biomedis dan
Farmasi Badan. Penelitian Kesehatan Departemen Kesehatan RI.
Rohaendi. 2008. Treatment Of High Blood Pressure. Jakarta :Gramedia Pustaka
Utama
Rimoldi, S. F., Messerli, F. H., Chavez, P., Stefanini, G. G., and Scherrer, U.,
2015. Efficacy and Safety of Calcium Channel Blocker/Diuretics
Combination Therapy in Hypertensive Patients: A Meta-Analysis.
Available From : http://onlinelibrary.wiley.com/doi/10.1111/jch.12462/pdf
Rossi, S., 2006. Australian Medicines Handbook 2006 Ed. Adelaide: Australian
Medicines Handbook Pty Ltd.
Sarnak, M. J., 2003. Cardiovascular Complications in Chronic Kidney
Disease.

Available

6386(03)00372-X/pdf

From

:

http://www.ajkd.org/article/S0272-

99

Sarwanto, Wilujeng, L. K., Rukmini, 2007. Prevalensi Penyakit Hipertensi
Penduduk Di Indonesia Dan Faktor Yang Berisiko. Available From :
http://download. portalgaruda.org/article.php?article=80593&val=4892
Schrier, R. W., 2009. Mannual of Nephrology Seven Edition. Philadelphia :
Lippincott Williams & Wilkins
Segura, J., Garcı´a-Donaire, J. A., and Ruilope, L. M., 2006. Calcium Channel
Blockers and Renal Protection: Insights from the Latest Clinical
Trials.Available From : http://jasn.asnjournals.org/content/16/3_suppl_1/
S64.full.pdf
Sever, V. S., and Messerli, F. H., 2011. Hypertension Management 2011:
Optimal Combination Therapy. Available From : http://eurheartj.
oxfordjournals.org/content/32/20/2499.full.pdf
Sheps, 2005. Mayo Klinik Hipertensi. Mengatasi Tekanan Darah Tinggi.
Jakarta: PT Intisari Mediatama
Sherwood, L., 2001. Fisiologi Manusia : dari Sel ke Sistem, Edisi 2. Jakarta :
EGC
Smeltzer, S. C., and Bare, B. G., 2001. Buku Ajar Keperawatan Medikal
Bedah. Jakarta : EGC
Soenarta, A. A., Erwinanto, Mumpuni A. S. S., Barack R., Lukito A. A.,
Hersunarti N., dan Pratikto R. S., 2015. Pedoman Tatalaksana
Hipertensi

Pada

Penyakit

Kardiovaskular.

Available

From

:http://www.inaheart.org/upload/file/Pedoman_TataLaksna_hipertensi_pad
a_penyakit_Kardiovaskular_2015.pdf
Spasovski, G.,Massy, Z., and Vanholder R. 2009. Phosphate Metabolism in
Chronic

Kidney

Management.

Disease:

Available

From
From

Pathophysiology
:

to

Clinical

http://www.mmh.org.tw/taitam/

kid_int/Blog/Entries/2009/12/14_Dec_2009_Schedule_files/Phosphate_M
etabolism_in_Chronic_Kidney_Disease.pdf

100

Sukandar, E., 2006. Neurologi Klinik : Edisi ketiga. Bandung: Pusat Informasi
Ilmiah (PII) Bagian Ilmu Penyakit Dalam Fakultas Kedokteran UNPAD.
Sullivan, K., 2013. 2013 Nurse’s Drug Handbook, Twelfth Edition. Burlington
: Jones & Bartlett Learning
Sustrani, L., 2006. Hipertensi. Jakarta : GramediaPustaka.
Suyono, S., 2004. Patofisiologi Diabetes Mellitus : Pnatalaksanaan DM
Terpadu. Jakarta : Balai Penerbit FKUI
Suwitra, K., 2006. Gagal Ginjal Kronik Buku Ajar Ilmu Penyakit Dalam Jilid
1 Edisi ke-4. Jakarta: Balai pustaka FK UI.
Sweetman, S. C., 2009. Martindale 36 : The Complete Drug Reference.
London : Pharmaceutical Press
Syamsir, A., and Iwan, H., 2007. Gagal Ginjal. Jakarta : Gramedia Pustaka
Utama
Tatro, D. S., 2003. A to Z Drug Facts. San Francisco : Facts and Comparisons
Thomas, R., Kanso, A., and Sedor, J. R., 2008. Chronic Kidney Disease and Its
Complications. Available From : http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC2474786/pdf/nihms54692.pdf
Tilley, L. P., 2008. Manual of Canine and Feline Cardiology, Fouth
Edition.United Kingdom : Elsevier
Toal, C. B., Meredith, P. A., Elliott, H. L., 2012. Long-Acting Dihydropyridine
Calcium-Channel Blockers and Sympathetic Nervous System Activity
in Hypertension: A Literature Review Comparing Amlodipine and
Nifedipine GITS. Available From : http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3469239/pdf/sblo21-3.pdf
Tobias, J. D., Tulman, D. B., and Bergese, S. D., 2013. Clevidipine for
Perioperative Blood Pressure Control in Infantsand Children.
Available From : http://www.mdpi.com/1424-8247/6/1/70/pdf

101

Toth-Manikowski, S., and Atta, M. G., 2015. Diabetic Kidney Disease:
Pathophysiology

and

Therapeutic

Targets.

Available

From

:

http://www.hindawi.com/journals/jdr/2015/697010/
Tzanakaki, E., Boudouri, V., Stavropoulou, A., Stylianou, K., Rovithis, M., dan
Zidianakis, Z., 2014. Causes and Complications of Chronic Kidney
Disease in Patients on Dialysis. Available From : http://www.hsj.gr/
medicine/causes-and-complications-of-chronic-kidney-disease-in-patientson-dialysis.pdf
Vikrant, S., and Tiwari, S. C., 2001. Essential Hypertension – Pathogenesis and
Pathophysiology. Available From : http://medind.nic.in/jac/t01/i3/jact01i3
p140.pdf
Wade, A Hwheir, D N Cameron, A. 2003. Using a Problem Detection Study
(PDS) to Identify and Compare Health Care Privider and Consumer
Views of Antihypertensive therapy. Journal of Human Hypertension.
Available From : http://www.nature.com/jhh/journal/v17/n6/full/1001565
a.html
Walker, R., and Whittlesea, C., 2012. Clinical Pharmacy and Terapeutics.
London : Elsivier.
Walt, I., Swanepoel, C. R., Mahala B., and Meyers, A. M., 2015. Important
Complications of Chronic Kidney Disease. Available From :
http://www.samj.org.za/index.php/samj/article/view/9536/6646
Wan, X., Ma, P., and Zhang, X. 2013. A promising choice in hypertension
treatment: Fixed-dose combinations. Available From : http://www.
sciencedirect.com/science/article/pii/S1818087613000810
Wearns, B., 2007. Chronic Kidney Disease Prevalence Modelling Briefing
Document. UK: Associated People Health Observatorium.
Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H.,
Kenerson, J. G., Flack, J. M., Carter, B. L., Materson, B. J., Ram, V. S.,
Cohen, D. L., Cadet, J. C., Jean-Charles, R. R., Taler, S., Kountz, D.,

102

Townsend, R. R., Chalmers, J., Ramirez, A. J., Bakris, G. L., Wang, J.,
Schutte, A. E., Bisognano, J. D., Touyz, R. M., Sica, D., and Harrap, S. B.,
2014.

Clinical

Practice

Guidelines

for

the

Management

of

Hypertension in the Community A Statement by the American Society
of Hypertension and the International Society of Hypertension.
Available From : http://csc.cma.org.cn/attachment/2014315/1394885445
745.pdf
Weir, M.R., and Dworkin, L.D., 2000. Antihypertensive drugs, dietary salt,
and renal protection: How low should you go and with which therapy.
Baltimore : Department of Medicine, University of Maryland School
of

Medicine.

Available

From

:http://www.ajkd.org/article/S0272-

6386(98)00173-5/fulltext
Wilkerson, J. A., 2010. Medicine for Mountaineering & Other Wilderness
Activities. Seattle : The Mountaineers Books

BAB II
TINJAUAN PUSTAKA

2. 1

Hipertensi

2. 1. 1 Definisi Hipertensi
Hipertensi didefinisikan sebagai peningkatan tekanan darah arteri sistemik
akibat tekanan yang diberikan pada dinding pembuluh darah. Diagnosis hipertensi
dilakukan secara berulang untuk menetapkan penyebab timbulnya hipertensi yang
dilihat dari kenaikan tekanan sistolik dan diastolik (Walker dan Whittlesea, 2012).
Diagnosis hipertensi ditegakkan bila tekanan darah (TD) lebih tinggi atau sama
dengan 140/90 mmHg, yang ditetapkan dengan pengukuran berulang minimal dua
kali

selama

beberapaminggu,

kecuali

bila

TD

sangat

tinggi

yang

memerlukantindakan atau terapi segera (Aziza, 2007). Hipertensi merupakan
faktor resiko utama timbulnya penyakit kardiovaskular dan sekitar 1 milyar orang
telah mengidap hipertensi diseluruh dunia (Haller, 2008).

2. 1. 2 Epidemologi Hipertensi
Hipertensi seringkali disebut sebagai pembunuh gelap (silent killer),
karena termasuk penyakit yang mematikan, tanpa disertai dengan gejala-gejalanya
lebih dahulu sebagai peringatan bagi korbannya. Kalaupun muncul, gejala
tersebut seringkali dianggap gangguan biasa, sehingga korbannya terlambat
menyadari akan datangnya penyakit (Sustrani, 2006). Hipertensi masih menjadi
masalah kesehatan pada kelompok lansia. Sebagai hasil pembangunan yang pesat
dewasa ini dapat meningkatkan umur harapan hidup, sehingga jumlah lansia
bertambah tiap tahunnya, peningkatan usia tersebut sering diikiuti dengan
meningkatnya penyakit degeneratif dan masalah kesehatan lain pada kelompok
ini (Abdullah, 2005).
Data WHO tahun 2000 menunjukkan, diseluruh dunia, sekitar 972 juta
orang atau 24,6% penghuni bumi mengidap hipertensi dengan perbandingan
26,6% pria dan 26,1% wanita. Angka ini kemungkinan akan meningkat menjadi

6

7

29,2% di tahun 2025. Dari 972 juta pengidap hipertensi, 333 juta berada di negara
maju dan 639 sisanya berada di negara sedang berkembang, temasuk Indonesia
(Andra,2007). Angka-angka prevalensi hipertensi di Indonesia telah banyak
dikumpulkan dan menunjukkan di daerah pedesaan masih banyak penderita yang
belum terjangkau oleh pelayanan kesehatan. Baik dari segi penemuan kasus
maupun penatalaksanaan pengobatannya. Jangkauan masih sangat terbatas dan
sebagian besar penderita hipertensi tidak mempunyai keluhan. Prevalensi
terbanyak berkisar antara 6 sampai 15%, tetapi angka prevalensi yang rendah
terdapat di Ungaran, Jawa Tengah sebesar 1,8% dan Lembah Balim Pegunungan
Jaya Wijaya, Irian Jaya sebesar 0,6% sedangkan angka prevalensi tertinggi di
Talang Sumatera Barat 17,8% (Wade, 2003).
Hipertensi menjadi masalah kesehatan masyarakat yang serius, karena jika
tidak terkendali akan berkembang dan menimbulkan komplikasi yang berbahaya.
Akibatnya bisa fatal karena sering timbul komplikasi, misalnya stroke (perdarahan
otak), penyakit jantung koroner, dan gagal ginjal (Gunawan, 2001).

2. 1. 3 Manifestasi Klinis Hipertensi
Pada tahap awal, seperti hipertensi pada umumnya kebanyakan pasien
tidak ada keluhan. Bila simtomatik, maka biasanya disebabkan oleh peninggian
tekanan darah itu sendiri seperti berdebar-debar, rasa melayang (dizzy) dan
impoten, cepat capek, sesak napas, sakit dada, bengkak kedua kaki atau perut.
Gangguan vascular lainnya adalah epistaksis, hematuria, pandangan kabur karena
perdarahan retina. Penyakit dasar seperti pada hipertensi sekunder yaitu
polidipsia, poliuria, kelemahan otot pada aldosteronisme primer, peningkatan
berat badan cepat dengan emosi

yang labil pada Cushing sindrom.

Feokromositoma dapat muncul dengan keluhan sakit kepala, palpitasi, banyak
berkeringat, dan rasa melayang saat berdiri (Panggabean, 2002).
Hipertensi sejatinya tidak menimbulkan gejala. Sakit kepala, kelelahan dan
pusing kadang-kadang dianggap sebagai hipertensi, namun gejala nonspesifik
seperti ini tidak umumlagi pada hipertensi dibanding kontrol normotensifnya.
Sebaliknya, kondisi ini ditemukan saat pasien menerima perawatan medis untuk
komplikasinya. Komplikasi ini bisa menjadi serius dan bisa berakibat fatal.

8

Komplikasi yang dapat terjadi antara lain termasuk infark miokard, gagal jantung
kongestif, stroke trombotik maupun hemoragik, hipertensi ensefalopati, dan gagal
ginjal. Ini sebabnya mengapa hipertensi disebut "Silent Killer" (Mcphee, et al,
2003)

2. 1. 4 Klasifikasi Hipertensi
Hipertensi dapat diklasifikasi berdasarkan penyebabnya yaitu Hipertensi
primer (esensial) dan Hipertensi sekunder. Hipertensi primer adalah hipertensi
yang penyebab spesifiknya tidak dapat diketahui. Sedangkan hipertensi sekunder
merupakan jenis yang penyebab spesifiknya dapat diketahui (Sustrani, 2006).
Berdasarkan bentuknya, hipertensi dapat dibedakan menjadi dua jenis,
yaitu hipertensi sistolik, hipertensi diastolik, maupun hipertensi campuran.
Hipertensi sitolik adalah peningkatan tekanan sistolik tanpa diikuti peningkatan
tekanan diastolik, umumnya ditemukan pada usia lanjut. Hipertensi diastolik ialah
peningkatan tekanan diastolik tanpa diikuti peningkatan tekanan sistolik. Biasanya
ditemukan pada anak-anak dan orang dewasa. Sedangkan hipertensi campuran
adalah peningkatan tekanan darah pada sistol dan diastol (Ismudiati,
2003).Berdasarkan JNC 7 (The Seventh Report of The Joint National Committee
on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure),
klasifikasi tekanan darah pada orang dewasa dibagi menjadi kelompok normal,
pra-hipertensi, hipertensi derajat 1, dan hipertensi derajat 2 (Kasper, et al, 2012).

Tabel 2.1 : Klasifikasi Hipertensi (JNC 7, 2003)
Blood Pressure Classification
Normal
Prehypertention
Stage 1 hypertention
Stage 2 hypertention

Systolic, mmHg
< 120
120-139
140-159
≥ 160

Diastolic, mmHg
< 80
80-89
90-99
≥ 100

Pada pasien hipertensi dengan CKD usia 18 tahun atau lebih perlu terapi
hipertensi untuk mendapatkan target tekanan darak sistolik kurang dari 140mmHg
serta diastolik kurang dari 90mmHg. Perlu diperhatikan pada pasien usia lebih
dari 60 tahun, jika tidak ada CKD target tekanan darah yang digunakan adalah

9

150/90mmHg sementara jika ada CKD, targetnya lebih rendah yaitu
140/90mmHg (Kasper, et al, 2012).

2. 1. 5 Etiologi Hipertensi

Gambar 2.1. Etiologi penyebab Hipertensi (Oparil, et al, 2003)

Hipertensi merupakan suatu penyakit dengan kondisi medis yang beragam.
Pada kebanyakan pasien etiologi patofisiologi-nya tidak diketahui (essensial atau
hipertensi primer). Hipertensi primer ini tidak dapat disembuhkan tetapi dapat
dikontrol. Kelompok lain dari populasi dengan persentase rendah mempunyai
penyebab yang khusus, dikenal sebagai hipertensi sekunder. Banyak penyebab
hipertensi sekunder; endogen maupun eksogen. Bila penyebab hipertensi sekunder
dapat diidentifikasi, hipertensi p