Apa Itu evolusi apa Hipertensi
HIPERTENSI
OLEH:
TREZZAH FIRMANSYAH
APA ITU
HIPERTENSI?
Tekanan darah tinggi (hipertensi) adalah
peningkatan tekanan darah di dalam
arteri (pembuluh darah nadi) di atas
angka normal. Seringkali hipertensi
terjadi tanpa gejala, sehingga penderita
tidak merasa sakit. Pada pemeriksaan
tekanan darah (tensi) akan didapat 2
angka yakni angka yang atas diperoleh
saat jantung berkontraksi (sistolik)
sedangkan angka bawah diperleh saat
jantung relaksasi (diastolik). Sehingga
Klasifikasi Hipertensi : JNC VII
Hypertension is defined as blood pressure 140/90
mmHg
Kategori
Systolic
(mmHg)
Diastolic
(mmHg)
Normal
90 mm Hg
50
64
65
70-79
80+
54
44
40
30
20
10
21
4
11
18-29
30-39
0
Usia)
40-49
50-59
60-69
Franklin, S.S., J Hypertens 1999; 17 (suppl 5): S29-S36
RULE OF HALF
Pasien yang
tidak berobat
dan tidak
kontrol
25%
Berobat tapi
tidak kontrol
rutin
12.5%
12.5%
50%
Yang tidak tahu
Source : Joffres et al. (1997) Am. J. Hypertension 10: 1097-1102
Berobat dan terkontrol
KOMPLIKASI HIPERTENSI
Mata
retinopathy
Target Gagal Organ
Kerusakan tergantung pada:
•
seberapa tinggi tekanan
darah
•
Berapa lama tidak
terkontrol dan tertangani
Ginjal
Gagal Jintang
Otak
stroke
Jantung
Peny.Jantung Koroner
Pembesaran Jantung kiri
Gagal Jantung
Peripheral arterial disease
PENGOBATAN
• DIET.
• MENURUNKAN BERAT BADAN.
• OLAH RAGA AEROBIK.
WORLD OBESITY TRENDS GLOBESITY – DIABESITY
44
(Summarized
(Summarized :: Tjokroprawiro
Tjokroprawiro 2005-2007)
2005-2007)
STAGE – 0
Healthy Lifestyle
STAGE – 1
STAGE – 2
STAGE – 3
STAGE – 4
“Westernized”
Obesity
Preclinical : the MetS
Clinical : CAD
IFG, IGT, Pedr.-Obese
T2DM, Pedr.-T2DM, Stroke
Unhealthy Lifestyle (Abdominal Obesity)
Lingkar Pinggang
PEDIATRIC
OBESE
o > 90 cm
4 GDS
PEDIATRIC
T2DM
1 Triglyceride
> 100 mg/dl
ATP-III 2001 - Criteria
o
+ > 80 cm
GULOH
3 Blood Pressure
> 130/85 mmHg
> 150 mg/dl
CISAR
IDF 2005 - Criteria
2 HDL-Chol
o < 40 mg/dl
o
+ < 50 mg/dl
ASK-DNC
Stage― 3 or the MetS will be "TIME-BOMB DISEASE” in Indonesia ?
TEN
TEN PRACTICAL
PRACTICAL GUIDELINES
GUIDELINES FOR
FOR HEALTHY
HEALTHY LIFE
LIFE
34
GULOH-CISAR = SYNDROME-10
(Tjokroprawiro
(Tjokroprawiro 1995-2007)
1995-2007)
1 G Limit Sugar Consumption
6 C Stop Smoking
2 U Restrict Purine Intake : JAS-BUKET
7 I
3 L Consume Low Fat Diet : TEK-KUK-CS2
4 O Prevent Obesity (Target : BMI < 25)
+300 kcal/day or 3 km walk
+Sit up 50-100 x/day
8 S TAKE MINIMALLY 6-HOUR SLEEP/DAY
9 A Stop Alcohol
5 H Measure BP Regularly
10 R Regular Check-Up
(Less than 3 g Sodium/day)
G = Glucose
C = Cigarette
U = Uric Acid
I = Inactivity
Daily Regular Exercise :
Esp. > 40 Years Old : 3, 6 or 12 Months
L = Lipids
S = Stress
O = Obesity
A = Alcohol
H = Hypertension
R = Regular Check Up
JAS-BUKET : Jerohan, Alkohol, Sarden - Burung Dara, Unggas, Kaldu, Emping, Tape
(Bowels, Alcohol, Sardines - Pigeon, Fowls, Meat-Broth, Beaten Nut, Fermented Cassava)
TEK-KUK-CS2 : Telor, Keju - Kepiting, Udang, Kerang - Cumi, Susu, Santen
(Egg, Cheese - Crab, Shrimp, Mussel - Squid, Milk, Coconut - Juice)
"MABUK" (Rich in Chromium) : Mrica, Apel, Brokoli, Udang, Kacang-kacangan; good for DM
ASK-DNC
Recommended Food Supplements : Green Bean, Onions, Green Tea, Pepper, ARGININE, TKW-PJKA-BK
INITIATION OF ANTIHYPERTENSIVE TREATMENT : ESC 2OO7
Other risk
factors, OD, or
disease
Normal SBP
120-129 or DBP
80-84
High normal
SBP 130-139 or
DBP 85-89
Grade 1 HT
SBP 140-159 or
DBP 90-99
Grade 2 HT
SBP 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 OD
Lifestyle
changes
Lifestyle
changes and
consider drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes +
immediate drug
treatment
Diabetes
Lifestyle
changes
Lifestyle
changes + drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes +
immediate 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
TERIMA KASIH
OLEH:
TREZZAH FIRMANSYAH
APA ITU
HIPERTENSI?
Tekanan darah tinggi (hipertensi) adalah
peningkatan tekanan darah di dalam
arteri (pembuluh darah nadi) di atas
angka normal. Seringkali hipertensi
terjadi tanpa gejala, sehingga penderita
tidak merasa sakit. Pada pemeriksaan
tekanan darah (tensi) akan didapat 2
angka yakni angka yang atas diperoleh
saat jantung berkontraksi (sistolik)
sedangkan angka bawah diperleh saat
jantung relaksasi (diastolik). Sehingga
Klasifikasi Hipertensi : JNC VII
Hypertension is defined as blood pressure 140/90
mmHg
Kategori
Systolic
(mmHg)
Diastolic
(mmHg)
Normal
90 mm Hg
50
64
65
70-79
80+
54
44
40
30
20
10
21
4
11
18-29
30-39
0
Usia)
40-49
50-59
60-69
Franklin, S.S., J Hypertens 1999; 17 (suppl 5): S29-S36
RULE OF HALF
Pasien yang
tidak berobat
dan tidak
kontrol
25%
Berobat tapi
tidak kontrol
rutin
12.5%
12.5%
50%
Yang tidak tahu
Source : Joffres et al. (1997) Am. J. Hypertension 10: 1097-1102
Berobat dan terkontrol
KOMPLIKASI HIPERTENSI
Mata
retinopathy
Target Gagal Organ
Kerusakan tergantung pada:
•
seberapa tinggi tekanan
darah
•
Berapa lama tidak
terkontrol dan tertangani
Ginjal
Gagal Jintang
Otak
stroke
Jantung
Peny.Jantung Koroner
Pembesaran Jantung kiri
Gagal Jantung
Peripheral arterial disease
PENGOBATAN
• DIET.
• MENURUNKAN BERAT BADAN.
• OLAH RAGA AEROBIK.
WORLD OBESITY TRENDS GLOBESITY – DIABESITY
44
(Summarized
(Summarized :: Tjokroprawiro
Tjokroprawiro 2005-2007)
2005-2007)
STAGE – 0
Healthy Lifestyle
STAGE – 1
STAGE – 2
STAGE – 3
STAGE – 4
“Westernized”
Obesity
Preclinical : the MetS
Clinical : CAD
IFG, IGT, Pedr.-Obese
T2DM, Pedr.-T2DM, Stroke
Unhealthy Lifestyle (Abdominal Obesity)
Lingkar Pinggang
PEDIATRIC
OBESE
o > 90 cm
4 GDS
PEDIATRIC
T2DM
1 Triglyceride
> 100 mg/dl
ATP-III 2001 - Criteria
o
+ > 80 cm
GULOH
3 Blood Pressure
> 130/85 mmHg
> 150 mg/dl
CISAR
IDF 2005 - Criteria
2 HDL-Chol
o < 40 mg/dl
o
+ < 50 mg/dl
ASK-DNC
Stage― 3 or the MetS will be "TIME-BOMB DISEASE” in Indonesia ?
TEN
TEN PRACTICAL
PRACTICAL GUIDELINES
GUIDELINES FOR
FOR HEALTHY
HEALTHY LIFE
LIFE
34
GULOH-CISAR = SYNDROME-10
(Tjokroprawiro
(Tjokroprawiro 1995-2007)
1995-2007)
1 G Limit Sugar Consumption
6 C Stop Smoking
2 U Restrict Purine Intake : JAS-BUKET
7 I
3 L Consume Low Fat Diet : TEK-KUK-CS2
4 O Prevent Obesity (Target : BMI < 25)
+300 kcal/day or 3 km walk
+Sit up 50-100 x/day
8 S TAKE MINIMALLY 6-HOUR SLEEP/DAY
9 A Stop Alcohol
5 H Measure BP Regularly
10 R Regular Check-Up
(Less than 3 g Sodium/day)
G = Glucose
C = Cigarette
U = Uric Acid
I = Inactivity
Daily Regular Exercise :
Esp. > 40 Years Old : 3, 6 or 12 Months
L = Lipids
S = Stress
O = Obesity
A = Alcohol
H = Hypertension
R = Regular Check Up
JAS-BUKET : Jerohan, Alkohol, Sarden - Burung Dara, Unggas, Kaldu, Emping, Tape
(Bowels, Alcohol, Sardines - Pigeon, Fowls, Meat-Broth, Beaten Nut, Fermented Cassava)
TEK-KUK-CS2 : Telor, Keju - Kepiting, Udang, Kerang - Cumi, Susu, Santen
(Egg, Cheese - Crab, Shrimp, Mussel - Squid, Milk, Coconut - Juice)
"MABUK" (Rich in Chromium) : Mrica, Apel, Brokoli, Udang, Kacang-kacangan; good for DM
ASK-DNC
Recommended Food Supplements : Green Bean, Onions, Green Tea, Pepper, ARGININE, TKW-PJKA-BK
INITIATION OF ANTIHYPERTENSIVE TREATMENT : ESC 2OO7
Other risk
factors, OD, or
disease
Normal SBP
120-129 or DBP
80-84
High normal
SBP 130-139 or
DBP 85-89
Grade 1 HT
SBP 140-159 or
DBP 90-99
Grade 2 HT
SBP 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 OD
Lifestyle
changes
Lifestyle
changes and
consider drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes +
immediate drug
treatment
Diabetes
Lifestyle
changes
Lifestyle
changes + drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes + drug
treatment
Lifestyle
changes +
immediate 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
TERIMA KASIH