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HYPERTENSI

CHAPTER I
INTRODUCTION

1.1. Background
High blood disease known as hypertension is a disease that gets
attention from all circles of society, considering its impact both short and long
term and thus require long-term response that fully. Hypertension cause
morbidity (illness) and mortality (death) is high.
Hypertension is a disease resulting from the interaction of various risk
factors a person has. Various studies have linked between the various risk
factors on the incidence of hypertension.
Based on the research that has been conducted poorer prevalence
(incidence) of hypertension increases with age.From various epidemiological
studies conducted in Indonesia showed 1.8 to 28.6% of the population aged
over 20 years are hypertensive.
Hypertension, currently there is a trend that more urban than rural
communities suffer from hypertension. This is partly attributed to the urban
lifestyle associated with the risk of hypertension such as stress, obesity
(overweight), lack of exercise, smoking, alcohol, and eating foods high in fat
content.
Along with age, almost everyone has experienced an increase in blood
pressure, systolic blood pressure continues to increase until the age of 80
years and diastolic pressures continue to increase until the age of 55-60
years, then decrease slowly or even decreased dramatically.

1.2. Problem Formulation


a. How does the definition of hypertension?
b. How to measure blood pressure?
c. Explaining the causes of hypertension?
d. Explain the symptoms of hypertension?
e. Describe the effect of hypertension?
f. How hypertension prevention?
g. Explain the treatment of hypertension?

1.3. The purpose


a. To find definitions of hypertension.
b. To learn how to measure blood pressure.
c. To determine the cause of hypertension.
d. To know the symptoms that caused.
e. To know the result of hypertension.
f. To know the prevention of hypertension.
g. To determine the treatment of hypertension.
CHAPTER II
DISCUSSION

2.1 Definitions
Hypertension or high blood pressure, is increased blood pressure or
force of blood pressing on the walls of the cavity where the blood was. High
Blood Pressure (hypertension) is an increase in blood pressure in the
arteries. (Hiper means Overrated, tension means pressure /
t egangan; j adi, hipertensi is p system disorders that cause blood
eredaran rise in blood pressure above the normal value.
Blood pressure in a person's life varies naturally. Infants and children
normally have a blood pressure that is much lower than adults. Blood
pressure is also affected by physical activity, which will be higher at the time
of the activity and lower when resting. Blood pressure is also different in one
day, the highest in the morning and most re ndah during nighttime sleep.

2.2 Measuring Blood Pressure


On examination the blood pressure will get two points. A higher figure
obtained when the heart contracts (systolic), a lower number obtained when
the heart relaxes (diastolic).Blood pressure is written as systolic pressure
diastolic pressure slash, eg 120/80 mmHg, read a hundred and twenty
eighty. Along with age, almost everyone has experienced an increase in blood
pressure , systolic blood pressure continues to increase until the age of 80
years and diastolic pressures continue to increase until the age of 55-60
years, then decrease slowly or even decreased dramatically.
Blood pressure is written with two numbers, the number units mmHg
(millimeters of mercury) in blood pressure tool / tension meter, the systolic
and diastolic. Is the highest systolic blood pressure is when the heart is doing
contract or contraction. Diastolic is the lowest figure at the heart expands in
the final relaxation.
For example, blood pressure 120/80 mmHg mean systolic pressure of
120 and diastolic pressure of 80 mmHg.

Blood pressure is the pressure generated by:


a. Strength buds urgent cardiac left ventricle to insert the contents of the
blood into the arterial trunk.
b. Resistance in the arterial blood flow.
c. Autonomic nerves are made up of the sympathetic and the sympathetic
system.

Classification of blood pressure


No Classification Systolic Diastolic
1 Optimal <120 mmHg <80 mmHg
2 Normal <130 mmHg <85 mmHg
3 Normal high 130-139 mmHg 85-89 mmHg
4 Mild hypertension 140-159 mmHg 90-99 mmHg
5 Hypertension was 160-179 mmHg 100-109 mmHg
6 Severe hypertension > 180 mmHg > 110 mmHg

Normal blood pressure


Blood pressure varies per person per day, depending on the
circumstances, and are affected by the activities of a person, so normalpun
blood pressure varies.
Adults when the blood pressure showed the number 140/90 mmHg is
considered normal upward. There is a perception of low blood pressure is not
good, it is less precise.Because statistics show that people with low blood
pressure have the same age with so-called normal. The best thing is to
maintain normal blood pressure and the assumption that increasing age is
higher blood pressure is not a problem, is the assumption that needs to be
clarified, because based on statistics of parents whose blood pressure in the
normal range, the trend gets low stroke disorders. Check your blood pressure
regularly at least once every 6 months or whenever the doctor / health facility.

2 classification known hypertension (by cause), namely:


a. primary hypertension (hypertension idiophatik), in which the cause is not
known with certainty. It also said that hypertension is the impact of
lifestyle and environmental factors.
b. secundary hypertension, is hypertension that occurs due to the disease
from other diseases such as abnormalities in the kidneys or keruskanan
of the hormone system.

WHO classifies hypertension based on the presence or absence of


abnormalities in other organs, namely:
a. hypertension without abnormalities in other organs.
b. hypertension with cardiac enlargement.
c. hypertension with abnormalities in other organs in addition to the heart.

Classification of hypertension by high blood pressure are:


a. borderline hypertension: blood pressure between 140/90 mmHg and
160/95 mmHg.
b. mild hypertension: blood pressure between 160/95 mmHg and 200/110
mmHg.
c. Moderate Hypertension: Blood pressure between 200/110 mmHg and
230/120 mmHg.
d. severe hypertension: blood pressure between 230/120 mmHg and
280/140 mmHg.

2.3 Causes of hypertension


There are 2 kinds of hypertension, essential and secondary.
a. hypertension Essential hypertension is the most not known
cause. There are 10 - 16% of adults suffer from high blood pressure.
b. hypertension Secondary hypertension is a known cause and why.
Hypertension kind is only a small part, which is only about 10%.
Some of the causes of hypertension, among others:
· Because hormonal, for example, from the adrenal glands.
· The use of drugs.
· smoking because the nicotine contained in tobacco.
· Alcoholic beverages.
· Abnormalities in the kidneys.
· Intracranial Abnormalities resulting in increased intracranial pressure or
because of its location near the center of persyarafan that affect blood
pressure.
· Abnormalities of the large blood vessels (aorta) that koartasio aorta where
the aortic arch aorta is continuous with decendens.

2.4. Anatomy
a. Heart
Measuring about one fist and is located within the chest, the limit on
the right is right and apeksnya sternum in the fifth intercostalis space
midclavicular left linea.
Relation of heart is:
Above: large blood vessels
Bottom: diaphragm
Each side: lung - lung
Rear: the descending aorta, esophagus, vertebral Columna
b. Arteries
Is the tube through which the blood flow in tissues and organs.Consists
of layers of the arteries: a slippery layer, the middle layer of elastin tissue /
muscle: the aorta and major branches have laposan center consisting of a
network of elastin (to deliver blood to the organs), smaller arteries have a
muscular middle layer (regulating the amount of Blood delivered to an organ).
c. Arterioles
Are the blood vessels with smooth muscle wall is relatively
thick. Arteriolar wall muscles to contract. Contractions caused kontriksi
diameter blood vessels. When kontriksi localized, blood supply to the
tissues/organs is reduced. If there kontriksi general, blood pressure will
increase.
d. Major blood vessels and capillaries
The main blood vessels are thin-walled vessels that run directly from
arterioles to venul. Capillaries are the network of small blood vessels open
major blood vessels.
e. Sinusoids
There are spleen, liver, bone marrow, and endocrine glands.Sinusoids
three to four times greater than in capillaries and partially coated with
reticulo-endothelial system cells. In places the sinusoid, having direct contact
with the blood cells and the exchange does not take place through the network
space.
f. Vena and venul
Venul is a combination of small veins formed capillaries. Veins formed
by the combined venul. Veins have three walls that are not adjacent to each
other perfectly. (Gibson, John. Issue 2 2002, p 110)

2.5. Physiology
The heart has the function as a pump oxygenated blood in the arterial
system, which was brought into the cell and the entire body to collect blood
deoxygenation (blood oxygen levels less) of the vein system are delivered to
the lungs for reoksigenasi (Black, 1997)

2.6. Pathophysiology of hypertension


The mechanisms that control the constriction and relaxation of blood
vessels located in the vasomotor center, the medulla of the brain.This stems
from the central vasomotor sympathetic nerve pathway, which continues
down to the spinal cord and the spinal cord out of the column to the
sympathetic ganglia in the thorax and abdomen.stimulation of the vasomotor
center is delivered in the form of impulse moves down through the
sympathetic nerves to the sympathetic ganglia. At this point, neurons release
acetylcholine preganglion, which will stimulate post-ganglion nerve fibers to
the blood vessels, which resulted in the release of norepinephrine constriction
of blood vessels. Various factors such as anxiety and fear can affect vascular
response to stimuli vasokontriktor. Individuals with hypertension are very
sensitive to norepinephrine, although it is not clear why it could happen.
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 vasoconstriction resulting in additional activities. Secreting
adrenal medullary epinephrine causes vasoconstriction. Adrenal cortex
secrete cortisol and other steroids, which DAPT strengthen blood vessels
vasokontriktor response.vasoconstriction resulting in decreased blood flow to
the kidneys, causing the release of renin. Renin stimulates the formation of
angiotensin I, which is then converted to angiotensin II, a potent
vasoconstrictor, which in turn stimulates aldosterone secretion by the adrenal
cortex. hormone causes retention of sodium and water by the kidney tubules,
causing an increase in intravascular volume. All of these factors tend to
provoke a state of hypertension.
Structural and functional changes in the peripheral vascular system
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, which 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 output and
increased peripheral resistance (Smeltzer, Bare, 2002).
2.7. The symptoms of hypertension
The symptoms of hypertension, among others:
a. Much of no symptoms.
b. Pain in the back of the head.
c. stiff neck.
d. Fatigue.
e. Nausea.
f. Shortness of breath.
g. Restless.
h. Vomiting.
i. easily offended.
j. hard to sleep.
Complaints are not always going to be experienced by a patient with
hypertension. Often a person with symptoms of pain behind his head,
irritability and difficulty sleeping, when the blood pressure measured showed
a normal blood pressure numbers. The only way to determine the presence or
absence of hypertension only by measuring blood pressure.

2.5 The effects of hypertension


Hypertension if not controlled can lead to serious complications, such as:
a. kidney damage.
b. damages blood vessels.
c. brain hemorrhage / stroke.
d. Paralysis.
e. enlarged heart / heart trouble.
f. Narrowing of the coronary arteries / heart attack.

2.6 Prevention of hypertension


Person's risk for hypertension (except essential), can be reduced by:
a. Checking blood pressure regularly .
b. Maintain ideal weight .
c. Reducing salt intake .
d. Do not smoke .
e. Exercising regularly .
f. regular life .
g. Reducing stress .
h. Do not rush .
i. Avoid fatty foods.

Primary Prevention:
· Adequate sleep, between 6-8 hours per day.
· Reduce high cholesterol foods and multiply physical activity to lose weight.
· Reduce alcohol consumption.
· Consumption of fish oil.
· The supply of calcium, although only slightly lower blood pressure but
calcium is also quite helpful.
Secondary Prevention
· Pattern whice food healthy.
· Reduce salt and sodium in your diet.
· Physical active.
· Reduce intake Alcohol.
· Stop smoking.

Tertiary Prevention
· Control of blood on a regular basis.
· Sports regularly and adjusted to body condition.

2.7 Treatment of hypertension


Treatment of hypertension is best:
a. Always control your blood pressure checked regularly by a doctor .
b. Always take medication regularly even without a complaint .
c. Reducing salt intake .
d. Increase consumption of vegetables and fruit .
e. Obeying doctor's advice.

The content of salt (Sodium or Sodium)


Someone who is suffering from hypertension should control themselves
in salt consumption. The meaning here is the sodium salt of salt present in
almost all foods derived from animals and plants.One major source of sodium
is table salt. Therefore, the recommended salt intake of no more than ¼ - ½
teaspoon / day or to use other than the sodium salt.
Low salt diet goal is to help eliminate the salt or water retention in the body
tissues and lowers blood pressure in hypertensive patients.The terms of a low
salt diet is:
· Enough energy, protein, minerals, and vitamins.
· Forms of foods according to the disease state.
· The amount of sodium adjusted to the severity of salt or water retention and
/ or hypertension.
This diet contains enough nutrients. In accordance with the state of the
disease can be given different levels of Low Salt Diet.
· Low Salt Diet I (200-400 mg Na)
This diet was given to patients with edema, ascites, and / or severe
hypertension. In the food processing no salt added. Avoided the foods high in
sodium.
· Low Salt Diet II (600-800 mg Na)
This diet was given to patients with edema, ascites, and / or hypertension
are not too heavy. Daily feeding with Low Salt Diet I. In the food processing
may not use salt ½ tsp (2 g). Avoided the foods high in sodium.
· Low Salt Diet III (1000-1200 mg Na)
This diet is given to patients with edema and/or mild hypertension.
Daily feeding with Low Salt Diet I. In the food processing may use 1 teaspoon
salt (4 g).
2.8. Content of Potassium or Potassium
Potassium suplements 2-4 grams per day can help lower blood
pressure. Potassium is generally fat found in some fruits and
vegetables. Fruits and vegetables that contain potassium and good for people
with hypertension consumed include watermelon, avocado, melon, bitter
melon fruit, squash, bligo, machete pumpkin / gourd, cucumber, aloe vera,
celery, onion and garlic. In addition, foods containing omega 3 sagat elements
known to be effective in helping to decrease blood pressure (hypertension).
In patients with hypertension where blood pressure> 160 / g mmHg, in
addition to the provision of anti-hypertensive drugs need dietetic therapy and
lifestyle changes. The objective of dietary management is to help lower blood
pressure and maintain blood pressure to normal. In addition, the diet is also
intended to reduce risk factors such as overweight, high cholesterol and fat
levels of uric acid in the blood. It should be noted also that accompanies other
degenerative diseases such as high blood pressure, heart, kidney and diabetes
mellitus.
a. SETTING MENU FOODS
Adjusting diet is recommended for patients with hypertension to avoid
and limit foods that can increase blood cholesterol levels and increase blood
pressure, so people do not have a stroke or cardiac infarction.
Foods to be avoided or restricted are:
1. The food is high in saturated fat (brain, kidney, lung, coconut oil, lard).
2. Food was prepared by using sodium salt (cookies, crakers, chips and dried
foods are salty).
3. Food and drinks in cans (sardines, sausage, korned, vegetables and fruits
in cans, soft drink ).
4. Preserved foods (jerky, pickled vegetables or fruit, shredded, salted, boiled,
dried shrimp, salted eggs, peanut butter).
5. Milk full cream , butter, margarine, cheese, mayonnaise, and other sources
of animal protein are high in cholesterol such as red meat (beef / mutton),
egg yolk, chicken skin).
6. Condiments such as soy sauce, maggi, shrimp paste, tomato sauce, chili
sauce, tauco and other flavorings generally contain sodium salt.
7. Alcohol and alcohol-containing foods such as durian, tape.

How to set up a diet for people with hypertension is to improve the taste
by adding sugar fresh red / white onion (red / white), ginger, and other spices
kencur are not salted or salt contains less sodium.Food can be sauteed to
improve the taste. Put salt at the table above can be taken to avoid excessive
use of salt. It is recommended to always use iodized salt and salt use no more
than 1 teaspoon per day.
Increasing potassium intake (4.5 grams or 120-175 mEq / day) can give
the effect of a mild decrease in blood pressure. In addition, administration of
potassium also helps to replace lost sodium and low potassium result. Can
generally used medium size (50 grams) of apples (159 mg potassium), orange
(250 mg potassium), tomato (366 mg potassium), banana (451 mg potassium)
baked potato (503 mg potassium) and 1 cup skim milk (406 mg
potassium). Adequacy of calcium is important to prevent and treat
hypertension: 2-3 glasses of skim milk or 40 mg / day, 115 grams of low-
sodium cheese to meet the needs of calcium 250 mg / day. While the needs
of the average daily calcium 808 mg.
In pregnant women food enough protein, calories, calcium and sodium
are associated with a lower incidence of hypertension of pregnancy. However,
pregnant women are especially hypertension accompanied by swelling and
urinary protein (pre-eclampsia), other than medicines recommended to
reduce salt intake and increase food sources of Mg (vegetables and fruits).
b. SUPPLEMENTATION anti oxidant
Despite antioxidant supplementation still require further research, but
today many supplements are sold and consumed by the public. As medical
personnel should be careful giving advice supplement drink to avoid overdose.

1. Vitamins and Decrease Homocysteine


Folic acid, vitamin B6, vitamin B12 and riboflavin are enzyme co-factor
essential for the metabolism of homocysteine. Various studies have shown
that elevated levels of homocysteine in the blood increases the risk of coronary
artery disease. Low levels of folic acid are associated with an increased risk of
coronary disease and low vitamin levels are also associated with an increased
risk of atherosclerosis, although the risk of atherosclerosis associated with
low levels of vitamin B6 was not associated with a high concentration of
homositein. while vitamin B12 is not associated with vascular disease.
2. Soybeans and Isoflavones
Soy contains many isoflavones are estrogen-Phy, which have weak estrogen
activity. Research meta-analysis in 1995 concluded that isoflavones from soy
protein more significantly reduce total cholesterol, LDL cholesterol and
triglycerides, without affecting HDL cholesterol levels. So it is recommended to
consume soy protein (20-50 grams / day) and dietary modifications in patients
with cholesterol (total and LDL) is high. Tempe is the result of processing soybeans
fermented with better nutritional content than soy. So that tempeh is
recommended for consumption by people with hypertension as a source of
vegetable protein.
3. Tempe
Tempe is one of the traditional food of Indonesia, fermented
fungus Rhizopus ohgosporis or rhizopusoryzal on soybean seed that has been
boiled. There are various kinds of tempeh, tempeh discussion is made of soy,
which is a compact product, wrapped flat by the mycelium fungus that
appears white in color, and when slicedpieces seem pale yellow soya beans,
among the mycelium. Fermentation mold produces a change in the texture of
soy, are soft and nutritional value of tempeh better than soybeans.
Nutritional value Tempe:
· Protein
Enzymes produced molds, producing free amino acids, so the level is
increased to 85 times the levels of soy protein.
· Carbohydrates
Soybeans contain carbohydrates in the form of sakrosa and stakhiosa and
rifinosa (the latter two led to the formation of gas in the stomach). Fermented
soybeans into soybean producing carbohydrates.
· Fat
Enzymes in the mold can reduce the total fat content from 22.2% to 14.4%
and increased free fatty acid levels from 0.5% to 21%.
· Mineral
In the soybean contained phytic acid which is a compound forfose, which can
not be utilized by the body. With fermentation, molds produce the enzyme
phytase which outlines the phytic acid, so it can be utilized forfosenya body.
· Vitamin
The fermentation process can increase levels of vitamin B2 (Riboferum),
Vitamin B6 (pyridoxine), folic acid, panthotenat, and nicotinic acid. While
vitamin B1 levels decreased due to the growth of mold and also vitamin B12
formed by bacteria that do not exist in other vegetable products.
Benefits Tempe:
Tempe is a good source of nutrients, especially for patients with hyper
kolesterolemia. From various studies it turns out tempeh can lower
cholesterol levels in the blood and prevent blood vessel constriction, because
tempeh contains polyunsaturated fatty acids. So that hypertensive patients
are encouraged to eat tempeh every day, in addition to a diet low in saturated
fat.
Tempe also contains antibacterial substances that can inhibit the
growth of some gram-positive bacteria as well as cause diarrhea
(Salmonella sp and Shigella sp.) Therefore, tempeh is also recommended to be
consumed under five with diarrhea.
4. Omega 3 Fatty Acids
Eating one serving of high-fat fish (or fish oil) per day can be the intake
of omega 3 fatty acids (EPA and DHA) of approximately 900 mg / dl, and has
been reported to lower cholesterol and prevent coronary heart disease.
5. Fiber
Although sharing of studies show an association between some types of
fibers with decreased cholesterol or LDL and total cholesterol, but there is no
direct evidence showing the relationship between fiber supplements with
decreased cardiovascular disease.
· Name the dish, main ingredient, processing methods, and tools food diet
hypertension and dyslipidemia
Menu Ingredients
Food Processing Equipment Method Supplementary Material misstatement
soft rice
Sauteed Chicken + Rice - Boiling + steaming porcelain dish
skinless chicken stir-fry dishes porcelain salt
Carrots Carrots
boiled Nutmeg Bowl
Coffee Milk Glass Milk Sugar Water +
Sugar Pudding Fruit Jelly boiled Saucer
Mango Mango
Milk cups low fat Milk
Rice Boiled Rice + Plato steamed
fish Pepes Fish Plato saffron steamed
soy chicken sauteed chicken red sugar Plato
Glass Milk Skimmed milk powder
Sugar
Watercress Oseng + carrots + green beans stir-fried salt Plato Carrots
Watercress
Beans
Diet
Breakfast Menu
• Nasi software
• Sauté chicken + carrots
soy milk • Coffee
(E: 225 Cal, KH: 30 g, L: 6.5 g, P: 30 g
Interlude 1 and 2
• Mango Pudding
• low fat milk
(E: 330 Cal, KH: 59 g, L: 7 g, P: 7 g)
Lunch
• White rice
• Pepes know
• Soup beans + carrots
• Papaya fruit
(E: 325 Cal, KH: 44 g, L: 7.5 g, P: 18.5 g)
Dinner
• White Rice
• Sauteed Spinach
• Pepes Fish
• Fruit Papaya
(E: 360Kal, KH: 57 g, L: 3 g, P: 12g)

CHAPTER III
CLOSING

3.1 Conclusion
Hypertension or high blood pressure, is increased blood pressure or
force of blood pressing on the walls of the cavity where the blood was.
Blood pressure in a person's life varies naturally. Infants and children
normally have a blood pressure that is much lower than adults. Blood
pressure is also affected by physical activity, which will be higher at the time
of the activity and lower when resting. Blood pressure is also different in one
day, the highest in the morning and lowest at night during sleep.

3.2. Suggestion
How to set up a diet for people with hypertension is to improve the taste
by adding sugar fresh red / white onion (red / white), ginger, and other spices
kencur are not salted or salt contains less sodium. Food can be sauteed to
improve the taste. Put salt at the table above can be taken to avoid excessive
use of salt. It is recommended to always use iodized salt and salt use no more
than 1 teaspoon per day.