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Penatalaksanaan Hipertensi Terkini Fokus Pada JNC 8 - Wachid Putranto PDF
Penatalaksanaan Hipertensi Terkini Fokus Pada JNC 8 - Wachid Putranto PDF
TERKINI :
FOKUS PADA JNC 8
WACHID PUTRANTO
Divisi Ginjal Hipertensi
Fakultas Kedokteran UNS/RS.Dr. Moewardi
Surakarta
Suatu keadaan klinis dimana tekanan darah
seseorang lebih tinggi daripada tekanan
darah normal
• Epidemiologi :
• Jumlah penderita hipertensi di seluruh dunia :
1 milyar
• USA : 65 juta
• Indonesia ? : belum ada data resmi
70
SBP > 140 mm Hg 65
64
prevalence of hypertension (%)
60 DBP > 90 mm Hg
50 54
44
40
30
21
20
4 11
10
0
age (yrs) 18-29 30-39 40-49 50-59 60-69 70-79 80+
HYPERTENSION
GUIDELINES
CLASSIFICATION BP SBP DBP
HYPERTENSION and
Optimal <120 <80
BP SBP DBP Normal 120-129and./or 80-84
Normal <120 and <80 High Normal 130-139 85-89
Pre HT 120-139 or 80-89 HT stg 1 140-159 90-99
Stg 1 140-159 or 90-99 HT stg 2 160-179 100-109
Stg 2 ≥160 or ≥100 HT stg 3 ≥180 ≥110
ISH ≥140 <90
and
BP SBP DBP
Optimal <120 and <80
JNC 8
Normal <130 and <85
High Nml 130-139 or 85-89 No definition of HT
HT stg 1 140-159 or 90-99
HT stg 2 160-179 or 100-109
HT stg 3 ≥180 or ≥110
Topic JNC 7 2014 Hypertension Guidelin
Methodology Non systematic literature review by Critical questions and review criteria defined by expert
expert committee including a range panel with input from methodology team
of study design Initial systematic review by methodologist restricted to
Recommendation based on consensus RCT evidence
Subsequent review of RCT evidence and recommendations
by the panel according to a standardized protocol
Definitions Defined hypertension and prehypertension Definision of hypertension and prehypertension not
addressed, but tresholds for pharmacologic treatment
were defined
Treatments Separate treatmen goals defined for Similar treatment goals defined for all hypertensive
Goals “uncomplicated” hypertension and for populations except when evidence review supports
subsets with various comorbid condition different goals for a particular subpopulation
Lifestyle Recommended lifestyle modifications Lifestyle recommendations recommended by endorsing
Recommendation based on literature review and expert the evidence based recommendations of the Lyfestyle
opinion Work Group
Drug therapy Recommended 5 classes to be considered Recommended selection among 4 specific medications
as initial therapy for most patients without classes ( ACEI or ARB, CCB or Diuretics) and doses based
compelling indication for another class on RCT evidence
Specified particular antihypertensive Recommended specific medication classes based on
medication classes for patients with evidence review for racial, CKD, and diuretics sub group
compelling indication,ie,diabetes,CKD,heart Panel created a table of drugs and doses used in the
failure,myocardial infarction,stroke,high outcome trials
CVD risk
Included a comprehensive table oral
Antihypertensive drugs including names
and usual dose ranges
Scope of topics Addressed multiple issues ( blood pressure Evidence review of RCT’S addressed a limited
measurements methods,patients evaluation number of questions,those judge by the panel
components,secondary hypertension, to be of highest priority
adherence to regimens,resistant hypertension,
and hypertension in special populations) based
on literature review and expert opinion
Review process Reviewed by the National High Blood pressure Reviewed by experts including those affiliated
Prior to Education Program Coordinating Committee, with professional and public organizations and
Publication a coalition of 39 major professional,public, and federal agencies; no official sponsorship by any
voluntary organizations and 7 federal agencies organization should be inferred
The Process
Literature review 1/1/1966 – 12/31/2009
Inclusion Criteria
(1) HTN
(2) 2000 participants
(3) multisenter
(4) Kriteria inklusi/eksklusi.
9 Recommendations
A
N
Strength of
Recommendation Recommendation
Recommendation 1
Populasi berusia ≥60 yrs,mulai terapi Grade A
farmakologi SBP≥150 mmHg, DBP≥90 mmHg
HYVET, Sys-Eur, SHEP, JATOS, VALISH,
CARDIO-SIS
Corollary Recommendation
Populasi usia ≥60 yrs, jika terapi farmakologi
mengakibatkan penurunan TD lebih rendah Grade E
(<140/90) dan pengobatan ditoleransi dengan
baik tanpa efek samping, teruskan pengobatan.
Usia ini TD <140 tidak lebih baik disbanding
140-160
Recommendation 2
Populasi usia <60 yrs, terapi farmacologi bila Grade A (30-59 yrs)
DBP≥90 mmHg . Target DBP<90 mmHg Grade E (18-29 yrs)
HDFP, HT-Stroke Cooperative, MRC,
ANBP, VA cooperative
Strength of
Recommendation Recommendation
Recommendation 3
Populasi usia <60 yrs, terapi farmacologi bila Grade E
SBP ≥140 mmHg.Target SBP<140 mmHg
Recommendation 4
Populasi usia ≥18 yrs dengan CKD, terapi
farmacologi bila SBP ≥140 mmHg or DBP ≥90 Grade E
mmHg . Target SBP <140 mmHg dan DBP <90
mmHg AASK, MDRD, REIN-2
Recommendation 5
Populasi usia ≥18 dengan DM, terapi Grade E
farmacologi bila SBP ≥140 mmHg atau DBP ≥ 90
mmHg. Target SBP<140 and DBP <90 SHEP, Syst-Eur, UKPDS, ACCORD,
ADVANCE, HOT
Strength of
Recommendation Recommendation
Recommendation 6
Pada populasi non black , termasuk dg DM, Grade B
initial anti HTN treatment : a thiazide type
diuretic, CCB, ACEI or ARB VA-cooperative, HDFP, SHEP
Recommendation 7
Populasi kulit hitam, termasuk dg DM, initial Grade B ( No DM)
anti HT: thiazide-type diuretic or CCB Grade C ( DM)
ALLHAT
Recommendation 8
Populasi usia ≥18 dg CKD dan HTN, initial (or Grade B
add on) anti HTN : ACEI or ARB utk
memperbaiki kidney outcomes. Tanpa melihat
ras atau status DM IDNT, AASK
Recommendation Strength of
Recommendation
Recommendation 9
βBlocker No Yes No No No No
as 1st line
NICE ESH/ESC ASH/ISH AHA/ACC JNC 7 JNC 8
/CDC
Diuretic Chorthali- Thiazides THZ THZ THZ THZ
done (THZ), CTD CTD
(CTD) CTD IND IDP
Indapami- ND
de (IND)
Initiate Not Pts w/ ≥160/90 ≥160/100 ≥160/100 Not
th/ with mentio- markedly mentioned
2 drugs ned elevated BP