HIPERTENSI

dr. Dewi Martalena Sp.PD,

M.Kes

ESC/ESH
guideline

The relationship between BP & risk of CVD events is continuous,

consistent, & independent of other risk factors.
The higher the BP, the greater the chance of heart attack, HF,
stroke, and kidney diseases.

Evaluation of hypertensive
patients has 3 objectives:
1. To assess lifestyle & identify
other cardiovascular risk
factors or concomitant
disorders that may affect
prognosis & guide treatment
2. To reveal identifiable causes of
high BP
3. To assess the presence or
absence of target organ
damage & CVD.

Terapi

ESC/ESH
2013

JNC 8

JNC 8

JNC 8

JNC 8

Green continuous lines: preferred combinations; green dashed

line: useful combination (with some limitations); black dashed
lines: possible but less well tested combinations; red continuous
line: not recommended combination.

Hypertensive Crises:
Emergencies &
Urgencies
Hypertensive emergencies
Severe elevations in BP (>180/120
mmHg)
Complicated by evidence of
impending or progressive target
organ dysfunction
Require immediate BP reduction
(not necessarily to normal) to
prevent or limit target organ
damage
Examples: hypertensive
encephalopathy, intracerebral
hemorrhage, acute MI, acute left

Hypertensive
urgencies
Severe elevations in BP
without progressive
target organ
dysfunction.
Examples: upper levels
of stage II hypertension
associated with severe
headache, shortness of
breath, epistaxis, or
severe anxiety.

Hypertensive Emergencies
should be admitted to ICU:
monitoring of BP & parenteral
administration
Excessive falls in pressure that may
precipitate renal, cerebral, or
coronary ischemia should be
avoided short-acting nifedipine is
no longer considered acceptable
Exceptions to the recommendation:
ischemic stroke patients
aortic dissection who should
have their SBP lowered to <100
mmHg if tolerated
patients in whom BP is lowered
to enable the use of

BP : MAP <25%
(within minutes to 1
hour)
Clinically
stable

BP 160/100110
mmHg within the
next 26 hours
Clinically
stable

further gradual
reductions toward a
normal BP in the
next 2448 hours

Hypertensive Urgencies
May benefit from treatment with an oral,
short-acting agent such as captopril,
labetalol, or clonidine followed by several
hours of observation.
Should not leave the ER without a
confirmed follow up visit within several
days.

TERIMA
KASIH