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Farmakoterapi hipertensi

Kelompok I
Aynul Qolby Nst
Dwi Novianti
Fera Astuti
Jimmy Tessa
Mainarti Ekasari
Mery Yulianda
Pipi Saputri
Ririn Andrian
Suryawati
Jon Frikson
Winda Wahidar
Roni M. Situmorang

Blood Pressure

Overview
Definition, classification of

hypertension (HTN)
Goals of therapy
Treatment
Monitoring antihypertensive drug
therapy

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DEFINISI
Hipertensi adalah suatu keadaan peningkatan
tekanan darah yang
mendadak (sistole ≥140 mmHg dan/atau
diastole ≥90 mmHg), pd penderita hipertensi,
yg membutuhkan penanggulangan segera.

Umumnya penderita tidak mengetahui dirinya mengidap hipertensi sebelum memeriksakan tekanan darahnya.  . Hipertensi dikenal pula sebagai heterogeneous group of disease karena dapat menyerang siapa saja dari berbagai kelompok umur dan kelompok sosial ekonomi .

. yaitu sekitar 13% dari total kematian.1 juta orang di seluruh dunia.Epidemiologi Hipertensi diperkirakan menjadi penyebab kematian sekitar 7.

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Mortality Is Related to Blood Pressure Mortality is Related to Blood Pressure 250 200 Men Women 150 100 50 0 88-97 98-127 128137 138147 148157 158167 168177 Systolic Blood Pressure 178187 >188 .

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natural products. renovascular disease  other causes: Rx drugs. food. industrial chemicals 10 .Etiology Essential hypertension:  > 90% of cases  hereditary component Secondary hypertension:  < 10% of cases  common causes: chronic kidney disease. street drugs.

Bakris GL.42(6):1206–1252. Detection. Black HR. and Treatment of High Blood Pressure.Adult Classification Classification Normal Prehypertensi on Stage 1 hypertension Stage 2 hypertension Less than 120 and Diastolic Blood Pressure (mmHg) Less than 80 120-139 or 80-89 140-159 or 90-99 > 160 or > 100 Systolic Blood Pressure (mmHg) Chobanian AV. Hypertension 2003. et al. Seventh report of the Joint National Committee on Prevention. Evaluation. 11 .

American Heart Association Recommended Blood Pressure Levels BP Category Systolic (mmHg) Diastolic (mmHg) Follow-up Optimal < 120 and < 80 Recheck 2 years Normal < 130 and < 85 Recheck 2 years High Normal 130-139 or 85-89 Recheck 1 years .

American Heart Association Recommended Blood Pressure Levels BP Category Systolic (mmHg) Stage 1 Diastolic (mmHg) Follow-up 140-159 or 90-99 Confirm within months 160-179 or 100-109 Evaluate within 1 month 180 or > or 110 or > Evaluate immediately (mild HTN) Stage 2 (moderate HTN) Stage 3 (severe HTN) .

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Penyebab Hipertensi yang Dapat Diidentifikasi .

What Causes High Blood Pressure? Controllable Risk Factors Increased salt intake Obesity Alcohol Coffein Stress Lack of exercise .

What Causes High Blood Pressure?  Uncontrollable Risk Factors Heredity Age Men between age 35 and 50 Women after menopause Race 1 out of every 3 African Americans Higher incidence in non-Hispanic blacks and Mexican Americans .

Women and High Blood Pressure Birth Control Pill Pregnancy Overweight After Menopause .

Algoritma pengobatan hipertensi .

et al. .Treatment Goals Reduce morbidity & mortality Select drug therapy based on evidence demonstrating risk reduction Patient Population Most patients Diabetes mellitus Chronic kidney disease Target Blood Pressure < 140/90 mmHg < 130/80 mmHg <130/80 mmHg 20 Chobanian AV.42(6):1206–1252. Detection. Evaluation. Black HR. Hypertension 2003. and Treatment of High Blood Pressure. Bakris GL. Seventh report of the Joint National Committee on Prevention.

Ca2+ channel blockers) • Reduction of body weight •  plasma volume (diuretics) •  peripheral vascular resistance (vasodilators) MAP = CO X TPR .TREATMENT OF HYPERTENSION Non-pharmacological Pharmacotherapy • Restriction of salt intake •  cardiac output (ßblockers.

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What Can I Do?  Loose weight if your overweight  Get regular physical activity  Avoid excessive alcohol  Stop smoking  Manage your stress .

What Can I Do?  Decrease salt intake  Eat for heart health  Discuss the use of oral contraceptives with your doctor  Discuss the use of some medications with your doctor .

Pharmacotherapy Primary: Diuretics Alternate: ACE Inhibitors Alpha1-blockers ARBs Alpha2-blockers Beta-blockers Direct-acting Calcium channel blockers vasodilators Peripheral adrenergic antagonist .

hydrochlorothiazide (HCTZ). spironolactone . furosemide. Pengobatan dengan obat-obatan (farmakologis). metolazone Loop  bumetanide. indapamide. triamterene Aldosterone antagonists  eplerenone. Diuretik Obat-obatan jenis diuretik bekerja dengan cara mengeluarkan cairan tubuh (lewat kencing) sehingga volume cairan ditubuh berkurang yang mengakibatkan daya pompa jantung menjadi lebih ringan. torsemide Potassium-sparing  amiloride. a. Contoh obatannya : Thiazide  chlorthalidone.2.

b. Penghambat Simpatetik Golongan obat ini bekerja dengan menghambat aktivitas saraf simpatis (saraf yang bekerja pada saat kita beraktivitas). . Contoh obatnya adalah : Metildopa. Klonidin dan Reserpin.

propranolol. metoprolol. timolol Intrinsic sympathomimetic activity  acebutolol. Jenis betabloker tidak dianjurkan pada penderita yang telah diketahui mengidap gangguan pernapasan seperti asma bronkial. bisoprolol. nebivolol Nonselective  nadolol.c. penbutolol. betaxolol. carteolol.and β-blockers . Contoh obat: Cardioselective  atenolol. Beta bloker Mekanisme kerja anti-hipertensi obat ini adalah melalui penurunan daya pompa jantung. pindolol Mixed α.

d. Vasodilator Obat golongan ini bekerja langsung pada pembuluh darah dengan relaksasi otot polos (otot pembuluh darah). f. Yang termasuk dalam golongan ini adalah : Prasosin. ACE inhibitor Cara kerja obat golongan ini adalah menghambat pembentukan zat Angiotensin II (zat yang dapat menyebabkan peningkatan tekanan darah). . Hidralasin. Contoh obat yang termasuk golongan ini adalah Kaptopril.

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g. Yang termasuk golongan obat ini adalah : Nifedipin. Antagonis kalsium Golongan obat ini menurunkan daya pompa jantung dengan cara menghambat kontraksi jantung (kontraktilitas). Diltiasem dan Verapamil .

ARBs Angiotensin II Receptor Blockers Angiotensin II generation  renin-angiotensin-aldosterone pathway  alternative pathway using other enzymes such as chymases Inhibit angiotensin II from all pathways  directly block angiotensin II type 1 (AT1) receptor  ACE inhibitors partially block effects of angiotensin II Do not block bradykinin breakdown  less cough than ACE Inhibitors Adverse effects:  orthostatic hypotension  renal insufficiency  hyperkalemia .h.

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ACE Inhibitor/ARB Warnings Reduce starting dose 50% in some patients due to hypotension risk  patients also taking diuretic  volume depletion  elderly patients May cause hyperkalemia in:  CKD patients  patients on other K+ sparing medications K+ sparing diuretics aldosterone antagonists 34 .

α1-Blockers 35 1st dose at bedtime Used with diuretics to minimize edema Caution in elderly patients Reduce benign prostatic hypertrophy symptoms  block postsynaptic α1-adrenergic receptors on the prostate relaxation decreased urinary outflow resistance Adverse effects:  sodium/water retention  angina Hydralazine can cause lupus-like syndrome Minoxidil can cause hypertrichosis .

36 β-Blockers Inhibit renin release  weak association with antihypertensive effect Negative chronotropic & inotropic cardiac effects reduce CO  β-blockers with intrinsic sympathomimetic activity (ISA) do not reduce CO lower BP decrease peripheral resistance  Membrane-stabilizing action on cardiac cells at high enough doses .

ekokardiogram. gula darah dan elektrolit. Ht. Urinalisis b. ultrasonogram. Hb. kreatinin. Pemeriksaan penunjang: ekg. . ureum.Pemeriksaan laboratorium awal dan penunjang Pemeriksaan laboratorium awal: a. foto toraks Pemeriksaan penunjang lain bila memungkinkan: CT scan kepala.

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MENGUKUR TEKANAN DARAH Sphygmomanometer .

prevent. prevent. Effective efforts ought to be taken in order to prevent. .Conclusion Hypertension is a serious problem that could be called "the silent killer". Its prevalence is very high especially in the GCC countries. prevent diagnose and treat it.

h i s a k a m i r Te ^ _ ^ .