Hypertension

Yasni Muchlis
WHY
IS IT IMPORTANT?

Top 5 Leading Cause of

Deaths in Indonesia

Hypertension
in Elevated Blood Pressure was the leading global contributor to premature death in 2015
Indonesia and has a continous relationship wiht the CV events, thus increasing the number of
deaths due to Ischemic Heart Disease, Hemorrhagic Stroke and Ischemic Stroke
HYPERTENSION
DEFINITION AND CLASSIFICATION It is recommended that BP be
AN OFFICE SBP VALUES > 140 MMHG AND/OR DBP VALUES > 90 MMHG classified as Optimal, Normal,
High-Normal,or Grades I-3
Hypertension, according to office
BP. (I C)
SCREENING & DIAGNOSIS

HYPERTENSION
TITLE

When hypertension is suspected, the diagnosis of

hypertension should be confirmed, either by repeated BP
measurements over a number of visits.

White-Coat Hypertension Masked Hypertension

BP that is elevated in the Normal office BP but

office but is normal when in elevated on ABPM or
ABPM or HBPM --> Routine HBPM. --> Lifestyle Changes
drug treatment is not recommended & Drug
indicated. Treatment considered

SCREENING AND DIAGNOSIS OF HYPERTENSION

CARDIOVASCULAR RISK ASSESSMENT

SCORE (Systematic Coronary Risk Evaluation)

WHEN TO INITIATE THERAPY ?
Prompt initiation of BP-Lowering drug
treatment is recommended in patients
with Grade 2 or 3 Hypertension, in any
level of CV risk simultant with lifestyle
changes (IA)

In Fit older patient with Hypertension

(even if aged > 80mmHg), BP lowering
treatment and lifestyle intervention is
recommended when SBP > 160 mmHg
(IA)

Withdrawal of BP-lowering drug

treatment on the bases of age, even
patient aged > 80 years --> is not
recommended. Provided the treatment
that well tolerated (IIIA)
LIFESTYLE INTERVENTION
HYPERTENSION

Angiotensin Receptor
Blocker

Angiotensin
Converting Enzyme
- Inhibitor DRUG
TREATMENT
STRATEGY Beta Blocker

Calcium Channel
Blocker
Diuretic
Uncomplicated
Hypertension
HTN + CAD
HTN + CKD
HTN + HFrEF
TARGET BLOOD PRESSURE
MONITORING
DURING
THERAPY
WHEN FAILED TO ACHIEVE THE TARGET BLOOD PRESSURE...
Efficacy of pharmacological therapies --> patients exhibit resistance
01 to the selected treatment regimen
Severeal reasons need

to be considered to

identify why the current Failure to inadequate uptitrate treatment --> suboptimal doses
02 --> suboptimal BP control
treatment strategy

failed to achieve BP
Patient adherence to the treatment and Complexicity of the
control
03 number presribed regiment --> single pills > 2 pills > 3 pills
HYPERTENSIVE
EMERGENCY
HYPERTENSION
IN PREGNANCY
TAKE HOME MESSAGE

DOSE
EDUCATING 01 02
ESCALATION /

ADD
COMBINATION

CONTROL RISK FACTORS 03 REFERRING

04
THANK YOU