Nothing Special   »   [go: up one dir, main page]
Scribd Logo
Upload

Welcome to Scribd!

  • 41 views

    Hi Per Tention

    Uploaded by

    Maya Arum Sari
    This document discusses classification of blood pressure for adults. It defines categories of blood pressure ranging from optimal to stage 3 hypertension based on systolic and diastolic blood pressure readings. When the systolic and diastolic readings fall into different categories, the higher category is used. The majority of hypertension cases are essential or primary hypertension with no identifiable cause, while secondary hypertension is caused by specific medical conditions. Hypertension develops gradually over time through adjustment of compensatory mechanisms. Potential causes include excess sodium intake, renal sodium retention, the renin-angiotensin system, stress, obesity, and other factors.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Hi Per Tention

    Uploaded by

    Maya Arum Sari
    41 views20 pages
    This document discusses classification of blood pressure for adults. It defines categories of blood pressure ranging from optimal to stage 3 hypertension based on systolic and diastolic blood pressure readings. When the systolic and diastolic readings fall into different categories, the higher category is used. The majority of hypertension cases are essential or primary hypertension with no identifiable cause, while secondary hypertension is caused by specific medical conditions. Hypertension develops gradually over time through adjustment of compensatory mechanisms. Potential causes include excess sodium intake, renal sodium retention, the renin-angiotensin system, stress, obesity, and other factors.

    Original Description:

    hipertention

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses classification of blood pressure for adults. It defines categories of blood pressure ranging from optimal to stage 3 hypertension based on systolic and diastolic blood pressure readings. When the systolic and diastolic readings fall into different categories, the higher category is used. The majority of hypertension cases are essential or primary hypertension with no identifiable cause, while secondary hypertension is caused by specific medical conditions. Hypertension develops gradually over time through adjustment of compensatory mechanisms. Potential causes include excess sodium intake, renal sodium retention, the renin-angiotensin system, stress, obesity, and other factors.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    41 views20 pages

    Hi Per Tention

    Uploaded by

    Maya Arum Sari
    This document discusses classification of blood pressure for adults. It defines categories of blood pressure ranging from optimal to stage 3 hypertension based on systolic and diastolic blood pressure readings. When the systolic and diastolic readings fall into different categories, the higher category is used. The majority of hypertension cases are essential or primary hypertension with no identifiable cause, while secondary hypertension is caused by specific medical conditions. Hypertension develops gradually over time through adjustment of compensatory mechanisms. Potential causes include excess sodium intake, renal sodium retention, the renin-angiotensin system, stress, obesity, and other factors.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 20

    Classification of Blood

    Pressure for Adults


    SBP DBP
    Category (mm Hg) (mm Hg)

    Optimal < 120 and < 80

    Normal < 130 and < 85

    High-normal 130-139 or 85-89

    Hypertension
    Stage 1 140-159 or 90-99
    Stage 2 160-179 or 100-109
    Stage 3  or 110
     180
    When SBP and DBP fall into different categories, use the higher category.

    slide 2
    Types of hypertension
    • Essential Hypertension
    hypertension with no apparent cause 90-95%

    • Secondary Hypertension
    hypertension of known cause
    • chronic renal diseases 2.5-5%
    • Renovascular diseases 0.5-4%
    • Oral contraceptive pills 0.2-1%
    • Coarctation of the Aorta 0.1-1%
    • Primary aldosteronism 0.1-0.5%
    • Pheochromocytoma 0.1-0.2%
    Patho-physiology of Hypertension
    • HTN develop gradually over a long period of time.
    • The development of HTN requires the adjustment of
    several compensatory mechanisms over time.
    • Several hypothesis exists for the original
    pathogenesis of HTN:
    • Excess Na intake
    • Renal Na retention
    • RAS
    • Stress & sympathetic over activity
    • Peripheral resistance
    • cell membrane and endothlial dysfunction
    • Obesity
    • insulin resistance
    Garry P. Reams & John H. Bauer
    Faktor risiko kardiovaskuler
    - Hipertensi
    - Merokok
    - Obesitas,
    - Inaktifitas fisik,
    - Dislipidemi,
    - Diabetes mellitus,
    - Mikroalbuminuri / laju infiltrasi glomerulus < 6 cc/mnt :
    Laki-laki usia > 55 th, wanita usia > 65 th.
    - Riwayat keluarga dengan riwayat kardiovaskuler dini :
    Laki-laki < 50 th, wanita < 65 th.
    kerusakan organ sasaran

    - Jantung : LVH
    Angina pectoris, Infark miokard
    Revaskularisasi coroner

    Gagal jantung.

    - Otak : stroke atau TIA


    - CKD : Penyakit arteri perifer.
    - Retinopati.
    Vascular Complications
    Komplikasi pada pembuluh darah
    • Arterioscelorosis
    –  wall:lumen ratio
    – remodeling
    • Atherosclerosis
    – Plaque
    • Fibrous cap
    • necrotic center
    • Fibrinoid necrosis.
    • Aortic dissection.
    Retinal complications
    • Hypertensive Venous
    tapering
    retinopathy Increased light
    reflexes from
    Blurred
    arterioles
    optic disc

    Punctate
    hard
    exudate

    Normal hemorrhage

    KW : I - IV
    Cardiac complications
    Left ventricular myocardium Coronary vascular bed
    (myocardial factor) (coronary factor)

    Hypertrophy Dilatation CAD Coronary


    Microangiopathy

    Decrease in contractility
    Abnormal increase in c. resistance

    Impairement in LV Impairment of O2 availability


    fuction
    Coronary insufficiency, MI
    Heart failure Heart failure
    The left ventricle is markedly thickened in this patient
    with severe hypertension that was untreated for many
    years. The myocardial fibers have undergone
    hypertrophy.
    Anti-Hypertensive Drugs
    Sites of Action
    Blood Cardiac Total
    Pressure = Output X Peripheral
    Resistance
    b-Blockers ACE Inhibitors
    AT1 Blockers
    a-Blockers
    a2-Agonists
    CCBs* CCBs
    DA1 Agonists
    Diuretics Diuretics
    Sympatholytics
    Vasodilators

    * = non-dihydropyridine CCBs
    Petunjuk pemilihan obat pd compelling indications
    Obat-obat yg direkomendasikan
    Kondisi Risiko
    tinggi dgn
    Diuretik Penyekat Penghambat Alfa Penghambat Antagonis
    compeling
    Reseptor ACE Blocker Kalsium Aldosteron
    indications
    b
    Gagal jantung
        

    Pasca Infark
    Miokard   

    Risiko tinggi
    peny. Koroner    

    DM
       

    Peny. Ginjal
    kronik  

    Pencegahan
    stroke
    berulang  
    DEFINITION :
     HYPERTENSIVE CRISIS
    A severe elevation in BP, generally a SBP > 220 mm Hg and / or
    DBP > 120 mm Hg. (JNC-VII, 2007 }
     HYPERTENSIVE EMERGENCIES
    Severe elevation in BP complicated by acute target organ
    dysfunction, such as coronary ischemia, stroke, intracerebral
    hemorrhage, pulmonary edema, or acute renal failure.
     HYPERTENSIVE URGENCIES
    Severe elevations in BP without evidence of target organ
    deterioration.
    HYPERTENSIVE CRISIS
    DBP >120 mmHg

    URGENCY EMERGENCY
     BP within hours < 24 hours  BP within minutes < 1 hours
    (PARENTERAL / ORAL) (PARENTERAL)

    - Accelerated malignant hypertension


    - Hypertensive encephalopathy
    - Intracerebral/Subarachnoid hemorrhage
    - Acute aortic dissection
    - Acute left ventricular failure
    - Acute myocardial infarction
    - Acute glomerulonephritis
    - Eclampsia
    KAPLAN NM . Lancet 344:1335,1994
    End-Organ Damage Associated Hypertensive Emergencies

    End-Organ Damage Type No of Cases (%)


    Cerebral Infarction 26 (24.5)
    Intracerebral or sub-arachnoid
    5 (4.5)
    hemorrhage
    Hypertensive encephalopathy 18 (16.3)
    Acute pulmonary edema 24 (22.5)
    Acute congestive heart failure 15 (14.3)
    Acute myocardial infarction or unstable
    13 (12.0)
    angina pectoris
    Eclampsia 5 (4.5)
    Aortic dissection 2 (2.0)

    Zampaglione, et al. AHA ; 27 (1) : 144


    MANAGEMENT OF HYPERTENSIVE EMERGENCIES
    JNC-VI RECOMMENDATION

    • Reduce Mean Arterial BP no More than 25 %


    over 2 hours then Reduce to 160 / 100 mm Hg
    within 2-6 hours.

    • Avoid excessive falls in Blood Pressure

    • Titrate with Intravenous antihypertensives.


    • Guideline of treatment based on concensus
    expert.
    Intravenous Drugs for Hypertensive
    Emergencies Available in Indonesia

    Vasodilators
    • Clonidine
    • Nitroglicerin
    • Sodium Nitropruside
    Ca-Antagonist
    • Diltiazem Hydrochloride
    COMMONLY USED DRUG IN
    HYPERTENSIVE EMERGENCY

    DILTIAZEM I.V. (HERBESSER)


     Useful for hypertensive emergency and urgency.
     Acts as calcium slow-channel blockers.
     Dose-dependent :
    • Predictable onset of action
    • Rapidly reduced BP.
    • No rebound on withdrawn
     Adverse effect : bradycardia, hypotension, headache, flushing.
     Has antiischemic and antiarrhythmic effect (class-IV)
    Be a Good Doctor’s with Active Learning and Share Knowledge Each Other
    Think Globally but Act Locally (WHO Statement)

    You might also like