FARKIN HIPERTENSI
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Transcript of FARKIN HIPERTENSI
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FARMAKOTERAPIHIPERTENSI
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HIPERTENSI :
Adalah kenaikan TD arteri yg tetap
(JNC-7 = Joint National Committee)
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KLASIFIKASI TEK DARAHJNC-7
KLASIFIKASI SISTOL(mmHg) DIASTOL (mmHg)
Normal 100
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Bila TDD < 90 mmHg &TDS 140 mmHg
= isolated systole HTBila TDD/TDS >
180/120 mmHgCrisis Hypertenson
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Definitions HPT emergency(crisis): Is characterized
by a severe elevation in BP, complicated byevidence of impending or progressivetarget/end organ dysfunction
VS
HPT urgency: is a severe elevation in BP
without progressive target organdysfunction
NB these definitions do not specifyabsolute BP levels
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PATOFISIOLOGI HT
A.Hipertensi esensial (HT primer)= HTIdiopatik, yg blm jelas penyebabnya.Dipenga-ruhi usia, kelamin, merokok, kholesterol, BB
B.Hipertensi sekunder. Dipengaruhi oleh obat,penyakit ginjal, penyakit endokrin (DM, tiroid, Cushing)
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Hypertension
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Hypertension Tingkat tekanan darah adalah fungsi
dari cardiac output dikalikan dengan
resistensi perifer (perlawanan dalampembuluh darah ke aliran darah) Dasar hemodinamik hipertensi
MAP = CO x TPRMAP=mean arteria pressure; CO=cardiac output; TPR=totalresistence perifer
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Prevalence of
Hypertension by Age Age 18-29
30-39
40-49
50-59
60-69
70-79 80+
% Hypertensive 4
11
21
44
54
64 65
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MANFAATMENURUNKAN TD
Stroke incidence 3540%
Myocardial infarction 2025%
Heart failure 50%
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Tanda-Tanda Klinik HT1.Pusing paroksismal
2.Berkeringat3.Takikardia
4.Palpitasi
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Organ yg terkena HT :
HeartLeft ventricular hypertrophyAngina or prior myocardial infarctionPrior coronary revascularizationHeart failure
Brain
Stroke or transient ischemic attackChronic kidney diseasePeripheral arterial diseaseRetinopathy
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Untreated hypertension can result in:Arteriosclerosis --Kidney damage
Heart Attack --StrokeEnlarged heart --Blindness
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FAKTOR RESIKO HTFaktor resiko mayorHipertensiMerokokObesitas (BMI 30)ImmobilitasDislipidemiaDiabetes mellitusMikroalbuminuria atau perkiraan GFR55 tahun untuk laki-laki, >65 tahun untukperempuan)Riwayat keluarga untuk penyakit kardiovaskularprematur (laki-laki < 55tahun atau perempuan < 65 tahun)
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TERAPI :NON FARMAKOLOGI
FARMAKOLOGI
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TUJUAN TERAPI HT :
1.Reduce CVD and renalmorbidity and mortality.2.Treat to BP
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Tx NON-FARMAKOLOGI
PENCEGAHAN & TERAPI1.Bagi yg obese, turunkan BB2.Diet garam ( 2.4g/hr)3.Kurangi konsumsi lemak
4.Tidak merokok, kurangi kopi &alkohol
5.Istirahat cukup
6.Olahraga teratur.
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Tx FARMAKOLOGI
A B C DA.ACE-1 / ACE-2 (ARB) / ALFA1-
BLOCKERB.BETA-BLOCKERS
C.CA-ANTAGONISTSD.DIURETICS
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T i K bi i
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Terapi Kombinasi
Rasional kombinasi obatantihipertensi:
Ada 6 alasan mengapa pengobatankombinasi pada hipertensi
dianjurkan: 1. Mempunyai efek aditif 2. Mempunyai efek sinergisme 3. Mempunyai sifat saling mengisi 4. Penurunan efek samping masing-masing obat
5. Mempunyai cara kerja yang saling mengisi pada organ target tertentu 6. Adanya fixed dose combination akan meningkatkan kepatuhan pasien (adherence)
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ANTIHIPERTENSI DI
PUSKESMAS 1.Propanolol / Bisoprolol 2.Nifedipin / Adalat OROS /
Amlodipin 3.Captopril / Lisinopril
4.HCT / Spironolakton
5.Reserpin
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Fixed-dose combinationyang paling efektif adalah
sebagai berikut:
1. Penghambat enzim konversi angiotensin (ACEI)
dengan diuretik 2. Penyekat reseptor angiotensin II (ARB) dengan diuretik 3. Penyekat beta dengan diuretik
4. Diuretik dengan agen penahan kalium 5. Penghambat enzim konversi angiotensin (ACEI) dengan antagonis kalsium 6. Agonis -2 dengan diuretik
7. Penyekat -1 dengan diuretic
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ALGORITMA Tx HT
Lifestyle Modifications
Not at Goal Blood Pressure (100 mmHg)
2-drug combination for most (usuallythiazide-type diuretic and
ACEI, or ARB, or BB, or CCB)
Stage 1 Hypertension(SBP 140159 or DBP 9099 mmHg)
Thiazide-type diuretics for most.May consider ACEI, ARB, BB, CCB,
or combination.
Without Compelling
Indications
Drug(s) for the compelling
indications
Other antihypertensive drugs(diuretics, ACEI, ARB, BB, CCB)
as needed.
With Compelling
Indications
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.Consider consultation with hypertension specialist.
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JNC 7 (cont)
Diuretics first Addition of a second drug from a
different class > 2 drugs (combo good) >160/100-start with 2 drugs (diuretic/BB,
diuretic/ACEI, diuretic/ARB,diuretic/CCB)
Multiple drugs if CAD, DM, Renal disease Monotherapy response rate 40-50% Multiple meds response rate 75-80% Racial differences in response disappear
with multiple drugs
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Kieran McGlade Nov Department of General Practice QUB
Logical Combinations
Diuretic b-blocker CCB ACE inhibitor a-blocker
Diuretic - -
b-blocker - * -
CCB - * -
ACE inhibitor - -
a-blocker -
* Verapamil + beta-blocker = absolute contra-indication
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Kieran McGlade Nov 2001
Department of General Practice QUB
British Hypertension Society Guidelines 2000Compelling and possible indications and contrindications for the major classes of
antihypertensive drugs
INDICATIONS CONTRAINDICATIONSCLASSS OF DRUG POSSIBLE COMPELLING POSSIBLE COMPELLING
a-blockers Prostatism Dyslipidaemia Postural Hypotension Unrinary incontinence
Angiotensin converting enzyme (ACE) inhibitors Heart failureLeft ventricular dysfunction
Chronic renal disease *Type II diabetic nephropathy
Renal impairment *Peripheral vascular disease
PregnancyRenovascular disease
Angiotensin II receptor antagonists Cough induced by ACE inhibitor Heart failureIntolerance of other antihypertensive drugs
Peripheral vascular disease PregnancyRenovascular disease
b-blockersMyocardial infarction
Angina
Heart failure
Heart failureDyslipidaemia
Peripheral vascular disease
Asthma or COPDHeart block
Calcium antagonists (dihydropyridine) Isolated systolic hypertension (ISH) in elderly patients AnginaElderly patients
_ _
Calcium antagonists (rate limiting) Angina Myocardial infarction Combination with b-blockade Heart blockHeart failure
Thiazides Elderly patients including ISH _ Dyslipidaemia Gout
* ACE inhibitors may be beneficial in chronic renal failure but should be used with caution. Close supervision andBritish Hypertension Society Guidelines 2000
specialist advice are needed when there is established and significant renal impairment Caution with ACE inhibitors and angiotensin II receptor antagonists in peripheral vascular disease because of association with renovascular disease.
If ACE inhibitor indicatedf b-blockers may worsen heart failure, but in specialist hands may be used to treat heart failure
KLASIFIKASI & MANAGEMEN HT PADA DEWASA
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BPclassification
SBP*mmHg
DBP*mmHg
Lifestylemodificati
on
Initial drug therapy
Without compelling
indication
With compellin
indicationsNormal 100
Yes Two-drug combinationfor most(usuallythiazide-type diureticand ACEI or ARB or
BB or CCB).
KLASIFIKASI & MANAGEMEN HT PADA DEWASA
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HATI HATI MENGGUNAKAN
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HATI-HATI MENGGUNAKAN: Presription Drugs:
NSAIDs, including Coxibs
Corticosteroids and anabolic steroids Oral contraceptive and sex hormones Vasoconstricting/sympathomimetic decongestants
(ephedrin, PPA, Pseudoefedrin) Calcineurin inhibitors (cyclosporin, tacrolimus)
Erythropoietin and analogues Monoamine oxidase inhibitors (MAOIs)
Other: Licorice root Stimulants including cocaine, amfetamin (Ecstasy, Sabu2) Garam Excessive alcohol use
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CONTOH KASUS RESEP Dr.Jantung R/.Tanapres 10 mg XXX
S.1-0-0
R/.Bisoprolol 5 mg XXX S.0-0-1
R/.Letonal 25 mg XXX
S.1-0-0
R/.Analsik XV
S.3dd 1
Pro : Tn. LK
Dr.Jantung R/.Cedocard 5 mg 90
S. 3 dd 1R/.Concor 2.5 mg 30
S. 1-0-0R/.Rhinofed XV
S. 1-1-0R/.OBH Combi 1 fl
S. 3 dd CR/.Xanax 0.5 mg 30S.0-0-1
Pro : Ny.Zakky
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