mahasiswa simpo jw marriot.pptx
Post on 14-Apr-2018
228 Views
Preview:
TRANSCRIPT
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
1/22
Hypertension, a long lifeuntreated diseases?
Dr Zainal Safri SpPD, SpJP, FIHADept. Cardiology, Fac. of Medicine USU
Adam Malik Hospital
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
2/22
Prevalence of hypertension: Asia
0
10
2030
40
50
60
7080
China
(200
0/200
1)
Taiw
an(199
4)
Hong
Kon
g(199
7)
Sing
apor
e(199
8)
Mala
ysia(1
996)
Thail
and(1
991)
Philip
pines(1
999)
Indo
nesia(1
994)
India
(Mum
bai,199
9)
Japa
n(1992
-95)
Prev
alence(%)
Men
Women
Total
Gu DF, et al. Hypertension2002;40:920-927; Singh RB, et al. J Hum Hyper tens2000;14:749-763; Janus ED. Cl in Exp Pharmacol Physiol1997;24:987-988; National Health Survey 1998, Singapore. Epidemiology and Disease Department, Ministry of Health, Singapore.; Lim TO, et al.
Singapor e Med J2004;45:20-27; Tatsanavivat P, et al. Int J Epidemiol1998;27:405-409; Muhilal H. Asia Pacif ic J Cl in Nutr1996;5:132-134;Gupta R. J Hum Hyper tens2004;18:73-78; Asai Y, et al. Nippon Ko shu Eisei Zasshi2001;48:827-836 [in Japanese]
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
3/22
CV Mortality Risk Doubles withEach 20/10 mm Hg BP Increment
*Individuals aged 40-70 years, starting at BP 115/75 mm Hg.CV, cardiovascular; SBP, systolic blood pressure; DBP, diastolic blood pressure
Lewington S, et al. Lancet. 2002; 60:1903-1913.JNC 7. JAMA. 2003;289:2560-2572.
CV
mortalityrisk
SBP/DBP (mm Hg)
0
1
2
3
4
5
6
7
8
115/75 135/85 155/95 175/105
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
4/22
Effects of blood pressure on the risk ofcardiovascular disease
Average annual incidence rate per 10.000
Source : Framingham study (after Gorlin)
100
90
80
70
60
50
40
30
2010
0
180
Systolic blood pressure (mmHg)
CHD
Stroke
CHF
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
5/22
Hypertension SyndromeIts More Than Just Blood Pressure
DecreasedArterial
Compliance EndothelialDysfunction
AbnormalGlucose
Metabolism
NeurohormonalDysfunction
Renal-FunctionChanges
Blood-ClottingMechanism
Changes
Obesity
AbnormalInsulin
Metabolism
LV Hypertrophyand Dysfunction
AcceleratedAtherogenesis
Abnormal LipidMetabolism
HYPERTENSION
Kannel WB.JAMA. 1996;275:1571-1576. Weber MA et al.J Hum Hypertens. 1991;5:417-423. DzauVJ et al.J Cardiovasc Pharmacol. 1993;21(suppl 1):S1-S5.
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
6/22
Coronary Artery Disease
Heart failure Ventricular hypertrophy
Ventricular systolic dysfunction
Renal impairment
End Stage RenalDisease
Proteinuria
CerebrovascularDisease
Dementia
Hypertensiveretinopathy
Fundalhemorrhages
Papiloedema
Aortic and otherarterial aneurysm
Peripheral arterialdiseases
Hypertension risk
Target
organ
damage
modified from :
Campbell, et al. CMAJ 2002
Williams B, et al.. BMJ 2004
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
7/22
Klasifikasi Hipertensi pada orang dewasa :
JNC 7 (The Seventh Report of The Joint NationalCommittee on Prevention Detection, Evaluation, andTreatment of High Blood Pressure)
WHO (World Health Organization) ; ISH (InternationalSociety of Hypertension); ESH (European Society of
Hypertension); BSH (British Hypertension Society); CHEP(Canadian Hypertension Education Program)
KLASIFIKASI HIPERTENSI
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
8/22
Classification of HypertensionESC/ESH & JNC VII
BP BP JNC VII
Bp Classification
Optimal 110
Isolated Systolic
Hypertension
ESH-ESC
BP Classification
>>140 < 90
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
9/229
*Computed by M. Wolz (unpublished data cited by Chobanian et al.)
Adapted from Chobanian AV, et al.JAMA. 2003;289:2560-2572.
NHANES III19911994
NHANES III19881991
Adults,
%
PatientAwareness
NHANES II19761980
Treatment
Control
19992000*
51
7368
31
55 54
10
29 27
70
59
34
0
10
20
30
40
50
60
70
80
Kesenjangan antara jumlah penderita HTNdan kontrol tekanan darah
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
10/22
Percentages of Patients whoseHypertension is Controlled
Adapted from G. Mancia / L. Ruilope
USA: JNC VI. Arch Intern Med 1997
Canada: Joffres et al. Am J Hypertens 1997
England: Colhoun et al. J Hypertens 1998
France: Chamontin et al. Am J Hypertens 1998
< 140/90 mmHg < 160/95 mmHg
USA
27
England
6
Canada
16
France
24
Finland
20.5
Germany
22.5
Spain
20
Scotland
17.5
Australia
19
India
9
> 65 years
Marques-Vidal P et al. J Hum Hypertens 1997
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
11/22
Hipertensi Resisten
Prevalensi sekitar : 20 sampai 30%
Faktor risiko : Usia tua, Obesitas
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
12/22
Caused of Hipertension :
I. Primer / essential / idiopathic (: 90-95%)
II. Sekunder: (5-10%)
A. RenalB. Endocrine
C. Coartation of the aorta
D. Pregnancy induced hypertension
E. Neurological disorder
F. Drug and other abused substancen
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
13/22
Patogenesis Hipertensi
MULTIFAKTORIAL
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
14/22
Tekanan Darah
Blood pressure = Cardiac output (CO) x Peripheral resistance (PR)
Hypertension = Increased CO and/or Increased PR
Preload
Fluid volume
Renal sodiumretention
Contractility
Fluid volume
Vasoconstriction
Sympatheticnervous
system
Renin-angiotensin-
aldosteronesystem
Geneticfactors
Excesssodiumintake
(Adapted from Kaplan, 1994)
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
15/22
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
16/22
HIPERTENSI DAN
KERUSAKAN ORGAN TARGET
*preclinical data
LV = left ventricular; MI = myocardial infarction; GFR = glomerular filtration rate
Adapted from Willenheimer R et al Eur Heart J1999;20(14):997-1008; Dahlf BJ Hum Hypertens 1995;9(suppl 5):S37-S44;
Daugherty A et al J Clin Invest2000;105(11):1605-1612; Fyhrquist F et alJ Hum Hypertens 1995;9(suppl 5):S19-S24;
Booz GW, Baker KM Heart Fail Rev1998;3:125-130; Beers MH, Berkow R, eds. The Merck Manual. 17th ed.
Whitehouse Station, NJ: Merck Research Laboratories, 1999:1682-1704; Anderson S Exp Nephrol1996;4(suppl 1):34-40;
Fogo ABAm J Kidney Dis 2000;35(2):179-188.
HTN
Atherosclerosis*Vasoconstriction
Vascular hypertrophy
LV hypertrophyFibrosisRemodelingApoptosis
GFRProteinuria
Aldosterone releaseGlomerular sclerosis
Stroke
Hypertension
Heart failureMI
Renal failure
DEATH
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
17/22
HIPERTENSI :The Disease Continuum
Early Paradigm
Elevated BP Target Organ Damage
Natural History of CVD Progression
More Recent Paradigm
Vascular Dysfunction Elevated BP Target Organ Damage
A Proposed Future Paradigm
EndothelialDysfunction
LVH
Renal
DamageMI Stroke
AnginaPectoris
VascularDysfunction
Elevated BP Target OrganDamage
?
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
18/22
NEW TREATMENT APPROACH
Vascular biology altered
Hypertension = disease of blood vessels
Therapeutic options
ACE
InhibitorsAT1
blockersCalcium
channel
blockers
-
Blockers*Diuretics
*Others
* Minimal evidence of effects on endothelial function
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
19/22
Masalah hipertensi :
Meningkatnya prevalensi Hipertensi
Pasien Hipertensi : terapi (-) ; target (-)
Komplikasi Hipertensi (HTN)keberhasilan penanganan HTN tergantung
edukasi pasien & komunikasi thd kepatuhanminum obat
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
20/22
How to improve compliance with treatment
Inform the patient of the risk of hypertension and thebenefit of effective treatment.
Provide clear written and oral instructions abouttreatment.
Tailor the treatment regimen to patients lifestyle Simplify treatment by reducing, if possible, the number of
daily medicaments. Involve patients partner or family in information on
disease and treatment plans. Pay great attention to side effects (even if subtle) and be
prepared to change drug doses or types if needed.
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
21/22
KESIMPULAN
Hipertensi esensial merupakan penyakit multifaktorial yang timbulkarena interaksi : faktor risiko, sistim saraf simpatis, keseimbanganantara modulator vasodilatasi dan vasokonstriksi, pengaruh sistemrenin-angiotensin-aldosteron
Disfungsi endotel dan vaskular menyebabkan hipertensi, ygselanjutnya menyebabkan kerusakan target organ : jantung, otak,penyakit ginjal kronis, penyakit arteri perifer, retinopati
Prevalensi hipertensi makin meningkat (15-25%), Pendekatanyang baik terhadap hipertensi akan meningkatkan angkapengendalian hipertensi dan mengurangi komplikasi
-
7/30/2019 Mahasiswa simpo JW Marriot.pptx
22/22
Thank You
top related