mahasiswa simpo jw marriot.pptx

7/30/2019 Mahasiswa simpo JW Marriot.pptx

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Hypertension, a long lifeuntreated diseases?

Dr Zainal Safri SpPD, SpJP, FIHADept. Cardiology, Fac. of Medicine USU

Adam Malik Hospital


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]


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


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


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.


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


7/22

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


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


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


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


11/22

Hipertensi Resisten

Prevalensi sekitar : 20 sampai 30%

Faktor risiko : Usia tua, Obesitas


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


13/22

Patogenesis Hipertensi

MULTIFAKTORIAL


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)


15/22


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


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

?


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


19/22

Masalah hipertensi :

Meningkatnya prevalensi Hipertensi

Pasien Hipertensi : terapi (-) ; target (-)

Komplikasi Hipertensi (HTN)keberhasilan penanganan HTN tergantung

edukasi pasien & komunikasi thd kepatuhanminum obat


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.


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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


22/22

Thank You

mahasiswa simpo jw marriot.pptx

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