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Introduction

Hypertension is a common disease that is simply defined as

persistently elevated arterial blood pressure (BP).

The risk of cardiovascular (CV) morbidity and mortality isdirectly correlated with blood pressure (BP). Even patients

with prehypertension have an increased risk of CV disease.

Etiology :- an unknown pathophysiologic etiology (essential or

primary hypertension).

- a specific cause of their hypertension (secondary

hypertension).


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Genetic factors may play an important role in thedevelopment of essential hypertension.

Starting at a BP of 115/75 mm Hg, risk of CV disease

doubles with every 20/10 mm Hg increase.

Even patients with prehypertension have an increasedrisk of CV disease.

When a secondary cause is identified, removing theoffending agent (when feasible) or treating/correctingthe underlying comorbid condition should be the firststep in management.

Introduction


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Classification of Blood Pressure in Adults


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Potential Mechanisms of Pathogenesis


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The RAA System


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Clinical Presentation of Hypertension


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Overall Goal of Therapy

The overall goal of treating hypertension is to reducehypertension associated morbidity and mortality.

This morbidity and mortality is related to target-organdamage (e.g., CV events, heart failure, and kidneydisease).

Reducing risk remains the primary purpose ofhypertension therapy and the specific choice of drugtherapy is significantly influenced by evidencedemonstrating such risk reduction.


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Goal BP Values Recommended by AHA in 2007


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Algorithm for treatment of hypertension.


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Compelling indications for individual drug classes


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Lifestyle Modification to Prevent and

Manage Hypertension


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The rationale for dietary intervention in

hypertension

1. Hypertension is two to three times more likely inoverweight than in lean persons.

2. More than 60% of patients with hypertension areoverweight.

3. As little as 10 pounds of weight loss can decrease BPsignificantly in overweight patients.

4. Abdominal obesity is associated with the metabolicsyndrome, which is a precursor to diabetes,dyslipidemia, and, ultimately, CV disease.

5. Diets rich in fruits and vegetables and low insaturated fatlower BP in patients with hypertension.

6. Most people experience some degree of SBPreduction with sodium restriction.


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Hypertension in Older People

Hypertension often presents as isolated systolic hypertension in the

elderly. Epidemiologic data indicate that CV morbidity and mortality are

more closely related to SBP than to DBP in patients ages 50 years

and older, so this population is at high risk for hypertension-related

target-organ damage Older patients with isolated systolic hypertension are often at risk

for orthostatic hypotension when antihypertensive drug therapy is

started, particularly with diuretics, ACE inhibitors, and ARBs.

Although overall treatment should be the same, low initial dosesshould be used and dosage titrations should be gradual to minimize

risk of orthostatic hypotension.

Centrally acting agents and -blockers should generally be avoided

or used with caution in the elderly because they are frequently

associated with dizziness and postural hypotension


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Hypertension in Children and Adolescents

Equal to or greater than 120/80 mm Hg in adolescents, isconsidered prehypertension.

Hypertensive children often have a family history of highBP, and many are overweight, predisposing them to insulin

resistance and associated CV disease.

Unlike hypertension in adults, secondary hypertension ismore common in children and adolescents. An appropriateworkup for secondary causes is essential if elevated BP is

identified.

Kidney disease (e.g., pyelonephritis, glomerulonephritis) isthe most common cause of secondary hypertension inchildren.


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Nonpharmacologic treatment, particularly weight lossin those who are overweight, is the cornerstone oftherapy for essential hypertension in children.

ACE inhibitors, ARBs, -blockers, CCBs, and thiazide-type diuretics are all acceptable choices in children.

ACE inhibitors, ARBs, and direct renin inhibitors arecontraindicated in sexually active girls because ofpotential teratogenic effect, and in those who mighthave bilateral renal artery stenosis or unilateralstenosis in a solitary kidney.

Hypertension in Children and Adolescents


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Pregnancy

Hypertension during pregnancy is a major cause of maternaland neonatal morbidity and mortality.

Preeclampsia, defined as a elevated BP greater than or equalto 140/90 mm Hg that appears after 20 weeks gestationaccompanied by new-onset proteinuria (300 mg/24 hours),can lead to life-threatening complications for both motherand fetus.

Eclampsia, the onset of convulsions in preeclampsia, is amedical emergency.

Gestational hypertension is defined as new-onsethypertension arising after midpregnancy in the absence ofproteinuria, and chronic hypertension is elevated BP that isnoted before the pregnancy began.


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Parameter laboratorium untuk masing-masing obat

dan asuhan kefarmasian


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Efek samping dan kontraindikasi obat-obat

antihipertensi


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Interaksi antara obat antihipertensive dengan obat lain

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