Patofisiologi HT

Definitions and classification ofDefinitions and classification of blood pressure levels (mmHg)blood pressure levels (mmHg)

Definitions and classification ofDefinitions and classification of blood pressure levels (mmHg)blood pressure levels (mmHg)

When a patient s systolic and diastolic blood pressures fall into When a patient s systolic and diastolic blood pressures fall into different categories, the higher category should applydifferent categories, the higher category should apply

WHO -ISHWHO -ISHWHO -ISHWHO -ISH

CategoryCategory SystolicSystolic SystolicSystolic Diastolic Diastolic

OptimalOptimal < 120 < 120 < 80 < 80NormalNormal < 130 < 130 < 85 < 85High-normalHigh-normal 130 - 139130 - 139 85 - 89 85 - 89Grade 1 hypertension (mild)Grade 1 hypertension (mild) 140 - 159140 - 159 90 - 99 90 - 99

Subgroup : borderline Subgroup : borderline 140 - 149140 - 149 90 - 94 90 - 94Grade 2 hypertension (moderate)Grade 2 hypertension (moderate) 160 - 179160 - 179 100 - 109100 - 109Grade 3 hypertension (severe)Grade 3 hypertension (severe) > 180 > 180 > 110 > 110 Isolated systolic hypertensionIsolated systolic hypertension > 140 > 140 <90 <90

Subgroup : borderlineSubgroup : borderline 140 - 149 140 - 149 < 90 < 90

Raised BP

Raised BP

Raised BP

Raised BP

P3

Neurogenic hyper

response

P2

Insulin resistance

Raised BP

Raised BP

Raised BP

Raised BP

P1

Salt sensitivity

P4

Vascular structure

G1G1

G4G4

G3G3G2G2

SKELETALMUSCLE

SKELETALMUSCLE BRAINBRAIN

KIDNEYKIDNEY

RESISTANCE VESSELS

RESISTANCE VESSELS

Candidate genes

Candidate genes

E1Raised dietary

salt

E1Raised dietary

salt

E2Physical inactivity

E2Physical inactivity

E3StressE3

Stress

E4Adverse dietary

Na/K ratio

E4Adverse dietary

Na/K ratio

A VARIETY OF DIFFERENT GENOTYPES (G) LEADS TO DIFFERENT PHENOTYPES (P) EXPRESSION. THESE ARE SUBJECT TO VARIOUS ENVIROMENT (E) INFLUENCES

PRODUCING HIGH BLOOD PRESSURE BY DIFFERENT PATHWAYS

A VARIETY OF DIFFERENT GENOTYPES (G) LEADS TO DIFFERENT PHENOTYPES (P) EXPRESSION. THESE ARE SUBJECT TO VARIOUS ENVIROMENT (E) INFLUENCES

PRODUCING HIGH BLOOD PRESSURE BY DIFFERENT PATHWAYS

PRELOADPRELOAD

VASCULAR VASCULAR RESISTANCERESISTANCEVASCULAR VASCULAR

RESISTANCERESISTANCE

CENTRAL NERVOUS SYSTEMCENTRAL NERVOUS SYSTEMCENTRAL NERVOUS SYSTEMCENTRAL NERVOUS SYSTEM

SOME FACTORS INVOLVED IN THE REGULATION OF SOME FACTORS INVOLVED IN THE REGULATION OF BLOOD PRESSUREBLOOD PRESSURE

SOME FACTORS INVOLVED IN THE REGULATION OF SOME FACTORS INVOLVED IN THE REGULATION OF BLOOD PRESSUREBLOOD PRESSURE

StressStressNucleus tractus solitariusNucleus tractus solitarius

Arterial baroreceptorsArterial baroreceptorsCardiac Cardiac OutputOutputCardiac Cardiac OutputOutput

Parasympathetic efferentsParasympathetic efferents

Sympathetic efferents

Sympathetic efferents

Atrial natriuretic peptide

Atrial natriuretic peptide

Plasma renin angiotensin II Prostaglandins Kinin

Plasma renin angiotensin II Prostaglandins Kinin

Sympathetic efferents

Sympathetic efferents

Renal efferentsRenal efferents

Renal efferentsRenal efferents

Aldosterone ← Angiotensin IIAldosterone ← Angiotensin II

Renal Regulation of NaCl and H2ORenal Regulation of NaCl and H2O

Na, K+, Ca2-

( NaCl and H2O )

Cardiopulmonary baroreceptorsCardiopulmonary baroreceptors

1970 - 1975 1975 - 1980 1980 - 1985 1985 - 1990

Aware (%) 51 64 73 84

Treated (%) 36 34 56 73

Control (%) 16 20 34 55

HIPERTENSION, AWARENESS, TREATMENT, AND CONTROL RATES

HIPERTENSION, AWARENESS, TREATMENT, AND CONTROL RATES

WHO ISH (1999)WHO ISH (1999)Merekomendasikan 6 kelas obat anti hipertensi

DiuretikDiuretik

Beta BlokerBeta Bloker

Alpha BlokerAlpha Bloker

Ca - antagonistCa - antagonist

ACE Inhibitor (ACEI)ACE Inhibitor (ACEI)

Angiotensin II Receptor Bloker (AIIRA)Angiotensin II Receptor Bloker (AIIRA)