slide belajar hipertensi

7/25/2019 Slide Belajar Hipertensi

1/39

Nephrology Hypertension Division ofInternal Medicine Medical Faculty

Sebelas Maret University of Surakarta

HipertensiHipertensi

Prof. Dr. HM.Bambang Purwanto, dr. SpPD-KGH, FINASIM


2/39

PENDAHULUAN

Faktor risiko mayor

Coronary Heart Disease (CHD)

Myocard Infarct (MI)

Cerebrovascular Accidents (CVA)

Chronic Kidney Diseases (CKD)

Congestive Heart Failure (CHF)

!isiko men"adi hipertensi # $%&

!eappraisal of 'uropean (uidelines on Hypertension Management) 'uropean Society of Hypertension *ask Force Document+Blood ressure! "##$% &' #'*+,


3/39

KLASIFIKASI

,N- . !eport /%%0


4/39

1H23ISH Statement on Management of Hypertension /%


5/39

'SH3'S- (uidelines for the Management of )rterial Hypertensi


6/39

4rimerBelu- di.etahui(-isgeneti.)

Sekunder /enal

AdrenalFa.tor Biologi lain0.sogen

ETIOLOGI


7/39

Hypertension and Chronic Rena Disease!He"odyna"ic A#nor"aities

Mean BPTotal Systemic

Vascular Resistance= X

Increased Cardiac OutputIntravascular Volume Glomerular filtration

Sodium excretion

Extracellular Fluid

Renal Nerve ActivityMyocardial Performance Adrenergic Activity

Increased Cardiac OutputIntravascular Volume Glomerular filtration Sodium excretion

Extracellular Fluid

Renal Nerve ActivityMyocardial Performance

Adrenergic Activity

IncreasedVasoconstriction

Adrenergic Stimuli Angiotensin II Endothelin Endothelium-derived

Contracting Factors

Thromoxane

IncreasedVasoconstriction Adrenergic Stimuli

Angiotensin II Endothelin

Endothelium-derived

Contracting Factors Thromoxane

CardiacOutput

DecreasedVasodilation !rostacyclin

Nitric oxide E"#F$

DecreasedVasodilation !rostacyclin Nitric oxide

E"#F$

Tetor SC! "tlas of Diseases of t#e $idney% &''(!

$Endothelium-derived#y%er%olari&ing Factors


8/39

Hypertension ; basic mechanism..


9/39

Serangan Stroke

4enyakit )rteri

(angguan pada ,antung (angguang Fungsi (in"


10/39

Hipertensi kronisHipertensi kronis

Merusak autoregulasi ginjalMerusak autoregulasi ginjal

Permeabilitas kapilerPermeabilitas kapiler

Proteinuri (miProteinuri (mikkroalbuminuri)roalbuminuri)

Hukum HomeostasisHukum Homeostasis

Reabsorbsi proteinReabsorbsi protein

oleh sel tubulus berlebihanoleh sel tubulus berlebihan

(stressor)(stressor)

Ekspresi sitokin :Ekspresi sitokin :- TNFTNF poptosis! nekrosispoptosis! nekrosis- "#$%"#$% PlagPlag teroskleroristeroskleroris

- T&F%$T&F%$

FibrosisFibrosis

Patogenesis Komplikasi Hipertensi pada GinjalPatogenesis Komplikasi Hipertensi pada Ginjal

Robbin! '


11/39

Chronic hypertensionChronic hypertension

En*othelial +tressorEn*othelial +tressor

E,pressionE,pression

TNFTNF "#$"#$%%T&FT&F%%$$

poptosispoptosis PlauePlaue FibrosisFibrosisNe.rosisNe.rosis

theros.lerosistheros.lerosis

RenalRenal

FailureFailure

/oronar0/oronar0

Heart 1iseaseHeart 1isease

CerebralCerebral- +troke+troke

- 1ementia1ementia- ParkinsonParkinson

Hypertension Complication PathogenesisHypertension Complication Pathogenesis

Robbin! '2

"#3"#3

H/RPH/RP


12/39

TNF $$

Hypotalamus

PG2

+ ILIAspirin

FEVER

(Endogenic Pyrogen)

Hepatosit

Syntase

Coagulation

Strong Activation

Chachexia

Seru Ay!oid

"i#rinogen

C$P

% Contraction& 'ascu!ar sooth usc!e ce!!s& eart

'asodi!atation

Shock

Fat Cells

Perea#i!ityEudation

In!aation ce!!s

Congestion

%

Endhotel

& *issue "actor

& % *ro#o odu!in

& Shring,ing

Protea!itic

e#rane $eceptor -isruptionEritropoietin $eceptor -isruption

!nemia

& 'asopressor receptors& Proteo!itic

(.rata /id0aya1 234 .a#ang P1 25)

I'II'(

6A6E6*I7 % Appetite CACEC*IC (*I7)


13/39

Dis%&n'si EndotheDis%&n'si Endothe

oxLDLoxLDL

HipertensiHipertensi Angiotensin IIAngiotensin II MerokokMerokok

HomoHomosisisteinstein

DiabetesDiabetes

()a"#an' P* Pre+ent ,asc&ar Da"a'e -./01

2Anti Oksidan 2 Bradikinin

Stres O3sidati%

RISIKO KARDIO,ASKULER DANRISIKO KARDIO,ASKULER DANDISFUNGSI ENDOTHELDISFUNGSI ENDOTHEL

NatriumNatrium

EN4I5 NADPH OKSIDASE

N!"N!"

Ateros3erosisAteros3erosis

#ndothe$in#ndothe$in

%D&!%D&!


14/39

Res&t o% A Ris3 Factors in Kidney Disease

A'e Fa"iy History

Gender Dia#etes

Ure"ia2reated /. 6 -. 7 5or#iditas 8 5ortaitas

Hypertensio S"o3in' Hi'h o7idant stress

Dysipide"ia In%a"ation

Non2"odi%ia#e

5odi%ia#e

Ane"ia 9 ET

9PTH 9 CRP

9 PO: ROS

;GFR 2 AGEP9 AD5A 2 AOPP

2 Ho"osistein

Ure"ia2reated

L,H

CHF

P,D CAD

5I

()a"#an' P* Pre+ent ,asc&ar Da"a'e -./01


15/39

L2Ar'inineL2Ar'inine

NO SynthaseNO Synthase

NONO'' (itru$$ine(itru$$ine

ADMAADMAAsymetric Dimethy$Asymetric Dimethy$

ArginineArginine

(itru$$ine(itru$$ine

Rena e7cretionRena e7cretion

DDAHDDAHDimethy$aminoDimethy$amino

hydro$asehydro$ase

O7idati+eO7idati+e

stressstress

)A*N +,-*/ 011)A*N +,-*/ 011


16/39


17/39

(2eiss et a$./ 01+3; Obasi et a$./ 01+01


18/39

Merusak

&$iko %rotein 4 Nephrin

A%O%O*I*

#NDO#LMerusak I5B

A$buminuri 6 *itokin %ro In7$amasi

8N!"/ IL"+/ IL"9:

6 N!5B

A#O*5L#O*I*

*O5# 5OON# %&5

PGK

ROS

Age1A2Ho-osistein

8Bambang %/ 01+0

5a3ro%a'

SKE5A PENGARUH STRES OKSIDATIF (ROS1 PADA PGK


19/39

Angiotensin II

Endotelin

Vasokonstriksi

Iskemi

Defisiensi Aerob Metabolik

angguan pompa !a

Retensi !a

Retensi Air Intra "el

#dem Intra "el

"el pecah $ %nkosis

Robbin& '(()


20/39

he renin system p$ays a centra$ ro$e inregu$ation o7 B%

)uxtag$omeru$ar ce$$s

&$omeru$us

enin is re$eased

into the


21/39

enin secretion is regu$ated by = mechanisms

Dista$ tubu$e

%ressure in the

a77erent arterio$e

1


22/39


Na'at the macu$a densa

Dista$ tubu$e

3


23/39


Negati


24/39

!enin )ngiotensin!enin )ngiotensinSystemSystem 567567

-lassical 8circulating8 system 5!)S7

Angiotensin II

Angiotensin I

Angiotensinogen

Aldosterone

3a45retentionK45loss

glo-erular 6one

)-'

!enin

Blood1ressure3a4

7y-1atheticsyste-

!enin

-aculadensa

adrenalglands

Ada1t! fro- Do-inia. 8 9nger (eds!) in Ang II5A:&5/ece1tor Antagonists; 7tein.o1< (&$$,)


25/39

t5A = tissue 1las-inogen activCA>0 = chy-ostatin5sensitiveangiotensin generating en6y-e

9ocal 8tissue:bound8 system 5!)S7

A:& A:"

Brady.inin

inactive frag-ents

B"B&

Angiotensin II

Angiotensin I

Angiotensinogen

)-'

/enin

s1eci?c cellular res1onse

Chy-asesCathe1sin >

CA>0

t5A

Cathe1sin >:onin

s1eci?c cellular res1onse

Ada1t! fro- Do-inia. 8 9nger (eds!) in Ang II5A:&5/ece1tor Antagonists; 7tein.o1< (&$$,)

!enin )ngiotensin!enin )ngiotensinSystemSystem 5/75/7


26/39

Distribution of )-'

Mod! fro- D6au V; Arch Intern Med &@ (&$$)

!enin )ngiotensin!enin )ngiotensinSystemSystem 507507

! ) S6%&6%&

)cute and short:term e;ectscardiovascular

renal ho-eostasis

9ong:term e;ects

local organ ada1tation

$%&$%&

Circulating (las-a) ocal (:issue)

PROTECTIONPROTECTION


27/39

6< Monitoringtekanan darah = faktor resiko

/< Managemen pola hidup

0< Farmakologi

Pen'eoaan Hipertensi


28/39

Base$ine tekanan darah diukur periodik pada semuade>asa muda/ $ebih intensi7 pada pasien dengan -

+.*udah?baru terdeteksi hipertensi0.%unya kerusakan target kardio


29/39

&! :ida.Mero.o. *sa-a se.ali; hindari secondhand

s-o.e

"! A.tivitas Fisi.*+5,-g; #5E#-nt; s.ala sedang;

dina-i.

! engurangan Berat Badan *BMI nor-al; $#c-

'#c-

+! /e.o-endasi Diet*tinggi seratsayuran; rendah

le-a..olest

Managemen 4ola Hidup


30/39

>2NDISI *'>)N)ND)!)H

Hi1ertensi 7istoli.Diastoli. &+#$#

Diabetes $#

CKD $#

roteinuria &gra-"+Ga- &"@,@

*arget *erapi

*he -anadian Hypertension 'ducation 4rogram 5-H'47 (uidelines+ /%%$


31/39


32/39


33/39


34/39

Diuretik


35/39

Diuretik

*hort acting

!urosemid 8$asix:0

ch$orothia@ide8Diuri$:3

Intermediate

Hidroc$rotia@ide8Apo"Hydro/ Aua@ideH/Dich$otride/ Hydrodiuri$/ Hydro*a$uric/ Hydroch$orot/ Micro@ide/

#sidrex/ and Oretic:=

Ben@thia@ide 8Auatag/ Dihydrex/ Diucen/ #demax/ #xna/ !o


36/39

Obat"Obat Beta B$ocker+

+. *e$ekti7 dan Non *e$ekti7

a. *e$ekti7- b. Non *e$ekti7

" Asebuto$o$ " %ropano$o$

" Metopro$o$ " imo$o$

" Ateno$o$ " Nado$o$

" Bisopro$o$ " *ota$o$

" %indo$o$

" Okspreno$o$

" A$preno$o$

" Labeta$o$C

0. Hidro7i$ik dan Lipo7i$ik

a. Hidro7i$ik c. Hidro7i$ik dan LIpo7i$ik

" *ota$o$ " Okspreno$o$

" Nado$o$ " Labeta$o$C

" Ateno$o$ " Metopro$o$

b. Lipo7i$ik " imo$o$

" %ropano$o$ " Bisopro$o$

" A$preno$o$ " Asebuto$o$

" %indo$o$

3. I*A8Intrinsic *ympatomimetic Acti


37/39

(aantagonis+

+. Long Acting-

Am$odipin8Nor


38/39

+. %encegahan hipertensi harus sedini mungkin 8pre"hipertensi:0. %enge$o$aan hipertensi harus di>aspadai 7aktor resiko yg $ain

8sindrom metabo$ik:

3. %rogram non"drug treatment >aib dia$ankan penderita

=. %atogenesis hipertensi harus dipe$aari dengan baik da$am rangka -

a. Memi$ih obat yang tepatb. Memi$ih kombinasi obat

c. Meminima$kan e7ek samping

,. arget penurunan tensi sedapat mungkin mendekati idea$ 8harusbertahap:

9. %enge$o$aan krisis hipertensi harus memi$ih obat yg tepat/ targetpenurunan tensi sesuai protoko$ 8supaya re'SIM4U9)N


39/39

:eri-a .asih

slide belajar hipertensi

Documents