Escolar Documentos
Profissional Documentos
Cultura Documentos
Rudy Salam
DEPARTEMEN FARMASI KLINIS
PRODI FARMASI FAKULTAS KEDOKTERAN
UNIVERSITAS BRAWIJAYA
WHAT IS BLOOD PRESSURE (BP)?
WHAT IS HIPERTENSION (HTN)?
EPIDEMIOLOGY
EPIDEMIOLOGY
Percentage of
Hypertensives with
Controlled BP
CVD RISK
ETIOLOGY
WHITE COAT HYPERTENSION
Clinic BP reading
Night Time Period
Systolic BP
Diastolic BP
Normal Bands
White coat window
vasodilating
substance (prostacyclin
and bradykinin)
HTN
vasoconstricting
substances (angiotensin II
and endothelin I)
nitric oxide
ELECTROLYTES AND OTHER CHEMICALS
BENEFITS OF LOWERING BP
JNC-7 CLASSIFICATION
Goals of Therapy
Pharmacologic treatment
http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm
CLASSIFICATION & MANAGEMENT OF BP FOR ADULTS
LIFESTYLE MODIFICATION
(NONPHARMACOLOGIC THERAPY)
LIFESTYLE MODIFICATION
ARB’s
ACEI’s
Renin Blocker
ACE INHIBITORS
ARB’S
RENIN BLOCKERS
MoA Agents SE
Decreases Aliskiren (Do: Hyperkalemia,
plasma renin 150-300 mg PO GERD, diarrhea,
activity qd elevated BUN/Cr
Interfering Pregnancy:
conversion of
angiotensinogen fetal/neonatal
to angiotensin I harm/death
Avoid
combinations
with ACEI/ARB
SIDE EFFECTS & INTERACTIONS
ACEI’S/ARB’S
BETA (Β) BLOCKERS
BETA (Β) BLOCKER AGENTS
SIDE EFFECTS & INTERACTIONS
BETA BLOCKERS
CALCIUM CHANNEL BLOCKERS
CALCIUM CHANNEL BLOCKERS
clevidipine
SIDE EFFECTS & DRUG INTERACTION
CCB’S
CENTRAL ALPHA-2 AGONIST
PERIPHERAL ALPHA-1 BLOCKERS
DIRECT VASODILATORS
OTHERS ANTIHYPERTENSIVES
5. COMPELLING INDICATIONS
Compelling Indication Initial Therapy Options Clinical Trial Basis
High CAD risk Thiazide, BB, ACEI, CCB ALLHAT, HOPE, LIFE, Convince
Individualize treatment
HYPERTENSIVE URGENCIES
AND EMERGENCIES
HYPERTENSIVE URGENCIES
AND EMERGENCIES