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HYPERTENSION MANAGEMENT

Lusiana
Overview

Initial evaluation :

1.confirm diagnosis of hypertension

2.detect causes of secondary hypertension

3.assess CV risk, organ damage, concomitant


conditions
Heart failure :
ACEI/ARB + BB + diuretic + spironolactone

Post MI / CAD : Recurrent stroke


ACEI / ARB + BB prevention :
ACEI, diuretic
CAD :
ACEI, BB, diuretic, CCB Pregnancy :
labetalol, nifedipine,
DM : methyldopa
ACEI,ARB, CCB, diuretic

CKD :
ACEI/ARB
BP goal

>/= 60 yrs : < 150/90

< 60 yrs : < 140/90

DM or CKD :
DM : < 140 / 90
CKD with or without DM : ACEI/ ARB alone or combination
1. DX evaluation :
- BP measurement
- medical history
- physical examination
- summary of previous record
- Lab investigation
- genetic
- searching for asymptomatic organ damage
- searching for secondary hypertension
2. TX approach :
- tx reduction of high BP
- life style changes and tx
- initiation of hypertension drug tx
- BP tx goal

3. TX strategies :
- life style changes
- pharmacological

4. TX strategies in specific conditions


5. TX associated risk factors
6. Follow up / improvement of BP
1. DX evaluation:
- BP measurement :
a. Office BP measurement :
- sit 3 5 minutes
- take at least two BP measurement in sitting
position, spaced 1 2 min apart
- cuff at heart level
- measure BP in both arms at first visit
- measure at first visit BP 1 and 3 min after
assumption of standing position in elderly,
diabetic, orthostatic hypotension frequent or
suspected
Definitions and classification of office BP:
- Optimal : < 120 , < 80
- Normal :120-129, 85-89
- High normal : 130-139, 85 89
- Grade 1 : 140-159, 90-99
- Grade 2 : 160-179, 100-109
- Grade 3 : >=180, >=110
- Isolated : >=140, < 90
Out of office BP :
- day time / awake : >= 135, >=85
- night time : >=120, >=70
- 24 h : >=130, >=80
- home BP : >=135, >=85
Clinical indication for out of office BP :
- suspicion of white coat hypertension
- grade 1 hypertension in the office
- suspicion of masked hypertension
- variability offive BP over same or different visits
- autonomic, postural, post prandial, drug induced
hypotension
- s pre eclampsia
- identification true and false resistant hypertension
- marked discordance between office BP and home BP
-assessment of dipping status, s nocturnal hypertension
in sleep apnea, CKD, DM
-assessment BP variability
BP lowering drugs reduce the risk of major clinical cv
outcome ( fatal and non fatal stroke, myocardial
infarction, heart failure, other cv deaths )
Lifestyle changes
Corner stone for the prevention and important for
treatment

Control other cv risk factors and clinical condition

Salt restriction, increased consumption of vegetables,


fruits, low fat dairy products, reduction weight to BMI 25
kg/m2, waist circumference < 102 cm men, <88 cm in
women, regular exercise, quit smoking
Malignant hypertension
Hypertensive emergency defined as the presence of very
high BP associated with ischaemic organ damage (
retina, kidney, heart, brain )

Treatment is founded on agents that can be


administrated by intravenous infusion and titrated
THANK YOU
1. Sebutkan klasifikasi / pembagian hipertensi

2. Bila anda menemukan pasien dengan


hipertensi, bagaimana anda me manage pasien
anda ?