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Irma Wesprimawati,SpPD
.
Pendahuluan:
Hipertensi adalah keadaan
tekanan darah yang sama atau melebihi
140mmHg sistolik dan /atau sama atau
melebihi 90mmHg diastolik pada
seseorang yang tidak sedang minum
obat antihipertensi
2
Management of Hypertension in Diabetics
JNC-7 KLASIFIKASI
Cause of Hypertension:
4
Risk Factors of Hypertension:
1. Hyperlipidemia ( Deposition of fat in arteries & kidney )
2. Smoking
3. Diabetes mellitus
4. Stress ( Continuous production of O2- )
5
1- Measure BP Properly
The measurement of BP is likely the clinical Health care professionals should take particular
procedure of greatest importance that is care to ensure that they are using accurate
performed in the sloppiest manner.” techniques to measure BP in all their patients.”
(Norman Kaplan, M.D.) (International Working Group, 2008)
Lancet 2007; 370:591 J Hum Hypertens 2008; 22:63
∆ BP (mm Hg)
if not done
Rest ≥ 5min, quite ↑ 12/6
Seated, back supported ↑ 6/8
Cuff medsternal level ↑ ↓ 2/inch
Correct cuff size ↑ 6-18/3-14
Bladder center over artery ↑ 3-5/2-3
Deflate 2 mm Hg/ sec ↑ SBP/↓ DBP
Stronger
250
predictor of risk than diastolic BP:
Nondiabetic
Cardiovascular
disease
Diabetic
200
CV Diabetic Nephropathy
mortality
65% of 150
rate/ DM hypertensives have isolated systolic hypertension.
Systolic100hypertension more difficult to
10,000
person-yr
control
Lancet 2002; 360:1903 Hypertension 2003; 42:1206
50 National Kidney Foundation: Guideline 8. Am J Kidney Dis 43 (Suppl. 1):S142 –S159, 2004.
A: Accuracy, Apnea,
Aldosteronism
B: Bruit, Bad Kidney
C: Catecholamines,
Coarctation, Cushing's S.
D: Drugs, Diet
Investigations of Hypertension
Basic test for initial evaluation
a) Always included:
1. Urine for: Protein, blood, glucose
2. Haematocrit
3. Serum electrolytes- specially POTASSIUM
4. Blood urea & serum creatinine
5. ECG
6. Plasma cholesterol
Investigations of Hypertension
Basic test for initial evaluation
b) Usually included depending on cost & other factors:
1. Microscopic analysis
2. WBC
3. Blood / plasma glucose
- Fasting Blood glucose level
- 2 HPP blood glucose level
4. Serum – Total cholesterol, HDL, LDL, Triglycerides
5. Serum – calcium, phosphate, uric acid
6. X-ray chest P/A view
7. ECG
Management of Hypertension in Diabetics
4- Therapy
1. Blood Pressure Goal
2. Life Style Modification
3. Phamacological Therapy
4- Therapy
Life Style Modifications
Management of Hypertension in Diabetics
4- Therapy
Resistant Hypertension
Marketed antihypertensive drugs:
24
Anti Hypertensive Drugs
Class Drug (Trade Name) Usual Dose Range in MG/ DAY
CNS
Dypsogenia
AVP Vaso-
constriction
Efferent
Constriction
+
Mesangial Na
Contraction Retention
Vessel Myocardial
Aldosterone Hypertrophy Hypertrophy Increased
Norepinephrine
Release
Treatment of Hypertension in Special
Situations
Complications of Hypertension:
Hypertension is a
risk factor
TIA, stroke LVH,
HF,CHD,
Renal failure
Peripheral vascular disease
TIA = transient ischemic attack; LVH = left ventricular hypertrophy; CHD = coronary heart disease;
HF = heart failure.
Cushman WC. J Clin Hypertens. 2003;5(Suppl):14-22.
Prehypertension …
Is not a disease,
Is not “hypertension”,
In the 2nd & 3rd trimester, antihypertensive agents often are not
indicated unless the Diastolic BP exceeds 100 mm Hg.
In one study treatment with diuretics & an ACEi are better than other drug.
IDNT
JASN 2005;16(7):2170–2179
Management of Hypertension in Diabetics
Monitor GFR
1. If GFR >30% within 4 weeks, evaluate.
2. Continuo ACE-I or ARBs if GFR < 30% from baseline over 4 months.
5. Hypertension in Dyslipidaemia:
High dose THIAZIDES, LOOPS DIURETICS & BETA BLOCKERS may transiently
increase total cholesterol, still has significant reduction CV morbidity &
sudden death. So should be used without hesitation.
6. Hypertension with ASTHMA & COPD:
Loop diuretics should be used & potassium sparing diuretics should be avoided.
A) Emergency B) Urgency
i) Malignant HTN
ii) Accelerated HTN
Goal of reducing BP 160/100 mm of Hg with in 24 hrs
Drugs of Choice:
Oral Drugs are better than I/V
ORAL I/V
1. Clonidine 1. Nitroprusside
2. Labetalol 2. Nitroglycerin
3. Captopril 3. Labetalol
4. Prazosine 4. Hydralazine
Follow up & Monitoring
Physician Patient
55
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