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Jabatan : Sebagai Staf Bagian Ilmu Penyakit Dalam RSU Langsa 2010-sekarang
Riwayat Jabatan :
Riwayat Pendidikan :
Tulisan :
Association of anti dsDNA, proteinuria, and Mex-SLEDAI in patients with
Lupus Nephritis ( Indonesian Journal of Hypertension, May 2011)
Mortality risk in relation to sex and B.P.
Systolic blood pressure
mmHg Standard risk
woman
87–97 men
98–127
128-137
138-147
148-157
158-177
178-197
> 198
Diastolic blood pressure
woman
48-68 men
69-83
83-88
88-93
93-98
98-108
108-118
> 118
0 100 200 300 400 500 600 700
800 Mortality ratio in %
Definitions
Hypertensive Emergency: A relatively
high blood pressure with evidence of
target organ damage.
Stroke syndromes
• Embolic
• Hemorrhagic
• Subarachnoid hemorrhage
Categories of Hypertensive
Emergencies
Cardiovascular
• Acute LV failure (“Flash” pulmonary edema)
• Acute coronary syndrome
• Aortic dissection
Pregnancy related hypertension
• Pre-eclampsia
• Eclampsia
• HELLP syndrome
Categories
Catecholamine excess
• Pheochromocytoma
• MAOI + tyramine
• Cocaine/amphetamines/OTCs
• Clonidine withdrawal
Other
• Renal failure
• Epistaxis
• Childhood hypertension
Hypertensive Encephalopathy
Symptoms:
• Mental status change – somnolence,
confusion, lethargy, stupor, coma, seizure
• Focal neurologic deficit
• Headache – alone not sufficient to diagnose a
hypertensive encephalopathy
• Nausea and vomiting
Signs:
• Papilledema, cotton wool exudates
Diagnostics
Hypertensive encephalopathy is a
diagnosis of exclusion – thus, exclude
the other possibilities!
Only definitive criteria is a favorable
response to BP reduction. However
clinical improvement may lag behind BP
improvement by hours to days
Pathophysiology
A loss of cerebral autoregulation.
Autoregulation is best studied in the
brain but present in heart and kidneys
as well
Represents the body’s attempt to
maintain constant FLOW of blood to
perfuse the cells
Autoregulation
In the uninjured, normotensive brain,
autoregulation is effective over MAP
ranging from about 50 – 150
Intravenous therapy
Principles of Therapy for
Hypertensive Emergencies
Patients must be hospitalized for monitoring
Dire consequences of lowering BP too quickly
Treated with parenteral
Lower MAP {1/3(SBP-DBP)+DBP} by no more
than 25% within minute to 1 hours or diastolic
110 mmHg, then 160/100 mmHg within 2-6
hours (JNC VII). Exception for ischemic stroke
IV infusion is prefer than bolus
Avoid the urge to turn to sublingual nifedipine