HYPERTENSION
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1800077
D3-3B
What is hypertension ?????
Hypertension is the most common cardiovascular disease. The prevalence of
hypertension increases with advancing age; for example, about 50% of people
between the ages of 60 and 69 years old have hypertension, and the prevalence is
further increased beyond age 70.
.
Hypertension is defined conventionally as a sustained increase in blood pressure
≥140/90 mm Hg, a criterion that characterizes a group of patients whose risk of
hypertension-related cardiovascular disease is high enough to merit medical attention.
Causes of hypertension:
1. Consume lots of salt
2. Stressful
3. Smoke
4. Less moving
Symptoms of hypertension :
1. Red spots on the eyes
2. Blushed face
3. Headache
4. Dizzy
5. Out of breath
6. Irreguler heartbeat
Criteria for Hypertension in Adults
CLASSIFICATION BLOOD PRESSURE (MM
HG
Systolic Diastolic
Normal <120 and <80
Pre-hypertension 120–139 or 80–89
Hypertension, stage 1 140–159 or 90–99
Hypertension, stage 2 ≥160 or ≤100
Systolic blood pressure is the pressure produced by the hear muscle when pushing
blood from the leafventricle to the aorta ( oressure when hte ventricular muscle of
the hear contracts ). Systolic blood pressure is the maximum pressure caused by the
arteries when blood is sprayed into the vessels during the systolic period with an
average of 120 mmHg.
Diastolic blood pressure is the pressure on the walls of the arteries and blood vassels
due to loosening of the heart ventricular muscles ( the pressure when the heart’s
atrial muscles contract and the blood goes to the ventricles). Diastolic blood
pressure is the arteries when blood flows out into smaller vassels downstream
during the diastolic period wiht an average of 80 mmHg.
Classification of Antihypertensive
1. Diuretics
2. Sympatholytic drugs
3. Alfabloker
4. Betabloker
5. Vasodilator
6. Angiotensin converting enzyme inhibitors
7. Angiotype receptor inhibitors II
8. Calcium antagonist
DIURETICS
Diuretics, which lower blood pressure by depleting the body of sodium and
reducing blood volume and perhaps by other mechanisms.
Diuretics are generally divided into groups :
1. Loop diuretic
2. Thiazides and related agents
3. K+-sparing diuretics
1. Loop diuretic
Works in the henle ascending ansa thick epithelial section by bloking the transport of Cl-,
inhibiting reabsorption of Na+,increasing the expenditure of K+ and water.
Indication : rarely used as an anti hypertension, except in patients with impaired renal
function or heart failure.
Cons of indication: electrolyte deficiency,anuria, comahepatic, youthulness, hypokalemia.
Side effects: Lower blood calcium
Examples of drug : furosemid, torasemid, bumetanid, and asam etakrinat.
Dose : dewasa 40mg/hr
anak 2-6 mg/kg BB/hr
2. Thiazides and related agents
Remove sodium from the kidneys
Indication : used as a single drug in mild to moderate hypertension.
Cons of indication: anuria, lithium joint therapy, renal decompensation.
Side effects: hypokalemia which can be dangerous in patients who get digitalis
Examples of drug : hydroklorotiazid, bendroflumetiazid and kortalidon.
Dose : dewasa 25-50 mg/hr
anak 0,5-1,0 mg/kgBB/ 12-24 jam
3. K+-sparing diuretics
hold potassium needed in the body
Indication : prevent hypokalemia
Cons of indication: acute renal insufficiency, anuria, hypokalemia, pregnancy
Side effects: menstrual disorders, decreased libido in men
Examples of drug : amilorid, triamteren and spironolakton
Dose :
2. Sympatholytic drugs
stimulates adrenergic alpha-2 receptors which are abundant in the central nervous system. Due to this
stimulation there is a decrease in paripheral adrenergic saraf activity
Indication : decrease peripheral resistance and high blood pressure
Cons of indication: in nursing women because the drug can enter milk
Side effects: sedation, dry mounth, difficulty sleeping, nasal congestion, dizziness, reduced vision
Examples of drug : clonidine, mosonidine and metildopa
Dose :
3. Alfabloker
Blocking alpha adrenoceptor blocking receptors round in the smooth muscle of the vessels, especially in the
skin vessels and mucosa
Indication : for hypertensive patients with dyslipidemia and diabetes mellitus
Cons of indication: impaired kidney function, severe hepatic insufficiency
Side effects: orthostatic hypotension that occurs specifically at the beginning of therapy and after increasing the
dose
Examples of drug : fentalamin, prazosin, terazosin and tamsulosin.
Dose :
4. Betabloker
Against blood pressure can be associated with B-1 receptor blockage
Indication : as a first stage drug in patients with mild to moderate hypertension, especially in patients with
coronary heart disease
Cons of indication: in patients with bronchial asthma
Side effects: bronchospasm in patients with a history of bronchial asthma or chronic obstructive pulmonary
disease
Examples of drug :asebutomol, atenolol, betaxolol, celiprolol,propanolol and alpnolol.
Dose :
5. Vasodilator
With vasodilatation of the arteries and thurs reduce high blood pressure
Indication : as a third-choice hypertension drug with adrenoreceptor B blockers and diuretics
Cons of indication: in nursing women because the drug can enter milk
Side effects: dizziness, headache, red face, flat nose and stomach disorders
Examples of drug : hidralazin, dihidralazin.
Dose :
6. Angiotensin converting enzyme inhibitors
Inhibits the change from angiotensin 1 to angitensin 2, resulting in vasodilation and descreased aldosterone
secretion
Indication : for hypertension in diabetes, dyslipidemia, obesity
Cons of indication: in pregnant woman because it is keratogenic
Side effects: hipotension, dry cough, hyperkalemia, distrubances in taste, edema, acute renal failure and
keratogenic effects
Examples of drug : kaptropil, lisonipril, enalapril, ramipril.
Dose :
7. Angiotype receptor inhibitors II
Angiotensin II receptor inhibitors occupy angiotensin II receptors found in the body. Angiotensin II effects on
blocking such as increased blood pressure and potassium excretion, sodium and water retention
Indication : reduce blood pressure in hypertension sand with high renim genetic hypertension
Cons of indication: angiotensin II receptor blokers in trimester 2 and 3 pregnancies, breastfeeding women,
bilateral renal artery stenosis or stenosis of the only functioning kidney
Side effects: angiotensin II receptor blockers in the form of hypotension that can occur in patients with high
renin levels such as hypovolamin, heart failure, renovascular hypertension and hepatic cirrhosis
Examples of drug : losartam, valsartan , candesartan, eprosartan, olmesartan.
Dose :
8. Calcium antagonist
Inhibits the entry of extracellular calcium ions into the vascular cells of smooth muscle so that the vascular
tension decreases and peripheral vasodilation occurs
Indication : vasodilation is very strong, then it is used as a hypertension medicine
Cons of indication: pregnant women, breastfeeding women, hypersensitivity, heart failure. Hypotension,
bradycardia, and acute kidney disease
Side effects: dizziness, headache, and burning sensation in the body
Examples of drug : nifeditin, nisoldipin, amlodipin, verapamil, lacidipin, diltiazem
Dose :
