A.

DEFINITION OF HYPERTENSION
Hypertension or high blood pressure is an increase in systolic blood pressure
more than 140 mmHg and diastolic blood pressure more than 90 mmHg at 2 times
measurements with an interval of 5 minutes in a state of sufficient rest or calm.
Classification of hypertensionaccordingto ESC
2018canbedividedinto5categories,namelynormal where systolic / diastolic 160/100-
109)andhypertensionstageIII (> 180 /> 110) (Dr. Sardjito, nd ). now it is one of the
diseases which is quite common among Indonesians and is the second largest cause of
death.
The higher blood pressure of systole and diastole is likely to cause a greater
stroke, because there has been damage to the walls of blood vessels, making it easier
for blockages or even rupture of blood vessels in the brain. Rise and fall of blood
pressure is determined by systolic blood pressure (the highest blood pressure when the
furrowed heart pumps blood into the arteries) while diastole blood pressure (is blood
pressure when the heart breaks for an instant between two pulses).
The prevalence of hypertension patients not only occur in developed countries
but also occur in developing countries including Indonesia, hypertension cases in
Indonesia based on Riskesdas Data in 2013 showed 25.8% whereas hypertension
cases in the province East Java Based on 2018 Riskesdas data 10 shows 10.7%
(Riskesdas East Java 2018., n.d.)
Complications that can occur due to hypertension are coronary heart disease,
heart failure, stroke, chronic kidney failure, and retinopathy. The cause of pertensi
hypertension to date has not been ascertained, but the impact of hypertension resulted
in morbidity that requires serious treatment, and mortality high enough so that
hypertension is referred to as "the silent killer". Some of the factors that are known to
cause hypertension consist of factors that can be modified (diet, obesity, smoking, and
DM) and factors that cannot be modified (age, race, sex and genetic). (Nuraini, 2015)

Based on the cause, hypertension can be grouped into two groups 

namely (WHO, 2014): 
a. Essential hypertension or primary hypertension 
As many as 90-95 percent of hypertension cases that occur are not known
with certainty what causes it. The experts found an association between family
history of hypertension (genetic) sufferers and the risk of suffering from this
 disease. In addition, experts show stress as the main accused, and other factors
that influence it. Other factors that can be included in the cause of this type of
hypertension are the environment,disorders metabolic, intra-cellular, and factors
that increase the risk such as obesity, smoking, alcohol consumption, and 
blood disorders. 

b. Renal hypertension or secondary hypertension 

In the remaining 5-10 percent of cases, specific causes are known, namely hormonal
disorders, diabetes, heart disease, kidney disease, blood vessel disease or related
to pregnancy. Frequent cases are due togland tumors adrenal. Kitchen salt will
exacerbate the risk of hypertension but not a causative factor. 
Table 1. Classification of Blood Pressure in Adults 
Category Systolic mmHg  Diastolic mmHg
Normal <130 mmHg  <85 mmHg
Normal High 130-139 mmHg  85-89 mmHg
Stage 1 (Hypertension)  Mild140-159 mmHg While 90-99 mmHg
Stage 2 (Hypertension)  160 -179 mmHg  100-109 mmHg
Stage 3 (Hypertension)  Heavy180-209 mmHg  110-119 mmHg
Stage 4 (Hypertension Very)  201 mmHg or more 120mmHg or more 

WeightMalignantSource: Heniwati, 2008

B. PATOFISIOLOGY

GENETIC FACTORS ENVIRONMENTAL

FACTOR

NA HOMEOSTASIS FUNCTIONAL STRUCTURAL

DEFECT IN THE KIDNEY VASOCONSTRICTION DEFECTS AND
VASCULAR SMOOTH
MUSCLE GROWTH

NA EXCRETION IS
ADEQUATE

WATER AND SALT

RETENTION
NATRIURETIC
HORMONE

PLASMA VOLUME VASCULAR

REACTIVITY VASCULAR
THICKNESS

CARDIAC OUTPUT
PERIPHERAL
RESISTANCE

HYPERTENSION
 C. ETIOLOGY OF HYPERTENSION

a. Essential hypertension/ primary hypertension

Essential hypertension is defined by its lack of identifiable causes. However, certain

risk factors that make the condition more likely have been identified. These include:

1. Obesity

Obesity puts extra strain on the heart, increasing the risk of high blood pressure.

2. Genetics

Those with a family history of essential hypertension are more likely to be at risk of
developing the condition themselves. Fifty genes have been identified as linked to high
blood pressure.

3. Aging

Multiple factors related to aging have been shown to increase the likelihood of essential
hypertension. These include the stiffening of the arteries and the onset of certain renal
microvascular diseases not yet perceived as a cause.

4. Stress

It is thought that long-term or chronic mental stress is linked to the development of

essential hypertension.

5. Salt

Excessive salt (sodium) consumption, defined by the American Heart Association as

eating over 2300 mg per day, can play a role in the onset of essential hypertension. Salt
increases retention of water in the body, which in turn increases the volume of blood and,
consequently, blood pressure.

6. Renin

The enzyme renin, produced by the kidneys, is part of the body’s “renin angiotensin
system”, which is responsible for controlling arterial blood pressure and is closely linked
to both essential hypertension and hypertension in general. People with both low and high
levels of renin are at risk of the condition.

7. Lack of exercise

The link between leading a sedentary lifestyle and an increased chance of essential
hypersensitivity is well studied. To lead a healthy lifestyle and reduce the risk of high
blood pressure, it is recommended that adults engage in at least 30 minutes of moderate
physical activity five days a week.

8. Race
 Research indicates that hypertension is often more common in people of Afro-Caribbean
descent. Hypertension also tends to occur earlier in life, be more severe and be associated
with a higher risk of organ damage in people from this group.

9. Alcohol consumption

Excessive alcohol intake, defined by the U.S. Department of Health as consuming more
than one drink per day for women and two drinks per day for men, is associated with
hypertension.

10. Physical inactivity

A lack of physical activity is associated with hypertension. Exercise is one of the key
methods of managing high blood pressure.

b. Secondary hypertension

Directly linked to a variety of vascular, endocrine (related to hormones), heart and

kidney conditions. It is far less common than essential hypertension.

C. RISK FACTORS

A number of factors increase the risk of hypertension.

 Age: Hypertension is more common in people who are more than 60 years of age.
Blood pressure can increase steadily with age as the arteries stiffen and narrow due to
plaque buildup.

 Ethnicity: Some ethnic groups are more prone to hypertension than others. African
Americans have a higher risk than other ethnic groups, for example. · Size and
weight: Being overweight or obese is a primary risk factor.

 Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco
can increase blood pressure.

 Sex: According to a 2018 review, males have a higher risk of developing hypertension
than females. However, this is only until after women reach menopause.

 Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease,

and high cholesterol levels can lead to hypertension, especially as people age.
Other risk factors include:

 sedentary lifestyle

 salt rich, high fat diet

 low potassium intake

D. SIGNS AND SYMPTOMS OF HYPERTENSION

Hypertension is thought to develop into more serious health problems and can even
cause death. Hypertension is often referred to as the silent killer because of two things,
namely:

1. Hypertension is difficult for someone to realize because hypertension does not

have special symptoms. Mild symptoms such as dizziness, anxiety, nosebleeds,
and headaches are usually rarely directly related to hypertension. Hypertension can
be known by measuring blood pressure regularly.

2. People with hypertension, if not treated properly, will have a great risk of dying
from cardiovascular complications such as stroke, heart attack, heart failure, and
kidney failure.

Symptoms of hypertension
Someone who has hypertension will feel some symptoms that arise. Symptoms that arise due
to hypertension include:
1. Headache
2. Fatigue
3. Nausea
4. Vomiting
5. Shortness of breath
6. Restless
7. Blurred vision occurs due to damage to the brain, eyes, heart and kidneys.
8. Frequent urination, especially at night
9. Ears ringing
 E. HYPERTENSION CASES

RISK FACTORS FOR HYPERTENSION IN TERMS OF COFFEE DRINKING HABITS

(CASE STUDY IN THE WORKING AREA OF UNGARAN PUSKESMAS)

Background: Coffee is one of the favorite drinks in the world. Coffee consumption affecting
hypertension has long been debated. Several studies have shown that at certain frequencies
the habit of drinking coffee is actually a protective factor of hypertension. Coffee can affect
blood pressure due to the presence of polyphenols, potassium, and caffeine. Polyphenols and
potassium are reducing blood pressure, while caffeine is raising blood pressure. This study
aims to determine the risk factors for hypertension in terms of coffee drinking habits.

Method: This research is an observational study using case contro; design. Research subjects
were 94 people consisting of 47 cases and 47 controls. The research subjects were male
residents of the Ungaran Community Health Center working area aged 45-65 years, taken by
consecutive sampling. Coffee drinking habits seen from the type of coffee, frequency,
thickness, and duration of drinking coffee are asked directly with a questionnaire. The
statistical analysis performend was the Chi Square test and the OR (Odd Ration) calculation
was carried out for the magnitude of the risk.

Results: OR subjects who drink coffee >5 cups per day of coffee (p=1,000 OR = 1.27, 95%
Cl: 0.08-21.10) were lower than subjects who drink coffee 1-2 cups per day (p = 0.017 OR =
4.12, 95% Cl: 1.22-13.39) even though it was not statistically significant. OR subjects drink
coffee 3-4 cups per day (p = 1,000; OR = 0.95; 95% Cl; 0.020-4.57) lower than subjects who
did not drink coffee although statistically not significant. Subjects who consumed 1-2 cups of
coffee per day increased their risk of hypertension 4.11 times higher (p = 0.017; O = 4.11 ; IK
95%: 1.22-13.93) compared to subjects who did not drink coffee.

CONCLUSIONS: Coffee drinking habits increase the risk of hypertension, but depends on
the frequency of daily consumption.