BAB I

PRELIMINARY

1.1 BACKGROUND

Hypertension is a public health problem. Uncontrolled hypertension can lead to

degenerative diseases, such as congestive heart failure, kidney failure, and vascular
disease. Hypertension is called the "silent killer" because it is asymptomatic and has
caused fatal strokes or heart disease for several years. Although not treatable,
prevention and management can reduce the incidence of hypertension and its
accompanying diseases.

It is estimated that about 80% increase in cases of hypertension, especially in

developing countries in 2025 from a total of 639 million cases in 2000, is estimated to
be 1.15 billion cases in 2025. This prediction is based on the current number of
hypertension sufferers and the current population growth.

Hypertension is the number 3 cause of death after stroke and tuberculosis, reaching
6.7% of the population of deaths at all ages in Indonesia. Based on the 2007 Basic
Health Research (Riskesdas), it is known that almost a quarter (24.5%) of the
Indonesian population over the age of 10 consumes salty foods every day, once or
more. Meanwhile, the prevalence of hypertension in Indonesia reaches 31.7% of the
population aged 18 years and over. Of that number, 60% of people with hypertension
end up in a stroke. While the rest is on the heart, kidney failure, and blindness. In
adults, a 20 mmHg increase in systolic blood pressure results in a 60% increased risk
of death from cardiovascular disease.
According to the American Heart Association (AHA, 2001), there was an increase in
the mortality rate due to hypertension by 21% from 1989 to 1999. Overall mortality
due to hypertension has increased.

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by 46%. Riskesdas data states that hypertension is the third leading cause of death
after stroke and tuberculosis, which amounts to 6.8% of the proportion of causes of
death at all ages in Indonesia.

Hypertension prevalence figures in Indonesia have been collected and show, in rural
areas there are still many patients who have not been reached by health services. In
terms of case-finding and treatment management, the reach is still very limited and
most hypertension sufferers have no complaints. The highest prevalence ranges from
6 to 15% but extreme numbers are low, such as in Ungaran, Central Java, 1.8%;
Lembah Balim Mountains Jaya Wijaya, Irian Jaya 0.6%; and West Sumatra Gutter
17.8% ..

Most people feel healthy and energetic despite hypertension. According to the results
of Riskesdas 2007, most cases of hypertension in the community have not been
detected. This situation is certainly very dangerous, which can cause sudden death in
the community. Because of the large number of hypertension incidence, it will be
studied further about the hypertension disease.

1.1 LIMITATION OF PROBLEM

Based on the above background, the problem limitation of this paper is the definition,
diagnosis and management of hypertension

1.2 PURPOSE OF WRITING

The purpose of writing this paper is:

a. To know the definition of hypertension.

b. To find out the types of hypertension.

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c. To determine the causes (risk factors) for hypertension.

d. To determine the mechanism of hypertension.

e. To find out how to prevent hypertension.

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BAB II

DISCUSSION

2.1 DEFENITION OF HYPERTENSION

The Joint National Community on Preventation, Detection evaluation and treatment

of High Blood Preassure from the United States and the world body WHO with the
International Society of Hypertension define hypertension, namely when a person's
blood pressure is 140 mmHg or more or a diastolic pressure of 90 mmHg or more or
moderate taking anti-hypertensive drugs.

In children, the definition of hypertension is when blood pressure is more than 95

percentile in terms of age, sex, and height measured at least three times on separate
measurements. The sixth Report of The joint national Committee on Prevention,
detection, Evaluation and Treatment of High Blood Presure (JNC VI) classifies blood
pressure for adults into six groups.

High blood pressure or hypertension is a condition in which a person has an increase

in blood pressure above normal, which is indicated by the systolic (upper) and lower
(diastolic) numbers on blood pressure checks using a blood pressure measuring
device in the form of a mercury cuff (sphygmomanometer). ) or other digital tools ..

The normal value of a person's blood pressure with measurements of height, weight,
normal activity level and general health is 120 / 80mmHg. In daily activities, normal
blood pressure is a stable numeric value. But in general, the number of blood pressure
checks decreased during sleep and increased during activity or exercise.

If a person experiences high blood pressure and does not get treatment and control
regularly (routine), then this can bring the sufferer into serious cases and can even
cause death. Continuous high blood pressure causes a person's heart to work extra
hard, eventually this condition results in damage to the blood vessels of the heart,

4
kidneys, brain and eyes. Hypertension is a common cause of strokes and heart
attacks.

2.2 TYPES OF HYPERTENSION

Hypertension grouping consists of:

2.2.1 Hypertension according to the cause is divided into:

1. Primary Hypertension
Essential hypertension or primary hypertension with no known cause is also called
idiopathic hypertension. There are about 95% of cases. Many factors influence it such
as genetics, environment, hyperactivity of the sympathetic nervous system, the renin
angiotensin system, defects in Na excretion, increased intracellular Na and Ca and
factors that increase risk such as obesity, alcohol, smoking, and polycythemia.
Primary hypertension usually occurs at the age of 30-50 years ..

2. Secondary Hypertension
Secondary hypertension is a condition where there is an increase in high blood
pressure as a result of someone experiencing / suffering from other diseases such as
heart failure, kidney failure, or damage to the body's hormone system. Whereas for
pregnant women, blood pressure generally increases at 20 weeks of pregnancy.
Especially in women whose weight is above normal or obese.
Pregnancy-induced hypertension (PIH), this is a term in health (medical) terms for
pregnant women who suffer from hypertension. Hypertension conditions in pregnant
women can be moderate or severe / dangerous, a pregnant woman with high blood
pressure can experience preeclampsia during her pregnancy.
Preeclampsia is a condition of a pregnant woman who has hypertension, so she feels
complaints such as dizziness, headaches, visual disturbances, stomach pain, swollen
face, lack of appetite, nausea and even vomiting. If a spasm occurs as a result of
hypertension, it is called Eclampsia.

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Secondary hypertension or renal hypertension accounts for about 5% of cases.
Specific causes are known, such as the use of estrogen, kidney disease, renal vascular
hypertension, primary hyperaldosteronism, and Cushing's syndrome,
pheochromocytoma, aortic coarctation, pregnancy-related hypertension, and others.

The Renin-Angiotensinogen-Aldoterone (RAA) system is clinically difficult to

distinguish between the two conditions, especially in chronic kidney disease. The
severity of the influence of hypertension on the kidneys depends on the high blood
pressure and duration of suffering from hypertension. The higher the blood pressure
in a long time, the more severe the complications that may be caused.

a. Hypertension in kidney disease

Kidney disease can increase blood pressure and conversely hypertension for a long
time can irritate the kidneys. Hypertension in kidney disease can occur in acute
kidney disease and chronic kidney disease, both in glumerolic disorders and in
vascular disorders. Hypertension in kidney disease can be grouped into:
1. Acute glumerolus disease
Hypertension occurs due to sodium retention which causes hypervolemia. Sodium
retention occurs due to increased sodium reabsorption in the choligenic duct. This
increase is due to the relative retention of peptide Natriuretic Hormones and an
increase in the activity of the Na - K - ATPase pump in the colligent duct.
2. Vascular disease
In this situation ischemia occurs which then stimulates the renin angiotensin
aldosterone system.
3. Chronic renal failure
Hypertension that occurs due to sodium retention, increased Renin Angiotensinogen
Aldosterone system due to relative ischemia due to regional damage, increased
sympathetic nerve activity due to renal damage, secondary hyperparathyroidism, and
erythropoetin administration.
4. Chronic glumerolus disease

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an enzymatic hormonal system that is multicomplex and plays a role in increasing
blood pressure, controlling body fluid and electrolyte balance.
a. Hypertension in renovascular disease
Renovascular hypertension is the most common cause of secondary hypertension.
The diagnosis of renovascular hypertension is important because this disorder has the
potential to be treated by eliminating the cause, namely renal artery stenosis. Renal
artery stenosis is a condition where there are anatomically obstructive lesions in the
renal arteries. While renovascular hypertension is hypertension that occurs
physiologically due to the presence of renal artery stenosis.
The term ischemic nephropathy describes a state of decreased kidney function due to
renal artery stenosis. If there is impaired kidney function, this disorder will persist
even though the blood pressure can be controlled with treatment which includes
antihypertensive medicaments, revascularization with surgery or angioplasty.

b. Hypertension in endocrine disorders

One of the diseases caused by endocrine damage is primary aldosteronism (Conn's
syndrome). Primary hyperaldosteronism is a syndrome caused by uncontrolled
hypersecretion of aldesterone that generally originates from the adrenal cortex glands.
Primary hyperaldosteronism is known clinically by the triad consisting of
hypertension, hypokalemia, and metabolic alkalosis. This syndrome is caused by
hyperplasia of the adrenal cortex glands, adenoma or adrenal carcinoma.

c. Cushing's Syndrome
Cushing's syndrome is caused by bilateral adrenal hyperplasia caused by a pituitary
adenoma that produces Adenocorticotropin Hormone (ACTH).

d. Congenital adrenal hypertension

Congenital adrenal hypertension is the cause of hypertension in children (rarely).

e. Phaeochromocytoma

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Phaeochromocytoma is a type of endocrine hypertension that should be suspected if
there is a family history. Signs that suspect pheochromocytoma include hypertension,
headache, hypermetabolism, hyperhidrosis, and hyperglycemia.
Pheochromocytomia is caused by chromatin cell tumors of neural origin that secrete
catecholamines. Most originate from the adrenal glands, and only 10% occur
elsewhere in the sympathetic chain. 10% of these tumors are malignant and 10% of
adrenal adenomas are bilateral. Pheochromocytomia is suspected if high fluctuating
blood pressure is accompanied by tachycardia, sweating or pulmonary edema due to
heart failure.

f. Coarctation of the aorta

Coarctation of the aorta most commonly affects the aorta distal to the left subclavian
artery and produces hypertension in the arms and decreases pressure in the legs, with
weak or absent femoral artery pulses. This hypertension can persist
even after successful surgical resection, especially if hypertension occurs long before
surgery.

a. Hypertension in pregnancy

Hypertension in pregnancy is a major cause of increased maternal, fetal and neonatal

morbidity and mortality. Hypertensive emergencies can be a complication of
preeclampsia as is the case with chronic hypertension. Pregnant women with
hypertension are at high risk for serious complications such as placental abruption,
cerebrovascular disease, organ failure, and intravascular coagulation. Observational
studies of patients with mild chronic hypertension found 10–25% risk of preeclamptic
pregnancies, 0.7–1.5% abruption, 12–34% less than 37 weeks of preterm pregnancy,
and 8–16% fetal growth restriction. The risk of chronic severe hypertension in the
first trimester increases with the acquisition of preaklampsia by up to 50%. To the
fetus, resulting in the risk of intrauterine developmental retardation, prematurity and
intrauterine death. In addition, the risk of hypertension such as heart failure,
encephalopathy, retinopathy, cerebral hemorrhage, and acute renal failure can occur.

8
It is not yet clear whether controlled blood pressure aggressively reduces the
incidence of eclampsia.

b. Hypertension due to the use of drugs.

The most common use of drugs associated with hypertension is the oral contraceptive
pill (OCP) where 5% of women experience hypertension since starting use. Women
of older age (> 35 years) are more susceptible, as are women who have had
hypertension during pregnancy. At 50% the blood pressure will return to normal 3–6
after stopping the pill. Postmenopausal estrogen use is cardioprotective and does not
increase blood pressure. Other drugs associated with hypertension include
cyclosporine, erythopoietin, and cocaine.

2.2.2 According to Blood Pressure Disorders

a. Diastolic Hypertension (diastolic hypertension)

Namely an increase in diastolic pressure without an increase in systolic pressure.

Usually this form of hypertension is found in children and young adults.

b. Systolic hypertension (isolated systolic hypertension)

Namely an increase in systolic pressure without an increase in diastolic pressure.

Generally this form of hypertension is found at an advanced age.

c. Mixed Hypertension (elevated systole and diastole)

Namely the increase in blood pressure in systole and distole.

2.2.3 According to the weight or height of the increase in blood pressure

a. Mild hypertension is when the measurement of blood pressure, systolic blood

pressure is between 140-159mmHg and diastolic blood pressure is between 90-
99mmHg.

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b. Moderate hypertension is when the measurement of blood pressure, systolic blood
pressure is between 160-179mmHg and diastolic blood pressure is between 100-
109mmHg.

c. Severe hypertension is when the measurement of blood pressure, systolic blood

pressure> 180mmHg and diastolic blood pressure ≥110mmHg.

2.2 SYMPTOMS OF HYPERTENSION

Hypertension is thought to develop into a more serious health problem and can
even lead to death. Often hypertension is called the silent killer because of two
things, namely:

a. Hypertension is difficult for someone to realize because hypertension has no

specific symptoms. Mild symptoms such as dizziness, restlessness, nosebleeds and
headaches are rarely directly related to hypertension. Hypertension can be identified
by measuring blood pressure regularly.

b. Patients 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.

In most patients, hypertension does not cause symptoms; although accidentally some
of the symptoms co-occur and are believed to be associated with high blood pressure
(but they are not). The symptoms referred to are headache, bleeding from the nose,
dizziness, facial flushing and fatigue; which can occur both in people with
hypertension, and in someone with normal blood pressure.

If the hypertension is severe or chronic and is not treated, the following symptoms
may develop:

a. Headache

b. Fatigue

c. Nausea

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d. Throw up

e. Out of breath

f. Restless

g. Blurred vision that occurs due to damage to the brain, eyes, heart and kidneys.

h. Frequent urination, especially at night

i. Ringing in ears

Sometimes people with severe hypertension experience a decrease in consciousness

and even coma because of swelling of the brain. This condition is called hypertensive
encephalopathy, which requires immediate treatment

2.3 HYPERTENSION RISK FACTORS

Hypertension is caused by factors that can be modified or controlled as
well as factors that cannot be modified.
a. Factors that cannot be modified or controlled
1. Genetic
The existence of genetic factors in certain families will put that family
at risk of suffering from hypertension. Individuals with hypertensive
parents have twice the risk of suffering from hypertension than
individuals who do not have a family history of hypertension. In 70-
80% of cases of primary hypertension, a family history of hypertension
is obtained. If a history of hypertension is obtained in both parents, then
the suspicion of primary hypertension is greater. Hypertension is also
often found in patients with monozygous twins (one egg), if one of them
is suffering from hypertension. This assumption supports that genetic
factors have a role in the occurrence of hypertension.

2. Age

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The incidence of hypertension increases with age. Individuals over 60
years of age, 50-60% have blood pressure greater than or equal to
140/90 mmHg. This is the effect of degeneration that occurs in people
who get older.

3. Gender
Men have a higher risk of developing hypertension earlier. Men also
have a greater risk of cardiovascular morbidity and mortality,
meanwhile over the age of 50, hypertension is more common in women.

4. Ethnicity
Hypertension is more common in black people than whites. The exact
cause is not known, but black people found lower renin levels and
greater sensitivity to vasopressin.

5. Kidney Disease
The kidneys control blood pressure in several ways:
a) If the blood pressure increases, the kidneys will increase the
excretion of salt and water, which will cause a decrease in blood volume
and return blood pressure to normal.
b) If blood pressure decreases, the kidneys will reduce the removal of
salt and water, so that blood volume increases and blood pressure
returns to normal.
c) The kidneys can also increase blood pressure by producing an
enzyme called renin, which triggers the formation of the angiotensive
hormone, which in turn triggers the release of the hormone aldosterone.
The kidneys are important organs in controlling blood pressure,
therefore various diseases and disorders of the kidneys can cause high
blood pressure. For example, narrowing of the arteries leading to one of

12
the kidneys (renal artery stenosis) can cause hypertension. Inflammation
and injury to one or both kidneys can also cause blood pressure to rise.

6. Medicines
The use of drugs such as some hormone drugs (birth control pills),
corticosteroids, cyclosporine, erythropoietin, cocaine, and cinnamon (in
very large quantities), including some anti-inflammatory drugs (anti-
inflammatory) continuously (often) can increase blood pressure
someone. Drinks that contain alcohol are also one of the factors that can
cause high blood pressure.

7. Preeclampsia in pregnancy
Preeclampsia in pregnancy is when there is a blood pressure of 140/90
mmHg after 20 weeks of gestation (end of the second trimester to the
third trimester) or it can occur earlier. Preeclampsia occurs as a result of
impaired organ function due to general narrowing of blood vessels
which results in placental ischemia (placenta) resulting in insufficient
blood supply that carries nutrients to the fetus.

8. Acute lead poisoning

Lead can cause proximal tubular lesions, henle arch, and cause
aminosiduria, so that abnormalities in the kidneys (inflammation and
injury to one or both kidneys) can cause high blood pressure.

a. Factors that can be modified or controlled

1. Stress
Stress will increase peripheral vascular resistance and cardiac output
so that it will stimulate sympathetic nerve activity. This stress can be
related to work, social class, economy, and personal characteristics. The
mechanism of the relationship between stress and hypertension is

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thought to be through activation of the sympathetic nerves. Sympathetic
nerves are nerves that work when we are active, parasympathetic nerves
are nerves that work when we are not active.
Increased sympathetic nerve activity can increase blood pressure
intermittently (erratically). When stress is prolonged, it can cause blood
pressure to remain high. Although this has not been proven, the
incidence rate in urban communities is higher than in rural areas.
This can be related to the influence of stress on community groups
living in cities.

1. Obesity
Epidemiological studies indicate a relationship between body weight
and blood pressure in both hypertensive and normotensive patients. In a
population where there is no increase in body weight with age, there is
no increase in blood pressure with increasing age. Obesity, especially in
the upper body, with an increase in the amount of fat in the abdomen.

2. Nutrition
Sodium is an important cause of essential hypertension, high salt intake
will lead to excessive secretion of natriouretic hormone which will
indirectly increase blood pressure.
High salt intake that can cause detectable changes in blood pressure is
more than 14 grams per day or if converted into a tablespoon dose is
more than two tablespoons.

3. Smoking
Recent studies suggest that smoking is a modifiable risk factor for
hypertension. Smoking is a potential risk factor to be eliminated in an
effort to fight the current increase in hypertension in particular and
cardiovascular disease in general in Indonesia.

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 4. Lack of exercise
An inactive lifestyle (lazy to exercise) can lead to hypertension in
people with inherited sensitivity.

2.4 HYPERTENSION MECHANISM

The mechanism of hypertension is through the formation of angiotensin II

from angiotensin I by angiotensin I-converting enzyme (ACE). ACE plays an
important physiological role in regulating blood pressure. Blood contains
angiotensinogen which is produced in the liver. Furthermore, by hormones, renin
(produced by the kidneys) will be converted into angiotensin I. By ACE which is
in the lungs, angiotensin I is converted into angiotensin II. Angiotensin II has a
key role in raising blood pressure through two main actions. The first action is to
increase the secretion of antidiuretic hormone (ADH) and thirst. ADH is
produced in the hypothalamus (pituitary gland) and acts on the kidneys to
regulate urine osmolality and volume. With increasing ADH, very little urine is
excreted outside the body (antidiuresis), so it becomes concentrated and high in
osmolality. To dilute it, the volume of extracellular fluid will be increased by
drawing fluid from the intracellular part. As a result, blood volume increases,
which in turn increases blood pressure. The second action is to stimulate
aldosterone secretion from the adrenal cortex.

Aldosterone is a steroid hormone that plays an important role in the kidneys.

To regulate extracellular fluid volume, aldosterone will reduce the excretion of
NaCl (salt) by reabsorption from the renal tubules. The increase in the
concentration of NaCl will be diluted again by increasing the volume of
extracellular fluid which in turn will increase the volume and blood pressure.

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 2.5 PREVENTION OF HYPERTENSION

Hypertension can be prevented by managing a good diet such as

consumption of foods rich in fiber, reducing salt consumption and
a diet low in saturated fat, total fat and cholesterol and adequate physical
activity. Avoid other habits such as smoking and consuming alcohol which are
thought to have an effect on increasing the risk of hypertension, although the
mechanism of its occurrence is not yet known. It is recommended to reduce
sodium / sodium consumption. The main sources of sodium / sodium are sodium
chloride (table salt), seasonings (monosodium glutamate = MSG), and sodium
carbonate. Consumption of table salt (contains iodine)

which is recommended no more than 6 grams per day, equivalent to one

teaspoon. In fact, excess consumption is caused by the cooking culture of our
society which is generally wasteful of using salt.
Our taste buds have been accustomed to having a high threshold for saltiness
since childhood, making it difficult to accept foods that are rather bland. Salt
consumption is difficult to control, especially if we are accustomed to eating
food outside the home (stalls, restaurants, hotels, etc.).
Sources of sodium that also need to be watched out are those that come from
cooking flavorings (MSG). The culture of using MSG has reached a very
alarming level. Almost all housewives, food vendors, and catering service
providers always use it. The use of MSG in Indonesia has become so free that
sellers of meatballs, chicken porridge, soup, and others simply add it to their
bowl without a clear measurement.

Some forms of prevention of hypertension include:

a. Primordial prevention
b. Health promotion
c. Early protection: reduce salt as a risk factor
d. Early diagnosis: screening, examination / check-up

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 e. Appropriate treatment: immediately get comprehensive treatment and initial
causal complaints
f. Rehabilitation: efforts to improve the after effects of untreated hypertension

2.4 TREATMENT

Hypertension crisis management should be done in a hospital, but it can be

carried out in primary care as a preliminary service by administering oral anti-
hypertensive drugs. Management of hypertensive crises based on initial
assessment can be seen in table 3.

Tabel 3: Algoritma untuk Evaluasi Krisis Hipertensi

Parameter Urgent Hypertension Hypertension Emergency

The usual Urgent

Blood > 180/110 > 180/110 > 220/140
pressure
(mmHg)
Symptoms Headache, anxiety; Severe headache, Shortness of breath, chest
often without shortness of breath pain, nocturia, dysarthria,
symptoms weakness, decreased
consciousness
Examination No target organ Target organ damage; Encephalopathy, pulmonary
damage, no appears clinical edema, renal insufficiency,
cardiovascular cardiovascular cardiac ischemia
disease disease, stable
Therapy Supervise 1-3 Supervise 3-6 hours; Install IV line, check
hours; starting / short-acting oral standard laboratory, IV drug
continuing oral medication therapy
medication,
increase dose
Plan Check back in 3 Check back in 24 Hospital / ICU
days hours

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The oral hypertension drugs that can be used for urgent hypertension (urgency) can
be seen in table 4.

Tabel 4: Obat hipertensi oral

Obat Dosis Effect / Duration of Special attention

Work
Captopril 12.5 - 25 mg PO; 15-30 min / 6-8 Hypotension, renal failure,
repeat per 30 min; hours; SL 10-20 renal artery stenosis
SL, 25 mg min / 2-6 hours
Clonidine PO 75 - 150ug, 30-60 min / 8-16 Hypotension, drowsiness, dry
repeat per hour hours mouth
Propanolo 10 - 40 mg PO; 15-30 min / 3-6 Bronchoconstriction, heart
l repeat every 30 min hours block, orthostatic hypotension
Nifedipin 5 - 10 mg PO; 5 -15 min / 4-6 hours Tachycardia, hypotension,
e repeat every 15 coronary disorders
minutes
SL, Sublingual. PO, Peroral

Whereas for emergency hypertension (emergency) it is more recommended for

parenteral use, a list of parenteral hypertension drugs that can be used can be seen in
table 5.
Tabel 5: Obat hipertensi parenteral3,5

Obat Dosis Effect / Special attention

Duration of
Work
Sodium 0.25-10 mg / kg immediately / 2- Nausea, vomiting, prolonged use can
nitroprusside / minute as an 3 minutes after cause thiocyanate poisoning,
IV infusion infusion methemoglobinemia, acidosis,
cyanide poisoning.
Silver coated infusion hose
Nitrogliserin 500-100 mg as 2-5 min /5-10 Headache, tachycardia, vomiting,
an IV infusion min methemoglobinemia; need a special
delivery system because the drug
binds the PVC pipes
Nicardipine 5-15 mg / hour 1-5 min/15-30 Tachycardia, nausea, vomiting,

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 as an IV min headache, increased intracranial
infusion pressure; hypotension
Klonidin 150 ug, 6 amp 30-60 min/ 24 Encephalopathy with coronary
per 250 cc jam disorders
Glukosa 5%
mikrodrip
5-15 ug / kg / 1-5 min/ 15- 30 Tachycardia, nausea, vomiting,
Diltiazem min as an IV min headache, increased intracranial
infusion pressure; hypotension

In emergency hypertension (emergency) with complications such as hypertensive

emergencies with heart disease, it is necessary to choose the right drug so that it does
not worsen the situation. Selection of drugs for hypertension with complications can
be seen in table 6.

Tabel 6: Obat yang dipilih untuk Hipertensi darurat dengan komplikasi2,5

Complications Medicine of choice Blood Pressure Targets
Aortic dissection Nitroprusside + esmolol SBP 110-120 sesegera
mungkin
AMI, ischemia Nitrogliserin, nitroprusside, Sekunder untuk bantuan
nicardipine iskemia
Pulmonary edema Nitroprusside, nitrogliserin, 10% -15% dalam 1-2 jam
labetalol
Kidney disorders Fenoldopam, nitroprusside, 20% -25% dalam 2-3 jam
labetalol
Catecholamine excess Phentolamine, labetalol 10% -15% dalam 1-2 jam
Hipertensi ensefalopati Nitroprusside 20% -25% dalam 2-3 jam
Subarachnoid Nitroprusside, nimodipine, 20% -25% dalam 2-3 jam
hemorrhage nicardipine
Stroke Iskemik nicardipine 0% -20% dalam 6-12 jam
AMI, infark miokard akut; SBP, tekanan sistolik bood.

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20
 BAB III

CLOSING

3.1 KESIMPULAN
 Definition of Hypertension:
Hypertension is a condition in which a person's blood pressure has a systolic
pressure of 140 mmHg or more or a diastolic pressure of 90 mmHg or more or
is taking anti-hypertensive drugs.
 Risk Factors for Hypertension
a. Unmodifiable factors, such as::
1. Genetic
2. Age
3. Gender
4. Ethnicity
5. Kidney Disease
6. Medicines
7. Preeclampsia in pregnancy
8. Acute lead poisoning
b. Factors that can be modified or controlled
1) Stress
2) Obesity
3) Nutrition
4) Smoking
5) Lack of Exercise

• Types of Hypertension
1) According to the cause
a. Primary Hypertension

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 b. Secondary Hypertension
a) Hypertension in the kidneys
b) Hypertension in renovascular disease
c) Hypertension in endocrine disorders
d) Cushing syndrome
e) Conginetal adrenal hypertension
f) Coarctation of the aorta
g) Pheochromocytoma
h) Hypertension in pregnancy
i) Hypertension use of drugs
2) According to blood pressure disorders
a. Diastolic Hypertension
b. Systolic Hypertension
c. Mixed Hypertension
• The Mechanism of Occurrence of Hypertension
The mechanism of hypertension is through the formation of angiotensin II from
angiotensin I by angiotensin I-converting enzyme (ACE). Furthermore, by hormones,
renin (produced by the kidneys) will be converted into angiotensin I. By ACE which
is in the lungs, angiotensin I is converted into angiotensin II. Angiotensin II has a key
role in raising blood pressure through two main actions. The first action is to increase
the secretion of antidiuretic hormone (ADH) and thirst. The second action is to
stimulate the secretion of aldosterone from the adrenal cortex.

• How to Prevent Hypertension

Hypertension can be prevented by setting a good diet, as well as adequate physical
activity such as regular exercise. In addition, by avoiding bad habits such as smoking
and alcohol consumption, as well as excessive sodium / sodium consumption such as
excessive table salt, flavoring (MSG). In addition, by making an early diagnosis as a
preventive way.

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3.2 SUGGESTIONS
In an effort to prevent hypertension, someone should adopt a healthy lifestyle. Both in
terms of dietary application, including avoiding foods that have the risk of increasing
blood pressure, avoiding stressors (stressors), and balanced nutritional intake. In
addition to physical activities such as regular exercise , so that obesity does not occur.
Avoid bad habits such as smoking and alcohol consumption. In preventing
hypertension in adulthood, prevention should be started early. This is where the
active role of parents is needed in controlling the consumption patterns of their
children.

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1. Anonym.Tanpa tahun.Penyakit Darah Tinggi (Hipertensi). www.w3.org
2. Armilawaty, dkk..2007. Hipertensi dan Faktor Resiko dalam Kajian
Epidemiologi.Makassar : FKM Unhas.
3. Bustan, M.N. 2007.Epidemiologi Penyakit Menular. Jakarta : Rineka Cipta
4. Dedy. 2010. Tekanan Darah Tinggi (Hipertensi). Sidenreng.com
5. Sitorus, Sampe. 2009. Tekanan Darah Tinggi (Hipertensi). Wordpress.com
6. Surya, Andari. Tanpa tahun.Makalah Hipertensi. www.scribd.com
7. Tohaga, Edwin. Tanpa tahun.Hipertensi, Gejala dan Komplikasi.
Wordpress.comhttp://id.wikipedia.org/

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