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    1. Hypertension and chronic kidney disease are interlinked, as sustained hypertension can worsen kidney function over time and declining kidney function can exacerbate high blood pressure. 2. The risk of adverse health outcomes increases as kidney function declines through the stages of chronic kidney disease. Intensive blood pressure control is recommended to reduce cardiovascular risk, especially in later stages of CKD. 3. Treatment involves lifestyle modifications like weight loss, dietary changes, exercise, and sodium restriction as well as pharmacologic therapy. Drug choices depend on factors like kidney function and comorbidities, but ACE inhibitors, ARBs, calcium channel blockers, and diuretics are commonly used either alone or in combination to control blood pressure

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    Penatalaksanaan hipertensi

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    1. Hypertension and chronic kidney disease are interlinked, as sustained hypertension can worsen kidney function over time and declining kidney function can exacerbate high blood pressure. 2. The risk of adverse health outcomes increases as kidney function declines through the stages of chronic kidney disease. Intensive blood pressure control is recommended to reduce cardiovascular risk, especially in later stages of CKD. 3. Treatment involves lifestyle modifications like weight loss, dietary changes, exercise, and sodium restriction as well as pharmacologic therapy. Drug choices depend on factors like kidney function and comorbidities, but ACE inhibitors, ARBs, calcium channel blockers, and diuretics are commonly used either alone or in combination to control blood pressure

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    9 views28 pages

    HIpertensi

    Uploaded by

    asna tuppang
    1. Hypertension and chronic kidney disease are interlinked, as sustained hypertension can worsen kidney function over time and declining kidney function can exacerbate high blood pressure. 2. The risk of adverse health outcomes increases as kidney function declines through the stages of chronic kidney disease. Intensive blood pressure control is recommended to reduce cardiovascular risk, especially in later stages of CKD. 3. Treatment involves lifestyle modifications like weight loss, dietary changes, exercise, and sodium restriction as well as pharmacologic therapy. Drug choices depend on factors like kidney function and comorbidities, but ACE inhibitors, ARBs, calcium channel blockers, and diuretics are commonly used either alone or in combination to control blood pressure

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    of 28

    CURRICULUM VITAE

    Dr. GERY DALA PRIMA BASO, SpPD

    TTL : Makassar, 04 Oktober 1985

    Alamat : Jalan Kesehatan No.3, Dok 2 Jayapura Papua


    Status Pernikahan : Menikah

    Pendidikan Jabatan/Pekerjaan
    • Sp Ilmu Penyakit Dalam, Universitas Indonesia (2018) • Staf bagian Ilmu Penyakit Dalam RSU
    • Pendidikan Dokter, Universitas Hasanuddin (2009)
    Jayapura
    • SMA Negeri 2, Jayapura (2003)
    • SMP Kr. Kalam Kudus, Jayapura (2000) • Ketua Komite PPRA RSU Jayapura
    • SD Kr. Kalam Kudus, Jayapura (1997) • Kepala Unit TB – HIV RSU Jayapura
    • SD Harapan Bunda, Jakarta (1993)
    HYPERTENSION IN
    CHRONIC KIDNEY DISEASE

    Dr. Gery Dala P. Baso, SpPD


    Penyakit Dalam RSU Jayapura
    FK Universitas Cenderawasih
    HIPERTENSI
    INTRODUCTION
    Hypertension = High Blood Pressure

    http://sharinginhealth.org/biology/blood_pressure
    HIPERTENSI

    PATHOPHYSIOLOGY
    HIPERTENSI
    PATHOPHYSIOLOGY
    HYPERTENSION - CKD

    Ku, E, et al. Hypertension in CKD: Curriculum 2019.


    American Journal of Kidney
    HIPERTENSI PATOFISIOLOGI

    Factors – Hypertension in CKD

    FM Tedla. Hypertension in Chronic Kidney Disease


    Journal of Hypertension
    HIPERTENSI
    INTRODUCTION

    Hypertension - CKD are interlinked pathophysiologic


    states
    • Sustained hypertension  worsening kidney function
    • Progressive decline in kidney function  worsening blood pressure
    (BP) control
    • Clinical Trials  BP control not always affecting progression of CKD,
    • Intensive BP control reduces the risk for adverse cardiovascular +
    mortality in CKD

    Ku, E, et al. Hypertension in CKD: Curriculum 2019.


    American Journal of Kidney
    HIPERTENSI

    Stages of CKD – Risk & Mortality

    KDIGO 2012
    HIPERTENSI
    CRITERIA

    DEFINITIONS OF NORMAL AND ABNORMAL BP BASED ON THE


    2017 AHA/ACC GUIDELINE IN PATIENTS WITH CKD

    Accurate BP Measurement
    • ABPM Preferred
    • Clinic : 5 min Rest, calibrated cuff
    device, no caffeine+exercise 30 min
    prior, at least 2-3 readings

    Ku, E, et al. Hypertension in CKD: Curriculum 2019.


    American Journal of Kidney
    HIPERTENSI
    CRITERIA

    ESC/ESH CLASSIFICATION OF BP
    AND DEFINITIONS HYPERTENSION GRADE

    2018 ESC/ECH Hypertension Guidelines


    HIPERTENSI
    CRITERIA

    2017 AHA/ACC GUIDELINE IN PATIENTS WITH CKD


    DIFFICULT TO CONTROL

    Ku, E, et al. Hypertension in CKD: Curriculum 2019.


    American Journal of Kidney
    HIPERTENSI DIAGNOSIS
    Causes of Secondary Hypertension

    If & When :
    • Elevated BP before puberty
    • Severe/malignant HT
    • Sudden worsening of BP
    • Electrolyte Imbalance

    • Special Workup & Analysis


    •  Consult Internal
    Medicine/Nephrologist
    Ku, E, et al. Hypertension in CKD: Curriculum 2019.
    American Journal of Kidney
    TREATMENT
    HIPERTENSI
    INISIASI TERAPI FARMAKOLOGIS

    Konsensus inaSH 2019.


    HIPERTENSI
    STRATEGI TATALAKSANA HIPERTENSI TANPA KOMPLIKASI

    Konsensus inaSH 2019.


    HIPERTENSI

    JNC VIII Guideline. 2014


    HIPERTENSI
    TREATMENT
    Lifestyle Modification
    WEIGHT LOSS/5-10 KG 5 – 20 (DECLINES BP)

    DIETS (DASH) 8 – 14

    Sodium Restriction 2– 8

    Physical Exercise 4– 9

    Limit Alcohol Intake 2– 4

    Smoking Cessation
    JNC VIII Guideline. 2014
    HIPERTENSI
    TREATMENT
    SELECTED INDICATIONS AND CONSIDERATIONS IN THE CHOICE OF
    ANTIHYPERTENSIVE AGENTS FOR PATIENTS WITH CKD

    Ku, E, et al. Hypertension in CKD: Curriculum 2019.


    American Journal of Kidney
    HIPERTENSI
    TREATMENT
    SELECTED INDICATIONS AND CONSIDERATIONS IN THE CHOICE OF
    ANTIHYPERTENSIVE AGENTS FOR PATIENTS WITH CKD

    Ku, E, et al. Hypertension in CKD: Curriculum 2019.


    American Journal of Kidney
    HIPERTENSI
    TREATMENT

    SELECTED INDICATIONS AND CONSIDERATIONS IN THE CHOICE


    OF ANTIHYPERTENSIVE AGENTS FOR PATIENTS WITH CKD

    Ku, E, et al. Hypertension in CKD: Curriculum 2019.


    American Journal of Kidney
    HIPERTENSI
    TREATMENT
    2018 ESC/ECH HYPERTENSION GUIDELINES
    ANTIHYPERTENSIVE AGENTS FOR PATIENTS WITH CKD

    Evaluate Potassium levels &


    Ur/Creatinin serum

    2018 ESC/ECH Hypertension Guidelines


    HIPERTENSI
    TREATMENT
    2018 ESC/ECH HYPERTENSION GUIDELINES
    ANTIHYPERTENSIVE AGENTS FOR PATIENTS WITH CKD

    2018 ESC/ECH Hypertension Guidelines


    HIPERTENSI

    JNC VIII Guideline. 2014


    HIPERTENSI
    TREATMENT
    SPECIAL CASES & CONSIDERATIONS
    Older Patients (Geriatric)
    • JNC VIII  Target <150/90
    • SPRINT (Systolic Blood Pressure Intervention Trial-USA) - 2017
    Target  130/80 (>65 tahun)
    CV Benefits in tighter BP Control
    • Current ACC/AHA Guidelines
    NOTE  Individualization of BP Targets : comorbid,
    life expectancy, cognitive, QOL
    JNC VIII Guidelines, ACC/AHA Guidelines on Hypertension
    Ku, E, et al. Hypertension in CKD: Curriculum 2019.
    HIPERTENSI
    TREATMENT
    SPECIAL CASES & CONSIDERATIONS
    Women and Pregnancy
    • Avoid ACE-I or ARB
     Teratogenic Effect (esp 1st Trimester)
    • Use Ca Antagonist + B-blocker
    Nifedipine, Labetalol, Methyldopa
    • Diuretics may increase Risk of Olygohydramnions

    JNC VIII Guidelines, ACC/AHA Guidelines on Hypertension


    Ku, E, et al. Hypertension in CKD: Curriculum 2019.
    HIPERTENSI
    TREATMENT
    SPECIAL CASES & CONSIDERATIONS

    CKD post Kidney Transplant

    • KDIGO + ACC/AHA  Target <130/90


    • No Specific 1st line drug of choice.

    JNC VIII Guidelines, ACC/AHA Guidelines on Hypertension


    Ku, E, et al. Hypertension in CKD: Curriculum 2019.
    HIPERTENSI
    TREATMENT SUMMARY
    2018 ESC/ECH HYPERTENSION GUIDELINES
    ANTIHYPERTENSIVE AGENTS FOR PATIENTS WITH CKD

    2018 ESC/ECH Hypertension Guidelines

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