Isbandiyah, dr, SpPD

Secondary HTN
HTN that has a demonstrable underlying cause,
sach as: ABCDE
– A: apnea (sleep apnea), aldosteronism
(hyperaldosteronism)
– B: bruit (renal arteri stenosis), bad kidney
– C: catecholamine, coartatio aorta, cushing’s
– D: drug (stimulans, NSAID, contraseptives oral)
– E: eritropoitin (increase EPO)
endocrine (tyroid/paratyroid,
pheochromocytoma)
 Bahan-
Asupan Jumlah
Perubahan bahan yang
garam nefron Stress Obesitas
genetis berasal dari
berlebih berkurang
endotel

Aktivitas
Retensi Penurunan Renin Perubahan
berlebih Hiper-
natrium permukaan angiotensin membran
saraf insulinesmia
ginjal filtrasi berlebih sel
simpatis

↑ Volume Konstriksi
cairan vena

Konstriksi Hipertrofi
↑ Preload ↑ Kontraktilitas struktural
fungsionil

TEKANAN CURAH TAHANAN

DARAH = JANTUNG X PERIFER

Hipertensi ↑ curah jantung ↑ tahanan perifer

Autoregulasi
 Lifestyle Modifications to Manage HTN
Modification Recommendations Approximate Systolic
Blood Pressure
Reduction
Weight Reduction Maintain normal body 5-20 mm Hg for each
weight (BMI 18.5-24.9) 10 kg weight loss

Adapt eating plan Consume diets rich in fruits, 8-14 mm Hg

vegetables, low fat dairy
and low saturated fat
Dietary sodium reduction Reduce sodium to no more 2-8 mm Hg
than 2.4 g/day sodium or
6 g/day NaCl
Increase physical activity Engage in regular aerobic 4-9 mm Hg
activity such as walking
(30 min/day on most days)
Moderate alcohol consumption Limit alcohol to no more 2-4 mm Hg
than 2 drinks/d for men and
1 drinks/day for women.
Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.