Hipertensi Esensial

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Hypertension Am erica n
Volume 75, Issue 6, June 2020; Pages 1334-1357 He a r t
https://doi.org/10.1161 /HYPERTENSIONAHA.120.15026 Associa t ion
.

CLINICAL PRACTICE
GUIDELINES
2020 International Society of Global
Hypertension
Hypertension Practice Guidelines
Thomas Unger, Claudio Borghi, Fadi Charchar, Nadia A. Khan,
Hypertension:
Prabhakaran, Agustin Ramirez, Markus Schlaich, George S. St
Richard D. Wainford, Bryan Williams, and Aletta E. Schutte
The Silent Killer:
2018 ESC/ESH Guidelines for the management Updated JNC-8
of arterial hypertension
Guideline
The Task Force for the
management
hypertension of the European
of arterial
Recom m end ation
Society of Cardiology (ESC)
Aut ho r s/T ask Fo r ce Me m b e r s: Br ya n W illia m s* (ESC Ch a ir pe r son ) (UK),
and the European Society of
G iuseppe Ma ncia * (ESH Ch a ir pe r so n ) (It a ly), W ilko Sp ie r in g (T he
s
Hypertension
Ne (ESH)
t he r la nd s), En r ico Aga bit i Rosei (It a ly), Mic he l Azizi (France), Mic he l June Twiggs, Pharm.D.
Authors: Candidate 2015
Bur nie r (Sw it ze r la nd ), Denis L. Cle m e nt (Be lgium ), Ant o nio C oca (Sp a in ), Harrison
Kayce School of Pharmacy,
Bell, Pharm.D. Auburn
Candidate 2015
Giovanni de Sim o ne (It a ly), Anna Dom iniczak (UK), T h o m as Ka ha n (Sw eden), University;
Harrison School of Pharmacy, Auburn University;
Bernie R. Olin, Pharm.D.,
Fe lix Ma hf ou d (Ge r m a ny), Jo se p Redon (Sp a in ), Luis Ruilop e (Sp a in ), Al b erto Associate Clinical Prof essor of Pharmacy
Za nch e t t it (It a ly), Ma r y Ker ins (Ir ela nd ), Sve r r e E. Kje ldse n (Norway), Re in h o ld Practice, Drug Inf or mation and Learning
Kr e ut z (Ge r m a ny), Resource Center, Harrison School of Pharmacy,
Auburn Univer sity
Stephane Laurent (France), Gregory Y . H. Lip (UK), Richard McManus
(UK), Krzysztof Narkiewicz (Poland), Frank Ruschitzka (Switzerland), Universal Activity# : 017 8-0000-15 -10 4-H OI- P I 1, 25 contact hours (.12 5
Roland E. Schmieder (Germany), Evgeny Shlyakhto (Russia), Costas Tsioufis CE Us)
(Greece), Victor Aboyans (France), and Ileana Desormais (France)
Init ial Release Date: June 1, 2015 I Expires: March. 1,
2018

Ala ba m a Pha r m a cy Asso ciat ic n I 334 271 4222 I www apa r x or g I apa@aparx
or g

Unger et al : American Heart Association 2020. Volume 75. Pages 1334-1357

Lukito et al : Perhimpunan Dokter hipertensi Indonesia 2021. 2
 Hipertensi
• Definisi :
Tekanan Darah Sistolik ≥140 mmHg dan/atau Tekanan Darah Diastolik
≥90 mmHg pada pengukuran di klinik atau fasilitas layanan kesehatan.

Hipertensi Esensial adalah hipertensi yang tidak diketahui

penyebabnya. Beberapa penulis memilih istilah hipertensi primer,
untuk membedakan dengan hipertensi sekunder (diketahui
penyebabnya)
Riskesdas 2018
Hipertensi terjadi pada kelompok umur 31-44 tahun (31,6%), umur 45-
54 tahun (45,3%), umur 55-64 tahun (55,2%)
Lukito et al : Perhimpunan Dokter hipertensi Indonesia 2021. 3
Faktor Risiko Hipertensi

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Bell et al : APAR 2015
Klasifikasi Berdasarkan JNC VIII

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Patofisiologi

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Lilly, Leonard S. Pathophysiology of heart disease sixth edition
Pengukuran Tekanan Darah

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Unger et al : American Heart Association 2020. Volume 75. Pages
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Unger et al : American Heart Association 2020. Volume 75. Pages
 Grade 1 Hypertension:
140-159/90-99mmHg Grade 2 Hypertension:
1. Start lifestyle interventions 2: 160/100 mmHg
Treatment 2. Start drug treatment in: 1. Start drug treatment
- High-risk patients (CVD,CKD, immediately
diabetes, organ damage, or 2. Start lifestyle intervention
aged 50-80 years)
-Ali others with persistent BP
elevation after 3-6 months of
lifestyle intervention

Drug Therapy
Lifestyle Steps
Interventions Use any drugs available and include as many of those below as
• Stop smoking possible. Consider monotherapy in low-risk grade 1 hypertension
and in patients aged
• Regular exercise
>80years or frail. Simplify regimen with once daily dosing and
• Lose weight
single pill combinations.
• Salt reduction
• Healthy diet and
drinks
• Lower alcohol Non-Black Patients Black Patients
intake 1. Low dose AC El/ARB" + DHP- 1. Low dose ARB"+ DHP-CCB or DHP-
CCB CCB
2. Increase to full dose + thiazide/thiazide-like diuretic
3. Add thiazide/thiazide-like 2. Increase to full dose
diuretic 3. Add diuretic or ARB /ACEI
4. Add spironolactone or, if not 4. Add spironolactone or, if not toler•
toler• ated or contraindicated, ated or contraindicated,
amiloride, doxazosin, amiloride, doxazosin,
eplerenone, cionidine or beta- eplerenone, clonidine or beta-
blocker blocker
Monitorin
g
Monitor Referral
Target • BP control • If BP still uncontrolled, or
• Reduce BP by at least 20/10 (achieve target within 3 other issue, refer to care
mmHg, ideally to c 140/90 mm months) provider with hypertension
Hg • Adverse effects expertise
• Individualize for elderly based • Long-term adherence
on
frailty

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• No ACE/ARB In women with or plaming
pregnancy Unger et al : American Heart Association 2020. Volume 75. Pages
 Tatalaksana Hipertensi
Established Diagnosis
of Hypertension

Lifestyle advice

Grade 2
Grade 1
BP 2:160/100 Table 4. Blood Pressure Goals
BP 140-159/90-99 mmHg
mmHg Pop ulat io n Blood Pressur e Go al
(Systolic/Diastolic)
-
esensial Target BP reduction by at least 20/10mmHg, ideally to < 60 years old <14 0/ 90 mm Hg
<140/90 mmHg
> 60 years old <15 0/ 90 mm Hg
·
Aim for Chronic Kidney Disease (CKD) <14 0/ 90 mm Hg
BP control
<65 years: BP target <130 / 80 mmHg if tolerated (but >120170 within 3 months Diabetes <14 0/ 90 mm Hg
mmHg).
optimal .>= 65 years : BP target <140 t 90 mm Hg if tolerated but consider an
Individualised BP target in the context of frailty, Independence and
likely tolerability of treatment.

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Unger et al : American Heart Association 2020. Volume 75. Pages
Modifikasi Gaya Hidup

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Unger et al : American Heart Association 2020. Volume 75. Pages 1334-1357
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Unger et al : American Heart Association 2020. Volume 75. Pages 1334-1357
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Lukito et al : Perhimpunan Dokter hipertensi Indonesia 2021.
 Indikasi Rujukan
Kecurigaan hipertensi sekunder

Pasien muda (<40 tahun) dengan hipertensi derajat 2 keatas

(sudah disingkirkan kemungkinan hipertensi sekunder)

Hipertensi mendadak dengan riwayat TD normal

Hipertensi resisten

Pasien dengan penilaian HMOD lanjutan yang akan

mempengaruhi pengobatan

Kondisi klinis lain dimana dokter perujuk merasa evaluasi

spesialistik diperlukan

Lukito et al : Perhimpunan Dokter hipertensi Indonesia 2021.

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 . Klasifikasi Risiko Hipertensi Berdasarkan Derajat Tekanan Darah, Faktor Risiko Kardiovaskular, HMOD atau
Komorbiditas

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Williams et al : ESC/ESH 2018. Volume 39. Page 3021-3104 KONSENSUS PENATALAKSANAAN HIPERTENSI 2021: Update Konsensus
 Risiko Penyakit Kardiovaskular dalam 10
tahun

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Williams et al : ESC/ESH 2018. Volume 39. Page 3021-3104
Terima Kasih

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