FARMAKOTERAPI HIPERTENSI TERBARU: Klasifikasi, Risiko (SCORE), Alur Terapi PERHI 2021, AHA 2020

Summary

This video lecture discusses hypertension, focusing on its pathophysiology, diagnosis, and pharmacological treatment. It covers the factors influencing blood pressure, including cardiac output and peripheral resistance, and explains how hypertension is classified based on blood pressure levels. Risk factors for cardiovascular diseases are highlighted, such as age, sex, lifestyle, and comorbid conditions. The video also emphasizes the importance of lifestyle modifications and details the drug treatment approach, including the use of antihypertensive medications like ACE inhibitors, ARBs, and calcium channel blockers. Special attention is given to managing hypertension in pregnancy and emergencies.

Takeaways

• 😀 Hypertension is a condition marked by elevated blood pressure, with systolic pressure above 140 mmHg or diastolic pressure above 95 mmHg.
• 😀 Blood pressure is influenced by cardiac output (amount of blood pumped by the heart) and peripheral resistance (how narrow or wide the blood vessels are).
• 😀 Hypertension classification includes normal, elevated, stage 1, and stage 2 hypertension, with different thresholds for systolic and diastolic pressures.
• 😀 A diagnosis of hypertension should not rely on a single measurement; multiple measurements are necessary to confirm the diagnosis.
• 😀 Diagnosis of hypertension involves a thorough medical history, physical examination, blood pressure measurement, and laboratory tests to rule out secondary hypertension.
• 😀 Risk factors for hypertension include age, gender, family history, obesity, smoking, high cholesterol, diabetes, and lack of physical activity.
• 😀 Organ damage due to hypertension can include microalbuminuria, chronic kidney disease, and retinopathy.
• 😀 Hypertension treatment depends on both blood pressure levels and cardiovascular risk, with lifestyle changes often recommended initially for low-risk patients.
• 😀 For higher-risk patients, antihypertensive medications such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics are used, often in combination.
• 😀 Hypertension in pregnancy (gestational hypertension) requires careful management with medications like methyldopa and labetalol, with specific contraindications for certain drugs.
• 😀 Non-pharmacological treatments for hypertension include the DASH diet, physical activity, weight loss, and reducing alcohol and smoking intake.

Q & A

What is hypertension and how is it defined?

Hypertension is a condition characterized by an increase in blood pressure, where the systolic pressure exceeds 140 mmHg and the diastolic pressure exceeds 95 mmHg. Systolic pressure is the force when the heart contracts, and diastolic pressure is when the heart is at rest.

What factors influence blood pressure?

Blood pressure is influenced by two main factors: cardiac output (the amount of blood pumped by the heart) and peripheral resistance (the resistance of blood vessels, which can be affected by conditions like atherosclerosis).

What are the different classifications of hypertension according to the 2021 guidelines?

The 2021 classification of hypertension includes normal (systolic < 130 mmHg, diastolic < 85 mmHg), elevated (systolic 130-139 mmHg or diastolic 85-89 mmHg), hypertension stage 1 (systolic 140-159 mmHg or diastolic 90-99 mmHg), and hypertension stage 2 (systolic ≥ 160 mmHg or diastolic ≥ 100 mmHg).

How is hypertension diagnosed?

Hypertension diagnosis includes a thorough history, family history, lifestyle assessment, and physical examination. Blood pressure should be measured multiple times, and laboratory tests may be used to rule out secondary hypertension and assess organ damage.

What are the risk factors for hypertension?

Risk factors for hypertension include age, gender (males are more at risk), smoking, obesity, high cholesterol, diabetes, family history of cardiovascular diseases, and conditions like kidney disease and sleep apnea.

What is the significance of organ damage in hypertension?

Organ damage in hypertension, referred to as 'hypertensive-mediated organ damage' (HMOD), can include kidney damage (e.g., microalbuminuria), chronic kidney disease, and retinal damage. The presence of these signs indicates that the hypertension has led to significant organ harm.

How is cardiovascular risk assessed in hypertension?

Cardiovascular risk is assessed using a scoring system that takes into account factors like age, gender, smoking, and the presence of diabetes or kidney disease. This risk assessment helps determine the urgency and type of treatment required.

What is the target blood pressure for treatment in patients with hypertension?

The general treatment goal is to reduce blood pressure to below 140/90 mmHg. However, for patients with diabetes or chronic kidney disease, the target is often below 130/80 mmHg to reduce complications.

What are the first-line treatments for hypertension?

First-line treatments for hypertension include Angiotensin-Converting Enzyme inhibitors (ACE inhibitors) like enalapril or Angiotensin Receptor Blockers (ARBs) like losartan. These may be combined with other medications such as calcium channel blockers (CCBs) or diuretics for better control.

What lifestyle modifications are recommended for managing hypertension?

Lifestyle changes include following the DASH diet (rich in fruits, vegetables, and low-fat dairy), exercising 3-5 days a week, maintaining a healthy weight, reducing salt intake, avoiding alcohol and smoking, and managing stress.