Hipertensi - Interna - Dr. Muzakkir
Hipertensi - Interna - Dr. Muzakkir
Hipertensi - Interna - Dr. Muzakkir
and management
MUZAKKIR
DEPT. CARDIOLOGY VASCULAR HASANUDDIN UNIVERSITY
Objectives
Systolic Diastolic
Normal <120 And <80
Prehypertension 120 – 139 Or 80 – 89
Stage 1 140 - 159 Or 90 – 99
Stage 2 > 160 Or > 100
Cardiovascular Risk
Adverse effects:
Electrolyte imbalance:
potassium, magnesium,
sodium, calcium, uric acid,
glucose
Hypercholesterolemia
Diuretics
Useful in:
All populations
CHF
Block formation of
angiotensin II
Promote vasodilation &
decrease aldosterone
Increase bradykinin &
vasodilatory PG’s
Angiotensin Converting
Enzyme Inhibitors
Preferred in:
Congestive heart failure
Nephropathy
Angiotensin Converting
Enzyme Inhibitors
Adverse effects:
Cough (5-15% of patients)
Skin rash, taste alterations (esp.
Captopril)
Hyperkalemia
Hypotension, dizziness
Renal dysfunction (up to 35% inc in SCr)
Rare: angioedema (most frequent in
African Americans), neutropenia,
proteinuria
Teratogenic
Angiotensin Receptor
Blockers
Losartan, valsartan,
candesartan, et.al.
Systolic Diastoli
c
Normal An <80
<120
d
Prehypertensio 120 – 80 – 89
Or
n 139
Stage 1 140 - Or 90 – 99
159
Stage 2 > 160 Or > 100
Stage 1, No Compelling
Indications
Choices
– Diuretic, diuretic, diuretic
– Maximize both beta-blocker and ACE
receptor blocker
– Consider long acting di-hydropiridine CCB
Calculate and use GFR rather than
SCreat
“That’s just great. I discover the cure for the
common cold and all you do is criticize.”
Patient Education Tool
Assessment of the overall cardiovascular risk
Search for target organ damage
Cerebrovascular disease
- transient ischemic attacks
- ischemic or hemorrhagic stroke
- vascular dementia
Hypertensive retinopathy
Left ventricular dysfunction
Coronary artery disease
- myocardial infarction
- angina pectoris
- congestive heart failure
Chronic kidney disease
- hypertensive nephropathy (GFR < 60
ml/min/1.73 m2)
- albuminuria
Peripheral artery disease
- intermittent claudication
Some recommended electronic blood
pressure monitors for home blood
pressure measurement