Tekanan darah


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Tekanan Darah Tinggi

Tekanan darah tinggi , istilah medis hypertensi adalah tekanan darah yang diukur dalam keadaan istirahat.

Pre Hypertension
between 120/80 and 139/89 mmHg
Lebih dari140/90 is considered high

Risk of cv disease starts to rise at blood pressures over 115/75mmHg
and doubles with each increment of 20/10 mmHg

Detection of ” the silent killer”
(often there are no symptoms)

2 or more readings of 140/90 mmHg or higher taken on more than one occasion.

Tips for assessing an accurate blood pressure
(You don’t want to be misdiagnosed)

Don’t eat, exercise, drink coffee or smoke cigarettes for 1 hr before.
Empty yout bladder.
Sit relaxed for five minutes with back supported and feet flat on the ground.
Your arm should be supported and even with your heart when tested.
Make sure the correct cuff size is used.
Wear short sleeves so your is exposed.
Risk Factors for HBP
Sedentary Lifestyle (couch potato)
Poor Diet
Aging- vessel lose elasticity ( > 60 years age )
Tobacco , alcohol, caffeine
Obesity / Overwight
Sleep apnea
Male sex
Family history
African- American
Some sports / weight loss suplements or medications ( cold medications , antihistamines)
Oral contraceptives
Stress

How Does HBP Effect the Body ?

Can cause a break in a weakened blood vessel which then bleeds in the brain.
High Blood Pressure is major risk factor for heart attack.
HBP is the number one risk factor for congestive heart failure.
Kidneys act as filters to rid the body of wastes, HBP can narrow and chicken the blood vessels.
Waste builds up in the blood , can result in kidney damage.
The Eyes, Can eventually cause blood vessels to break and bleed in the eye.
Swelling of the optic nerve , retina damage.
Can result in blurred vission or even blindness.

What can you do to prevent or reduce HBP ?

Exercise
Low to moderate intensity cardivascular improves bllod flow and keeps vessel elastic and   healthy.
Heart becomes a stronger more efficient pump.
Quit Tobaco
Smoking injures the walls of blood vessels accelerating hardening of the arteries.
Smokeless tobacco contains high levels of sodium.
Both constrict or “squeeze” arteries.
Decrease your intake of sodium and increase potassium.
Humans evolved on the low sodium, high potassium diet.
Today’s modern diet is high in sodium and low in potassium.
Eat More Potassium Rich Foods
Banana, Tomato, Orange, Spinach, Cantaloupe, Brussells Sprouts, Almonds, Grapefruits,
Broccoli, Corn, Cucumbers, Dates/ raisins, Most salt water fish, Dried beans.
Get 1000 mg Calcium.………  Mgs of Calcium
3/4 cup Total Cereal ………..   1000 mg
1 cup skim milk ………………   300.  mg
1 oz. Swiss cheese…………    270.  mg
1 cup low-fat plain yogurt     400.  mg
3 oz sardines canned………    220.  mg
8 oz orange juice…………….    350. mg
3 oz shrimp, canned………..    145. mg

Try the DASH Diet (Dietary Approach to Stop Hypertension)
Diet rich in fruits and vegetables found effective in clinical study onreducing HBP
Moderate Alcohol Intake (1-2 drinks)
Alcohol raises blood pressure and can harm liver, brain, and heart.
Maintain Healthy Weight
Blood pressure risesas weight rises. Obesity is also a risk factor for heart disease.
Even a 10 lb weight loss can reduce blood pressure.
Supplements to avoid.
Any supplement advertised to speed up metabolism, burn fat, or loss weight should be avoided.
Some reports of creatine elevating BP.
If Lifestyle
Modification is not working, blood pressure medication may be neede ( i.e. diuretics, beta blockers, ace inhibitors )

HYPETTENSIVE EMERGENCY

Why should we care about hupertension?
One of the most common chronic medical concerns in the USA
Affects > 30% of the population > age 20
Risk factor for
* Cardiovascular disease and mortality
* Cerebrovascular disease and mortality
* End stage renal disease
* Other rnd organ damage
Why should we care about hypertension?
* 30% of population is unware they have hypertension
* Control rates for known cases is about 50%
Risk factors
* If > 50 , systolic BP > 140 is more concerning risk factor for cardiovascular disease than diastolic BP.

Definitions
Hypertension (according to JNC VII)
* Normal BP. < 120/<80
* Prehypertension. 160 / > 100
* Severe HTN. > 180 / > 110

Hypertensive Emergency
* Acute, rapidly evolving end-organ damage associated with HTN (usu. DBP > 120 )
* BP should be controlled within hours and requires admission to a critical care setting.
Hyprrtensive Urgency
* DBP > 120 that requires control in BP over 24 to 48 hours
* No end organ damage
Malignant Hypertension is no longer used.

End–Organ damage
* Cerebral infarction
* Hypertensive encephalopathy
* Intracranial hemorrhage
* Acute aortic dissection
* Acute coronary syndrome / myocardial infarction
* Pulmonary edema with respiratory failure
* Severe eclampsia / Hellp syndrome
* Acute congestive heart failure
* Acute renal failure

Pathophysiology
Hypertensive Emergency
* Failure of normal autoregulatory function
* Leads to a sharp increase in systemic vascular resistance
* Endovascular injury with arteriole necrosis
* Ischemia, platelet deposition and release of vasoactive substances
* Further loss of autoregulatory mechanism
* Exposes organs to increased pressure

Diagnosis and Recognition
Presentation
* Always present with new onset symptom
* Take a good history
History of HTN and previous control
Medications with dosage and compliance
* Ilicit drug use, OTC drugs

Physical

===============================

HYPERTENSI , DIABETES

APA HYPERTENSI

TEKANAN TINGGI DALAM PEMBULUH DARAH
BUKAN KARENA KENAIKAN TEKANAN OLEH KARENA EMOSI
TEKANAN DARAH > 140/90 mm Hg

BAGAIMANA MENGUKUR TEKANAN DARAH?
PASIEN DUDUK NYAMAN DENGAN LENGAN POSISI RELAX
SEKALI UKUR TIDAK CUKUP
LEBIH BAIK DENGAN ALAT TYPE MERCURY

APA PENYEBAB HIPERTENSI?

HIPERTENSI PRIMER 95% KARENA
KELEBIHAN MAKAN GARAM,
BLACK RACE,
GENETIC
KEGEMUKAN

HIPERTENSI SKUNDER
KARENA AKIBAT PENYAKIT GINJAL, AORTA, KELENJAR ADRENAL

APAKAH ALKOHOL, KOPI, MEROKOK MENINGKATKAN TEKANAN DARAH?
MEROKOK MENAIKAN TEK DARAH 5-10 mm Hg
ALKOHOL MENAIKAN TEK DARAH DALAM JANGKA PANJANG
KOPI MENAIKAN TEK DARAH

APA YANG DIKELUHKAN DENGAN TEK DARAH TINGGI?
* TIDAK ADA GEJALA UNTUK BEBERAPA TAHUN (SILENT KILLER)
* MUNGKIN MUNCUL DENGAN KOMPLIKASI FATAL
* KONTROL TEK DARAH ADALAH ESSENTIAL
* BEBERAPA GEJALA SAKIT KEPALA, PANDANGAN BLURRED
* DATANG DENGAN KEGAGALAN GINJAL, KETAJAMAN PENGLIHATAN TURUN

KOMPLIKASI TEK DARAH TINGGI
JANTUNG ENLARGED
GAGAL GINJAL
KERUSAKAN OTAK
PERUBAHAN RETINA MATA, LEAKING OF BLOOD IN THE RETINA, SWELLING

MODIFIKASI GAYA HIDUP
DIET
KURANGI MAKAN GARAM
REDUCING wt.
EXCERCISE
HENTI MINUM ALKOHOL
HENTI MEROKOK

KEGEMUKAN
PROBLIM TIDUR , SLEEP APNOE WYNDROME
INCREASED INCIDENCE OF BP , ON REDUCTION OF wt-
BP REDUCES
BP DRUGS ACT WELL
INSULIN ALSO ACT WELL

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