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Definitions and classification ofDefinitions and classification of blood pressure levels (mmHg)blood pressure levels (mmHg)
Definitions and classification ofDefinitions and classification of blood pressure levels (mmHg)blood pressure levels (mmHg)
When a patient s systolic and diastolic blood pressures fall into When a patient s systolic and diastolic blood pressures fall into different categories, the higher category should applydifferent categories, the higher category should apply
WHO -ISHWHO -ISHWHO -ISHWHO -ISH
CategoryCategory SystolicSystolic SystolicSystolic Diastolic Diastolic
OptimalOptimal < 120 < 120 < 80 < 80NormalNormal < 130 < 130 < 85 < 85High-normalHigh-normal 130 - 139130 - 139 85 - 89 85 - 89Grade 1 hypertension (mild)Grade 1 hypertension (mild) 140 - 159140 - 159 90 - 99 90 - 99
Subgroup : borderline Subgroup : borderline 140 - 149140 - 149 90 - 94 90 - 94Grade 2 hypertension (moderate)Grade 2 hypertension (moderate) 160 - 179160 - 179 100 - 109100 - 109Grade 3 hypertension (severe)Grade 3 hypertension (severe) > 180 > 180 > 110 > 110 Isolated systolic hypertensionIsolated systolic hypertension > 140 > 140 <90 <90
Subgroup : borderlineSubgroup : borderline 140 - 149 140 - 149 < 90 < 90
Raised BP
Raised BP
Raised BP
Raised BP
P3
Neurogenic hyper
response
P2
Insulin resistance
Raised BP
Raised BP
Raised BP
Raised BP
P1
Salt sensitivity
P4
Vascular structure
G1G1
G4G4
G3G3G2G2
SKELETALMUSCLE
SKELETALMUSCLE BRAINBRAIN
KIDNEYKIDNEY
RESISTANCE VESSELS
RESISTANCE VESSELS
Candidate genes
Candidate genes
E1Raised dietary
salt
E1Raised dietary
salt
E2Physical inactivity
E2Physical inactivity
E3StressE3
Stress
E4Adverse dietary
Na/K ratio
E4Adverse dietary
Na/K ratio
A VARIETY OF DIFFERENT GENOTYPES (G) LEADS TO DIFFERENT PHENOTYPES (P) EXPRESSION. THESE ARE SUBJECT TO VARIOUS ENVIROMENT (E) INFLUENCES
PRODUCING HIGH BLOOD PRESSURE BY DIFFERENT PATHWAYS
A VARIETY OF DIFFERENT GENOTYPES (G) LEADS TO DIFFERENT PHENOTYPES (P) EXPRESSION. THESE ARE SUBJECT TO VARIOUS ENVIROMENT (E) INFLUENCES
PRODUCING HIGH BLOOD PRESSURE BY DIFFERENT PATHWAYS
PRELOADPRELOAD
VASCULAR VASCULAR RESISTANCERESISTANCEVASCULAR VASCULAR
RESISTANCERESISTANCE
CENTRAL NERVOUS SYSTEMCENTRAL NERVOUS SYSTEMCENTRAL NERVOUS SYSTEMCENTRAL NERVOUS SYSTEM
SOME FACTORS INVOLVED IN THE REGULATION OF SOME FACTORS INVOLVED IN THE REGULATION OF BLOOD PRESSUREBLOOD PRESSURE
SOME FACTORS INVOLVED IN THE REGULATION OF SOME FACTORS INVOLVED IN THE REGULATION OF BLOOD PRESSUREBLOOD PRESSURE
StressStressNucleus tractus solitariusNucleus tractus solitarius
Arterial baroreceptorsArterial baroreceptorsCardiac Cardiac OutputOutputCardiac Cardiac OutputOutput
Parasympathetic efferentsParasympathetic efferents
Sympathetic efferents
Sympathetic efferents
Atrial natriuretic peptide
Atrial natriuretic peptide
Plasma renin angiotensin II Prostaglandins Kinin
Plasma renin angiotensin II Prostaglandins Kinin
Sympathetic efferents
Sympathetic efferents
Renal efferentsRenal efferents
Renal efferentsRenal efferents
Aldosterone ← Angiotensin IIAldosterone ← Angiotensin II
Renal Regulation of NaCl and H2ORenal Regulation of NaCl and H2O
Na, K+, Ca2-
( NaCl and H2O )
Cardiopulmonary baroreceptorsCardiopulmonary baroreceptors
1970 - 1975 1975 - 1980 1980 - 1985 1985 - 1990
Aware (%) 51 64 73 84
Treated (%) 36 34 56 73
Control (%) 16 20 34 55
HIPERTENSION, AWARENESS, TREATMENT, AND CONTROL RATES
HIPERTENSION, AWARENESS, TREATMENT, AND CONTROL RATES
WHO ISH (1999)WHO ISH (1999)Merekomendasikan 6 kelas obat anti hipertensi
DiuretikDiuretik
Beta BlokerBeta Bloker
Alpha BlokerAlpha Bloker
Ca - antagonistCa - antagonist
ACE Inhibitor (ACEI)ACE Inhibitor (ACEI)
Angiotensin II Receptor Bloker (AIIRA)Angiotensin II Receptor Bloker (AIIRA)