Keterangan
Hypertension is a common condition characterized by abnormally high blood pressure levels. The mechanism underlying hypertension involves an increase in peripheral vascular resistance and/or an increase in cardiac output. Several factors can contribute to the development of hypertension, including age, family history, obesity, physical inactivity, and smoking. Hypertension can cause damage to target organs such as the heart, kidneys, and brain, leading to cardiovascular disease, renal failure, and stroke. Effective management of hypertension involves targeting the underlying mechanism and implementing measures to protect target organs from damage. The mainstay of hypertension management is lifestyle modifications, including weight loss, regular physical activity, and a healthy diet. In addition to lifestyle modifications, pharmacological interventions are also used to manage hypertension. Antihypertensive medications can be classified based on their mechanism of action, including diuretics, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors.
Ringkasan
- Blood pressure is the force exerted by circulating blood on the walls of blood vessels, crucial for maintaining blood circulation throughout the body. It's primarily determined by two key factors: cardiac output (the amount of blood pumped by the heart per minute) and peripheral vascular resistance (the resistance to blood flow in the arteries). Several mechanisms regulate these factors, including the sympathetic nervous system, the renin-angiotensin-aldosterone system, endothelial function, and vasoactive substances.
- The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in regulating blood pressure. When kidney perfusion is reduced, the juxtaglomerular apparatus releases renin, which converts angiotensinogen to angiotensin I. Angiotensin-converting enzyme (ACE) then converts angiotensin I to angiotensin II, a potent vasoconstrictor. Angiotensin II also stimulates aldosterone release, leading to sodium and water retention, further increasing blood pressure.
- Endothelial function, particularly nitric oxide production, is vital for maintaining vascular tone. Reduced nitric oxide availability, often due to oxidative stress, can increase vascular resistance and contribute to hypertension. Other vasoactive substances like arachidonic acid metabolites, reactive oxygen species, vasoactive peptides, and microparticles also influence vascular tone, with dysfunction leading to increased blood pressure.
- Hypertension is defined as a blood pressure level at which the benefits of treatment outweigh the risks. The diagnostic threshold varies depending on the measurement setting. Office blood pressure readings above 140/90 mmHg, 24-hour ambulatory readings above 130/80 mmHg, or home readings consistently above 135/85 mmHg are generally considered indicative of hypertension. Accurate blood pressure measurement requires proper technique, including using an appropriate cuff size, ensuring correct patient positioning, and avoiding caffeine or smoking beforehand.
- Hypertension is a significant global health problem, affecting a large proportion of adults over 60 and contributing to millions of deaths annually. Lifestyle modifications, including weight reduction, reduced sodium intake, increased physical activity, smoking cessation, and moderate alcohol consumption, are essential for managing hypertension, although they often have a limited impact. Different guidelines (ACC/AHA vs. ESC) have varying target blood pressure goals, but generally, a target of less than 130/80 mmHg is recommended for most patients.
- Pharmacological treatment options for hypertension are diverse, including ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, diuretics, beta-blockers, and others. ACE inhibitors or ARBs are often the first-line choice, followed by diuretics or calcium channel blockers. Treatment is typically initiated with one or two drugs, and escalated as needed to reach target blood pressure. Resistant hypertension, defined as uncontrolled blood pressure despite three medications, requires investigation for secondary causes.
- Uncontrolled hypertension can lead to significant target organ damage, affecting the kidneys (chronic kidney disease), heart (left ventricular hypertrophy, heart failure), brain (stroke), and eyes (hypertensive retinopathy). Early detection and effective management of hypertension are crucial to prevent these complications. Distinctions are made between white coat hypertension (high in-office readings, normal at home), masked hypertension (normal in-office readings, high at home), and hypertensive crises requiring immediate intervention.
Contoh Sertifikat
Tentang Pembicara
Dr. Ramkumar Sundaraperumal
Dokter Spesialis Penyakit Dalam dan HOD, Rumah Sakit Zulekha, Dubai
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