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Monday, April 4, 2011

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Goal: <140/90

< 130/80 if diabetic or renal disease

Therapy:

120-139 or 80-89

140-159 or 90-99

>160 or >100

Lifestyle Modifications

(mengubah gaya hidup, nek kowe do rangerti bahasane)

Thiazide-type diuretics yang utama. boleh dipertimbangkan ACEI, ARB, BB, CCB, or combination.

dua obat kombinasi dari yang palign sering digunakan biasanya  thiazidetype diuretic and ACEI, or ARB, or BB, or CCB).

keterangan obat :

Thiazide –type =chlorothiazide

ACEI =angiotensin-converting enzyme inhibitors=LISINOPRIL and CAPTOPRIL 

ARB =Angiotensin Receptor Blocker=Losartan, irbesartan, olmesartan, candesartan, and telmisartan

BB=beta blocker=propanolol, atenolol

CCP =calcium channel blocker,

ALDO ANT=aldosterone antagonist

Compelling indications:

• Heart failure: THIAZ, BB, ACEI, ARB, ALDO ANT

• Post myocardial infarction: BB, ACEI, ALDO ANT

• High CVD risk: THIAZ, BB, ACEI, CCB

• Diabetes: THIAZ, BB, ACEI, ARB, CCB

• Chronic kidney disease: ACEI, ARB (Obat ini bersifat renoprotektif/nefroprotektif sehingga cocok untuk penderita yang ginjalnya rusak seperti komplikasi DM—hal ini dikarenakan ACEI atau ARB menyebabkan vasodilatasi pada ginjal)

• Recurrent stroke prevention: THIAZ, ACEI

Identifiable causes of HTN:

• Sleep apnea

• Cushing’s syndrome

• Drug induced/related

• Steroid therapy

• Chronic kidney disease

• Pheochromocytoma

• Primary aldosteronism

• Coarctation of aorta

• Renovascular disease

• Thyroid/parathyroid disease

CVD Risk factors:

• Hypertension

• Physical inactivity

• Obesity (body mass index >30 kg/m2)

• Age (>55 for men, >65 for women)

• Dyslipidemia

• Diabetes mellitus

• Microalbuminuria, est GFR <60 mL/min

• FH of early CVD (men age <55, women age <65)

• Cigarette smoking

• Physical inactivity

Lifestyle Modifications:

Weight reduction

Maintain normal body weight (body mass index 18.5–24.9 kg/m2).

5–20 mmHg/10 kg

DASH eating plan

Adopt a diet rich in fruits, vegetables, and lowfat dairy products with reduced content of saturated and total fat.

intinya nek kowe duwe penyakit iki, kudu diet Magnesium, Kalsium, dan kalium. Nah…iki kadar tingginya ada di buah – buahan. Trus dihindari konsumsi Na berlebih koyo nang makanan kaleng, makanan instan berpengawet ada Na benzoat, dan MSG.

8–14 mmHg

Dietary sodium reduction

Reduce dietary sodium intake to <100 mmol per day (2.4 g sodium or 6 g sodium chloride).

2–8 mmHg

Aerobic physical activity

Regular aerobic physical activity (e.g., brisk walking) at least 30 minutes per day, most days of the week.

4–9 mmHg

Moderation of alcohol consumption

Men: limit to <2 drinks per day. Women and lighter weight persons: limit to <1 drink per day.

2–4 mmHg

Contraindications and Side Effects:

THIAZ

gout, HypoNa, hypoK

BB

Asthma, heart block, cocaine use, bradycardia

ACEI

Pregnancy, angioedema, cough

CCB

Edema, flushing

ARB

Pregnancy, angioedema

2ndary benefits:

angina: nitrates

BPH: a-blocker

Migraine: b-blocker, calcium channel blocker

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