Kuliah Antihipertensi
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Transcript of Kuliah Antihipertensi
Farmakoterapi Hipertensi
Edy Junaidi
Factors involved in the pathogenesis of hypertension
Straka, R.J., et al., 2008
Saseen, J.J. & Carter, B.L., 2005
JNC7JNC7
JNC 7
ESC/ESHESC/ESH
ESC/ESH Guidelines, 2007ESC/ESH Guidelines, 2007
Goal BP Value Recommended by the JNC7
Most patients < 140/90 mmHg Patients with diabetes < 130/80 mmHg Patients with Chronic Kidney Disease <
130/80 mmHg Estimated GFR < 60 ml/min Serum creatinine > 1.3 mg/dl in women
or >1.5 mg/dl in men, or Albuminuria > 300 mg/day, or ≥ 200 mg/g creatinine
Initiation of Antihypertensive Treatment(ESC/ESH Guideline, 2007)(ESC/ESH Guideline, 2007)
Classification of Antihypertensive drugs by Their Primary Site or Mechanism of Action Diuretics
Thiazides & related agents Loop diuretics K+-sparing diuretics
Symphatolytic drugs Centrally acting agents (methyldopa, etc) Adrenergic neuron blocking agents (guanadrel,
reserpine, etc) Beta-blockers Alpha-blockers Mixed adrenergic antagonists (labetalol, carvedilol)
Vasodilators Arterial (Hydralazine, Minoxidil, diazoxide, fenoldopam) Arterial & Venous (Nitroprusside)
Calcium channel blockers (CCB) Dihydropyridine (nifedipine, amlodipine, etc) Verapamil & Diltiazem
ACE Inhibitors Captopril, enalapril, etc
Ang II receptor Blockers (ARB) Valsartan, Losartan, etc
Lüllmann, H., et al., 2005
Lüllmann, H., et al., 2005
Lüllmann, H., et al., 2005
1 = ACEIs; 2 = ARBs; 3 = Beta-blockers; 4 = CCBs; 5 = Diuretics; 1 = ACEIs; 2 = ARBs; 3 = Beta-blockers; 4 = CCBs; 5 = Diuretics; 6 = Aldosterone antagonists6 = Aldosterone antagonists
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Saseen, J.J. & Carter, B.L., 2005
Diagram of Renin – Angiotensin – Aldosterone System (RAAS)
Straka, R.J., et al., 2008
Flowchart of various Beta-Blockers
Straka, R.J., et al., 2008
There are some controversies exist There are some controversies exist on diuretics and Beta-blockers as on diuretics and Beta-blockers as first-line therapyfirst-line therapy
Saseen, J.J. & Carter, B.L., 2005
Saseen, J.J. & Carter, B.L., 2005
Clinical trial & guideline basis for compelling indications for individual drug classes
Adapted from JNC7, 2004Adapted from JNC7, 2004
Cutler, J.A & Davis, B.A., 2008
Incidence of hospitalized (Hosp) Heart Failure (HF) outcome by Antihypertensive Treatment Group (Amlodipine/Lisinopril vs. Chlortalidone)
Preferred drugs in related conditionsLVH = left ventricular hypertrophyESRD = end-stage renal disease /
renal failureISH = isolated hypertensionACEI = ACE inhibitorCA = Calcium antagonist / CCBARB = Angiotensin II receptor
blockerBB = Beta-blockers
ESH/ESC guideline, 2007
ESC/ESH guideline, 2007
Possible combinations between some classes of antihypertensive drugs.The preferred combination in the general hypertensive population are represented as Thick Line. Thick Line. The frame indicate classes of agents proven to be beneficial in controlled intervention trialsESC/ESH Guideline, 2007
Rate of persistence on treatment after 6, 12, and 24 months in difference subgroup of patients treated with ARBs, CCBs, BBs, ACEIs,Lercanidipine, & Diuretics* ** *** p<0.05, 0.01, 0.005 vs ARBs
Veronessi, M., et al., 2007
Adverse Effects of drugs : percentage of people with one or more symptoms attributable to treatment*; according to category of drug and dose
in randomized trial
Bramlage, P. & Hasford, J., 2009
Kesselheim, A.S., et al., 2008
Bourgoult, C., et al., 1999
Bourgoult, C., et al., 1999
Bourgoult, C., et al., 1999
Fischer, M.A. & Avorn, J., 2004
Monthly cost of antihypertensive drugs in UK was found £23.44
Hypertension expenditures in Italy represents 42.7% of total expenditure for medicines