Kuliah Hipertensi Krisis (1)

7/17/2019 Kuliah Hipertensi Krisis (1)

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HIPERTENSI KRISIS

SYAIFUL AZMI

SUB BAGIAN GINJAL HIPERTENSI

BAG ILMU PENYAKIT DALAM

FDOK UNAND / RSUP DR M DJAMIL

PADANG



•HIPERTENSI KRISIS



PREVALENSI

• HIPERTENSI KRISIS

• 1 % dari !"#a$i i&r'&($i d&)a$a

• Hi&r'&($i E*&r+&($i

, - .% &(d&ri'a di I0U

, ar&(a '&rai 'a ad&"a'

P&r+!#i(i MS2 0#i('&r 13/4/45

Mar PE 0&$' 161/3/47



PROGNOSIS

• A(+a &*a'ia( 'i(++i

• Ta(a '&rai 8 1 9&ar $"r:i:a#

ra'& 1,4%

• T&rai ad&"a' 8 . 9&ar $"r:i:a#

ra'& .,3%

Ka#a(; <#i(i<a# 9&r'&($i!(



DEFINISI

• HIPERTENSI KRISIS

• P&(i(+a'a( '&a(a( dara

*&(dada =- 1>/14 **H+?

, T2O2D @/,

, KELUHAN @/,

, PENANGGULANGAN SEGERA



KLASIFIKASI

HIPERTENSI URGENSI

• TANPA GEJALA

, Bia$a(9a '&a(a( dara - 1>/14 **H+

, Ta(a &#"a( =$ai' &a#a/<&*a$?

, TOD A"' 'ida ada

• DGN GEJALA

, Bia$a(9a '&a(a( dara - 1>/14 **H+, K&#"a( $ai' &a#a &a'; (aa$

&(d&; ardi!:a$"#&r $'ai#

, TOD a"' 'ida ada



KLASIFIKASI

Hi&r'&($i E*&r+&($i

, Bia$a(9a '&a(a( dara -

44/1C **H+

, K&#"a( TOD 8 $&$a; (9&ri

dada; (!'"ria; di$ar'ria;

+a(++"a( &$adara(



Ta#& 4 8 A#+!ri'* !r Tria+& E:a#"a'i!(

Para*&'&r

S&:&r& H9&r'&($i!( =Ur+&(<9? 9&r'&($i:& E*&r+&(<9

A$9*'!*a'i< S9*'!*a'i<

B#!!d r&$$"r&

=**H+?

- 1>/11 - 1>/11 U$"a##9 - 44/1C

S9*'!*$ H&ada<&; a(i&'9

!'&( a$9*'!*a'i<

S&:&r& &ada<&;

$!r'(&$$ ! r&a'

S!r'(&$$ ! r&a'; <&$' ai(;

(!<'"ria; d9$ar'ria; )&a(&$$;

a#'&r&d <!($<i!"$(&$$

Ea*i(a'i!( N! 'ar+&' !r+a(da*a+&; (! <#i(i<a#

<ardi!:a$<"#ar

di$&a$&

Tar+&' !r+a(da*a+& <#i(i<a#

<ardi!:a$<"#ar

di$&a$& r&$&(';

$'a#&

E(<&a#!a'9;"#*!(ar9&d&*a; r&(a# i($"i<i&(<9;

<&r&r!:a$<"#ar a<<id&('; <ardia<

i$<&*ia

T&ra9 O$&r:& 1,6 r

i(i'ia'&; r&$"*&

*&di<a'i!( i(<r&a$&

d!$a+& ! i(ad&"'&a+&('

O$&r:& 6,3 r

#!)&r BP )i'

$!r'a<'i(+ !ra#

a+&(' ad"$'<"rr&(' '&ra9

Ba$&#i(& #a!ra'!r9 '&$'$

i('ra:&(!"$ #i(& *!(i'!r BP; *a9

i(i'ia'& ar&('&ra# '&ra9 i(

&*&r+&(<9 r!!*

P#a( Arra(+& !##!),"

)i'i( 6,7 da9$ i (!

ri!r &:a#"a'i!(;

$<&d"#& a!i('*&('

Arra(+& !##!),"

&:a#"a'i!( i( #&$$

'a( 74 r

I**&dia'& ad*i$$i!( '! I0U 'r&a'

'! i(i'ia# +!a# BP; addi'i!(a#

dia+(!$'i< $'"di&$

BP, Blood pressure; ICU, Intensive care unit

Sumber : Hebert e.j Prim Care 200. !" #!$



DIAGNOSIS

ANAMNESIS

, La*a *&(d&ri'a i&r'&($i

, Oa',!a' 9a(+ di*aa(

, K&#"a( TOD

, P&(9ai' &(9&r'a



DIAGNOSIS

PEMERIKSAAN FISIS

, P&(+""ra( '&a(a( dara

, P&raaa( a2 radia#i$; a2 ar!'i$

, TOD



Ta#& 6 8 0#i(i<a# 0ara<'&ri$'i<$ ! '& H9&r'&($i:& E*&r+&(<9

B#!!d

Pr&$$"r&

=**H+?

F"(d"$<!i

< Fi(di(+$

N&"r!#!+i<

S'a'"$

0ardia<

Fi(di(+$

R&(a#

S9*'!*$

Ga$'r!i('&$'i(a#

S9*'!*$

U$"a##9

-44/1C

H&*!rra+&

$; &"da'&$;

ai#&d&*a

H&ada<&;

<!("$i!(;

$!*(!#&(<&;

$'"!r; :i$"a#

#!$$; $&i"r&$;

!<a#

(&"r!#!+i<

d&i<i'$; <!*a

Pr!*i(&('

ai<a#

"#$a'i!(;

<ardia<

&(iar+&*&(';

<!(+&$'i:&

&ar' ai#"r&

A!'&*ia;

r!'&i("ria;

!#i+"ria

Na"$&a2

:!*i'i(+




Ta#& C 8 0#i(i<a# Ma(i&$'a'i!($ ! E(d,Or+a( Da*a+& Fr!*

H9&r'&($i:& E*&r+&(<9

0&('ra# (&r:!"$

$9$'&*

Di(&$$; NV; <!("$i!(; )&a(&$$; &(<&a#!a'9; I0H; SAH; i$<&*i<

$'r!&

E9&$ O<"#ar &*!rra+&; &"da'&$; !r ai#&d&*a !( "(d!$<!i< &a*;

#"rr&d :i$i!(; #!$$ ! $i+'

H&ar' A(+i(a; A0S; LVF; PE; a!r'i< di$$&<'i!(; <ardi!+&(i< $!<

Kid(&9$ H&*a'"ria; r!'&i("ria; 9&#!(&ri'i$; &#&:a'&d S0r a(d BUN; ARF

ACS; acute coronary syndrome; ARF: acute renal failure: BUN: blood urea nitrogen: ICH: intracranial

hemorrhage; !F: left "entricular failure; N!: nausea and "omiting: #$: %ulmonary edema: SAH:

subarachnoid hemorrhage; SCr& serum creatinine

Per%olini &S. '(e &ana%ement o) (*pertensive crises. Clin 'er 200+. -0 #2$



PENGOBATAN

Hi&r'&($i Ur+&($i

, Tida *&*&r#"a( &("r"(a(

'&a(a( dara $&+&ra $ (!r*a#da#a* )a'" !$&r:a$i

, Ora# a('i i&r'&($i &&ra <&a'

, Tar+&' 'ida '&r<aai; 'i(+a'a(d!$i$

, Tar+&' '&r<aai da#a* 6,7 ari



Ta#& . 8 Ma(a+&*&(' ! H9&r'&($i:& Ur+&(<i&$

AGENT DOSE

ONSET/DURATION OF

A0TION

=AFTER

DIS0ONTINUATION?

PRE0AUTIONS

0a'!ri# 4. *+ 2!2; r&&a' a$ (&&d&d SL;

4. *+

1.,6 *i(/3,> SL;

1.,6 *i(/4,3

H9!'&($i!(; r&(a#

ai#"r& i( i#a'&ra# r&(a#

ar'&r9 $'&(!$i$

0#!(idi(& 21,24 *+ 2!2; r&&a' !"r#9 a$

r&"ir&d '! '!'a# d!$& ! 23 *+

6,3 *i(/>,13 H9!'&($i!(;

dr!)$i(&$$; dr9 *!"'

La&'a#!# 4,C *+ 2! r&&a' &:&r9 4,6 6 *i(,4 /4,14 Br!(<!<!($'ri<'i!(;

&ar' #!<; !r'!$'a'i<

9!'&($i!(

A*#!dii

(

4;.,. *+ 1,4 r/14,1> r Ta<9<ardia;

9!'&($i!(

Ni&dii( . *+ $# .,4 *i(/4,3 r Ta<9<ardi!;

9!'&($i!(Ada'&d )i' &r*i$$i!( r!* Vid' DG2 H9&r'&($i:& <ri$&$8 &*&r+&(<i&$ a(d "r+&(<i&$2 J 0#i( H9&r'&($ =Gr&&()i<% ?2

4C38.4,.4.Sumber :

/daptec etc

InaSH

Hebert C. H*pertensive Crises Prim Care 200. !" #!$



PENGOBATAN

Hi&r'&($i E*&r+&($i

, Dira)a' di I0U

, Oa' a('i i&r'&($i ar&('&ra#

, Tar+&' 8 , P&("r"(a( '&a(a( dara d a*

&r'a*a 4,4. %

, Mi(i*a#i$ir i!&r"$i !r+a( :i'a#

, P&("r"(a( '&a(a( dara $&#a("'(9a d# 4C a*



Ta#& 3 8 Tr&a'*&(' ! H9&r'&($i:& E*&r+&(<i&$

A+&('

Par&('&ra#

Va$!di#a'!r$

D!$a+& O($&'/D"ra'i!( !

A<'i!( =a'&r

di$<!('i("a'i!(?

Pr&<a"'i!($

S!di"*

Ni'r!r"$$id&

24.,1 µ+/+/*i( a$

IV i("$i!(

I**&dia'&/4,6 *i(

a'&r i("$i!(

Na"$&a; :!*i'i(+ r!#!(+&d "$&

*a9 <a"$& 'i!<9a(a'&

i('!i<a'i!(;

*&'&*!+#!i(&*ia; a<id!$i$;

<9a(id& !i$!(i(+ a+$; !''#&$;

d&#i:&r9 $&'$ *"$' & #i+'

r&$i$'a('Ni'r!+#9<&ri( .,1 µ+ a$ IV

i("$i!(

4,. *i(/.,1 *i( H&ada<&; 'a<9<ardia; :!*i'i(+

#"$i(+2 M&'&*!+#!i(&*ia

r&"ir&$ $&<ia# d&#i:&r9 $9$'&*

&<a"$& ! dr"+ i(di(+ '! PV0

'"i(+Ni<ardii(& .,1. *+/r a$ IV

i("$i!(

1,. *i(/1.,6 *i(;

"' *a9 &<&&d 14

r a'&r r!#!(+&d

i("$i!(

Ta<9<ardia; (a"$&a; :!*i'i(+;

&ada<&; i(<r&a$&d i('ra<ra(ia#

r&$$"r& 9!'&($i!( *a9 &

r!'ra<'&d a'&r r!#!(+&d

i("$i!($F&(!#d!a*

M&$9#a'&

21,26 µ+/+/*i( a$ IV

i("$i(!(

. *i(/6 *i( H&ada<&; 'a<9<ardia; #"$i(+;

#!<a# #&i'i$; dii(&$$

H9dra#ai(& .,4 *+ a$ IV !#"$ !r

1,C *+ IM r&&a'

&:&r9 C,3 r

1 *i( IV/- 1 r =IV?

4,6 *i( IM/C,3 r

=IM

Ta<9<ardia; &ada<&;

:!*i'i(+; a++ra:a'i!( ! a(+i(a

&<'!ri$; $!di"* a(d )a'&r

r&'&($i!(; i(<r&a$&d i('ra<ra(ia#

r&$$"r&Sumber : Hebert e.j Prim Care 200. !" #!$



K&adaa( "$"$

12 Di$&$i A!r'a

, R!&a( d di(di(+ a!r'a

, K#i(i$ 8 (9&ri dada =S' M0I?

8 Si(!&

, P&*&ri$aa( 8 E<!; 0T S<a(; MRI

, T&rai 8 Tar+&' TDS 11,14 **H+/d#a'" 1,4 *&(i'

, K!($"# &da



K&adaa( "$"$

42 Si(dr!*a !r!(&r a"'

, A(+i(a &'!ri$ 'a $'ai#; STEMI/N!( STEMI

, K#i(i$ 8 (9&ri dada a$

, P&*&ri$aa( 8 EKG; 0KMB; Tr!!(i( T, T&rai 8

, !a' 8 , Ni'r!+#i$&ri(

, Na Ni'r!r"$id&

, 0202B =Ni<ardii(?

, Tar+&' 8 ↓ 1,4% d# 1,6 a* &r'a*a

8 a+a TDD - 3 **H+

, Oa' 8 P&(+i#a(+ ra$a $ai'

M&*"a !#"$i !r!(&r



K&adaa( "$"$

62 Ed&* Par"

, K#i(i$ 8 , $&$a (aa$ &a'; 'ia,'ia

, r!(i; &(d"(+a(

, +a##! r9'&*

, T&rai 8

, Oa' 8 , Na Ni'r!r"$id&

, F&(!#d!a*

, Oa',!a' di"r&'i, Tar+&' 8 TDS '"r"( 6 **H+ d# &&raa *&(i'

8 16/> **H+ d# 6 a*



K&adaa( "$"$

C2 AKI/0KD

, Bia$a(9a i&r'&($i $&"(d&r =!#"$i a2 r&(a#i$?

, K#i(i$ 8 U$ia *"da

R&ra'&r

RPK 'ida ada

, P&*&ri$aa( 8 i$i(+ a r&(a#i$

, T&rai 8 T"r"(a( '&a(a( dara

4 , 4.% d# 1,6 a*

Oa' 8 Na (i'r!r"$id&

La&'a#!#



K&adaa( "$"$

.2 Kri$i$ adr&(&r+i<

, Kar&(a r!d"$i a'&!#a*i( ↑

, T&rai 8 T"r"(a( '&a(a( dara

1,1. % d# 1,4 a*

Oa' 8 , F&('!#a*i(, La&'a#!#



K&adaa( "$"$

32 Hi&r'&($i E($&a#!a'i

, P&r"$i & $&r&ra# ↓ &d&* $&r&ra# r!+r&$i

, K#i(i$ 8 ↓ &$adara(

P&rdaraa( r&'i(a

Pai# &d&*

D&i$i' (&"r!#!+i

, T&rai 8 ↓ '&a(a( dara 4,4.% a* &r'a*a

Oa' 8 Na Ni'r!r"$id&

La&'a#!#



K&adaa( "$"$

72 S'r!& I$&*i

, P&("r"(a( '&a(a( dara *a$i

!('r!:&r$i, ↓ '&a(a( dara 'ia,'ia i$&*i<&r&ri &r'a*a

, ↓ '&a(a( dara i#a a)a# - 44/14**H+; 'd #&i 1% d a* I; 4%ada 3,14 a* &ri"', Oa' 8 , Na Ni'r!r"$id&

, Ni<ardii(



K&adaa( "$"$

>2 P&rdaraa( $&r&ra#

, Bia$a(9a '&a(a( dara - 4C/14 **H+

, K#i(i$ 8 , &("r"(a( &$adara(

, (+!r!, 'a(da,'a(da d&i$i' (&"r!#!+i

, T&rai 8 , ↓ '& dara 4,4. % a* &r'a*a

, 13/5 **H+ d# 4C a*

, Oa' 8 Na Ni'r!r"$id&Ni<ardii(

00B



K&adaa( "$"$

52 K&a*i#a(

, K&#"a( 8 , Sai' &a#a

, S&$a (aa$, O#i+"ri

, K&a(+

, La2 Pr!'&i("ria

, T&rai 8 T&r*i(a$i &a*i#a(Oa' 8 , Ni<ardii(

, La&'a#!#



K&adaa( "$"$

12P&(++"(a NAPZA

, Oa' !ai(; a*&'a*i(;

*&'a*&'a*i( &(<9<#idi(&

, Oa' i#ia( 00B



Ta#& 7 8 Pr&&rr&d Dr"+$ !r S&#&<' H9&r'&($i:& E*&r+&(<i&$

E*&r+&(<9 Dr"+$ ! <%!i<& Tar+&' B#!!d Pr&$$"r&

A!r'i< di$$&<'i!(

AMI; i$<&*ia

P"#*!(ar9 &d&*a

R&(a# &*&r+&(<i&$

0a'&<!#a*i(& &<&$$

H9&r'&($i:& &(<a#!a'9

S"ara<(!id &*!rra+&

I$<&*i< $'r!&

Ni'r!r"$$id& @ &$*!#!#

Ni'r!+#9<&ri(; (i'r!r"$$id&; (i<ardii(&

Ni'r!r"$$id&; (i'r!+#9<&ri(; #a&'a#!#

F&(!#d!a*; (i'r!r"$$id&; #a&'a#!#

P&('!#a*i(&; #a&'a#!#

Ni'r!r"$$id&

Ni'r!r"$$id&; (i*!dii(&; (i<ardii(&

Ni'r!r"$$id& =<!('r!:&r$ia#?;

(i<ardii(&

11,14 SBP a$ $!!( a$ !$$i#&

S&<!(dar9 '! i$<&*ia r&#i&

I*r!:& $9*'!*$ 1%,1.% i( 1,4 r

Tar+&' BP 4%,4.% i( 4,6 r

0!('r!# ar!9$*$; 1 %,1.% i( 1,4 r

4%,4.% i( 4,6 r

4%,4.% i( 4,6 r

%,4% i( 3,14 r

/&I, acute m*cardial in)arction; SBP, s*stolic bood pressure




KESIMPULAN

12 Hi&r'2 Kri$i$ 8 ↑ '& dara *&(dada

d+( a'a" 'a(a TOD

42 Hi&r'2 Ur+&($i 8 , &r!a' a#a(

, !ra# a('i i&r'&($i

62 Hi&r'2 E*&r+&($i 8 , ra)a' di I0U

, !a' a('i i&r'&($i

ar&('&ra#



TAKE HOME MESSAGE

D!'&r ada &#a9a(a( ri*&r;

daa' *&*&ria( a('i i&r'&($i

!ra# 9a(+ &&ra <&a'; da#a**&(a'a#a$a(a i&r'&($i

$&&#"* *&r"" & RS r""a(



31

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