Hipertensi

JNC 8 Am Fam Physician. 2014 Oct 1;90(7):503-504.

Prinsip Terapi:
In the general population, pharmacologic treatment should be initiated when
blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or
140/90 mm Hg or higher in adults younger than 60 years.
In patients with hypertension and diabetes, pharmacologic treatment should
be initiated when blood pressure is 140/90 mm Hg or higher, regardless of
age.
Initial antihypertensive treatment should include a thiazide diuretic, calcium
channel blocker, ACE inhibitor, or ARB in the general nonblack population or a
thiazide diuretic or calcium channel blocker in the general black population.
If the target blood pressure is not reached within one month after initiating
therapy, the dosage of the initial medication should be increased, or a second
medication should be added.

For persons 18 years or older with chronic kidney disease (CKD) or diabetes
mellitus, the treatment threshold and target blood pressures are the same as
those for the general population younger than 60 years (i.e., threshold systolic
pressure of 140 mm Hg or threshold diastolic pressure of 90 mm Hg; target
systolic pressure of less than 140 mm Hg; target diastolic pressure of less than
90 mm Hg)

In the general nonblack population, including those with diabetes, initial anti-
hypertensive treatment should include a thiazide diuretic, calcium channel
blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor
blocker (ARB).
Diuretics:
Hydrocholorotiazide
Initial dose: 25 mg orally once daily
Maintenance dose: May increase to 50 mg orally daily, as a single or 2
divided doses
Comments:
-Patients usually do not require doses in excess of 50 mg daily when used
concomitantly with other antihypertensive agents.
Diabetes Mellitus

CLASSIFICATION
Diabetes can be classified into the following general categories: 1. Type 1 diabetes (due to autoimmune b-
cell destruction, usually leading to absolute insulin deficiency) 2. Type 2 diabetes (due to a progressive loss
of b-cell insulin secretion frequently on the background of insulin resistance) 3. Gestational diabetes
mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt
diabetes prior to gestation) 4. Specific types of diabetes due to other causes, e.g., monogenic diabetes
syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the
exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with
glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation)
Diabetes Tipe 1
Tipe-tipe:
1. Immune-Mediated Diabetes
This form, previously called “insulindependent diabetes” or “juvenile-onset diabetes,” accounts for 5–10%
of diabetes and is due to cellular-mediated autoimmune destruction of the pancreatic b-cells. Autoimmune
markers include islet cell autoantibodies and autoantibodies to GAD (GAD65), insulin, the tyrosine
phosphatases IA-2 and IA-2b, and ZnT8. Type 1 diabetes is defined by the presence of one or more of these
autoimmune markers.
2. Idiopathic Type 1 Diabetes
Some forms of type 1 diabetes have no known etiologies. These patients have permanent insulinopenia and
are prone to ketoacidosis, but have no evidence of b-cell autoimmunity
Patients with type 1 diabetes often present with acute symptoms of diabetes and
markedly elevated blood glucose levels, and approximately one-third are diagnosed
with life-threatening ketoacidosis.

Diabetes Tipe 2
Type 2 diabetes, previously referred to as “noninsulin-dependent diabetes” or “adult-onset diabetes,”
accounts for 90–95% of all diabetes. This form encompasses individuals who have relative (rather than
absolute) insulin deficiency and have peripheral insulin resistance.
Ketoacidosis seldom occurs spontaneously in type 2 diabetes;
Type 2 diabetes frequently goes undiagnosed for many years because hyperglycemia develops gradually
and, at earlier stages, is often not severe enough for the patient to notice the classic diabetes symptoms.