Presentation 1

Hypertension
By :
Dzakiyyah Fiddin (12310129)
Lintang Novita P (12310260)
Putri Nurul Aprilia (12310360)
Yance Carina (12310490)
 Case 35
A 56-year-old man comes in for a routine health
maintenance visit. He is new to your practice and has spesific
complains today . he has hypertension for which he takes
hydroclorotiazide, and he occasionally takes aspirin because
someone told him that it was good for him. He has no other
significant medical history. He does not smoke cigarettes,
occasionallly drinks alcohol, and does not exercise. His father
died of a heart attack at age 60 years and his mother died at
age 72 years of cancer. He has two younger sisters who are in
good health. On examination, his blood pressure is
130/80mmHg and his pulse is 75 bpm. He is 6 ft tall and
weights 200 lb. His complete physical examination is normal.
You order a fasting lipid panel, which subsequently returns
with the following results : total cholestrol 242mg/dl;
triglyserides 138 mg/dl; high density lipoprotein (HDL)
cholesterol 48 mg/dl; and low density lipoprotein (LDL)
cholesterol 155 mg/dl.
 Keyword
A 56-year-old man
Has no spesific complains today
He has hypertension
He takes hydroclorotiazide, and takes aspirin
He has no other significant medical history.
He does not smoke cigarettes, drinks alcohol, and
doesnt exercise.
His father died of a heart attack and his mother
died of cancer.
 Problem
A 56-year-old man comes in for routine
consultation about his hypertension.
 Differential diagnose
Hypertension
hypercholesterolemia
 hypotesa
Hypertension
Learning issue
Definition of hypercholesterolemia
Hypercholesterolemia is a disorder
characterized by high levels of blood
cholesterol.
 Definition of hypertension
Hypertension is defined as a systolic blood
pressure (SBP) of 140 mmHg or more, or a
diastolic Blood pressure (DBP) of 90 mmHg or
more, or the patient taking antihypertensive
medication.
 Predisposisi
A number of factors increase BP, including
(1) obesity
(2) insulin resistance
(3) high alcohol intake
(4) high salt intake (in salt-sensitive patients),
(5) aging and perhaps
(6) stress
(7) low potassium and calcium intake.
 Classification BP
Based on recommendations of the Seventh Report of the
Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC 7),
the classification of BP for adults aged 18 years or older has
been as follows[3] :
Normal: Systolic lower than 120 mm Hg, diastolic lower
than 80 mm Hg
Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89
mm Hg
Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg
Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg
or greater
 Sign and symtoms
High blood pressure that doesn't respond to
blood pressure medications (resistant
hypertension)
Very high blood pressure systolic blood
pressure over 160 millimeters of mercury (mm
Hg) or diastolic blood pressure over 100 mm Hg
A blood pressure medication or medications that
previously controlled your blood pressure no
longer work
Sudden-onset high blood pressure before age 30
or after age 55
No family history of high blood pressure
No obesity
 Therapy and education for
hypertension
Lifestyle modifications
JNC 7 recommendations to lower BP and decrease
cardiovascular disease risk include the following:
Weight loss
Limit alcohol intake
Reduce sodium intake

Pharmakotherapy :
An angiotensin-converting enzyme (ACE) inhibitor
Angiotensin receptor blocker (ARB)
Calcium channel blocker (CCB), and beta-blocker
 Conclution
Maintain adequate intake of dietary
potassium (approximately 90 mmol/day)
Maintain adequate intake of dietary calcium
and magnesium for general health
Stop smoking and reduce intake of dietary
saturated fat and cholesterol for overall
cardiovascular health
Engage in aerobic exercise at least 30 minutes
daily for most days.
Thank you for attention