Hipertensi Resisten
Authors
-
Starry H Rampengan
Faculty of Medicine,
Sam Ratulangi University, Manado
Keywords:
Hipertensi resisten, Tekanan darah, ManajemenAbstract
Hipertensi resisten merupakan faktor risiko utama dari berbagai penyakit, sehingga terjadi peningkatan kejadian penyakit jantung iskemik, gagal jantung, kejadian serebrovaskular, dan disfungsi ginjal. Hipertensi dikatakan resisten terhadap pengobatan ketika strategi terapi yang mencakup modifikasi gaya hidup yang tepat ditambah penggunaan diuretik dan dua obat antihipertensi lain dari kelas yang berbeda pada dosis yang memadai (tapi tidak harus termasuk antagonis reseptor mineralokortikoid) gagal untuk menurunkan angka tekanan darah ke < 140/90mmHg. Lebih jauh, prevalensi hipertensi yang tidak terkontrol juga meningkat, meskipun terjadi kemajuan dalam farmakoterapi. Pasien dengan pengobatan hipertensi resisten (tekanan darah ? 140/90 mmHg) meskipun telah menggunakan ? 3 obat antihipertensi, termasuk diuretik, sering memiliki faktor risiko tinggi untuk kejadian penyakit jantung dan akibatnya beresiko lebih tinggi mengalami kerusakan organ serta morbiditas kardiovaskular. Penyebab hipertensi resisten bervariasi seperti hipertensi white-coat, ketidakpatuhan terhadap terapi obat, dan pilihan obat atau dosis yang tidak tepat, maka estimasi proporsi pasien dengan rentang dirawat karena hipertensi 5-16%.
Resistant hypertension is a major risk factor of numerous diseases, that resulting the increase of incidence of ischemic heart disease, heart failure, cerebrovascular events, and renal dysfunction. Hypertension is defined resistant to the treatment if therapeutic strategy that includes appropriate lifestyle modification and the using of diuretic and two antihypertensive drugs from different classes in adequate doses (without mineralocorticoid receptor antagonist) fails to reduce blood pressure level to < 140/90mmHg. Furthermore, the prevalence of uncontrolled hypertension is also increase, in spite of advances in pharmacotherapy. The treatment of patients with resistant hypertension (blood pressure ? 140/ 90 mmHg despite ? 3 antihypertensive medications, including a diuretic) often have other risk factors for cardiovascular disease and consequently they have higher risk for end-organ damage and cardiovascular morbidities. The proportion of patients with resistant hypertension ranges from 5 to 16%, when confounding causes, such as white-coat hypertension, non-adherence to drug therapy, and inappropriate drug selection or dosing, are eliminated.
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