Hypertention 3: Handling

F. Handling

Destination handling detection and decrease the risk of hypertension is a disease and mortality cardiovascular and morbidity's related. Therapy goal is to reach and maintain pressure systolic under 140 mm Hg pressure and diastolic below 90 mm Hg and control risk factors. This can be achieved through lifestyle modifications alone, or with drugs antihipertensi.

Are categorized into risk groups:
1. Patients with blood pressure boundary, or the level of 1.2, or 3, cardiovascular disease without symptoms, organ damage, or other risk factors. If lifestyle modifications with the blood pressure has not yet been revealed, it should be given drugs antihipertensi.
2. Cardiovascular patients without disease or other organ damage, but have one or more risk factors listed above, but not diabetes mellitus. If there are several factors then must be given directly antihipertensi drugs.
3. Patients with clinical symptoms of disease or damage to organs cardiovascular clear.

Risk factors: age over 60 years, smoking, dislipidemia, diabetes mellitus, gender (male and female menopause), cardiovascular history of disease in families.
or organ damage cardiovascular disease: heart disease (hypertrophy ventricle left, infarct miokard, angina pektoris, heart failure), history revaskularisasi coronary, stroke, transient ischemic attack, nefropati, perifer arterial disease, and retinopati.

handling based classification risk:
Blood pressure Risk Group A Risk Group B Risk Group C
130-139 / 85-89 Modifications lifestyle modification with lifestyle drugs
140-159 / 90-99 Modifications lifestyle modification with lifestyle drugs
≥ 160 / ≥ 100 By the drug With drug medication

Lifestyle modification is effective, can reduce the risk cardiovascular with little cost, and minimal risk. Still like this even though it is recommended the medicine must be accompanied antihipertensi because it can decrease the number of drug and dose. The steps recommended for:
- Reduce body weight if there is excess (body mass index ≥ 27).
- Restrict alcohol.
- Increase aerobic physical activity (30-45 minutes / day).
- Reduce Feed natrium
- Maintain a adequate Feed potassium (90 mmol / day).
- Maintain Feed of calcium and magnesium adequate.
- Stop smoking and reduce the Feed saturated fat and cholesterol in food.

Handling with antihipertensi medicine for most patients begin with low doses and increased titrasi in accordance with the age, needs, and age. The optimal therapy should be effective for 24 hours, and preferably in a single dose because compliance is better, cheaper, can continue to control the hypertension and smoothly, and protect patients against the risk of a variety of sudden death, heart attack or stroke due to a sudden increase in blood pressure wake up when sleeping. Now there are medicines that contain a combination of low doses of two different classes of drugs. This proven combination provides additional effectiveness and reduce side effects.
After the decision to use drugs antihipertensi and if there is no indication to select the drugs certain, given diuretic or beta Blocker. If the response is not well with the full dose, followed by algorithm. Diuretic usually because it can be to increase the effect of other drugs. If the two additional drugs can control blood pressure well at least after 1 year, can be tested through the first drug dose decrease slowly and progressively.
In some patients may begin therapy with one or more drugs directly. Patients with blood pressure ≥ 200 / ≥ 120 mm Hg should be given immediate therapy and if symptoms have organ damage should be treated in the hospital.