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DEFINISI &

KLASIFIKASI
HIPERTENSI
Sub Program III Semester VII
FKUA 2012
Kuliah Ilmu Penyakit Dalam - Nefrologi
Divisi Nefrologi & Hipertensi Lab-SMF Penyakit Dalam
FK Unair RSU Dr. Soetomo, Surabaya

DEFINISION AND CLASIFICATION OF BLOOD PRESSURE LEVEL


THE 7th REPORT OF THE JOINT NATIONAL COMMITTEE
ON PREVENTION, DETECTION, EVALUATION, AND TREATMENT OF HIGH BLOOD PRESSURE
(2003)

CATEGORY

BLOOD PRESSURE (mmHg)


Systolic

Diastolic

< 120

and

< 80

Pre hypertension

120-139

or

80-89

Hypertension, stage 1

140-159

or

90-99

Hypertension, stage 2

> 160

or

> 100

Normal

DEFINISION AND CLASIFICATION OF BLOOD PRESSURE LEVEL


2003 European Society of Hypertension-European Society of Cardiology
Guidelines for management of arterial hypertension
CATEGORY

BLOOD PRESSURE (mmHg)


Systolic

Diastolic

Optimal

< 120

< 80

Normal

120-129

80-84

High Normal

130-139

85-89

Grade 1 hypertension (mild)

140-159

90-99

Grade 2 hypertensive (moderate)

160-179

100-109

Grade 3 hypertensive (severe)

> 180

> 110

Isolated Systolic Hypertension

> 140

< 90

When a patients systolic and diastolic blood pressure fall into different categories, the higher
category should apply. Isolated systolic hypertension can also be graded (grade 1,2,3) according to
systolic blood pressure values in the range indicated, provided diastolic values are <90.

Denitions and classication of blood


pressure (BP) levels (mmHg)
European Society of Hypertension (ESH) and European Society of Cardiology (ESC)
2007 Guidelines for the management of arterial hypertension

Category

Systolic

Diastolic

Optimal

<120

and

<80

Normal

120129

and/or

8084

High normal

130139

and/or

8589

Grade 1 hypertension

140159

and/or

9099

Grade 2 hypertension

160179

and/or

100109

Grade 3 hypertension

>180

and/or

>110

Isolated systolic hypertension

>140

and

<90

Isolated systolic hypertension should be graded (1 , 2,3) according to systolic blood pressurevalues in the ranges
indicated,
provided thatdiastolicvaluesare ,90 mmHg. Grades 1 , 2and 3 correspond toclassication in mild, moderate and
severe hypertension, respectively. These terms have been now omitted to avoid confusion with quantication
of total cardiovascular risk.

Stratication of CV Risk in four categories


Blood Pressure (mmHg)
Other risk factors,
OD, or disease

No other risk
factors,

Normal SBP
120129 and/or
DBP 8084

Average risk

High normal
SBP 130139
and/or
DBP 8084
Average risk

Grade 1 HT
SBP 140159
and/or
DBP 9099

Grade 2 HT
SBP 160179
and/or
DBP 100109

Grade 3 HT
SBP >180
and/or
DBP >110

Low added risk

Moderate added
risk

High added risk

1-2 risk factors

Low added risk

Low added risk

Moderate added
risk

Moderate added
risk

Very high added


risk

3 or more risk
factors, MS, OD,
or diabetes

Moderate added
risk

High added risk

High added risk

High added risk

Very high added


risk

Established CV or
renal disease

Very high added


risk

Very high added


risk

Very high added


risk

Very high added


risk

Very high added


risk

Stratication of CV Risk in four categories. SBP: systolic blood pressure; DBP: diastolic blood pressure; CV: cardiovascular; HT: hypertension.
Low, moderate, high and very high risk refer to 10 year risk of a CV fatal or non-fatal event. The term added indicates that in all categories risk
is greater than average. OD: subclinical organ damage; MS: metabolic syndrome. The dashed line indicates how denition of hypertension
may be variable, depending on the level of total CV risk.

Initiation of antihypertensive treatment


Blood Pressure (mmHg)
Other risk
factors, OD, or
disease
No other risk
factors,

Normal SBP
120129
and/or
DBP 8084
No BP intervention

High normal
SBP 130139
and/or
DBP 8084

Grade 1 HT
SBP 140159
and/or
DBP 9099

Grade 2 HT
SBP 160179
and/or
DBP 100109

Grade 3 HT
SBP >180
and/or
DBP >110

No BP intervention

Lifestyle changes for


several months then
drug treatment if BP
uncontrolled

Lifestyle changes for


several weeks then
drug treatment if BP
uncontrolled

Lifestyle changes
+
Immediate drug
treatment

Lifestyle changes for


several weeks then
drug treatment if BP
uncontrolled

Lifestyle changes for


several weeks then
drug treatment if BP
uncontrolled

Lifestyle changes
+
Immediate drug
treatment

Lifestyle changes
+
Drug treatment

Lifestyle changes
+
Drug treatment

Lifestyle changes
+
Immediate drug
treatment

Lifestyle changes
+
Immediate drug
treatment

Lifestyle changes
+
Immediate drug
treatment

Lifestyle changes
+
Immediate drug
treatment

1-2 risk factors

Lifestyle changes

Lifestyle changes

> 3 risk factors,


MS or OD

Lifestyle changes

Lifestyle changes and


consider
drug treatment

Diabetes

Lifestyle changes

Lifestyle changes and


consider
drug treatment

Established CV
or renal disease

Lifestyle changes
+
Immediate drug
treatment

Lifestyle changes
+
Immediate drug
treatment

Goals of treatment

In hypertensive patients, the primary goal of


treatment is to achieve maximum reduction in
the longterm total risk of cardiovascular
disease.
This requires treatment of the raised BP perse
as well as of all associated reversible risk
factors.
BP should be reduced to at least below 140/90
mmHg (systolic/diastolic), and to lower values,
if tolerated, in all hypertensive patients.

Target BP should be at least <130/80 mmHg in


diabetics and in high or very high risk patients,
such as those with associated clinical
conditions (stroke, myocardial infarction, renal
dysfunction, proteinuria).
Despite use of combination treatment,
reducing systolic BP to < 140 mmHg may be
difcult and more so if the target is a reduction
to < 130 mmHg.

Choice of antihypertensive drugs


The main benets of antihypertensive therapy are due
to lowering of BP per se.
Five major classes of antihypertensive agents thiazide
diuretics, calcium antagonists, ACE inhibitors,
angiotensin receptor antagonists and -blockers are
suitable for the initiation and maintenance of
antihypertensive treatment, alone or in combination.
-blockers, especially in combination with a thiazide
diuretic, should not be used in patients with the
metabolic syndrome or at high risk of incident
diabetes.

TERIMA KASIH
Sub Program III Semester VII
FKUA 2012
Ilmu Penyakit Dalam Nefrologi

Divisi Nefrologi & Hipertensi Lab-SMF Penyakit Dalam


FK Unair - RSU Dr. Soetomo