REFERAT HIPERTENSI DALAM KEHAMILAN
Disusun oleh:
R.RA R.RAVI VIND NDER ERA A REDD REDDY Y
C11. C11.04 04.4 .470 708 8
RISNALDO JAYA
C11.05.0215
PERI HANDAYANI
C11 05 0007
ANDINO ZAVTRA
C11 05 0008
BAGIAN OBSTETRI DAN GINEKOLOGI GINEKOLOGI FAKULTAS KEDOKTERAN UNIVERSITAS PADJADJARAN RSU SUMEDANG BANDUNG 2!
HIPERTENSI DALAM KEHAMILAN
Penyak! "#e$!en% &a'a( ke"a('an (e$)#akan ke'anan *a%k)'a$ yan+ !e$,a& %e-e')( ke"a('an a!a) !(-)' &a'a( ke"a('an a!a) #a&a (a%a na%. /'n+an #enyak! n &!an&a &en+an "#e$!en% &an %e$n+ &%e$!a #$!en)$ e&e(a ke,an+ k(a a!a) +e,a'a +e,a'a 'an. Penyak! n %e$n+ &,)(#a &an (a%" (e$)#akan #enye-a- ke(a!an -). H#e$!en% &a'a( ke"a('an ,)+a (en,a& #enye-a- yan+ #en!n+ &a$ ke'a"$an (a! &an ke(a!an #e$na!a'. 3e(a!an -ay !e$)!a(a &%e-a-kan 'e" #a$!)% #$e(a!)$)% yan+ (e$)#akan ak-a! &a$ #enyak! "#e$!en%.
KLASIFIKASI
1. 3e"a('an yan+ (enye-a-kan "#e$!en% "#e$!en% yan+ !(-)' %e-a+a ak-a! ke"a('an &an akan "'an+ #a&a (a%a na% %e#e$! "#e$!en% !an#a #$!en)$ a!a) e&e(a #$eek'a(% &en+an a!a) !an#a #$!en)$ &an e&e(a ya!) #$eek'a(#% $n+an &an #$eek'a(#% -e$a! ek'a(% ya!) ke,an+ &%e$!a a!a) !an#a #$!en)$ &an e&e(a. 2. H#e$!en% %ea$a ke-e!)'an "#e$!en% k$n% yan+ (en&a")') ke"a('an &an (ene!a# #a&a (a%a na% 6. 3e"a('an yan+ (e(#e$-)$)k "#e$!en% "#e$!en% yan+ %)&a" !e$,a& &#e$-)$)k &en+an a&anya ke"a('an ya!) "#e$!en% yan+ &#e$-)$)k &en+an #$eek'a(#% &an ek'a(#%. 4. H#e$!en% /e%!a%na'
H#e$!en% /e%!a%na' !(-)' %e!e'a" (n++) ke 20 &an &!an&a kenakan !ekanan &a$a" $n+an !an#a (en++an++) ke"a('an. H#e$!en% n akan (en+"'an+ %e!e'a" #e$%a'nan !e!a# &a#a! -e$)'an+ #a&a ke"a('an -e$k)!.
PREEKLAMPSI
Dke!a") &en+an !(-)'nya "#e$!en% #$!en)$ &an a!a) e&e(a #a&a %e$an+ +$a*&a yan+ !a&nya n$(a'. Penyak! n !(-)' %e%)&a" (n++) ke 20 &an #a'n+ %e$n+ !(-)' #a&a #$(+$a*&a yan+ ()&a. Jka !&ak &-a! a!a) !&ak !e$#)!)% 'e" ke"a('an &a#a! (en,a& ek'a(#%. P$eek'a(#% a&a'a" #enyak! #$(+$a*&a &an ,ka !(-)' #a&a ()'!+$a*&a -a%anya &ka$enakan ak!$ ak!$ #$e&e%#%% %e#e$! "#e$!en% &a-e!e% a!a) ke"a('an +an&a.
GEJALA " GEJALA
1 H#e$!en% +e,a'a yan+ #a'n+ &a")') !(-)' a&a'a" "#e$!en% yan+ !e$,a& !-a !-a. Se-a+a -a!a% &a(-' !ekanan &a$a" 140((H+ %%!'k &an 90 ((H+ &a%!'k &an ,)+a kenakan %%!'k 60 ((H+ &an &a%!'k 15 ((H+ &a!a% !ekanan -a%anya. J'ka !ekanan &a$a" (e'e-" 200 ((H+ -a%anya &%e-a-kan "#e$!en% k$n%. 2 E&e(a !(-)'nya e&e(a &&a")') 'e" #ena(-a"an -e$a! -a&an yan+ -e$'e-"an. Pena(-a"an -e$a! : k+ %e(n++) #a&a %e$an+ yan+ "a(' &an++a# n$(a' !e!a# ,ka (ena#a 1 k+ %e(n++) a!a) 6 k+ %e-)'an ke()n+knan !(-)' #$eek'a(#% "a$)% &)$+a. 6 P$!en)$ %e$n+ &!e()kan #a&a #$eek'a(#% &ka$enakan *a%%#a%(e #e(-)'a" &a$a" +n,a' &an !(-)' %e!e'a" "#e$!en% &an e&e(a. 4 /e,a'a +e,a'a %)-,ek! Sak! ke#a'a ka$ena *a%%#a%(e a!a) e&e(a !ak Sak! )') "a! ka$ena $e+an+an %e'a#)! "a! 'e" #e$&a$a"an a!a) e&e(a a!a) %ak! ka$en #e$)-a"an #a&a 'a(-)n+ +en++)an #en+'"a!an ka$ena *a%%#a%(e e&e(a a!a) a-'a% $e!na.
P$eek'a(#% &%e-)! -e$a! ,ka 1 S%!'k (ena#a 1;0 ((H+ a!a) 'e-" a!a) &a%!'k 110 ((H+ a!a) 'e-" 2 P$!en)$ 5 +$a( a!a) 'e-" &a'a( 24 ,a( 6 O'+$ ya!) #$&)k% )$ne 400 a!a) k)$an+ &a'a( 24 ,a(
4 /an++)an %e$e-$a' < +an++)an #en+'"a!an 5 E&e(a #a$) < %an%%
ETIOLOGI
Penye-a-nya -e')( &ke!a") &en+an #a%!. =e%k#)n &e(kan #enyak! n 'e-" %e$n+ &!e()kan #a&a >an!a "a(' yan+ 1 P$(+$a*&a 2 H#e$#'a%en!%% +a(e'' anak -e%a$ ('a "&a!&&%a &an "&$#% e!a'% 6 =e(#)nya #enyak! *a%k)'a$ &a-e!e% (e''!)% &an "#e$!en% 4 =e('k $>a$ya! #$eek'a(#% a!a) ek'a(#% &a'a( ke')a$+anya
Pe'-a+a !e$ yan+ (ene$an+akan ak!$ yan+ -e$#e$an &a'a( #enyak! n a&a'a" 1 ?ak!$ ()n'+% en&k$n a!a) +ene!k "a' n &ka$enakan -a">a #enyak! n %e$n+ !e$,a& #a&a #$(+$a*&a "#e$#'a%en!%% ke"a('an &en+an n%e(na% &n$ #en)$)nan kn%en!$a% k(#'e(en C4 @an!a &en+an en!# HLA DR4 &an a&anya ak!*a% k(#'e(en ne!$' &an (ak$a+ a!a) &an!a$a ke'(#k a!a) ke')a$+a !e$!en!). 2 ?ak!$ n)!$% a&a yan+ (en+e()kakan -a">a #enyak! n -e$")-)n+an &en+an kek)$an+an ka'%)( #$!en ke'e-"an +a$a( na!$)( a!a) kek)$an+an a%a( 'e(ak ,en)" & &a'a( (akanannya. 6 ?ak!$ en&!e' !e$ n ak"$ ak"$ n -anyak &ke()kakan %e")-)n+an &en+an #e$anannya &a'a( (en+a!)$ ke%e(-an+an an!a$a ka&a$ a! *a%kn%!$k!$ !$(-k%an en&!e'n an+!en%n &an 'anB'an &an *a%&'a!$ #$%!a%k'n n!$k%&a &'' %e$!a #en+a$)"nya #a&a %%!e( #e(-ek)an &a$a". Reak% ()n'+ #e$a&an+an a!a)#)n !e$+an++)n+ ya
ke%e(-an+an $a&ka' -e-a% &an an!k%&an -anyak &a(a! %e-a+a #enye-a- !e$,a&nya *a%%#a%(e &an ke$)%akan en&!e'.
PATOGENESIS
@a'a)#)n e!'+nya -e')( ,e'a% "a(#$ %e()a a"' %e#aka ! -a">a *a%%#a%(e (e$)#akan a>a' &a$ #enyak! n Va%%#a%(e -%a (e$)#akan ak-a! &a$ ke+a+a'an n*a% !$#-'a% ke &a'a( 'a#%an !! #'% #e(-)')" &a$a" $eak% ()n'+% (a)#)n $a&ka' -e-a%. Se()a n akan (enye-a-kan !e$,a&nya ke$)%akan en&!e' yan+ %e'an,)!nya akan (en++an+++) ke%e(-an+an an!a$a *a%kn%!$k!$ &an *a%&'a!$ %e$!a +an++)an #a&a %%!e( #e(-ek)an &a$a". Va%kn%!$k% yan+ (e')a% akan (enye-a-kan !e$,a&nya #e$)-a"anB#e$)-a"an #a&a -anyak $+an < %%!e( an!a$a 'an 3a$&*a%k)'a$ 1. H#e$!en% 2. #en+)$an+an )$a" ,an!)n+ 6. !$(-%!#en 4. +an++)an #e(-ek)an &a$a" 5. #e$&a$a"an ;. DIC 7. Pen+)$an+an *')(e #'a%(a 8. Pe$(a-'!a% #e(-)')" &a$a" (enn+ka! 9. e&e(a P'a%en!a 1. Nek$%% 2. PJT 6. /a>a! ,ann 4. S')! #'a%en!a
/n,a' 1 En&!e'%% ka#'e$ +n,a' 2 Pen)$)nan k'$en% a%a( )$a! 6 Pen)$)nan /?R 4 O'+$
5 P$!en)$ ; /a+a' +n,a'
O!ak 1. E&e(a 2. "#k%a 6. ke,an+ 4. /an++)an #e(-)')" &a$a" !ak Ha! 1. /an++)an )n+% 2. Pen)$)nan ka&a$ en( 6. k!e$)% 4. E&e(a #e$&a$a"an &an $e+an+an ka#%)'a
=a!a 1. E&e(a #a#' 2. Ik%e(a 6. Pe$&a$a"an 4. A-'a% $e!na
Pa$) 1. E&e(a k%e(a &an nek$%% 2. #e$&a$a"an 6. /an++)an #e$naa%an "n++a a#ne)
DIAGNOSIS
Da+n%% &!e+akkan a#a-'a >an!a "a(' &en+an )()$ ke"a('an 20 (n++) a!a) 'e-" &!e()kan +e,a'a "#e$!en% #$!en)$ &an a!a) e&e(a. Penyak! +n,a' &an "#e$!en% e%%en%a'% "a$)% &%n+k$kan !e$'e-" &a")'). /e,a'a "#e$!en% e%%en%a'%
1. Tekanan &a$a" 200 2. Pe(-e%a$an ,an!)n+ 6. ()'!#a$!a% !e$)!a(a 60 !a")n 4. #e$na" (en&e$!a #$eek'a(#% #a&a ke"a('an yan+ 'a') 5. !&ak a&a e&e(a &an #$!en)$ ;. Pe$&a$a"an &a$ $e!na
PENGOBATAN
P$'ak%% Pa&a !n+ka! #e$()'aan #$eek'a(#% !&ak (en(-)'kan +e,a'a yan+ &a#a! &$a%akan 'e" #a%en 'e" ka$ena !) &a+n%% &n "anya &a#a! &-)a! %e'a(a PNC yan+ -ak. Pa%en "a(' %e-aknya &#e$k%a 2 ka' %e(n++) %e!e'a" -)'an ke ; &an %eka' %e(n++) %e'a(a -)'an -)'an !e$ak"$. Pa&a #e(e$k%aan ke"a('an %ea$a $)!n "a$)% &!en!)kan !ekanan &a$a" #ena(-a"an -e$a! &an a&a a!a) !&aknya e&e(a<#$!en)$. Pe$"a!an "a$)% &!),)kan #a&a >an!a yan+ (e('k ak!$ #$e&e%#%% #$eek'a(#% ya!) 1. N)'#a$a 2. R>aya! #$eek'a(#% < ek'a(#% #a&a ke')a$+a 6. /a(e'' 4. D= 5. H#e$!en% k$n% ;. ='a "&a!&%a 7. H&$#% e!a'%
Pa%en ,)+a "a$)% (en+ena' !an&a !an&a -a"aya ya!) %ak! ke#a'a +an++)an #en+'"a!an -en+kaknya !an+an a!a) ()ka. Jka %a'a" %a!) &a$ +e,a'a !(-)' "a$)% %e+e$a (e(e$k%akan & $. Den+an PNC yan+ -ak %e"a$)%nya #$eek'a(#% &a#a! &&e!ek% %e&n ()n+kn %e"n++a &a#a! (ene+a" k(#'ka% -e$)#a PE Ek'a(#% Sa(#a ke(a!an -) &an anak.
PREEKLAMPSI RINGAN
Pena!a'ak%anaan 1. Ra>a! ,a'an a. anyak %!$a"a! -. De! )k)# #$!en $en&a" ka$-"&$a! 'e(ak &an +a$a( . Se&a! $n+an en-a$-!a' a!a) &ae#a( %e'a(a 7 "a$ &. R-$an%a e. 3n!$' %e!a# (n++) 2. Ra>a! na# a. 2 (n++) #en+-a!an $a>a! ,a'an !&ak a&a ke(a,)an -. -e$a! -a&an (enn+ka! 2 k+<(n++) %e'a(a 2 ka' -e$!)$)!B!)$)! . !(-)' +e,a'aB+e,a'a #$eek'a(% -e$a!
PREEKLAMSI BERAT
T),)an #en+-a!an 1. =ene+a" !e$,a&nya ek'a(% 2. Anak "a$)% 'a"$ &ena+n ke()n+knan "&)# yan+ -e%a$ 6. Pe$%a'nan "a$)% &en+an !$a)(a yan+ %e&k!B&k!nya 4. =ene+a" "#e$!en% yan+ (ene!a#
INDIKASI PERA#ATAN AKTIF
1. I-) a. 3e"a('an 67 (n++) -. A&anya !an&aB!an&a impending eklamsi %ak! ke#a'a yan+ "e-a! #en+'"a!an ka-)$ nye$ )') "a! ke+e'%a"an &an "#e$$e'ek% . Se!e'a" ; ,a( #en+-a!an (e&%na' !e$,a& kenakan !ekanan &a$a" &. Se!e'a" 24 ,a( #en+-a!an (e&%na' !&ak a&a #e$-akan 2. Jann +a>a! ,ann &an #e$!)(-)"an ,ann !e$"a(-a! 6. La-$a!$k HELLP Syn&$(e He('y%% E'e*a!e& '*e$ en(e L> P'e!e'e! )n!
PENGOBATAN MEDISINAL
1. O-a! an!ke,an+ a. =+SO4 &en+an %ya$a! . Te$%e&a an!&!)( 3a'%)( +')kna% . ?$ek)en% #e$naa%an 1; ka'<(en! . P$&)k% )$ne 60 <,a( *. Re'ek% #a!e''a #%! =+SO4 &"en!kan a#a-'a .
A&a !an&aB!an&a n!k%ka%
.
24 ,a( #a%a#e$%a'nan
.
; ,a( #a%a#e$%a'nan !e$,a& #e$-akan
-. Dae#a(
2. O-a! an!"#e$!en% a. H&$a'ane -. 3'n&ne . Ne&#n #e$$a' 6B4 ka' 10 (+ &. =e!'&#a E!an'' La-e!'' e. O-a! an!"#e$!en% "anya &-e$kan ,ka !ekanan &a$a" %%!'k 180 ((H+ &an &a%!'k 110 ((H+ 6. LanB'an a. D)$e!k)( -'a a&a e&e(a #a$) #aya" ,an!)n+ kn+e%! e&e(a ana%a$ka -. 3a$&!nka . O-a! an!#$e!k -'a a&a &e(a( &. An!-!k -'a a&a !an&a nek% e. An!nye$ -'a #en&e$!a +e'%a" ka$ena ke%ak!an
PENGELOLAAN OBSTETRIK
Te(na% ke"a('an ka$ena 1. ke"a('an !) %en&$ 2. #$eek'a(% akan (e(-ak %e!e'a" #e$%a'nan 6. )n!)k (ene+a" !(-)'nya ke(a!an ,ann &an -)
EKLAMSI
A&a'a" ke,an+ #a&a >an!a "a(' &a'a( #e$%a'nan a!a) (a%a na% yan+ &%e$!a +e,a'aB+e,a' #$eek'a(%. D-e&akan a!a% 1. ek'a(% an!e#a$!)( !e$,a& %e-e')( #e$%a'nan 2. ek'a(% n!$a#a$!)( !e$,a& %e>ak!) #e$%a'nan 6. ek'a(% #%!#a$!)( !e$,a& %e!e'a" #e$%a'nan a. ea$'y #%!#a$!)( 24 ,a(B7 "a$ #a%a#e$%a'nan -. 'a!e #%!#a$!)( %e!e'a" 7 "a$ #a%a#e$%a'nan Tn+ka!an ke,an+ ek'a(% 1. Tn+ka! n*a% (a!a !e$#ak) ke#a'a &#a'n+kan ke %a!) #"ak ke,an+Bke,an+ "a')% !e$'"a! #a&a ()ka -e-e$a#a &e!k 2. Tn+ka! kn!$ak% !n+ka! ke,an+ !n% %e')$)" -a&an kak) ka&an+Bka&an+ !e$,a& e#%!!n)% 15B20 &e!k 6. Tn+ka! kn*)'% !n+ka! ke,an+ k'n% !e$,a& ke,an+ yan+ "'an+ !(-)' $a"an+ &an (a!a (e(-)ka (en)!)# !!B!! ()ka -e$kn!$ak% %an+a! k)a! 1 (en! 4. Tn+ka! k(a %e!e'a" ke,an+ k'n% #a%en ,a!)" &a'a( k(a -e$*a$a% &a$ -e-e$a#a (en! %a(#a -e$,a(B,a( a(ne%a $e!$+$a&
Penye-a- ke(a!an ek'a(% e&e(a #a$) a##'ek%a a%&%%. 3a&an+B ka&an+ !e$,a& ek'a(% !an#a ke,an+ &an !e$,a& #en)$)nan ke%a&a$an eclamsi sine eclamsi, !e$,a& ke$)%akan "a! yan+ -e$a!. Pa&a ek'a(% •
Tekanan &a$a" !n++ 180<110 ((H+
•
Deny)! na& k)a! &an -e$%
•
Na& ke' &an e#a!
•
De(a( yan+ !n++
•
Pe$naa%an e#a! &an -e$-)ny
•
San%%
•
P$!en)$ "a(#$ %e'a') a&a
•
E&e(a
Ek'a(% yan+ !&ak %e+e$a &%)%)' &en+an #e$%a'nan &%e-)! eclamsi intercurrent #a%en &an++a# -e')( %e(-)" (en+a'a( #e$-akan ke !n+ka! yan+ 'e-" $n+an. Se!e'a" #e$%a'nan kea&aan #a%en (e(-ak &a'a( 12B24 ,a(. P$!en)$ akan (en+"'an+ &a'a( 4B5 "a$ %e&an+kan !ekanan &a$a" akan n$(a' &a'a( >ak!) 2 (n++). T&ak ,a$an+ !e$,a& #a%en #a%aek'a(% akan (en,a& #%k!% #a&a "a$ keB2 a!a) keB6 #a%a#e$%a'nan &an &a#a! -e$'an+%)n+ %e'a(a 2B6 (n++). P$+n%% #a&a )()(nya -ak. Peny)'! 'annya a'a" "e(#'e+ &an +an++)an #en+'"a!an -)!a ka$ena e&e(a $e!na.
P$%olo&
Pa&a #en&e$!a yan+ (enn++a' ka$ena ek'a(% &a#a! &!e()kan ke'ananB ke'anan #a&a "a! +n,a' !ak #a$) &an ,an!)n+. Pa&a )()(nya akan &!e()kan !an&aB!an&a nek$%% "#e$e( a!a) %ke( #e$&a$a"an e&e(a &an !$(-%%. Pa&a #'a%en!a &a#a! &!e()kan a&anya na$kBna$k ka$ena &e+ene$a% 'a#%an !$-'a%. Pe$)-a"an 'an yan+ !e$&a#a! a'a" $e!en% a$ &an na!$)( "e(kn%en!$a% %e$!a ka&an+Bka&an+ a%&%%.
E%iolo&i
Penye-a- ek'a(% -e')( &ke!a") -ena$. O'e" ka$ena ek'a(% (e$)#akan ke'an,)!an a!a) %!a&)( ak"$ &a$ #$eek'a(% ak!$Bak!$ yan+ (e(#en+a$)" ke,a&annya %a(a %a,a &en+an #$eek'a(%.
Di$&nosis
Fn!)k (ene+akkan &a+n%% ek'a(% "a$)% &ke%a(#n+kan kea&aanBkea&aan 'an &en+an ke,an+ a&an k(a %e#e$! )$e( ke$a)nan !e!an)% e#'e#% "%!e$ en%ea'!% (enn+!% !)($ !ak #ea"nya ane)$%(a !ak &an a!$ k)nn+ ak)! &a$ "a!. Da+n%% ek'a(% yan+ !e$,a& 'e-" &a$ 24 ,a( #a%a #e$%a'nan "a$)% &)$+a. =e%k#)n &e(kan %e()a -) &a'a( ke"a('an&an (a%a na% yan+ (en+a'a( ke,an+B ke,an+ &an "#e$!en% "a$)% &an++a# %e-a+a #en&e$!a ek'a(% %a(#a !e$-)k! ke()&an -)kan ek'a(%.
P$+n%% Ek'a(% a&a'a" %)a!) kea&aan yan+ %an+a! -e$-a"aya. O'e" ka$ena !) #$+n%%nya k)$an+ -ak )n!)k -) (a)#)n anak. P$+n%% ,)+a &#en+a$)" 'e" #a$!a% &an )()$ -) a$!nya ()'!#a$a (e(#)nya #$+n%% yan+ 'e-" -)$)k !e$)!a(a ,ka )()$nya (e'e-" 65 !a")n &an ,)+a 'e" kea&aan #a%en >ak!) (a%)k $)(a" %ak!. D)$e%% ,)+a (e(#en+a$)" #$+n%%nya. Jka #$&)k% )$ne 'e-" &a$ 800 &a'a( 24 ,a( a!a) 200 !a# ,a( #$+n%%nya akan 'e-" -ak. Se-a'knya '+)$ a!a) an)$ (e$)#akan +e,a'a yan+ -)$)k. /e,a'aB+e,a'a 'an yan+ (e(-e$a!kan #$+n%% !e'a" &ke()kakan 'e" E'en ya!) 1. 3(a yan+ 'a(a 2. Na& & a!a% 120G<(en! 6. S)") & a!a% 69C 4. Ten% & a!a% 200 ((H+ 5. 3e,an+ yan+ 'e-" &a$ 10 ka' %e$an+an ;. P$!en)$ 'e-" &a$ 10 +$a( %e"a$ a!a) 'e-"
7. !&ak a&anya e&e(a
Te$a# 1. #$'ak%% B (e$)#akan )#aya #ene+a"an ek'a(% &en+an a$a (ene()kan ka%)% #$eeka'(% %e&n ()n+kn &en+an (en+&en!ka% ak!$ #$e&%#%% (ene()kan +e,a'a a>a' "#e$!en% &an #$!en)$. 2. #en+-a!an %ea$a !e$!% ek'a(% (e$)#akan #enyak! yan+ &%e-a-kan 'e" ke"a('an. O'e" ka$ena !) #en+-a!an yan+ !e$-ak a'a" %ee#a! ()n+kn (en+ak"$ ke"a('annya. T),)an #en+-a!an ek'a(% a&a'a" a. =ene+a" !(-)'nya ke,an+ %e'an,)!nya yan+ &a#a! (enye-a-kan a%k%a a%&%% $e%#$a!$ (a)#)n (e!a-'k -. =en)$)nkan < kn!$' !ekanan &a$a" &en+an %ya$a! #en)$)nan !ekanan &a$a" !&ak -'e" 'e-" &a$ 20 &a'a( 1 ,a( . =en+a!a% "e(kn%en!$a% &an (e(#e$-ak &)$e%% &en+an #e(-e$an a$an (%a'nya a$an 2A a!a) Rn+e$ Lak!a!. P$&)k% )$n !&ak -'e" k)$an+ &a$ 60 <,a( &an !ekanan *ena %en!$a' !&ak (e'e-" ;B8 ( a$. &. =en+a!a% "#k%a &an a%&%% &en+an (en+)%a"akan a+a$ #en&e$!a (e(#e$'e" k%+en e. =en+ak"$ ke"a('an !an#a (e(an&an+ )()$ ke"a('an %e!e'a" ke,an+ &a#a! & a!a%
PENGOBATAN MEDISINAL
O-a! An!ke,an+ O-a! #'"an )n!)k (en+a!a% ke,an+ #a&a ek'a(% a&a'a" %)'a% (a+ne%)( =+SO4 &en+an a$a #e(-e$an %a(a &en+an #en+-a!an #$eek'a(%.
O-a!B-a!an %)#$! O-a!B-a!an %)#$! &a#a! &-e$kan %e%)a &en+an n&ka%nya %e%)a &en+an #en+-a!an #$eek'a(%
Pe$a>a!an Se$an+an 3e,an+ &an 3(a e$%a(a &en+an -a+an %a$a #e$a>a!an #en&e$!a &'ak)kan 1. 3a(a$ "a$)% !enan+ 2. (a%)kan %)&# '&a" ke &a'a( ()')! 6. ke#a'a &$en&a"kan 4. k%a% -a&an ,an+an !e$'a') !e+an+ )n!)k (en+"n&a$ $ak!)$ 5. #a&a %!a!)% kn*)'%*)% &a#a! &-e$kan en&ae#n ?en!n Dae#a( ;. E&e(a !ak &a#a! &-e$kan (an!' 7. #e(an!a)an /CS 8. e+a" &ek)-!)% 9. #e(-e$an n)!$% -%a 'e>a! N/T
PENGOBATAN OBTETRIK
Se()a ke"a('an &en+an ek'a(% "a$)% &ak"$ !an#a (e(an&an+ )()$ ke"a('an &an kea&aan ,ann &en+an %ya$a! %)&a" !e$,a& %!a-'%a% ya!) 4B8 ,a( %e!e'a" %a'a" %a!) a!a) 'e-" &a$ kea&aanBkea&aan %e-a+a -e$k)! 1. #e(-e$an -a! ke,an+ !e$ak"$ 2. ke,an+ !e$ak"$ 6. #e(-e$an -a! an! "#e$!en% !e$ak"$ 4. #a%en ()'a %a&a$
HIPERTENSI KRONIS
H#e$!en% k$n% &a'a( ke"a('an -'a "#e$!en% %)&a" !e$,a& %e-e')( ke"a('an a!a) %e-e')( 20 (n++) ke"a('an &an "#e$!en% (ene!a# %e!e'a" #e$%a'nan. A&a -anyak ak!$ #enye-a- an!a$a 'an 1. ()'!#a$a 2. "#e$!en% e%en%a' a('a' %e-anyak 90 6. ke'anan a$!e$ 4. /'(e$)')%ne$!% ak)! &an k$n%
5. "#e$!en% -e$")-)n+an &en+an ke'anan &an ke$)%akan +n,a' ;. #enyak! ,a$n+an ka! SLE%k'e$&e$(a 7. ke+e()kan
3e(a!an #a&a -) ka$ena "#e$!en% k$n% !e$,a& ak-a! #aya" ,an!)n+ a!a) k(#'ka% %e$e-$*a%k)'a$ (a)#)n #enyak! +n,a' #$(e$. H#e$!en% k$n% &a'a( ke"a('an %e$n+ &%e$!a k(#'ka% %')% #'a%en!a #e$!)(-)"an ,ann !e$"a(-a! &an ke(a!an ,ann.
HIPERTENSI ESENSIAL
A&a'a" #enyak! "#e$!en% k$n% yan+ &%e-a-kan 'e" ke'anan *a%k)'e$ a$!e$%k'e$%%. Penyak! n !e$)!a(a #a&a >an!a )%a 'an,)! yan+ +e()k &an -a%anya &%e$!a D=. Se(akn &n ()n)'nya "#e$!en% &a'a( ke"a('an %e(akn -e$a! #enyak!nya &an %e(akn -)$)k #$+n%%nya.
P(o&nosis
Pa%en &en+an "#e$!en% e%en%a' &a#a! (e'e>a! (a%a ke"a('an ,ka !&ak &#e$-e$a! &en+an #$eek'a(% (a)#)n ek'a(%. 3ea&aan 'an yan+ (e(#e$-)$)k #$+n%%nya ya!) 1. Pe(-e%a$an ,an!)n+ 2. ?aa' +n,a' yan+ k)$an+ 6. 3e'anan #a&a $e!na 4. Ten% #e$()'aan 200<120 ((H+ 5. Jka ke"a('an %e-e')(nya a&a #$eek'a(%
Te($)i
Se()a >an!a "a(' &en+an "#e$!en% e%en%a' "a$)% (a%)k $)(a" %ak! )n!)k #en'aan &an #en+e''aan !ekanan &a$a" ,an!)n+ +n,a' &an $e!na. H#e$!en% e%en%a' yan+ (en+a'a( #$eek'a(% a!a) ek'a(% &ke''a %a(a %e#e$! #en+e''aan #$eek'a(% &an ek'a(%.
