√ Apa Itu HIPERTENSI dan 8 Penggolongan Obat ANTIHIPERTENSI

Definisi hipertensi dan penggolongan obat hipertensi– Apa itu hipertensi, bagaimana gejala terkena hipertensi, cara mencegah agar tidak terkena hipertensi lalu bagaimana cara mengobati penyakit hipertensi, apa obat untuk menurunkan tekanan darah tinggi dan penyebab naiknya tekanan darah dalam tubuh itu merupakan berbagai pertanyaan yang sering ditanyakan oleh seseorang yang baru pertama kali menderita gejala penyakit hipertensi. Definisi hipertensi adalah suatu keadaan tubuh tanpa gejala dimana tekanan darah meningkat  secara abnormal tinggi di dalam arteri yang menyebabkan peningkatan resiko terhadap stroke, anurisma, gagal jantung, serangan jantung dan kerusakan ginjal. Penyakit hipertensi ini biasanya lebih dikenal dengan istilah penyakit tekanan darah tinggi karena ditandai dengan tekanan darah yang melebihi batas normal.
penyakit hipertensi tekanan darah tinggi
penyakit hipertensi tekanan darah tinggi

Tekanan darah dalam tubuh diatur oleh Sistem Renin-Angiotensin-Aldosteron (RAAS). Bila aliran darah dalam glomeruli berkurang, ginjal akan melepaskan renin. Dalam plasma, renin bergabung dengan protein membentuk Angiotensin I yang oleh enzim ACE (Angiotensin Converting Enzyme) dirubah menjadi Angiotensin II yang aktif, bersifat vasokontriksi dan menstimulir hormon aldosteron yang mempunyai efek retensi air dan garam, sehingga volume darah bertambah dan tekanan darah meningkat. Namun selain faktor RAAS tekanan darah juga dipengaruhi oleh faktor di bawah ini.

Faktor yang dapat mempengaruhi tekanan darah selain RAAS yaitu :
– Volume denyut jantung : makin besar volume denyut jantung, tekanan darah makin tinggi.
– Curah jantung adalah hasil kali denyut jantung dan isi kuncup jantung. Besarnya isi sekuncup ditentukan oleh kekuatan kontraksi otot jantung dan volume darah yang kembali ke jantung.
– Resistensi perifer adalah gabungan tekanan otot polos arteri dan viskositas (kekentalan) darah. Resistensi perifer dapat berkurang disebabkan berkurangnya elastisitas dinding pembuluh darah akibat adanya arteriosclerosis karena bertambahnya usia atau karena pengendapan.
– Elastisitas/ kelenturan dinding arteri : makin berkurang elastis ,tekanan darah makin tinggi.
– Pelepasan neurohormon (adrenalin dan noradrenalin) yang dirangsang oleh emosi, gelisah, stress, takut, marah, lelah dan merokok. Neurohormon bersifat vasokontriksi perifer sehingga tekana darah naik.
Ada 2 macam tekanan darah, yaitu :
1. Tekanan darah sistolik
Adalah tekanan darah yang terjadi pada saat jantung berkontraksi. Tekanan ini selalu lebih besar dari tekanan diastolik.
2. Tekanan darah diastolik
Adalah tekanan darah yang terjadi pada saat jantung berelaksasi (mengembang).
Tekanan darah dinyatakan dengan satuan mm/Hg. Apabila tekanan darah 120/80 mm/Hg, artinya tekanan darah sistolik 120 mm/Hg dan tekanan darah diastolik 80 mm/Hg. Dikatakan hipertensi bila ada peningkatan tekanan darah lebih besar dari normal yang kronis.
Klasifikasi
Sistolik (mm/Hg)
Diastolik (mm/Hg)
Normal
< 120
< 80
Normal tinggi
120 – 139
80 – 89
Hipertensi tingkat I
140 – 159
90 – 99
Hipertensi tingkat II
≥ 160
≥ 100
Gejala hipertensi pada sebagian penderita seperti gejala yang khas memang tidak ada, penderita kadang hanya merasa nyeri kepala pada pagi hari sebelum bangun tidur, tetapi setelah bangun maka rasa nyeri akan hilang gangguan hanya dapat diketahui dari pengukuran tekanan darah secara teratur, sakit kepala, terjadi perdarahan dari hidung, pusing, wajah kemerahan, mudah mengalami kelelahan yang bisa saja terjadi baik pada penderita hipertensi maupun pada seseorang yang memiliki tekanan darah yang normal.
Hipertensi berdasarkan Etiologi
Hipertensi berdasarkan etiologinya dibagi menjadi 2 ,yaitu :
a. Hipertensi Essensial atau Primer
Disebut juga hipertensi idiopatik, yaitu hipertensi yang tidak diketahui dengan jelas faktor penyebabnya. Hipertensi ini merupakan 90 % dari kasus hipertensi. Faktor yang dapat mempengaruhinya antara lain usia, jenis kelamin, merokok, menderita kolesterol berlebih, obesitas dan aktifitas renin plasma.
b. Hipertensi Sekunder
Prevalensi hipertensi ini hanya 6 – 8 % dari seluruh penderita hipertensi. Dapat disebabkan karena penyakit sebelumnya, obat yang dikonsumsi, dan lain-lain. Hipertensi yang disebabkan oleh penyakit ginjal disebut dengan hipertensi renal sedangkan yang disebabkan oleh penyakit endokrin disebut hipertensi endokrin. Sedangkan obat-obatan yang dapat menyebabkan hipertensi misalnya seperti obat hormon kontrasepsi, hormon kortikosteroid, dan anti depresan.
Prinsip pengobatan hipertensi adalah menurunkan tekanan darah, bila mungkin sampai pada tekanan normal atau pada tekanan yang tidak mengganggu fungsi ginjal, otak dan jantung. Ada dua cara pengobatan hipertensi yaitu secara terapi farmakologi (dengan obat) atau secara terapi non farmakologi (tanpa obat).  Terapi non farmakologi adalah terapi tanpa menggunakan obat-obatan, yaitu tindakan umum yang perlu dilakukan untuk hipertensi ringan antara lain :
– Menurunkan berat badan bagi yang mengalami obesitas, dengan menurunkan 1 kg berat badan dapat menurunkan tensi darah sekitar 0.5 – 0.7 mm/Hg, karena volume darah juga akan berkurang.
– Diet garam maksimum 2 gram per hari serta mengurangi konsumsi lemak termasuk daging, sebaliknya memperbanyak konsumsi makanan nabati.
– Tidak merokok, sebab kandungan nikotin dalam rokok mempunyai efek vasokontriksi dan karbondioksida dalam asap rokok dapat mengganggu pernafasan dan mengikat hemoglobin sehingga penyerapan oksigen sangat berkurang. Selain itu kandungan tar dalam asap juga bersifat karsinogen dan menyebabkan atherosklerosis.
– Mengurangi minuman berkafein seperti kopi, karena kafein dalam kopi dapat menstimulasi kontraksi jantung dan menciutkan pembuluh darah secara akut dengan akibat terjadinya gangguan ritme jantung. Kopi tubruk dapat meningkatkan kolesterol darah akibat kandungan lemak jenuh. Minum llebih dari 5 gelas kopi sehari dapat meningkatkan resiko infark 70%.
– Tidak mengkonsumsi alkohol, pada tiap 10 gram alkohol dapat meningkatkan 0.5 mm/Hg tekanan darah.
– Istirahat atau relaksasi yang cukup untuk memulihkan stamina dari kelelahan dan jantung dapat beristirahat.
– Olahraga secara teratur dan cukup, dapat merangsang saraf parasimpatis untuk lebih aktif sedangkan saraf simpatis yang mempunyai efek vasokontriksi kurang aktif . olahraga yang dapat dilakukan misal seperti jalan cepat setiap hari selama 30 menit sebanyak 3 kali dalam seminggu.
Terapi Farmakologi Pengobatan Hipertensi
Terapi farmakologi hipertensi ialah terapi menurunkan tekanan darah tinggi menggunakan obat – obatan dengan cara bertahap, ada empat tahap dalam pengobatan hipertensi, yaitu :
– Tahap pertama, dengan satu obat diuretika tiazida atau beta bloker dengan dosis kecil kemudian dosis dinaikkan
– Tahap kedua, dengan dua obat : diuretika tiazida dan alfa atau beta bloker
– Tahap ketiga, dengan tiga obat : diuretika tiazida dan beta bloker dan vasodilator (biasanya Hidralazin) atau penghambat ACE
– Tahap keempat, dengan empat obat : diuretika tiazida, beta bloker, vasodilator dan guanetidin atau penghambat ACE
penggolongan obat anti hipertensi
penggolongan obat anti hipertensi

Menurut zat khasiat farmakologinya, obat anti hipertensi menurut efek farmakologi digolongkan menjadi 8, yaitu :

1. Diuretika, lebih praktis bila diberikan dalam bentuk long acting atau dosis tunggal, misalnya diuretika tiazida. Contohnya Hidroklorotiazida, Klortalidon.
2. Alfa Bloker, vasodilatasi langsung otot polos vascular. Contohnya Prasozin dan Terazosin.
3. Beta Bloker, menurunkan curah jantung. Contohnya Atenolol.
4. Pengaruh langsung pada kontrol saraf terhadap tekanan darah, misalnya Reserpin, Guanetidin, Brisokuin, Klonidin dan Metildopa.
5. Antagonis Kalsium, misalnya Nifedipine, Verapamil dan Diltiazem.
6. Inhibitor ACE, menghambat konversi angiotensin I menjadi angiotensin II. Contohnya Kaptopril, Cilazapril, Ramipril dan Enalapril.
7. Vasodilator, melebarkan vascular. Contohnya Hidralazin, Minoksidil dan Dihidralazin.
8. Antagonis reseptor Angiotensin II, vasodilatasi langsung pada otot polos vascular. Contoh obatnya Losartan, Valsartan, Kandesartan dan Irbesartan.
Kebanyakan obat hipertensi bekerja lambat, efeknya baru terlihat setelah beberapa hari, sedangkan efek maksimal setelah beberapa minggu penggunaan. Obat-obatan dengan plasma t  antara 2 – 5 jam efek hipotensinya dapat bertahan sampai 20 jam, misalnya Reserpin, meetildopa, hidralazin, propanolol dan metoprolol. Kombinasi antara obat-obatan tersebut menghasilkan potensiasi, dengan demikian dosis dapat diturunkan dan efek samping lebih ringan. Tetapi sebaliknya kombinasi obat tidak pada titik kerja yang sama (termasuk dalam satu kelompok) karena tidak menghasilkan potensiasi.
Semua obat hipertensi dapat menimbulkan efek samping seperti hidung tersumbat (karena vasodilator mukosa hidung), mulut kering, rasa letih dan lesu, gangguan usus dan lambung (diare, mual), gangguan penglihatan dan bradikardia (terkecuali Hidralazin yang justru menyebabkan takikardia). Waktu menelan obatsebaiknya pada pagi hari setelah makan, sebab tekanan darah paling tinggi pada pagi hari. Dosis pemberian obat maupun penghentian sebaiknya secara berangsur, untuk menghindari penurunan dan kenaikan tekanan darah secara drastis.

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