CHAPTER 1

INTRODUCTION

1. Background

Today, about one in three American adults is considered to be obese, but

obesity is also becoming an increasing health problem globally. Obesity increases

the risk for hypertension.

In developed countries, such as in the United States is estimated to

approximately 50 million Americans have high blood pressure. Incidence of

hypertension clients continues to increase along with age and hypertension are

usually more often attacks children younger than 65 years

In countries - developing countries such as Southeast Asia, hypertension is

also an experienced health problems with a prevalence of 6.3 percent figure in

until 9.17 percent. Hypertension or high blood pressure is a cause of high

mortality and morbidity. High blood are often given the title of The Silent Killer

since hypertension is the hidden killer.

Household Health Survey (Household Health Survey) in 1995, prevalence of

hypertension in Indonesia is 8.3%. According to WHO in Jakarta prevalence of

hypertension with blood pressure of 160/90 mmHg in the year 1988, respectively

- each reached 13.6% in men, whereas in women reached 16%, in the year 1993

reached 16.5% in men, women sedankan reached 17%, and in 2000 reached 12%

in men, whereas in women reached 12.2%

Household Health Survey 1995 showed that the prevalence of hypertension or

high blood pressure in Indonesia is quite high, ie 83 per 1000 member

households. In general, more women than men suffer from hypertension. Where,

prevalence in areas outside Java is bigger than the island of Java. It is closely

related to diet, especially salt intake, which is generally higher outside Java, such

as the Batak ethnic group that tends to develop hypertension due to dietary and

Java on tribe is more likely due to problems including Psychic distress or stress.

2. Problems

Diet and health transition in Indonesia has been following the developed

countries. Many eating habits have on the adoption by the Indonesian people who

actually make things worse nutritional status. Changes in eating patterns as

1

today's modern lifestyles lead to ready to eat meal that contains fat, protein, high

salt and low-fiber food but have consequences on the development of diseases

such as obesity and hypertension.

3. Limitation of Problem

In this paper, the writer makes a limitation for what will discuss about

the relationship betweem obesity and hypertention. The limitation is about:

1. What is obesity?

2. Where does it come from?

3. What is the dangerous of it?

4. What is hypertension?

5. How we prevent hypertension?

6. How it happen in Indonesia especially in men the age above 50 in West

Jakarta in 2008?

7. What is the relationship between obesity and hypertention?

With this limitation, the writer hope that, the reader can understand

about the correlation between obesity and hypertention, and also can help we

self to prevent the hypertention.

4. Objective

The objective of this paper are because there is an important

correlation between obesity and hypertention, which people have to know.

Besides that, this paper can help the reader to aware more about obesity and

hypertention and as fast as tey can to get a preventation and an early treatment.

5. Methods of Writing

The way for the writer to complete this paper is by find information

from library literature. Writer found about the teory about both of the disease,

about what is the disease, how it will happen in our body or in another person.

Writer also find this information from book and internet, that make the

information witer’s get will complete.

2

Internet literature will also writer use for find out how this disease

happen in society especially in West Jakarta that make people know how this

disease attack our life.

6. Frame of writing

To make the reader understand this paper easily, writer make some frame of

writing like this:

CHAPTER 1 INTRODUCTION

1. Background

2. Problems

3. Limitation of problem

4. Objectives

5. Methods of writing

6. Frame of writing

CHAPTER II DISCUSSION I

1. The theory about obesity

2. How it happen in men above 50 in West Jakarta,

2008

CHAPTER III DISCUSSION II

1. The theory about hypertension

2. How it happen in men above 50 in West Jakarta,

2008

CHAPTER IV THE CORRELATION BETWEEN OBESITY AND

HYPERTENSION IN MEN ABOVE 50 IN WEST JAKARTA, 2008

CHAPTER V CONCLUSION

CHAPTER VI REFERENS

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CHAPTER II

DISCUSSION I

1. The theory of obesity

A. Definition

The definition of obesity varies depending on what one reads, but in general, it

is a chronic condition defined by an excess amount body fat. A certain amount of

body fat is necessary for storing energy, heat insulation, shock absorption, and

other functions. 1

Obesity is more than just a cosmetic concern, though. It increases risk factor of

diseases and health problems such as diabetes and high blood pressure

(hypertention). 2

The normal amount of body fat (expressed as percentage of body fat) is

between 25%-30% in women and 18%-23% in men. Women with over 30% body

fat and men with over 25% body fat are considered obese. 1

The calculation of body mass index (BMI) has also been used in the definition

of obesity. Body mass index (BMI) is a simple index of weight-for-height that is

commonly used in classifying overweight and obesity in adult populations and

individuals. It is defined as the weight in kilograms divided by the square of the

height in meters (kg/m2). 3

BMI provides the most useful population-level measure of overweight and

obesity as it is the same for both sexes and for all ages of adults. However, it

should be considered as a rough guide because it may not correspond to the same

degree of fatness in different individuals.

The World Health Organization (WHO) defines "overweight" as a BMI equal

to or more than 25, and "obesity" as a BMI equal to or more than 30. These cut-

off points provide a benchmark for individual assessment, but there is evidence

that risk of chronic disease in populations increases progressively from a BMI. 3

4

See the following table for an example. 4

Extreme obesity, also called severe obesity or morbid obesity, occurs when you

have a BMI of 40 or more. With morbid obesity, you are especially likely to have

serious health problems. 2

B. Etiology

The balance between calorie intake and energy expenditure determines a person's

weight. If a person eats more calories than he or she burns (metabolizes), the

person gains weight (the body will store the excess energy as fat). If a person eats

fewer calories than he or she metabolizes, he or she will lose weight. Therefore

the most common causes of obesity are overeating and physical inactivity. At

present, we know that there are many factors that contribute to obesity, some of

which have a genetic component:

Genetics

A person is more likely to develop obesity if one or both parents are obese.

Genetics also affect hormones involved in fat regulation. For example, one

genetic cause of obesity is leptin deficiency. Leptin is a hormone produced in

fat cells, and also in the placenta. Leptin controls weight by signaling the brain

to eat less when body fat stores are too high. If, for some reason the body cannot

produce enough leptin, or leptin cannot signal the brain to eat less, this control

is lost, and obesity occurs. The role of leptin replacement as a treatment for

obesity is currently being explored. 2

A diet high in simple carbohydrates

The role of carbohydrates in weight gain is not clear. Carbohydrates increase

5

Height Weight Range BMI Considered

5' 9"

124 lbs or less Below 18.5 Underweight

125 lbs to 168 lbs 18.5 to 24.9 Healthy weight

169 lbs to 202 lbs 25.0 to 29.9 Overweight

203 lbs or more 30 or higher Obese

blood glucose levels, which in turn stimulate insulin release by the pancreas,

and insulin promotes the growth of fat tissue and can cause weight gain. Some

scientists believe that simple carbohydrates (sugars, fructose, desserts, soft

drinks, beer, wine, etc.) contribute to weight gain because they are more rapidly

absorbed into the blood-stream than complex carbohydrates (pasta, brown rice,

grains, vegetables, raw fruits, etc.) and thus cause a more pronounced insulin

release after meals than complex carbohydrates. This higher insulin release,

some scientists believe, contributes to weight gain.

Frequency of eating

The relationship between frequency of eating (how often you eat) and weight

is somewhat controversial. There are many reports of overweight people eating

less often than people with normal weight.

Slow metabolism

Women have less muscle than men. Muscle burns (metabolizes) more calories

than other tissue (which includes fat). As a result, women have a slower

metabolism than men, and hence, have a tendency to put on more weight than

men, and weight loss is more difficult for women.

Physical inactivity and Leading a sedentary lifestyle

Physical activity has an effect on how your hormones work, and hormones

have an effect on how your body deals with food. Several studies have shown

that physical activity has a beneficial effect on your insulin levels - keeping

them stable. Unstable insulin levels are closely associated with weight gain. 5

Medications

Medications associated with weight gain include certain antidepressants, anti-

convulsants [medications used in controlling seizures], diabetes medications.

Weight gain may also be seen with some high blood pressure medications and

antihistamines.1

• Psychological factors

For some people, emotions influence eating habits. Many people eat

excessively in response to emotions such as boredom, sadness, stress or anger.

While most overweight people have no more psychological disturbances than

normal weight people, about 30 percent of the people who seek treatment for

serious weight problems have difficulties with binge eating. 1

6

Diseases

Obesity can sometimes be traced to a medical cause, such as Prader-Willi

syndrome, Cushing's syndrome, polycystic ovary syndrome, and other diseases

and conditions. Some medical problems, such as arthritis, can lead to decreased

activity, which may result in weight gain. A low metabolism is unlikely to cause

obesity, as is having low thyroid function. 2

Not sleeping enough

If you do not sleep enough your risk of becoming obese doubles, according to

research carried out at Warwick Medical School at the University of Warwick.

The risk applies to both adults and children. If you do not sleep enough you

produce Ghrelin, a hormone that stimulates appetite. Lack of sleep also results in

your body producing less Leptin, a hormone that suppresses appetite. 5

Lower rates of smoking (smoking suppresses appetite)5

Pregnancy

During pregnancy a woman's weight necessarily increases. Some women find

this weight difficult to lose after the baby is born. This weight gain may contribute

to the development of obesity in women. 2

Environment

Our environment doesn't support healthy lifestyle habits; in fact, it encourages

obesity. 6

• Age

As you get older, you tend to lose muscle, especially if you're less active.

Muscle loss can slow down the rate at which your body burns calories. If you

don't reduce your calorie intake as you get older, you may gain weight.

Midlife weight gain in women is mainly due to aging and lifestyle, but

menopause also plays a role. Many women gain around 5 pounds during

menopause and have more fat around the waist than they did before. 6

• Ethnicity.

Ethnicity factors may influence the age of onset and the rapidity of weight

gain. African American women and Hispanic women tend to experience weight

7

gain earlier in life than Caucasians and Asians. Hispanic men tend to develop

obesity earlier than African American and Caucasian men.

• Childhood weight.

A person's weight during childhood, the teenage years, and early adulthood

may also influence the development of adult obesity. For example:

- Being mildly overweight in the early 20's was linked to a substantial

incidence of obesity by age 35.

- Being overweight during older childhood is highly predictive of adult

obesity, especially if a parent is also obese.

- Being overweight during the teenage years is even a greater predictor of

adult obesity.

C. Symptom

Symptoms associated with obesity can include:

• Difficulty sleeping

• Snoring

• Sleep apnea

• Pain in your back or joints

• Excessive sweating

• Always feeling hot

• Rashes or infection in folds of your skin

• Feeling out of breath with minor exertion

• Daytime sleepiness or fatigue

• Depression 2

D. Risk 6

Being overweight or obese isn't a cosmetic problem. It greatly raises the risk in

adults for many diseases and conditions.

8

Coronary Heart Disease

Coronary heart disease (CHD) is a condition in which a substance called

plaque (plak) builds up inside the coronary arteries. These arteries supply

oxygen-rich blood to your heart. Plaque is made up of fat, cholesterol, calcium,

and other substances found in the blood. As your body mass index (BMI)

increases, so does your risk of having CHD and a heart attack. Obesity also can

lead to heart failure.

Heart attack

A prospective study found that the risk of developing coronary artery disease

increased three to four times in women who had a BMI greater than 29. A Finnish

study showed that for every one kilogram (2.2 pounds) increase in body weight,

the risk of death from coronary artery disease increased by one percent. In

patients who have already had a heart attack, obesity is associated with an

increased likelihood of a second heart attack.

High Blood Pressure

Blood pressure is the force of blood pushing against the walls of the arteries as

the heart pumps out blood. If this pressure rises and stays high over time, it can

damage the body in many ways. Your chances of having high blood pressure are

greater if you're overweight or obese.

Stroke

Being overweight or obese can lead to a buildup of plaque in your arteries.

The risk of having a stroke rises as BMI increases.

Insulin Resistance

Insulin is necessary for the transport of blood glucose (sugar) into the cells of

muscle and fat (which is then used for energy). By transporting glucose into cells,

insulin keeps the blood glucose levels in the normal range. Insulin resistance (IR)

is the condition whereby the effectiveness of insulin in transporting glucose

(sugar) into cells is diminished. Fat cells are more insulin resistant than muscle

cells; therefore, one important cause of insulin resistance is obesity. The pancreas

initially responds to insulin resistance by producing more insulin. As long as the

pancreas can produce enough insulin to overcome this resistance, blood glucose

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levels remain normal. This insulin resistance state (characterized by normal blood

glucose levels and high insulin levels) can last for years. Once the pancreas can

no longer keep up with producing high levels of insulin, blood glucose levels

begin to rise, resulting in type 2 diabetes, thus insulin resistance is a pre-diabetes

condition. In fact scientists now believe that the atherosclerosis (hardening of the

arteries) associated with diabetes likely develops during this insulin resistance

period.

Type 2 Diabetes

Diabetes is a leading cause of early death, CHD, stroke, kidney disease, and

blindness. Most people who have type 2 diabetes are overweight.

Abnormal Blood Fats

If you're overweight or obese, you're at increased risk of having abnormal

levels of blood fats. These include high levels of triglycerides and LDL ("bad")

cholesterol and low levels of HDL ("good") cholesterol.

Cancer

While not conclusively proven, some observational studies have linked obesity

to cancer of the colon in men and women, cancer of the rectum and prostate in

men, and cancer of the gallbladder and uterus in women. Obesity may also be

associated with breast cancer, particularly in postmenopausal women. Fat tissue

is important in the production of estrogen, and prolonged exposure to high levels

of estrogen increases the risk of breast cancer.

Osteoarthritis

Osteoarthritis is a common joint problem of the knees, hips, and lower back.

The condition occurs if the tissue that protects the joints wears away. Extra

weight can put more pressure and wear on joints, causing pain.

Sleep Apnea

Reproductive Problems

Obesity can cause menstrual irregularity and infertility in women.

Gallstones

Gallstones are hard pieces of stone-like material that form in the gallbladder.

10

They're mostly made of cholesterol. Gallstones can cause abdominal or back

pain. People who are overweight or obese are at increased risk of having

gallstones. Also, being overweight may result in an enlarged gallbladder that

doesn't work right.

Respiratory problems 5

Obesity can also cause respiratory problems. Breathing is difficult as the lungs

are decreased in size and the chest wall becomes very heavy and difficult to lift.

E. Diagnosis

The most common way to find out whether you're overweight or obese is to

figure out your body mass index (BMI). BMI is an estimate of body fat, and it's a

good gauge of your risk for diseases that occur with more body fat. The higher

your BMI, the higher your risk of disease.

Body Mass Index for Adults 6

Use this table to learn your BMI. First, find your height on the far left column.

Next, move across the row to find your weight. Weight is measured with

underwear but no shoes.

Once you've found your weight, move to the very top of that column. This

number is your BMI.

Height 21 22 23 24 25 26 27 28 29 30 31

4'10" 100 105 110 115 119 124 129 134 138 143 148

5'0" 107 112 118 123 128 133 138 143 148 153 158

5'1" 111 116 122 127 132 137 143 148 153 158 164

5'3" 118 124 130 135 141 146 152 158 163 169 175

5'5" 126 132 138 144 150 156 162 168 174 180 186

5'7" 134 140 146 153 159 166 172 178 185 191 198

5'9" 142 149 155 162 169 176 182 189 196 203 209

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5'11" 150 157 165 172 179 186 193 200 208 215 222

6'1" 159 166 174 182 189 197 204 212 219 227 235

6'3" 168 176 184 192 200 208 216 224 232 240 248

Waist Circumference 6

If you have abdominal obesity and most of your fat is around your waist rather

than at your hips, you're at increased risk for coronary heart disease and type 2

diabetes. This risk goes up with a waist size that's greater than 35 inches for

women or greater than 40 inches for men.

A general physical exam 2

This includes measuring your height, checking vital signs, such as heart rate,

blood pressure and temperature, listening to your heart and lungs, and examining

your abdomen.

Laboratory tests 2

They may include a complete blood count (CBC), a check of cholesterol and

other blood fats, liver function tests, fasting glucose, a thyroid test, and others

depending on your health situation.

F. Therapy and treatment

Successful weight-loss treatments include setting goals and making lifestyle

changes, such as eating fewer calories and doing physical activity regularly.

Set Realistic Goals 6

Setting realistic weight-loss goals is an important first step to losing and

maintaining weight.

Lifestyle Changes 6

• Focus on balancing energy IN (calories from food and drinks) and energy

12

OUT (physical activity)

• Follow a healthy eating plan

• Learn how to adopt healthy lifestyle habits

Dietary changes 6

• Reducing your calorie intake.

• Feeling full on less.

• Adopting a healthy eating plan, such as the Mayo Clinic Healthy Weight

Pyramid.

• Following a very low calorie liquid diet if medically recommended.

Increases Exercise and activity

Behavior change

Prescription weight-loss medications

Weight-loss surgery 2

The surgery is usually for men who are at least 100 pounds overweight and

women who are at least 80 pounds overweight. Type of weigh-loss surgery is

as follows:

• Gastric bypass surgery.

• Laparoscopic adjustable gastric banding (LAGB).

• Biliopancreatic diversion with duodenal switch.

G. Prevention 2

Whether you're at risk of becoming obese, currently overweight or at a healthy

weight, you can take steps to prevent unhealthy weight gain and related health

problems. Not surprisingly, the steps to prevent weight gain are the same as the

steps to lose weight: daily exercise, a healthy diet, a long-term commitment to

watch what you eat and drink.

• Exercise regularly.

One of the most important things you can do to prevent weight gain is to

13

exercise regularly. According to the American College of Sports Medicine, you

need to get 150 to 250 minutes of moderate-intensity activity per week to prevent

weight gain. Moderately intense physical activities include fast walking and

swimming.

• Eat healthy meals and snacks.

Focus on low-calorie, nutrient-dense foods, such as fruits, vegetables and

whole grains. Avoid saturated fat and limit sweets and alcohol. Remember that no

one food offers all the nutrients you need. Choose a variety of foods throughout

the day. You can still enjoy small amounts of high-fat, high-calorie foods as an

infrequent treat. Just be sure to choose foods that promote a healthy weight and

good health more often than you choose foods that don't.

• Know and avoid the food traps that cause you to eat.

Identify situations that trigger out-of-control eating. Try keeping a journal and

write down what you eat, how much you eat, when you eat, how you're feeling

and how hungry you are. After a while, you should see patterns emerge. You can

plan ahead and develop strategies for handling these types of situations and stay

in control of your eating behaviors.

• Monitor your weight regularly.

People who weigh themselves at least once a week are more successful in

keeping off excess pounds. Monitoring your weight can tell you whether your

efforts are working and can help you detect small weight gains before they

become big problems.

• Be consistent.

Sticking to your healthy-weight plan during the week, on the weekends, and

amidst vacation and holidays as much as possible increases your chances of long-

term success.

If you really want to prevent weight gain, the best approach is to focus on an

14

active lifestyle that includes an eating plan that's enjoyable, yet healthy and low

in calories.

2. How it happen in men the age above 50 in West Jakarta 2008

Evidence is now emerging to suggest that the prevalence of overweight and

obesity is already a massive global pattern including Indonesia, and increasing

worldwide at an alarming rate. Indonesia has limited information for overweight of

all age groups. The first national survey was in 2008 colleted data on BMI of adult

male and female in urban areas (27 cities), this is included west Jakarta. It was found

that the rate of overweight (BMI >251) among adult male (above 50) was 14.9%

while adult female was 24.0%. The problem of overweight was also found higher

among the older age group. The overweight problem in rural areas was estimated

based on NSS-HKI data in 1999 to 2001 only for adult female. The same pattern as

in urban areas was observed, however, the magnitude of problem was lower than

their counterpart in rural areas.

Over-nutrition is a significant risk factor for a range of serious non-

communicable diseases, e.g cardiovascular disease (CVD), hypertension and stroke,

diabetes mellitus, various forms of cancer, and other gastrointestinal and liver

diseases, and other serious health problems.

National survey on morbidity for the non-communicable diseases has never been

conducted; however, the national health and household survey 1990 to 2008 estimated

the specific mortality rate of non-communicable disease increase from 15.41% (1980)

to 48.53% (2001). The proportion of death because of CVD increased from 9.1%

(1986) to 26.3% (2001); Ishaemic heart disease from 2.5% (1986) to 14.9% (2001);

stroke from 5.5% (1986) to 11.5% (2001) and cancer from 3.4% (1986) to 6% (2001).

15

CHAPTER III

DISCUSSION II

1. The theory of hypertention

A. Definition

Blood pressure numbers include systolic and diastolic pressures. Systolic blood

pressure is the pressure when the heart beats while pumping blood. Diastolic blood

pressure is the pressure when the heart is at rest between beats. Blood pressure

numbers written with the systolic number above or before the diastolic, such as

120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure

blood pressure.) 7

Blood pressure is determined by the amount of blood the heart pumps and the

amount of resistance to blood flow in the arteries. Heart blood pump and the more

narrow the arteries, can cause high blood pressure. High blood pressure typically

develops over many years, and eventually affect almost everyone. 8

Blood pressure based on the Seventh Report of the Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) is

as follows: 9

Category of Blood Pressure (BP) *

Category SBP mmHg DBP mmHg

Normal < 120 < 80

Prehypertension 120-139 80-89

Hypertension, Stage 1 140-159 90-99

Hypertension, Stage 2 160 100

See Blood Pressure Measurement Techniques (reverse side)

Key: SBP = systolic blood pressure

DBP = diastolic blood pressure

16

B. Etiology

There are two type of high blood pressure:

Primary (essential) hypertension

In 90 to 95 percent of high blood pressure cases in adults, there's no

identifiable cause. This type of high blood pressure, called essential hypertension

or primary hypertension, tends to develop gradually over many years.

Secondary hypertension

The other 5 to 10 percent of high blood pressure cases are caused by an

underlying condition. This type of high blood pressure, called secondary

hypertension, tends to appear suddenly and cause higher blood pressure than does

primary hypertension. Various conditions and medications can lead to secondary

hypertension, including: Kidney abnormalities, Tumors of the adrenal gland,

Certain congenital heart defects, Certain medications, such as birth control pills,

cold remedies, decongestants, over-the-counter pain relievers and some

prescription drugs, and Illegal drugs, such as cocaine and amphetamines. 10

C. Symptom

Most of the time, there are no symptoms. Symptoms that may occur include:

Chest pain

Confusion

Ear noise or buzzing

Irregular heartbeat

Nosebleed

Tiredness

Vision changes 11

D. Risk Factors

17

High blood pressure has many risk factors. High blood pressure risk factors include:

Age

Through early middle age, high blood pressure is more common in men.

Women are more likely to develop high blood pressure after menopause.

Race.

High blood pressure is particularly common among blacks, often

developing at an earlier age than it does in whites. Serious complications,

such as stroke and heart attack, also are more common in blacks.

Family history.

High blood pressure tends to run in families.

Being overweight or obese.

The more you weigh, the more blood you need to supply oxygen and

nutrients to your tissues. As the volume of blood circulated through your

blood vessels increases, so does the pressure on your artery walls.

Not being physically active.

People who are inactive tend to have higher heart rates. The higher your

heart rate, the harder your heart must work with each contraction — and

the stronger the force on your arteries. Lack of physical activity also

increases the risk of being overweight.

Using tobacco.

Not only does smoking tobacco immediately raise your blood pressure

temporarily, but the chemicals in tobacco can damage the lining of your

artery walls. This can cause your arteries to narrow, increasing your blood

pressure.

Too much salt (sodium) in your diet.

Too much sodium in your diet can cause your body to retain fluid, which

increases blood pressure.

Too little potassium in your diet.

Potassium helps balance the amount of sodium in your cells. If you don't

consume or retain enough potassium, you may accumulate too much

sodium in your blood.

Too little vitamin D in your diet.

It's uncertain if having too little vitamin D in your diet can lead to high

18

blood pressure. Researchers think vitamin D may affect an enzyme

produced by your kidneys that affects your blood pressure. More studies

are necessary to determine vitamin D's role in blood pressure.

Drinking too much alcohol.

Over time, heavy drinking can damage your heart. Having more than two

or three drinks in a sitting can also temporarily raise your blood pressure,

as it may cause your body to release hormones that increase your blood

flow and heart rate.

Stress.

High levels of stress can lead to a temporary, but dramatic, increase in

blood pressure.

Certain chronic conditions.

Certain chronic conditions also may increase a risk of high blood pressure,

including high cholesterol, diabetes, kidney disease and sleep apnea.

E. Complications

The excessive pressure on your artery walls caused by high blood pressure can

damage your blood vessels, as well as organs in your body. The higher your blood

pressure and the longer it goes uncontrolled, the greater the damage. Uncontrolled

high blood pressure can lead to:

• Damage arteries.

This can result in hardening and thickening of the arteries (atherosclerosis),

which can lead to a heart attack, stroke or other complications.

• Aneurysm.

Increased blood pressure can cause blood vessels to weaken and bulge,

forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

• Heart failure.

To pump blood against the higher pressure in a vessels, a heart muscle

thickens. Eventually, the thickened muscle may have a hard time pumping

enough blood to meet body's needs, which can lead to heart failure.

• A blocked or ruptured blood vessel in your brain.

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High blood pressure in the arteries leading to brain can either slow the blood

flow to brain or cause a blood vessel in brain to burst, causing a stroke.

• Thickened, narrowed or torn blood vessels in the eyes.

• Metabolic syndrome.

This syndrome is a cluster of disorders of your body's metabolism —

including increased waist circumference, high triglycerides, low high-density

lipoprotein (HDL), or "good," cholesterol, high blood pressure, and high

insulin levels. If you have high blood pressure, you're more likely to have

other components of metabolic syndrome. The more components you have,

the greater your risk of developing diabetes, heart disease or stroke.10

F. Diagnosis

The most common way to find out whether you're hypertension is to figure

out your blood pressure. The higher blood pressure, the higher your risk of

disease.

G. Treatment

High blood pressure (HBP) is treated with lifestyle changes and medicines.

Goals of Treatment

The treatment goal for most adults is to get and keep blood pressure below

140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal

is to get and keep blood pressure below 130/80 mmHg.

Lifestyle Changes

Healthy habits can help you control HBP. Healthy habits include: Following a

healthy eating plan, Doing enough physical activity, Maintaining a healthy

weight, Quitting smoking, and Managing your stress and learning to cope with

stress.

Medicines

Blood pressure medicines work in different ways to lower blood pressure.

Some remove extra fluid and salt from the body to lower blood pressure. Others

20

slow down the heartbeat or relax and widen blood vessels. Often, two or more

medicines work better than one.

Several types of antihypertensive drugs are: Diuretics, Beta Blockers, ACE

Inhibitors, Angiotensin II Receptor Blockers, Calcium Channel Blockers, Alpha

Blockers, Alpha-Beta Blockers, Nervous System Inhibitors, and Vasodilators. 10

H. Prevention

Adults over 18 should have their blood pressure checked routinely. Lifestyle

changes may help control your blood pressure:

Lose weight if you are overweight. Excess weight adds to strain on the

heart. In some cases, weight loss may be the only treatment needed.

Exercise regularly. If possible, exercise for 30 minutes on most days.

Eat a diet rich in fruits, vegetables, and low-fat dairy products while

reducing total and saturated fat intake (the DASH diet is one way of

achieving this kind of dietary plan).

Avoid smoking.

If you have diabetes, keep your blood sugar under control.

Do not consume more than 1 or 2 alcoholic drinks per day.

Try to manage your stress. 11

2. How it happen in men the age above 50 in West Jakarta 2008

Household Health Survey (SKRT) 1972, 1986, 1992, and 2008 showed an

increased prevalence of cardiovascular disease as the cause of death and blatant

since 2009 alleged as the number one cause of death. These diseases arise due to

various risk factors such as smoking, hypertension, disiplidemia, diabetes

mellitus, obesity, old age and family history. From the above risk factors are very

closely related to nutrition are hypertension, obesity, displidemia, and diabetes

mellitus. 17 Of Household Health Survey (Household Health Survey) in 2008,

the prevalence of hypertension in Indonesia is 8.3%.

Survey of risk factors for cardiovascular disease (PKV) by the WHO project in

West Jakarta, showed prevalence of hypertension with blood pressure 160 / 90

respectively in men abouve 50 is 13.6% (1988), 16.5% (1993), 18,3 % (2000) and

21

21.1 % (2008). In women above 50, the prevalence reached 16% (1988), 17%

method (1993), 12.2% (2000), and 16.8% (2008). In general, the prevalence of

hypertension in more than 50 years of age ranged between 15% -20%. 12

CHAPTER IV

THE CORELATION BETWEEN OBESITY AND HYPERTENSI IN MEN

ABOVE 50 IN WEST JAKARTA IN 2008

lifestyle changes is a factor influencing the occurrence of obesity and

hypertension. As we know, West Jakarta is a metropolitan area and have a large

population. Socioeconomic status, education, health, governance, employment,

transportation access, and information is good enough. But along with these

developments, the level of competition increased and the possibility of life impact on

the emergence of different shift in lifestyle, ranging from diet, physical activity, and

stress. This shift in lifestyle has a great opportunity to cause a variety of health

problems, especially obesity and hypertension.

Habits of life or one person's life style is determined by culture and beliefs in a

region (prohibition to eat, the myths about the food, the provision of food, food

preferences and the kind of basic livelihoods of the population) An area or region

sometimes have problems unique nutritional and health, is associated with a lifestyle

that is applied in the region. Given the large prevalence of hypertension in the

district / city, which almost reached 50% of the total population, the need for further

attention and treatment. What risk factors may be preventive (protective factor) and

trigger (trigger factor) in the area of hypertension, is associated with lifestyle and

nutritional status.

With the significant rise in obesity in this last decade comes a corresponding

increase in the prevalence of hypertension.  Almost 29 percent of the population is

hypertensive (having a blood pressure (BP) greater than 140/90 mmHg or using

hypertensive medications).  The relationship between obesity and BP appears to be

linear and exists throughout the non-obese range. But the strength of the association

of obesity with hypertension varies among different racial and ethnic groups.

Generally, risk estimates suggest that approximately 75 and 65 percent of the cases of

22

hypertension in men and women, respectively, are directly attributable to an

overweight condition and obesity.

It is important to recognize that long-duration obesity does not appear

necessary to elevate BP, as demonstrated by obesity in children without a condition of

hypertension. Therefore, rather than a special case, obesity hypertension should be

considered the most common form of hypertension due to unknown reasons.

Many but not all studies suggest that abdominal adiposity or “beer gut” is

more closely associated with high blood pressure rather than overall obesity.  Obese

individuals with elevated intra-abdominal (visceral) fat demonstrate a clustering of

coronary heart disease risk factors (i.e., the Metabolic Syndrome). Heretofore,

medical researchers believed the accumulation of visceral fat is the central feature of

this syndrome. However, recent evidence favors a role for ectopic or inappropriate fat

storage as a cause of the metabolic syndrome. In this regard, both the accumulation of

visceral fat and ectopic fat storage in a number of tissues and organs may be

important in the cause and consequences of obesity hypertension.

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CHAPTER V

CONCLUSION

Obesity is a chronic condition defined by an excess amount body fat, The normal

amount of body fat (expressed as percentage of body fat) is between 25%-30% in

women and 18%-23% in men. Women with over 30% body fat and men with over

25% body fat are considered obese. 1

The calculation of body mass index (BMI) has also been used in the definition of

obesity. Body mass index (BMI) is a simple index of weight-for-height that is

commonly used in classifying overweight and obesity in adult populations and

individuals. It is defined as the weight in kilograms divided by the square of the

height in meters (kg/m2). 3

The World Health Organization (WHO) defines "overweight" as a BMI equal to or

more than 25, and "obesity" as a BMI equal to or more than 30. These cut-off points

provide a benchmark for individual assessment, but there is evidence that risk of

chronic disease in populations increases progressively from a BMI. 3

Being overweight or obese isn't a cosmetic problem. It greatly raises the risk in

adults for many diseases and conditions, which one is hypertension/high blood

pressure. Blood pressure is the force of blood pushing against the walls of the arteries

as the heart pumps out blood. If this pressure rises and stays high over time, it can

damage the body in many ways. Through early middle age, high blood pressure is

more common in men. Women are more likely to develop high blood pressure after

menopause.

The continuing problem of weight gain and obesity in the West Jakarta shows no

sign of abating. With obesity a major cause of hypertension, and associated illnesses,

there is growing support that sympathetic nervous system activation and renin-

angiotensin-aldosterone system activation have an important role in the cause of

obesity hypertension.

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Today’s experts also believe that the enlarged abdomen, resulting from visceral fat,

has a role in the activation of these systems, thereby increasing the risk for the

development of hypertension. The abnormal deposition of fat may also contribute to

the BP raising effect of weight gain and the accompanying cardiac, vascular, and

renal dysfunction.

This comprehensive review reveals that there is much we do know about the

association between high blood pressure and obesity. But the most effective

treatment for obesity hypertension remains the tried and true method that leads to

weight loss and other lifestyle modification.

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CHAPTER VI

REFERENS

1. Jerry R. Balentine, DO. FACEP and Ruchi Mathur, MD. Obesity. Available

at:http://www.medicinenet.com/obesity_weight_loss/article.htm.accessed 20 June

2010.

2. Mayo clinic staff. Obesity (updated 09 March 2009). Available at:

http://www.mayoclinic.com/health/obesity/DS00314. Accessed: 20 June 2010.

3. WHO. Obesity and overweight ( updated September 2006). Available at:

http://www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed: 23 June

2010.

4. CDC Staff. Overweight and Obesity (updated June 21, 2010). Available at:

http://www.cdc.gov/obesity/defining.html. Accessed: 23 June 2010

5. Anonymous. What is Obesity. Available at:

http://www.medicalnewstoday.com/info/obesity/what-is-obesity.php. Accessed: 23

June 2010.

6. Overweight and Obesity. Available at:

http://www.nhlbi.nih.gov/health/dci/Diseases/obe/obe_causes.html. Accessed: 23

June 2010

7. Sherwood L. Pembuluh Darah dan Tekanan Darah. In: Santoso BI, editor. Fisiologi

Manusia dari Sel ke Sistem. 2 ed. Jakarta: Penerbit Buku Kedokteran EGC; 2001.

p. 297-344

8. Price SA, Wilson LM. In: Pendit BU, editors. Gangguan system kardiovaskular.

Patofisiologi vol 2 6th ed. Jakarta: EGC.p.582-5

9. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Guidelines

hypertension ( May 2003). Available at:

http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf. Accessed: 16 June

2010

26

10. High blood pressure/hypertension (updated Aug. 7, 2008). Available at:

http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=ca

uses. Accessed: 25 June 2010

11. Steven Kang. Hypertension (updated 4/23/2009). Available at:

http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm. Accessed: 25 June

2010

12. Prevalence of hypertension . Available at: www.depkes.go.id. Accessed: 19

June 2010

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