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Yusak Alfrets Porotuo
Respon tekanan darah pasien hipertensi ras Melanesia dan ras non Melanesia dengan pemberian penyekat enzim angiotensin = Blood pressure response in hypertensive patients Melanesian race and non Melanesian race with angiotensin converting enzyme inhibitors
"ABSTRAK
Latar belakang. Hipertensi merupakan salah satu kondisi yang paling banyak
ditemukan pada pelayanan kesehatan primer yang dapat meningkatkan mortalitas dan
morbidita apabila tidak mendapatkan pengobatan yang tepat. Beberapa penelitian
menunjukkan respon penurunan tekanandarah pada ras kulit hitam berbeda dibanding
ras kulit putih dengan antihipertensi golongan penyekat EKA, hal ini ditunjang
dengan perbedaan PRA pada kedua kelompok ras ini. Belum terdapat data tentang
respon tekanan darah pasien hipertensi ras melanesiadengan pemberian penyekat
EKA yang ditunjang dengan pemeriksaan kadar PRA pada kelompok ras ini.
Objektif. Menilai apakah terdapat perbedaan respon terapi terhadap penyekat enzim
konversi angiotensin (EKA) pada pasien hipertensi ras melanesia dan ras non
melanesia.
Metode. Penelitian ini adalah penelitian kohort prospektif yangdilakukan di kota
Jayapura bulan September-November 2015terhadap 85 subyek usia 30 sampai 55
tahun dengan hipertensi yang belum pernah diobati sebelumnya. Subyek terbagi atas
2 grup yaitu ras Melanesia (n=34) dan ras Non Melanesia(n=51). Kedua grup tersebut
diberikan lisinopril dosis awal 5 mg. Pemeriksaan tekanan darah dilakukan pada awal
dan diulangi setiap 7 hari selama 4 minggu berturut-turut.
Hasil. Terdapat perbedaan respon tekanan darah pasien hipertensi ras Melanesia dan
ras Non Melanesia. Perbedaan tekanan darah sistolik sebesar 24,5 ± 9,4 mmHg pada
subyek ras Melanesia dan pada subyek Non Melanesia sebesar 34,5 ± 13,5 mmHg
(p<0,001). Perbedaan tekanan darah diastolik subyek ras Melanesia sebesar 13,3±5,5
mmHg dan pada subyek Non Melanesia sebesar 22,6±9,3 mmHg (p<0,001).
Perbedaan tekanan rerata arteri pada subyek ras Melanesia sebesar 17,1±5,6 mmHg
dan pada subek ras Non Melanesia sebesar 26,21±8,8 mmHg (p<0,001). Reratakadar
Plasma Renin Activity (PRA) pada subyek ras Melanesia sebesar 1,48[1,86]
ng/ml/jam dan pada subyek ras Non Melanesia rerata kadar PRA sebesar 1,1[1,47]
ng/ml/jam. Tidak terdapat hubungan yang bermakna rerata kadar PRA pada kedua
kelompok ras ini (p=0,564).
Kesimpulan. Terdapat perbedaan penurunan tekanan darah (sistolik, diastolik dan
tekanan rerata arteri) dengan pemberian penyekat EKA pada kelompok ras Melanesia
dan kelompok ras Non Melanesia dan hal ini tidak berhubungan bermakna dengan
rerata kadar PRA pada kedua kelompok ini sehingga kemungkinan terdapat faktor lain yang mempengaruhi respon penurunan tekanan darah dengan penyekat EKA.ABSTRACT
Hypertension is one of the most commonconditionsin primary health
care that increase mortality and morbidity if it does not receive appropriate therapy.
Several studies show that blacks response differently compared with white in
conjunction with a decrease of blood pressure in response to administer ACE
inhibitor. The studies supported by PRA differences in both group of race. There are
no data ofblood pressure response in hypertensive patientsinMelanesian race by
administeringACE inhibitor supported withPRA levels examination in thisgroup of
race.
Objective. To compare therapeutic response ofangiotensin converting enzyme
blockers (ACE)inhibitorinreducing blood pressure between MelanesianandNon
Melanesian hipertensive patients.
Method. This study is a prospective cohort study conducted in the city of
Jayapura September to November 2015. We found85 subjects aged 30 to 55 years
oldwith hypertensionnever be treated before. Subjects are divided into two
groups, namely the Melanesian race (n = 34) and non Melanesian race (n = 51).
Both groups were given an initial dose of 5 mg of lisinopril. Blood pressure
checks performed at baseline and repeated every 7 days for 4 weeks in a row.
Results. There are differences in the response of blood pressure in hypertensive
patientofMelanesian race and Non Melanesiarace. Reduction ofsystolic blood
pressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject of
Non Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic blood
pressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of Non
Melanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure in
subjectMelanesian race at 17.1 ± 5.6 mmHg andNon Melanesian race at 26.21 ±
8.8 mmHg (p < 0.001). Mean Plasma Renin Activity (PRA) on the subject of the
Melanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian race
PRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationship
mean PRA levels in both these racial groups (p = 0.564).
Conclusion. There aredifferences in blood pressure reduction (systolic, diastolic
pressure and mean arterial pressure) with administer of ACE inhibitor in
Melanesianand Non Melanesiagroup of race. There is no significant relation with
averagePRAlevels in both group of race. Another factors affectsresponses of reduction blood pressure with administer ofACEinhibitor may be considered.;Background. Hypertension is one of the most commonconditionsin primary health
care that increase mortality and morbidity if it does not receive appropriate therapy.
Several studies show that blacks response differently compared with white in
conjunction with a decrease of blood pressure in response to administer ACE
inhibitor. The studies supported by PRA differences in both group of race. There are
no data ofblood pressure response in hypertensive patientsinMelanesian race by
administeringACE inhibitor supported withPRA levels examination in thisgroup of
race.
Objective. To compare therapeutic response ofangiotensin converting enzyme
blockers (ACE)inhibitorinreducing blood pressure between MelanesianandNon
Melanesian hipertensive patients.
Method. This study is a prospective cohort study conducted in the city of
Jayapura September to November 2015. We found85 subjects aged 30 to 55 years
oldwith hypertensionnever be treated before. Subjects are divided into two
groups, namely the Melanesian race (n = 34) and non Melanesian race (n = 51).
Both groups were given an initial dose of 5 mg of lisinopril. Blood pressure
checks performed at baseline and repeated every 7 days for 4 weeks in a row.
Results. There are differences in the response of blood pressure in hypertensive
patientofMelanesian race and Non Melanesiarace. Reduction ofsystolic blood
pressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject of
Non Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic blood
pressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of Non
Melanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure in
subjectMelanesian race at 17.1 ± 5.6 mmHg andNon Melanesian race at 26.21 ±
8.8 mmHg (p < 0.001). Mean Plasma Renin Activity (PRA) on the subject of the
Melanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian race
PRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationship
mean PRA levels in both these racial groups (p = 0.564).
Conclusion. There aredifferences in blood pressure reduction (systolic, diastolic
pressure and mean arterial pressure) with administer of ACE inhibitor in
Melanesianand Non Melanesiagroup of race. There is no significant relation with
averagePRAlevels in both group of race. Another factors affectsresponses of reduction blood pressure with administer ofACEinhibitor may be considered.;Background. Hypertension is one of the most commonconditionsin primary health
care that increase mortality and morbidity if it does not receive appropriate therapy.
Several studies show that blacks response differently compared with white in
conjunction with a decrease of blood pressure in response to administer ACE
inhibitor. The studies supported by PRA differences in both group of race. There are
no data ofblood pressure response in hypertensive patientsinMelanesian race by
administeringACE inhibitor supported withPRA levels examination in thisgroup of
race.
Objective. To compare therapeutic response ofangiotensin converting enzyme
blockers (ACE)inhibitorinreducing blood pressure between MelanesianandNon
Melanesian hipertensive patients.
Method. This study is a prospective cohort study conducted in the city of
Jayapura September to November 2015. We found85 subjects aged 30 to 55 years
oldwith hypertensionnever be treated before. Subjects are divided into two
groups, namely the Melanesian race (n = 34) and non Melanesian race (n = 51).
Both groups were given an initial dose of 5 mg of lisinopril. Blood pressure
checks performed at baseline and repeated every 7 days for 4 weeks in a row.
Results. There are differences in the response of blood pressure in hypertensive
patientofMelanesian race and Non Melanesiarace. Reduction ofsystolic blood
pressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject of
Non Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic blood
pressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of Non
Melanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure in
subjectMelanesian race at 17.1 ± 5.6 mmHg andNon Melanesian race at 26.21 ±
8.8 mmHg (p < 0.001). Mean Plasma Renin Activity (PRA) on the subject of the
Melanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian race
PRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationship
mean PRA levels in both these racial groups (p = 0.564).
Conclusion. There aredifferences in blood pressure reduction (systolic, diastolic
pressure and mean arterial pressure) with administer of ACE inhibitor in
Melanesianand Non Melanesiagroup of race. There is no significant relation with
averagePRAlevels in both group of race. Another factors affectsresponses of reduction blood pressure with administer ofACEinhibitor may be considered."
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Makalah dan Kertas Kerja  Universitas Indonesia Library
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Chorniansyah Indriyanto Rahayu
Pengaruh asupan garam terhadap tekanan darah nokturnal pada pasien hipertensi yang mendapatkan terapi penyekat EKA = Effects of salt intake to nocturnal blood pressure in hypertensive patients administered Angiotensin Converting Enzyme (ACE) inhibitors
"ABSTRAK
Latar Belakang : Hipertensi merupakan faktor resiko utama penyakit kardiovaskular,
terutama sindrom koroner akut dan stroke. Peningkatan konsumsi garam berhubungan
dengan kenaikan tekanan darah. Beberapa studi randomized-controlled trial (RCT)
menyatakan bahwa konsumsi rendah garam dapat menurunkan tekanan darah pada
populasi dewasa dengan atau tanpa hipertensi. Variabilitas tekanan darah selama 24 jam
bersifat dinamis. Peningkatan darah nokturnal memiliki makna klinis yang cukup besar,
merupakan salah satu prediktor dari penyebab kerusakan target organ, terutama kejadian
kardiovaskular dan stroke. Asupan garam dapat mempengaruhi variasi tekanan darah 24
jam, yang dalam hal ini dapat juga berpengaruh pada hipertensi nokturnal. Obat penyekat
EKA merupakan obat hipertensi lini pertama yang sering digunakan, terutama pada usia
muda dan hipertensi yang disertai sindrom metabolik, mengingat peranan Sistem Renin
Angiotensin memiliki peranan yang sangat penting dalam patofisiologi hipertensi. Asupan
garam juga memiliki peranan pada patofisiologi terjadinya hipertensi dalam sistem Renin
Angiotensin. Sedikit studi yang meneliti perpaduan obat penyekat EKA dengan asupan
rendah garam dalam menrunkan kejadian hipertensi. Oleh karena itu, Menarik untuk diteliti
pengaruh asupan garam dengan tekanan darah nokturnal pada pasien yang mengkonsumsi
obat penyekat EKA.
Tujuan : Menilai pengaruh asupan garam dengan tekanan darah nokturnal pada pasien
hipertensi yang mendapatkan terapi penyekat EKA.
Metode : Pasien poliklinik berusia 30 ? 50 tahun yang terdiagnosis hipertensi dan belum
pernah mendapatkan anti-hipertensi sebelumnya, dibagi menjadi 2 kelompok (asupan
rendah garam (Na <15 g/hari) dan asupan tinggi garam ≥15 g/hari). Kedua kelompok akan
diberikan lisinopril dan dilakukan pemeriksaan natrium urin 24 jam dan home blood
pressure monitoring..
Hasil Penelitian : Sebanyak 80 pasien hipertensi pasien hipertensi yang belum
mendapatkan terapi diikutsetakan dalam penelitian ini, yang terdiri dari 37 pasien
kelompok rendah garam dan 43 pasien kelompok tinggi garam. Kelompok pasien dengan
asupan rendah garam memliki delta penurunan darah nokturnal sistolik (p<0,001),
diastolic (p<0,001), dan rerata arteri (p<0,001) yang lebih besar dibandingkan pada
kelompok asupan tinggi garam. Rerata asupan garam pada penelitian ini sebesar 16,77
gram/hari. Pada analisa multivariat didapatkan delta penurunan tekanan darah tidak
dipengaruhi oleh usia, jenis kelamin, dislipidemia, IMT, dan durasi tidur.
Kesimpulan : Penelitian ini membuktikan asupan rendah garam dapat mempengaruhi efektivitas terapi penyekat EKA dalam menurunkan tekanan darah nokturnal. ABSTRACT
Background : Hypertension is one of important risk factor of cardiovascular
disease, especially acute coronary syndrome and stroke. High salt intake correlates
to high blood pressure. Some Randomized-Controlled-Trials stated that low salt
intake may decrease blood pressure in adult population with or without
hypertension. Blood pressure variation in 24 hours is not static but dynamically
changes. Increasing nocturnal blood pressure has significantly impacts, and become
one of predictor of target organ damage, especially cardiovascular events and
stroke. Salt intake may interferes both 24 hours blood pressure variation and
nocturnal blood pressure. Angiotensin Converting Enzyme(ACE) Inhibitors is first
drug of choice anti-hypertensive therapy, especially in young age and associated
with metabolic syndrome, due to important role of Renin Angiotensin Aldosterone
System in pathophysiology of hypertension, whereas salt intake also has role in that
system. Only few of studies that had proved combination of ACE Inhibitors and
low salt intake in decreasing blood pressure in hypertension population. Therefore,
it is so important to know the impact of low salt intake to nocturnal blood pressure
in hypertension patient treated with ACE Inhibitors.
Objectives : To know impact of low salt intake to nocturnal blood pressure in
hypertension patient treated with ACE Inhibitors.
Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreated
hypertension, divided into two groups (low salt intake (Na <15 grams/day) and high
salt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg and
underwent 24-hours sodium urine collection and home blood pressure monitoring
periodically.
Results : There are 80 ambulatory patients diagnosed as untreated hypertension,
consist of 37 patients in low salt intake group and 43 patients in high salt intake
group. Low salt intake group has lower nocturnal systolic (p<0.001), diastolic
(p<0.001), and mean arterial (p<0.001) blood pressure compared with high salt
intake group. Mean salt intake in this study was 16.77 grams/day. Multivariate
analyzes showed that the difference of decreasing nocturnal blood pressure was not
interfered by age, sex, dyslipidemia, BMI, and sleep duration.
Conclusion : This study has proved that low salt intake may interfere ACE Inhibitors therapy effectiveness in decreasing nocturnal blood pressure.;Background : Hypertension is one of important risk factor of cardiovascular
disease, especially acute coronary syndrome and stroke. High salt intake correlates
to high blood pressure. Some Randomized-Controlled-Trials stated that low salt
intake may decrease blood pressure in adult population with or without
hypertension. Blood pressure variation in 24 hours is not static but dynamically
changes. Increasing nocturnal blood pressure has significantly impacts, and become
one of predictor of target organ damage, especially cardiovascular events and
stroke. Salt intake may interferes both 24 hours blood pressure variation and
nocturnal blood pressure. Angiotensin Converting Enzyme(ACE) Inhibitors is first
drug of choice anti-hypertensive therapy, especially in young age and associated
with metabolic syndrome, due to important role of Renin Angiotensin Aldosterone
System in pathophysiology of hypertension, whereas salt intake also has role in that
system. Only few of studies that had proved combination of ACE Inhibitors and
low salt intake in decreasing blood pressure in hypertension population. Therefore,
it is so important to know the impact of low salt intake to nocturnal blood pressure
in hypertension patient treated with ACE Inhibitors.
Objectives : To know impact of low salt intake to nocturnal blood pressure in
hypertension patient treated with ACE Inhibitors.
Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreated
hypertension, divided into two groups (low salt intake (Na <15 grams/day) and high
salt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg and
underwent 24-hours sodium urine collection and home blood pressure monitoring
periodically.
Results : There are 80 ambulatory patients diagnosed as untreated hypertension,
consist of 37 patients in low salt intake group and 43 patients in high salt intake
group. Low salt intake group has lower nocturnal systolic (p<0.001), diastolic
(p<0.001), and mean arterial (p<0.001) blood pressure compared with high salt
intake group. Mean salt intake in this study was 16.77 grams/day. Multivariate
analyzes showed that the difference of decreasing nocturnal blood pressure was not
interfered by age, sex, dyslipidemia, BMI, and sleep duration.
Conclusion : This study has proved that low salt intake may interfere ACE Inhibitors therapy effectiveness in decreasing nocturnal blood pressure.;Background : Hypertension is one of important risk factor of cardiovascular
disease, especially acute coronary syndrome and stroke. High salt intake correlates
to high blood pressure. Some Randomized-Controlled-Trials stated that low salt
intake may decrease blood pressure in adult population with or without
hypertension. Blood pressure variation in 24 hours is not static but dynamically
changes. Increasing nocturnal blood pressure has significantly impacts, and become
one of predictor of target organ damage, especially cardiovascular events and
stroke. Salt intake may interferes both 24 hours blood pressure variation and
nocturnal blood pressure. Angiotensin Converting Enzyme(ACE) Inhibitors is first
drug of choice anti-hypertensive therapy, especially in young age and associated
with metabolic syndrome, due to important role of Renin Angiotensin Aldosterone
System in pathophysiology of hypertension, whereas salt intake also has role in that
system. Only few of studies that had proved combination of ACE Inhibitors and
low salt intake in decreasing blood pressure in hypertension population. Therefore,
it is so important to know the impact of low salt intake to nocturnal blood pressure
in hypertension patient treated with ACE Inhibitors.
Objectives : To know impact of low salt intake to nocturnal blood pressure in
hypertension patient treated with ACE Inhibitors.
Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreated
hypertension, divided into two groups (low salt intake (Na <15 grams/day) and high
salt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg and
underwent 24-hours sodium urine collection and home blood pressure monitoring
periodically.
Results : There are 80 ambulatory patients diagnosed as untreated hypertension,
consist of 37 patients in low salt intake group and 43 patients in high salt intake
group. Low salt intake group has lower nocturnal systolic (p<0.001), diastolic
(p<0.001), and mean arterial (p<0.001) blood pressure compared with high salt
intake group. Mean salt intake in this study was 16.77 grams/day. Multivariate
analyzes showed that the difference of decreasing nocturnal blood pressure was not
interfered by age, sex, dyslipidemia, BMI, and sleep duration.
Conclusion : This study has proved that low salt intake may interfere ACE Inhibitors therapy effectiveness in decreasing nocturnal blood pressure."
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Acil Aryadi
Perbandingan efektifitas antara lisinopril dan amlodipin terhadap penurunan tekanan darah pada pasien hipertensi ras melanesia = Effectiveness comparison between lisinopril and amlodipine in melanesian patients with hypertension
"Latar Belakang : Keberhasilan pengobatan antihipertensi dipengaruhi banyak hal, salah satunya adalah faktor genetik, termasuk perbedaan ras dan aktivitas renin plasma (ARP). Perbedaan ras, berkaitan dengan ARP, mungkin dapat memberikan perbedaan respon terhadap obat antihipertensi. Aktivitas renan plasma dan perbandingan efektifitas obat antihipertensi (lisinopril dan amlodipin) pada ras melanesia di Provinsi Papua belum pernah diteliti.
Tujuan : Mengukur aktivitas renin plasma dan membandingkan efektifitas obat lisinopril dan amlodipin pada pasien hipertensi ras melanesia untuk menurunkan tekanan darah.
Metode : Pada awal penelitian, 68 subjek berhasil direkrut, dilakukan randomisasi dan dibagi ke dalam dua kelompok. Sebanyak 34 subjek mendapat lisinopril 5 mg dan 34 subjek mendapat amlodipine 2.5 mg. Tekanan darah, ARP dan karakteristik dasar lainnya diukur sebelum intervensi, dan kemudian di follow up tiap minggu. Subjek yang belum mencapai target tekanan darah akan diberikan peningkatan dosis obat, lisinopril 10 hingga 20 mg dan amlodipin 5 hingga 10 mg. Pada akhir penelitian (minggu keempat), tekanan darah diukur sebagai luaran klinis. Sebanyak 7 subjek drop out, 4 subjek pada kelompok lisinopril dan 3 subjek pada kelompok amlodipin.
Hasil : Aktivitas renin plasma pada populasi penelitian ini 1.6 ng/ml/jam (normal). Karakteristik dasar klinis tidak berbeda antara kedua kelompok, termasuk rerata tekanan darah sebelum intervensi dan ARP. Pada kedua kelompok didapatkan penurunan tekanan darah yang signifikan setelah intervensi, baik pada tekanan darah sistolik (TDS), distolik (TDD) dan tekanan nadi (TN). Namun, pada penelitian ini, perbedaan respon penurunan tekanan darah antara kelompok lisinopril dan amlodipin tidak berbeda (TDS 24.6 ± 9.3 vs 25.9 ± 8.9 mmHg, p=0.56; TDD 13.3 ± 5.5 vs 11.4 ± 4.8 mmHg, p=0.15; TN 17.1 ± 5.6 vs 16.3 ± 5.0 mmHg, p=0.55).
Kesimpulan : Aktivitas renin plasma pada pasien hipertensi ras melanesia normal dan pemberian lisinopril tidak menunjukkan perbedaan penurunan respon penurunan tekanan darah dibandingkan dengan amlodipin.
Background: The success of antihypertensive treatment are influenced by many factors, one of which are genetic factors, including differences in race and plasma renin activity (PRA). Racial differences, regarding PRA, may give different response to antihypertensive drugs. Plasma renin activity and comparison of the effectiveness of antihypertensive medications (lisinopril and amlodipine) in the Melanesian race in the province of Papua have not been investigated.
Objectives: To measure plasma renin activity and compare the effectiveness of lisinopril and amlodipine in melanesian hypertensive patients to reduce blood pressure.
Methods: Sixty eight subjects were randomly assigned into 2 groups, those receiving lisinopril 5 mg (34 subjects) and amlodipine 2.5 mg (34 subjects). Blood pressure, PRA and other baseline characteristics were measured before the intervention, and then evaluated every week. Dose of lisinopril and amlodipine will be increased in subjects who have not achieved blood pressure target, 10 mg to 20 mg and 5 mg to 10 mg, respectively. At the end of the fourth week, blood pressure is measured as the main clinical outcome. Seven subjects were drop out, four from lisinopril group and three from amlodipin group.
Results: Plasma renin activity in this study population was 1.6 ng/ml/h (normal). Baseline characteristics did not differ between two groups, including blood pressure and PRA before intervention. Significant decrease in blood pressure occurred in both group after the intervention, including systolic blood pressure (SBP) , diastolic (DBP) and mean arterial pressure (MAP). However, there are no differences in blood pressure reduction between lisinopril and amlodipine groups. (SBP 24.6 ± 9.3 vs 25.9 ± 8.9 mmHg, p=0.56; DBP 13.3 ± 5.5 vs 11.4 ± 4.8 mmHg, p=0.15; MAP 17.1 ± 5.6 vs 16.3 ± 5.0 mmHg, p=0.55).
Conclusion: Plasma renin activity in melanesian hypertensive patients was normal and administration of lisinopril showed no difference in blood pressure reduction compared with amlodipine."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
I Made Putra Swi Antara
Hubungan tekanan darah rumah dengan derajat disfungsi diastolik pada penderita hipertensi dalam pengobatan = Correlation between home blood pressure monitoring and degree of diastolic dysfunction in treated hypertensive patients
"Latar Belakang. Hipertensi merupakan faktor utama penyebab gagal jantung yang saat ini sudah menjadi pandemi dunia, terutama dalam bentuk gagal jantung dengan preservasi fraksi ejeksi ventrikel. Kontrol terhadap hipertensi secara tradisional dilakukan berdasarkan pemeriksaan rutin ke fasilitas kesehatan yang diikuti dengan pengaturan terapi yang diberikan. Saat ini pengukuran tekanan darah rumah ditempatkan sebagai pemeriksaan tambahan yang dapat memberikan informasi tambahan mengenai kontrol tekanan darah sehingga mencegah terjadinya kerusakan target organ. Penelitian ini bertujuan untuk mengevaluasi hubungan antara nilai pengukuran tekanan darah rumah dengan derajat disfungsi diastolik sebagai indikator kerusakan target organ.
Metode. Studi potong lintang yang dilakukan di Departemen Kardiologi dan Kedokteran Vaskular FK UI / RS Pusat Jantung Nasional Harapan Kita, Jakarta pada kelompok pasien hipertensi dari poliklinik rawat jalan yang telah mendapatkan terapi rutin. Pengukuran tekanan darah rumah dilakukan dengan alat yang terstandarisasi. Pemeriksaan ekokardiografi lengkap terhadap parameter diastolik dilakukan dan dikelompokkan berdasarkan derajat disfungsi diastoliknya.
Hasil. Sebanyak 56 pasien ikut dianalisa dalam penelitian ini, dengan rerata umur subyek adalah 51,2 + 7,2 thn dan sebagian besar wanita (58,9%). Didapatkan disfungsi diastolik derajat I pada 11 subyek (19,6%), derajat II pada 19 subyek (33,9%). Parameter fungsi diastolik E/A memiliki hubungan linear yang paling signifikan terhadap TD Rumah sistolik setelah dikontrol terhadap usia, jenis kelamin, IMT, dan DM (R2=0,27;p<0,01). Uji ANOVA menemukan perbedaan rerata TD Rumah Sistolik yang signifikan antara fungsi diastolik normal dan disfungsi diastolik derajat 2 (p=0,02). Uji regresi logistik menemukan perbedaan yang signifikan antara TD Rumah sistolik <127 mmHg dengan TD >135 dengan OR 12,68 (IK 2.03-79.08;p<0.01).
Kesimpulan. Pengukuran TD Rumah Sistolik memiliki hubungan signifikan terhadap derajat disfungsi diastolik. Gangguan parameter fungsi diastolik dapat terjadi pada tekanan darah yang lebih rendah daripada target yang umum digunakan saat ini.
Background. Hypertension the main factor leading to heart failure which has become a world pandemic, especially in the form of heart failure with preserved ejection fraction. Traditional control for hypertension comprise of regular outpatient clinic visits followed by adjustment of the drug regimen. Recently, home blood pressure monitoring has been been accepted as an additional tool to provide more information on blood pressure control and prevent target organ damage. This study aim to evaluate the relationship between home blood pressure measurement with the degree of diastolic dysfunction as an indicator of target organ damage.
Methods. A cross-sectional study performed at Cardiology and Vascular Medicine Department FK UI / National Cardiac Centre Harapan Kita, Jakarta, on a group of hypertensive patients in the outpatient clinic currently receiving active treatment. Home blood pressure measurement are performed with a standarized device. Full echocardiography study on diastolic function parameters are performed and grouped based on the diastolic dysfunction grade criteria.
Result. Fifty six patients are enrolled in this study with average age of 51,2 + 7,2 y.o. which are mostly women (58,9%). Grade I diastolic dysfunction was found in 11 subjects (19,6%), Grade II on 19 subjects (33,9%). One parameter of diastolic dysfunction, E/A ratio, have the strongest linear correlation with systolic HBP after adjusted for age, sex, BMI, and DM (R2=0,27;p<0.01). ANOVA test found a significant difference on mean of systolic HBPM between normal and grade II diastolic dysfunction (p=0.02). Logistic regression test showed significant difference between <127 and >135 mmHg of systolic HBPM with OR 12,68 (CI 2.03-79.08;p<0.01).
Conclusion. Systolic HBPM have a significant relationship to the degree of diastolic dysfunction. A worsening of diastolic function parameter can occur on a level of blood pressure lower then the target level commonly used today."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tugas Akhir  Universitas Indonesia Library
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Oktorilla Fiskasianita
Hubungan kualitas tidur dengan tekanan darah pada pasien hipertensi di Puskesmas Beji Depok = Relationship of sleep quality and blood pressure on hypertensive patient in Puskesmas Beji Depok
"Tidur yang cukup merupakan kebutuhan dasar yang sangat dibutuhkan untuk pemeliharaan fungsi kardiovaskular. Penelitan ini merupakan penelitian descriptive correlative dengan desain studi cross sectional yang bertujuan mengidentifikasi hubungan antara kualitas tidur dengan tekanan darah pada pasien hipertensi. Penelitian dilakukan di Puskesmas Beji-Depok terhadap 97 pasien hipertensi rawat jalan yang dipilih dengan teknik consecutive sampling. Kualitas tidur diukur menggunakan kuesioner Pittsburgh Sleep Quality Index (PSQI), sedangkan tekanan darah diukur menggunakan sphygmomanometer digital.
Hasil penelitian menunjukkan mayoritas responden yaitu sebanyak 87 orang (89,7 %) memiliki kualitas tidur buruk (PSQI ≥ 5), sedangkan hanya 10 orang (10,3 %) memiliki kualitas tidur baik (PSQI ≤ 5). Rata-rata tekanan darah responden secara keseluruhan 145,19/86,15 mmHg. Hasil analisis uji T independent menunjukan secara statistik tidak ada hubungan yang signifikan antara kualitas tidur dengan tekanan darah. Namun, secara klinis hasil analisis data menunjukkan responden yang memiliki kualitas tidur buruk memiliki tekanan darah lebih tinggi daripada responden yang memiliki kualitas tidur baik dengan mean differece sistolik sebesar 6,228 mmHg dan mean difference diastolik 4,409 mmHg.
Adequate sleep is a basic need which is important to maintain cardiovascular system function. It is a descriptive correlative study using cross sectional approach which aims to identify the relationship between sleep quality and blood pressure on hypertensive patient. The research was conducted in Public Health Center of Beji-Depok towards 97 participants recruited using consecutive sample method. Sleep quality is measured using Pittsburgh Sleep Quality Index (PSQI) and blood pressure is measured using digital sphygmomanometer.
The result shows that 83 participants (89.7 %) have poor sleep quality (PSQI ≥ 5) while only 10 partcipants (10.3 %) have good sleep quality (PSQI ≤ 5). The average blood pressure of all participants is 145.19/86.15 mmHg. Statistical analysis using T independent test shows there is no significant relationship between sleep quality and blood pressure. However, in clinical basis the result shows a significant difference. Clinically speaking, participants with poor sleep quality indicates higher blood pressure compare to those with better sleep quality with systolic mean difference of 6.228 mmHg and diastolic mean difference of 4.409 mmHg."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2013
S47215
UI - Skripsi Membership  Universitas Indonesia Library
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Jeane Andini
Hubungan kadar high density lipoprotein hdl terhadap kendali tekanan darah pada pasien hipertensi poliklinik penyakit dalam RSIPN Dr. Cipto Mangunkusumo Jakarta = The association of high density lipoprotein hdl level to blood pressure control in hypertensive patients at internal medicine clinic Cipto Mangunkusumo General Hospital
"Hipertensi merupakan masalah utama kesehatan masyarakat di Indonesia. Dari Riskesdas tahun 2007 dilaporkan prevalensi penduduk Indonesia usia di atas 18 tahun yang menderita hipertensi mencapai 31,7%. Hipertensi seringkali disertai perubahan-perubahan metabolik, salah satunya dislipidemia.
Penelitian ini bertujuan untuk membuktikan hubungan kadar High Density Lipoprotein (HDL) terhadap kendali tekanan darah pada pasien hipertensi. Penelitian dilaksanakan dengan metode cross sectional menggunakan data sekunder dari 117 rekam medis pasien hipertensi poliklinik penyakit dalam RSUPN Dr. Cipto Mangunkusumo Jakarta. Uji hipotesis dilakukan menggunakan uji Chi-square.
Dari hasil penelitian didapatkan jumlah pasien hipertensi tidak terkendali sebanyak 48 pasien (41%). Jumlah pasien hipertensi tidak terkendali dengan kadar HDL rendah sebanyak 11 pasien (61,1%), sedangkan jumlah pasien hipertensi terkendali dengan kadar HDL rendah sebanyak 7 pasien (38,9%).
Dari penelitian ini didapatkan proporsi pasien hipertensi tidak terkendali dengan kadar HDL rendah secara signifikan lebih besar dibandingkan pasien hipertensi terkendali dengan kadar HDL rendah, namun nilai p=0,060 (p>0,05) yang didapatkan menyimpulkan bahwa secara statistik tidak ada hubungan bermakna antara kadar HDL terhadap kendali tekanan darah pada pasien hipertensi poliklinik penyakit dalam RSUPN Dr. Cipto Mangunkusumo Jakarta.
Hypertension is a major public health problem in Indonesia. Riskesdas 2007 reported the prevalence of Indonesia's population aged over 18 years who suffering hypertension achieve 31.7%. Hypertension is often accompanied by metabolic changes, one of them is dyslipidemia.
This study aims to prove the association of High Density Lipoprotein (HDL) level to blood pressure control in hypertensive patients. Research is carried out by cross sectional method using secondary data from 117 medical records of hypertensive patients at internal medicine clinic Cipto Mangunkusumo general hospital. Hypothesis testing is done using the Chi-square test.
From the results, the number of uncontrolled hypertensive patients were 48 patients (41%). The number of uncontrolled hypertensive patients with low HDL level were 11 patients (61.1%), while the number of controlled hypertensive patients with low HDL level were 7 patients (38.9%).
From this study, the proportion of uncontrolled hypertensive patients with low HDL level is significantly greater than controlled hypertensive patients with low HDL level, but the value of p = 0.060 (p> 0.05) were obtained concluded that no statistically significant relationship between the level of HDL to blood pressure control in hypertesive patients at internal medicine clinic Cipto Mangunkusumo general hospital."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Skripsi Membership  Universitas Indonesia Library
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Mellisya Ramadhany
Hubungan obesitas terhadap pengendalian tekanan darah pasien hipertensi di poliklinik ilmu penyakit dalam RSUPN Cipto Mangunkusumo = The association of obesity and blood pressure control among hypertensive patients in internal medicine clinic RSUPN Cipto Mangunkusumo
"Hipertensi menduduki tempat kedua sebagai penyakit tidak menular terbanyak di Indonesia. Penyakit ini menyebabkan kerusakan multi organ hingga kematian. Hipertensi yang terkendali diharapkan dapat menunda komplikasi. Saat ini, hampir seperlima penduduk Indonesia obes. Obesitas berkaitan dengan kemunculan hipertensi namun belum diketahui hubungannya terhadap pengendalian hipertensi. Oleh karena itu, dilakukan penelitian mengenai hubungan obesitas terhadap kendali tekanan darah pasien hipertensi agar dapat membantu dalam penatalaksanaan hipertensi.
Desain penelitian adalah cross-sectional mempergunakan data rekam medik pasien hipertensi poliklinik IPD RSUPN Cipto Mangunkusumo, Jakarta. Sejumlah 117 data terkumpul. Didapatkan prevalensi hipertensi tidak terkendali sebanyak 41%, dengan rasio terbanyak pada subjek laki-laki. Prevalensi obesitas sebesar 50,4%, dengan rasio terbanyak pada subjek perempuan. Pada kelompok obesitas didapatkan proporsi hipertensi terkendali 64,4%, dan hipertensi tidak terkendali 35,6%. Sedangkan pada kelompok tidak obes didapatkan proporsi hipertensi terkendali 53,4%, dan hipertensi tidak terkendali 46,6 % dengan nilai p = 0,228 (p>0,05), RP 0,765 dengan IK 95% 0,492 ? 1,188. Dengan demikian dapat disimpulkan bahwa tidak terdapat hubungan bermakna antara obesitas dengan hipertensi tidak terkendali.
Hypertension is the second most prevalent non-communicable disease in Indonesia capable of causing multi organ damages even death. The essential target in hypertension management is to achieve controlled blood pressure in order to delay its complications. Nowadays, approximately one in five Indonesian has become obese. Obesity itself is highly associated with hypertension occurrence. Yet, there is no distinct evidence that show its association to hypertension control. Thus, this research is aimed to find the association between obesity in hypertensive patients to the blood pressure control.
Method used in this study is cross-sectional. As much as 117 secondary datas were collected from patients? medical records in Internal Medicine clinic diagnosed with hypertension. The prevalence of uncontrolled hypertension is 41% , dominated by male subjects. The prevalence of obesity among subjects is 50.4%, with higher proportion in females. Within the obese group, the proportion of controlled hypertension reaches 64.4%, while proportion for uncontrolled is 35.6%. Meanwhile, in the non-obese group, the proportion of controlled hypertension is 53.4%, whereas uncontrolled is 46,6%. The p-value result is 0.228 (p >0.05) with PR 0.765 with 95% CI 0.492 ? 1.188. Therefore, it can be concluded that there is no significant association between obesity with uncontrolled hypertension."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Skripsi Membership  Universitas Indonesia Library
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Edrian
Pengukuran tekanan darah di rumah sebagai prediktor nilai indeks resistensi renalis pada pasien hipertensi dalam pengobatan = Role of home blood pressure monitoring as a predictor of renal resistive index in hypertensive patient on medication
"Latar belakang. Pengukuran tekanan darah di klinik (TDK) saat ini masih dianggap sebagai metoda referensi dalam mendiagnosis dan follow-up pasien hipertensi,tetapi disebabkan adanya fenomena white-coat hypertension dan masked hypertension terlihat semakin jelas informasi yang diberikan seringkali tidak adekuat tentang status tekanan darah pasien yang sebenarnya. Hipertensi sendiri dikaitkan dengan kerusakan target organ dan salah satu diantaranya ke organ ginjal. Pemeriksaan indeks resistensi renalis (RRI) dapat menjadi prediktor disfungsi ginjal dan dapat mencerminkan tingkat aterosklerosis sistemik. Khususnya pada kasus hipertensi, peningkatan RRI dihubungkan dengan berat dan lama nya durasi hipertensi esensial. Tujuan dari penelitian ini adalah melihat nilai pengukuran tekanan darah di rumah (TDR) dibandingkan TDK dalam memprediksi nilai RRI.
Metode. Tujuh puluh dua pasien hipertensi dalam terapi obat antihipertensi diambil secara konsekutif untuk studi potong lintang ini, mulai bulan Maret hingga Mei 2013 di poli rawat jalan Pusat Jantung Nasional Harapan Kita, Jakarta. Pasien menjalani pemeriksaan TDK saat kontrol dan TDR dilakukan selama 4 hari dimana keduanya memakai alat osilometri yang tervalidasi. Pemeriksaan Doppler renal dilakukan pada semua pasien untuk mendapatkan nilai RRI.
Hasil. Uji korelasi antara nilai TDR dan TDK mempunyai korelasi yang baik untuk sistolik maupun diastolik (r = 0,48/0,45 , p < 0,001). Pada uji korelasi regresi didapatkan korelasi yang bermakna antara nilai sistolik TDR dengan nilai RRI (r=0,118 dengan p=0,032), dan korelasi ini tidak signifikan baik untuk sistolik TDK, dan diastolik baik TDK dan TDR. Dari uji multipel regresi melihat prediktor independen terhadap nilai RRI didapatkan nilai sistolik TDR merupakan prediktor independen.
Kesimpulan. Penelitian ini menunjukkan bahwa TDR merupakan prediktor yang baik dari nilai RRI sebagai penilaian kerusakan target organ, dan metode ini lebih superior dibandingkan TDK.
Introduction. Office blood pressure monitoring still considered as method of reference for diagnosing an follow up hypertension patients, but due to white coat hypertension and masked hypertension it seems the information inadequate for the real blood pressure status. Hypertension itself was related to target organ damage and one of them is renal damage. Renal Resistive index (RRI) can be a predictor of renal dysfunction and it reflect sistemic atherosclerosis. Especially for hypertension, increase of RRI is related to severity and duration of essential hypertension. Our objective was to assess the value of home blood pressure (HBP) monitoring in comparison to office blood pressure in predicting renal resistive index value(RRI).
Methods. Seventy two hypertension patients on medication was consecutively included in our cross sectional study, starting from March to Mei 2013 at National Cardiac Centre Harapan Kita Hospital Outpatient clinic. Office Blood pressure was measured when patients controlled to the clinic and HBP was measured for 4 workdays with the same validated electronic device. Renal Doppler was performed to measured RRI value.
Results. Correlation test between HBP and OBP showed a good correlation for systolic and diastolic (r=0,48/0,45, p<0,001). The correlation regretion test showed a good correlation between systolic HBP with renal resistive index (r=0,118 with p=0,032), and this correlation was not significant for systolic OBP, and diastolic OBP and HBP. In multiple regression analysis assessing independent predictor for RRI, systolic HBP was seen as the only independent predictor.
Conclusions. This result suggest that home BP was a better predictor of RRI as assessment for target organ damage, and this method was superior compared to the blood pressure measurement at the clinic."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tugas Akhir  Universitas Indonesia Library
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Syamsyuriyana Sabar
Pengaruh isometric handgrip exercise terhadap perubahan tekanan darah pada pasien hipertensi = The Effect of isometric handgrip exercise on changes in blood pressure in patients with hypertension / Syamsyuriyana Sabar
"ABSTRAK
Isometric Handgrip Exercise merupakan salah satu terapi non farmakologis yang dikembangkan untuk menurunkan tekanan darah pasien hipertensi. Penelitian ini bertujuan untuk mengidentifikasi pengaruh isometric handgrip exercise terhadap perubahan tekanan darah pasien hipertensi. Desain penelitian quasi experiment dengan pendekatan control group pretest posttest design pada 44 responden meliputi kelompok kontrol dan kelompok intervensi. Kelompok intervensi mendapatkan latihan handgrip selama 3 menit, sekali sehari dan dilakukan selama 5 hari. Kedua kelompok dilakukan pengukuran tekanan darah sebelum dan setelah latihan pada hari 1 dan ke 5. Hasil penelitian menunjukkan bahwa ada pengaruh isometric handgrip exercise (IHG) terhadap perubahan tekanan darah pasien hipertensi. kesimpulan penelitian ini adalah isometric handgrip exercise secara bermakna dapat menurunkan tekanan darah sistolik dan tekanan darah diastolik. Hasil penelitian ini diharapakan menjadi dasar isometric handgrip exercise (IHG) sebagai intervensi keperawatan yang mandiri dan inovatif pada asuhan keperawatan klien dengan hipertensi
ABSTRACT
An Isometric Handgrip Exercise is one of the non-pharmacological therapies that is developed to lower blood pressure in hypertensive patients. The aim of the study was to identify the effect of isometric handgrip exercise on changes in blood pressure in hypertensive patients. A Quasi experimental research design approach pretest posttest control group design was employed with 44 respondents included control and intervention groups. The intervention group got handgrip exercise for 3 minutes, once a day and performed for 5 days. Both groups performed measurements of blood pressure before and after exercise on days 1 and 5. The results showed that there is influence of isometric handgrip exercise on changes in blood pressure in hypertensive patients. Conclusion of this study is the isometric handgrip exercise (IHG) can significantly lower systolic blood pressure and diastolic blood pressure. The result of this study recommended that isometric handgrip exercise (IHG) can bean independen and innovative therapeutic nursing intervension in nursing care of patients with hypertension.
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Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2014
T42776
UI - Tesis Membership  Universitas Indonesia Library
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Sri Wahyuni Dewanti
Pengaruh pemberian konseling dan leaflet terhadap kepatuhan dan tekanan darah pasien yang menggunakan obat hipertensi di Puskesmas kota Depok = The effect of counselling and leaflet on adherence and blood pressure of hypertension patient using medication in Puskesmas kota Depok
"Rendahnya kepatuhan dan self efficacy menjadi masalah yang signifikan untuk penggunaan obat hipertensi. Keterbatasan tenaga kesehatan menyebabkan pemberian informasi sulit dilakukan. Tujuan penelitian ini adalah untuk mengevaluasi efektivitas konseling dibandingkan dengan leaflet terhadap peningkatan self efficacy dan kepatuhan pasien serta penurunan tekanan darah pasien menggunakan obat hipertensi di Puskesmas Pancoran Mas dan Puskesmas Beji Depok. Rancangan penelitian ini menggunakan quasi eksperimen. Pengambilan data dilakukan dari bulan Maret sampai Juni 2013 dengan 37 pasien pada kelompok yang mendapatkan konseling dan 36 pasien pada kelompok yang mendapatkan leaflet. Penilaian self efficacy menggunakan skala MUSE dan untuk kepatuhan menggunakan MMAS 8.
Hasil penelitian menunjukkan konseling dan leaflet dapat meningkatkan self efficacy (P=0,000) dan kepatuhan (P=0,000) pasien, serta dapat menurunkan tekanan darah sistol (P=,010) pada kelompok konseling dan menurunkan tekanan darah sistol (P=0,000) maupun diastol (P=0,019) pada kelompok leaflet. Tidak ada perbedaan antara kelompok konseling dan leaflet dalam meningkatkan self efficacy (P=0,401) dan kepatuhan pasien P=(0,374) serta menurunkan tekanan sistol (P=0,663) dan tekanan diastol (P=0,466).
Low adherence and self efficacy was significant problem for using medication. However, the limitation of medical personnel makes medical information service is very hard to be done. The research purpose was to evaluate the effectiveness of counselling and leaflet againts self efficacy and adherence as well as the blood pressure of hypertension patients using the medication in Puskesmas Beji and Puskesmas Pancoran Mas Depok. Data collection was conducted from March to June 2013 with with 37 patients in the group receiving counseling and 36 patients in the group receiving leaflets. Self efficacy assessment using MUSE scale and adherence using the MMAS 8.
The result showed that counselling and leaflet can increase patient adherence (P=0.000) and self efficacy (P=0.000) and can lower systolic blood pressures (P=0.010) in group counseling and lowers systolic (P=0.000) and diastolic blood (P=0.019) pressure in the leaflet group. There was no difference between group counseling and leaflets to increase self-efficacy (P= 0.401) and patient adherence (P=0.374) and lower systolic pressure (P = 0.663) and diastolic pressure (P = 0.466)."
Depok: Fakultas Farmasi Universitas Indonesia, 2013
T35256
UI - Tesis Membership  Universitas Indonesia Library
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