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Abstrak :
Latar Belakang. Hipotensi ortostatik merupakan masalah yang sering ditemukan pada usia lanjut, dan berhubungan dengan peningkatan morbiditas dan mortalitas. Penyakit penyerta pads usia lanjut diketahui berpotensi mengakibatkan timbulnya hipotensi ortostatik Mengacu pada hal tersebut maka deteksi awal adanya hipotensi ortostatik pada pasien usia lanjut dan pengendalian faktor-faktor risiko hipotensi ortostatik perlu dilakukan dalam upaya mencapai kualitas hidup yang optimal. Tujuan. Mengetahui prevalensi dan faktor-faktor risiko yang mempengaruhi timbulnya hipotensi ortostatik pada usia lanjut yaitu usia, hipertensi, diabetes melitus, gagal jantung, riwayat strok, dehidrasi dan obat antihipertensi. Metodologi : Sembilan puluh tujuh subyek usia lanjut dengan usia 60 tahun atau lebih.yang berobat jalan di Poliklinik dan Instalasi Gawat Darurat RSCM diikutsertakan dalam penelitan. Data dikumpulkan dengan melakukan serangkaian anamnesis, pemeriksaan fisik, tekanan darah posisi berbaring, segera setelah 1-3 menit berdiri, pemeriksaan laboratorium, pemeriksaan EKG dan foto torak. Penelitian ini menggunakan desain cross sectional ..dengan variabel yang diteliti meliputi faktor usia, adanya hipertensi, diabetes melitus, gagal jantung, riwayat strok, dehidrasi dan penggunaan obat antihipertensi, dihubungkan dengan hipotensi ortostatik. Hasil : Laki-laki 40 (41,2%), wanita 57 (58,8%) dan usia rerata 67,4 tahun, didapatkan subyek yang mengalami hipotensi ortostatik sebanyak 15 orang(15,5%). Analisis bivariat dan multivariat menunjukkan bahwa variabel hipertensi dan dehidrasi menunjukkan hubungan bermakna dengan hipotensi ortostatik. Faktor risiko lainnya tidak terbukti secara bermakna dengan terjadinya hipotensi ortostatik. Kesimpulan : Hipertensi dan dehidrasi merupakan faktor risiko terjadinya hipotensi ortostatik. Subyek usia lanjut dengan hipertensi memerlukan pengendalian tekanan darah lebih baik. Kondisi dehidrasi pada usia lanjut perlu dikenali sedini mungkin, sehingga dapat dilakukan tatalaksana guna mencegah timbulnya hipotensi ortostatik.

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Background: Orthostatic hypotension is widely known as a problem that. frequently found in elderly individuals and is associated with an increase of morbidity and mortality rate. Comorbidity in elderly have been recognized to potentially give rise to the development of orthostatic hypotension. Reffering to this matter, early detection of orthostatic hypotension in elderly and management of.risk factors need to be done in effort to achieve the optimal quality of life. Objectives. To find out the prevalence and some risk factors for the development of orthostatic hypotension in elderly individuals such as age, hypertension, diabetes mellitus, heart failure, history of stroke,dehydration and anti-hypertension drug usage. Methods: Ninety-seven elderly subjects with 60 years of age or more who had come to Outpatient clinic and Emergency Room of Cipto Mangunkusumo Hospital were included in the study. Data were obtained by anamnesis, physical examination, blood pressure examination in lie down position, immediately after 1-3 minutes of standing. We also perfomed laboratory examination, ECG and thorax X-ray. This study had a cross-sectional design and the studied variables include age, hypertension, diabetes mellitus and heart failure, history of stroke, dehydration and anti-hypertension drug usage, which were correlated to orthostatic hypotension. Result: The subjects consists of found 40 males (41.2%), 57 females (58.8%) and mean of age 67.4 years. We found 15 subjects with orthostatic hypotension (15.5%)_ Analysis bivariate and multivariate indicated that the variables of hypertension and dehydration had a significant correlation to orthostatic hypotension. Other risk factors were not proven to have significant correlation with the development of orthostatic hypotension. Conclusion: Hypertension and dehydration were proven as risk factor of orthostatic hypotension. Elderly subject with hypertension needs a more careful management of blood pressure. Dehydration condition should be detected immediately in order to perform appropriate management to prevent the development of orthostatic hypotension.

Abstrak :
ABSTRAK
Latar Belakang: Diabetes Melitus (DM) merupakan salah satu penyakit tersering pada usia lanjut. Salah satu komplikasi DM adalah neuropati otonom, dimana hipotensi ortostatik merupakan tanda dari neuropati otonom yang berat. Adanya Hipotensi ortostatik pada pasien DM usia lanjut meningkatkan risiko kejadian kardiovaskular dan kematian. Saat ini belum ada studi di Indonesia yang menggambarkan proporsi hipotensi ortostatik pada pasien DM usia lanjut. Selain itu studi tentang hubungan kadar HbA1c dengan kejadian hipotensi ortostatik pada subjek DM masih terbatas dan hasilnya masih kontroversial. Tujuan: Mendapatkan proporsi hipotensi ortostatik pada pasien DM usia lanjut di RSCM Jakarta dan hubungannya dengan kadar HbA1c. Metode: Penelitian ini merupakan studi potong lintang terhadap 350 penderita DM usia ≥60 tahun yang berobat di poliklinik Geriatri dan Diabetes RSCM periode Januari-Maret 2016. Hipotensi ortostatik didefinisikan sebagai penurunan tekanan darah sistolik ≥ 20mmHg dan atau tekanan diastolik ≥10mmHg dalam 3 menit setelah perubahan posisi dari berbaring ke berdiri. Pemeriksaan kadar HbA1c menggunakan alat Nycocard dari Axis Shield. Uji chi square digunakan untuk analisis bivariat dan regresi logsitik digunakan untuk analisis multivariat terhadap variabel perancu. Hasil Penelitian: Proporsi hipotensi ortostatik sebesar 27,4% pada subjek DM usia lanjut. Median HbA1c didapatkan lebih tinggi pada subjek dengan hipotensi ortostatik dibandingkan tanpa hipotensi ortostatik (7,6% vs 7,1%; p<0,05). Terdapat hubungan antara kadar HbA1c ≥7,35% dengan kejadian hipotensi ortostatik (OR 1,987, 95%IK 1,2-3,2). Lama DM merupakan variabel perancu dalam penelitian ini. Kesimpulan: Hipotensi ortostatik banyak ditemukan pada subjek DM usia lanjut. Terdapat hubungan antara kejadian hipotensi ortostatik dengan peningkatan kadar HbA1c pada pasien DM usia lanjut di RSCM Jakarta.

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ABSTRACT
Background: Diabetes mellitus (DM) is one of the commonest diseases in the elderly. One of its complications is autonomic neuropathy. Orthostatic hypotension is a sign of severe autonomic neuropathy. The presence of orthostatic hypotension in elderly patients with DM increases the risk of cardiovascular events and death. Currently there are no studies in Indonesia that describe the proportion of orthostatic hypotension in elderly patients with DM. Moreover, studies about the relationship between HbA1c level and incidence of orthostatic hypotension in subjects with DM are still limited and the results are controversial. Objective: This study aims to obtain the proportion of orthostatic hypotension in elderly diabetic patients in Cipto Mangunkusumo Hospital, Jakarta and its relationship with HbA1c level. Methods: This study was a cross-sectional study on 350 patients with DM aged ≥60 years old who seeked treatment at the Geriatry and Diabetes clinic in Cipto Mangunkusumo Hospital from January to March 2016. Orthostatic hypotension was defined as a decrease in systolic blood pressure ≥ 20mmHg or diastolic pressure ≥10mmHg within 3 minutes after changing position from lying to standing. Level of HbA1c was measured using Nycocard from Axis Shield. Chi square test was used for bivariate analysis and logistical regression was used for multivariate analysis against confounding variables. Results: The proportion of orthostatic hypotension in elderly subjects with DM was 27.4%. Median of HbA1c level was higher in subjects with orthostatic hypotension than subjects without (7.6% vs. 7.1%; p <0.05). There was a relationship between HbA1c level ≥7,35% and incidence of orthostatic hypotension (OR 1.987, 95% CI 1.2-3.2). Length of having DM was a confounding variable. Conclusion: Orthostatic hypotension is more common in elderly subjects with DM. There is a relationship between the incidence of orthostatic hypotension with elevated level of HbA1c in diabetic elderly patients in Cipto Mangunkusumo Hospital, Jakarta.