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Abstrak :
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.

Abstrak :
Persistensi penggunaan obat antihipertensi pada pasien hipertensi sangat diperlukan mengingat hasil utama terapi hipertensi adalah mencegah keja- dian penyakit kardiovaskular seperti infark miokard, dan stroke yang beru- jung pada kematian. Penelitian ini bertujuan mengetahui pengaruh jenis ter- api dan jenis obat antihipertensi terhadap persistensi. Penelitian ini meng- gunakan desain studi kohort retrospektif dan menggunakan sumber data sekunder pasien hipertensi rawat jalan peserta asuransi kesehatan PT Askes di RSUD Panembahan Senopati Bantul. Metode pengukuran per- sistensi adalah metode the gaps between refill dengan tenggang waktu pengambilan obat selama 30 hari. Data dianalisis menggunakan uji kai kuadrat, Kaplan-Meier, dan Cox regression. Jumlah subjek yang ikut dalam penelitian ini adalah 304 pasien hipertensi yang menggunakan obat anti- hipertensi pertama kali (tanggal indeks diagnosis 1 Juli 2007 hingga 31 Desember 2008). Setelah pengamatan 4,5 tahun, hampir separuh subjek yang mendapat monoterapi (57,6%) dan kombinasi terapi (53,8%) tidak persisten menggunakan obat antihipertensi. Ketidakpersistenan penggu- naan obat antihipertensi lebih besar pada kelompok monoterapi daripada kelompok kombinasi, tetapi perbedaan tersebut tidak signifikan (RR = 0,94; 95% CI = 0,73 _ 1,21). Penggunakan diuretik (85,7%) dan kombinasi obat diuretik + ACE inhibitor (84,6%) cenderung tidak persisten dibandingkan subjek yang menggunakan ACE inhibitor (58,4%). Perbedaan ini bermak- na secara statistik (RR = 1,47; 95% CI = 1,05 _ 2,01 dan RR = 1,45; 95% CI = 1,10 _ 1,91). Persistensi dipengaruhi oleh jenis obat antihipertensi yang digunakan, yaitu ACE inhibitor.

Persistence of the use of antihypertensive drugs in hypertensive patients greatly needed. Considering the primary outcome of treatment for hyper- tension is to reduce or prevent the occurrence of cardiovascular events such as myocardial infarction, stroke resulting in the risk of death. This Persistensi Penggunaan Obat Antihipertensi pada Pasien Hipertensi Rawat Jalan Persistence of Antihypertensive Drugs among Outpatient with Hypertension Nurmainah* Ahmad Fudholi** Iwan Dwiprahasto*** study aims to determine whether persistence is influenced by the type of treatment or type of antihypertensive drugs. This study was designed with retrospective cohort study using database of prescribing claimed of subjects under health insurance (PT Askes) in Panembahan Senopati hospitals us- ing antihypertensive drugs. Persistency measurement method used is the method of the gaps between refilling. The grace period taking the drug for 30 days. Further data were analyzed using the chi square test, Kaplan_Meier, and Cox regression. This cohort study involving 304 patients using antihypertensive medications first (index diagnosis 1 July 2007 until 31 December 2008). After observation for 4,5 years found almost half of the subjects receive monotherapy (57,6%) or combination therapy (53,8%) are not persistent in the use of antihypertensive medications. Not persistent greater in the monotherapy compare to combination therapy group. However, this difference did not reach significance (RR = 0,94; CI 95% = 0,73 _ 1,21). Subject were using a diuretic (85,7%) and ACE inhibitor + di- uretic combination (84,6%) tends not to be persistent compare to subject using ACE inhibitors (58,4%). This difference was statistically significant (RR = 1,47; CI 95% = 1,05 _ 2,01 and RR = 1,45; CI 95% = 1,10 _ 1,91). Overall, persistence is influenced by the type antihypertensive drugs used, the ACE inhibitors.