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Abstrak :
Pendahuluan : Disfungsi endotel terjadi sejak fase awal dari aterosklerosis yaitu pada pasien-pasien hipertensi, diabetes, hiperhomosisteinemia, perokok maupun pada fase lanjut dari aterosklerosis. Kegagalan fungsi endotel pada respons dilatasinya akibat aktifasi eNOS yang menurun. Teh hijau terbukti mampu memperbaiki disfungsi endotel dinilai dari perbaikan forearm blood flow perokok sehat yang belum mengalami PJK. Tujuan Penelitian : Untuk membuktikan bahwa pemberian teh hijau sekali asupan dapat memperbaiki flow mediated dilatation pada pasien-pasien penyakit jantung koroner, yang berarti ada perbaikan disfungsi endotel. Metode : Penelitian dilakukan pada 23 pasien yang terbukti penyakit jantung koroner dari basil kateterisasi, bail( yang sudah menjalani revaskularisasi maupun yang belum. Sampel dibagi menjadi dua kelompok, kelompok pertama mendapatkan teh hijau setelah sebelumnya diperiksa FMDnya serta FMD pasca perlakuan 1,5jam sesudah pemberian teh, kelompok kedua mendapatkan placebo (air putih). Kemudian dilakukan crossover setelah 3-5 hari periode washout, kelompok pertama ganti mendapatkan placebo dengan diperiksa FMD sebelum dan sesudah perlakuan dan kelompok kedua mendapatkan teh hijau. Dilakukan pemeriksaan FMD pada orangorang yang sehat usia kurang dari 25 tahun sebagai kontrol populasi sehat. Hasil : Tidak ada perbedaan bermakna pada karakteristik dasar antara kelompok yang mendapatkan teh hijau dahulu dibandingkan yang mendapatkan placebo dahulu. Sedangkan FMD kelompok baseline kelompok teh 4,80±5,37 berbeda bermakna dibandingkan kontrol sehat 9,15±3,65 (p=0,047) sedangkan FMD baseline sebelum mendapatkan placebo 5,87±3,89 tidak ada perbedaan bermakna dibandingkan FMD baseline pre teh hijau (p=0,398) maupun dibandingkan kelompok kontrol sehat (p=0,082). FMD pasca perlakuan menunjukan perubahan perbaikan yang bermakna pada kelompok teh hijau bila dibandingkan baseline (4,80±5,37 vs 8,68±6,00 p=0.026) sedangkan kelompok placebo menunjukan perubahan perburukan FMD bila dibandingkan pre dan pasca placebo (5,87±3,89 vs 3,34±3,66 p=0,026)_ FMD pasca teh hijau berbeda bermakna bila dibandingkan pasca placebo (8,68±6,00 vs 3,35±3,66 p=0,002). Tidak ada perubahan diameter arteri brachialis kelompok teh hijau maupun placebo (4,60-0,36 vs 4,57±0,41 ; p=0,800 dan 4,57±0,41 vs 4,61±0,36 p=0,601). Tidak ada perubahan tekanan darah sistolik kelompok teh hijau dan placebo (144,78±25,69 vs 146,91±24,76 ; p=0,502 dan 141,30±25,46 vs 139,78±22,99 ; p=0,632). Tekanan darah diastolik kelompok teh hijau dan placebo juga tidak ada perubahan bermakna (86,82±10,55 vs 87,27±9,84; p0,549 dan 83,63±9,24 vs 81,81±8,73; p=0,510). Demikian juga nadi kelompok teh hijau dan kelompok placebo. (67,174±12,492 vs 66,609±11,900; p=0,236 dan 68,043±9,028 vs 66,739±8,247; p=0,127) Kesimpulan : Teh hijau mampu memperbaiki fungsi endotel dinilai dari perbaikan flow mediated dilatation jangka pendek pada pasien-pasien penyakit jantung koroner, dimana efek yang berlawanan justru diperlihatkan air putih, pada penelitian eksperimental dengan design crossover.

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Background : Endothelial dysfunction begins when atherosclerosis developed as what go through on hypertension, diabetes, hyperhomocysteinemia, and also what go through among smoker who hasn't have CAD until end phase of atherosclerosis. Impairment of endothelial function depends on vasodilatation due to the decreasing of eNOS activity. Green tea has been proved to have positive effect in reversing endothelial dysfunction among healthy smoker. Objectives : to determine the short term effect of green tea on flow mediated dilatation among coronary artery disease patients which repaired the dysfunction of endothelial cells. Methods : 23 coronary artery disease patients which had been confirmed by coronary angiography joined the study. The sample was divided into two groups, first was the group who took green tea, and the 2nd was the group who took placebo (mineral water). Before treatment, the FMD of both two groups were measured and one hour and half after treatment. After 3-5 days of treatment, both groups were crossover. FMD among healthy group of age Iess than 25 years old was also measured as control group. Results : There was no significant differences in baseline characteristic between the first group and the 2"d (both received green tea but in different time). FMD after treatment was increased among group who took green tea (4.8015.37 vs 8.6816.00, p=0.026), while FMD among placebo group was decreased (5.8713.89 vs 3.3413.66 p=0.026). There was significant differences of FMD after treatment with green tea and after treatment with placebo (8.68±6.00 vs 3.3513.66 p = 0.002). There was no differences of brachialis artery diameter in both groups (4.6010.36 vs 4.5710.41, p=0.8 and 4.5710.4I vs 4.61±0.36, ptl.601). There was no differences od systolic pressure in both group (144.78 125.69 vs 146.91124.76, p=0.502 and 141.30±25.46 vs 139.78122.99, p=0.632). Also there was no differences of diastolic pressure in both groups (86.82110.55 vs 87.2719.84, p= 0.549 and 83.6319.24 vs 81.8118.73, p=0.510). No differences of heart rate in both groups (67.174112.492 vs 66.609111.900, p=0.236 and 68.043 ±9.028 vs 6633918.247, p=0.127) Conclusion : From this study we conclude that green tea had positive effect in reversing endothelial dysfunction among coronary artery disease patient by assessing flow mediated dilatation in short time. The group who took placebo showed the paradoxical effect.

Abstrak :
Latar Belakang: Hipertensi berkontribusi secara bermakna terhadap morbiditas dan mortalitas kardiovaskular (KV) di dunia. Dua penyebab terpentingnya adalah asupan garam dan disfungsi endotel yang dapat dinilai menggunakan flow-mediated dilatation (FMD). Modifikasi keduanya dapat menurunkan morbiditas dan mortalitas hipertensi. Diet rendah natrium DRN belum diterapkan secara optimal di dunia karena keterbatasan produk garam rendah natrium. Belum ada studi tentang perbandingan efek diet rendah natrium yang bervariasi terhadap perbaikan fungsi endotel yang dinilai melalui FMD pada subjek hipertensi derajat I, khususnya di Indonesia. Metode: Uji klinis ini dilaksanakan di RSJPD Harapan Kita terhadap 52 subjek hipertensi derajat I (26 laki-laki dan 26 perempuan), berusia 25 - 59 tahun, dan berindeks massa tubuh 18,5 - 29,99 kg/m2. Subjek dieksklusi jika berpenyakit atau berfaktor risiko KV, memiliki penyakit liver, kanker, alergi rumput laut, infeksi berat, atau dalam terapi KV, hormonal, steroid, atau terapi herbal rutin. Data primer didapat dari anamnesis dan pemeriksaan fisik. Subjek-subjek dirandomisasi menjadi dua kelompok, yaitu kelompok DRN dengan kadar natrium 21 - 23% dan kelompok DRN dengan kadar natrium 38 - 40%, kedua diet diberikan dalam bentuk kuah. Nilai FMD diukur sebelum intervensi dan 60 menit setelahnya. Hasil: Karakteristik dasar, termasuk diameter arteri brakialis prakompresi dan pascakompresi serta FMD, tidak berbeda bermakna di antara kedua grup. Pada kelompok DRN 38 - 40%, nilai FMD pada menit ke-60 pasca-intervensi menurun dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut tidak bermakna median [kisaran]: 7,92 [0,00 - 17,50]; p>0,05). Pada kelompok DRN 21 - 23%, nilai FMD pada menit ke-60 pasca-intervensi meningkat dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut juga tidak bermakna 7,65 [1,36 - 19,51]; p>0,05). Simpulan: Nilai FMD pasca-intervensi tidak berbeda bermakna antarkelompok. Ketidakbermaknaan perbedaan nilai-nilai FMD dalam penelitian ini mungkin disebabkan oleh aspek-aspek internal subjek yang memengaruhi fungsi endotel dan prosedur evaluasi FMD.

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Background: Hypertension contributes significantly to cardiovascular (CV) morbidity and mortality in the world. Two of its most important causes are salt intake and endothelial dysfunction which can be assessed using flow-mediated dilatation (FMD) test. Modification of both may decrease its morbidity and mortality. Low-sodium diet (LSD) has not been optimally implemented in the world due to the limited low-sodiumsalt products. There has been no study regarding the effects of low-sodium salt with various sodium concentrations on FMD of grade-I-hypertension subjects, especially in Indonesia. Methods: This clinical trial was conducted at the NCC Harapan Kita on 52 grade-Ihypertension subjects 26 men, 26 women , aged 25 - 59 years old, with body mass index of 18.5 - 29.99 kg/m2. Subjects were excluded if they had CVD, CV risk factors, liver disease, cancer, seaweed allergy, severe infection, or on routine CV-, hormonal-, steroid, or herbal-therapy. Primary data were collected from anamnesis and physical examinations. We randomly assigned the subjects into two groups, i.e. the group LSD with natrium concentration of 21 - 23% and the group of LSD with natrium concentration of 38-40% . Both diets were given in a soup form. The FMD values were measured before the intervention and 60 minutes after it. Results: Baseline characteristics, including pre-compression and post-compression brachial artery diameter and baseline FMD, were not significantly different between both groups. At group LSD 38 - 40%, FMD value at 60 minutes post-intervention was decreased compared to its baseline value, but the difference was not significant median [range]: 7.92 [0.00 mdash;17.50]; p>0.05). At group LSD 21 - 23%, FMD value at 60 minutes post-intervention was increased compared to its baseline value, but the difference was also not significant 7.65 [1.36 mdash;19.51]; p>0.05). Conclusion: The post-intervention FMD values were not significantly different between both groups. The non-significant differences between FMD values in this study may be due to the subjects' internal aspects influencing endothelial function and FMD evaluation procedure.