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"Latar Belakang. Cedera Reperfusi Iskemia merupakan eksaserbasi paradoks mengakibatkan disfungsi dan kematian sel setelah aliran darah direstorasi ke jaringan yang sebelumnya iskemia. Pada iskemia tungkai akut, reperfusi menimbulkan reaksi kompleks melibatkan inflamasi lokal maupun sistemik dengan dampak lokal sindroma kompartemen dan dampak sistemik berupa disfungsi hingga kegagalan multi organ. Platelets activating factors (PAF) sebagai mediator inflamasi pospholipid mempunyai efek fisiologis yang poten dan beragam, sehingga meningkatkan respon inflamasi pada cedera reperfusi iskemik.Berbagai upaya untuk mencegah dan memperingan cedera reperfusi iskemik, antara lain penggunaan prosedur ischemic preconditioning, antioksidan dan terapi anti-sitokin telah diteliti namun hasil dan manfaat klinisnya belum memuaskan. PTX, phosphodiesterase nonspesifik derivat xanthine, memperlihatkan efek penekanan inflamasi dan menghambat interaksi lekositendotel yang menjanjikan dalam mencegah cedera reperfusi. Namun hasil penelitian mengenai peran pentoxifylinne dalam menekan reaksi inflamasi melalui penekanan PAF pada iskemia tungkai akut tidak konsisten. Sehingga penelitian ini bertujuan untuk menilai peran PTX dalam mengurangi cedera reperfusi melalui penekanan mediator inflamasi PAF pada hewan coba kelinci dengan Reperfusi Iskemia tungkai akut.Metodologi. Dilakukan tindakan iskemik tungkai kiri selama 3 jam yang diikuti 2 jam periode reperfusi pada 10 ekor kelinci New Zealand White jantan yang dibagi menjadi 2 kelompok (kelompok pentoksifin dan kelompok kontrol) secara acak. Pada kelompok perlakuan diberikan PTX 30 menit sebelum reperfusi dengan dosis initial bolus 40 mg/kgBB diikuti dengan dosis rumatan 1 mg/kg BB/jam hingga 3 jam periode reperfusi. Pada kelompok kontrol diberikan cairan garam fisiologis dengan kecepatan dan volume yang sebanding. Tindakan Iskemik dilakukan dengan oklusi arteri iliaka komunis sinistra mengunakan klem selama 3 jam kemudian dilanjutkan dengan restorasi aliran darah. Pengambialn sampel untuk pemeriksaan kadar PAF dilakukan pada 2,5 jam iskemik dan pada 2 jam reperfusi.Hasil. Pada periode Iskemik dua jam tiga puluh menit tidak mengakibatkan perbedaan bermakna (p=0,754), kadar rerata PAF pada kelompok PTX 13,09 ± 0,41 pg/mL dan kelompok kontrol I3,38 ± 0,28 pg/mL. Pada jam ke dua tindakan reperfusi ditemukan perbedaan bermakna (p=0,009) kadar rerata PAF dari kelompok PTX menurun menjadi 11,36±0,78 pg/mL dan kelompok kontrol meningkat menjadi 25,5±0,78 pg/dL.Kesimpulan. PTX menurunkan kadar PAF plasma kelinci dengan cedera reperfusi iskemikia tungkai akut.

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Background. Ischemic reperfusion injury is a paradoxical exacerbation of cell dysfunction and death following the restoration of blood flow to previously ischemic tissue. Restoration of blood flow is essential to salvage ischemic tissue, however reperfusion itself paradoxically causes further damage to the ischemic tissue, threatening function and viability both organ local and distal through the inflammation response.

In Acute limb ischemia, there are essentially two components: a local component that can result in increasing the regional damage from ischemia inflammatory responses which may result in local syndrome, compartment syndrome, and systemic syndrome, multi organ dysfunction and failure.

Several method and attempt had been studied and performed to prevent and attenuate reperfusion injury such as, ischemic preconditioning, antioxidant, and anti-cytokine therapy, but their clinical benefit were not satisfactory. Pentoxifylline has emerged as an agent that may attenuate inflammation response through several mechanisms. However, studies on PTX and its function to prevent and attenuate inflammation response through attenuating PAF in acute limb ischemic were not consistent. In this study the role of PTX and its function to prevent and attenuate inflammation response through attenuating PAF in acute limb ischemic was investigated.

Methods. Acute limb ischemia in the left lower limbs of 10 New Zealand White male rabbit were performed for 3 hour followed by 2 hours period of ischemia. The rabbits were randomly separated into 2 groups of five (group pentoxifylinne and group control). The Pentoxifylline group was given PTX 40 mg/kg bolus half an hour prior to reperfusion followed by maintenance dose 1 mg/kg/hour until 2 hour post reperfusion, while the control group was given normal saline solution with comparable volume and rate administration. Acute limb Ischemic procedure was performed by direct occlusion of the left femoral artery using non traumatic clamp and followed by releasing the clamp after 3 hours of occlusion. Level of PAF were measured after 2.5 hour of ischemic period and after 2 hours of reperfusion period.

Results. After 2.5 hours of ischemic period, the mean PAF levels did not show any significant difference (p=0.754). The mean PAF level of pentoxifylline group 13.09f0.41 pg/mL, while the mean PAF level of control group 13.38±0.28 pg/mL, After 2 hours period of reperfusion, there were significant differences of mean PAF level between the two groups (p=0.009). The mean PAF level in the control group increase by 12.1 110.79 to became 25.5±0.78 pg/dL, while the mean PAF level of the PTX group decrease by 1.73f1.1 pg/mL and became 11.36±0.78 pg/m L.

Conclusion. PTX decreased the PAF level in rabbits with acute limb ischemic reperfusion injury."

"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.

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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."

"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.

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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."

"ABSTRAK Latar Belakang : Hipertensi merupakan faktor resiko utama penyakit kardiovaskular, terutama sindrom koroner akut dan stroke. Peningkatan konsumsi garam berhubungandengan kenaikan tekanan darah. Beberapa studi randomized-controlled trial (RCT)menyatakan bahwa konsumsi rendah garam dapat menurunkan tekanan darah padapopulasi dewasa dengan atau tanpa hipertensi. Variabilitas tekanan darah selama 24 jambersifat dinamis. Peningkatan darah nokturnal memiliki makna klinis yang cukup besar,merupakan salah satu prediktor dari penyebab kerusakan target organ, terutama kejadiankardiovaskular dan stroke. Asupan garam dapat mempengaruhi variasi tekanan darah 24jam, yang dalam hal ini dapat juga berpengaruh pada hipertensi nokturnal. Obat penyekatEKA merupakan obat hipertensi lini pertama yang sering digunakan, terutama pada usiamuda dan hipertensi yang disertai sindrom metabolik, mengingat peranan Sistem ReninAngiotensin memiliki peranan yang sangat penting dalam patofisiologi hipertensi. Asupangaram juga memiliki peranan pada patofisiologi terjadinya hipertensi dalam sistem ReninAngiotensin. Sedikit studi yang meneliti perpaduan obat penyekat EKA dengan asupanrendah garam dalam menrunkan kejadian hipertensi. Oleh karena itu, Menarik untuk ditelitipengaruh asupan garam dengan tekanan darah nokturnal pada pasien yang mengkonsumsiobat penyekat EKA.Tujuan : Menilai pengaruh asupan garam dengan tekanan darah nokturnal pada pasienhipertensi yang mendapatkan terapi penyekat EKA. Metode : Pasien poliklinik berusia 30 ? 50 tahun yang terdiagnosis hipertensi dan belumpernah mendapatkan anti-hipertensi sebelumnya, dibagi menjadi 2 kelompok (asupanrendah garam (Na <15 g/hari) dan asupan tinggi garam ≥15 g/hari). Kedua kelompok akandiberikan lisinopril dan dilakukan pemeriksaan natrium urin 24 jam dan home bloodpressure monitoring..Hasil Penelitian : Sebanyak 80 pasien hipertensi pasien hipertensi yang belummendapatkan terapi diikutsetakan dalam penelitian ini, yang terdiri dari 37 pasienkelompok rendah garam dan 43 pasien kelompok tinggi garam. Kelompok pasien denganasupan 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 padakelompok asupan tinggi garam. Rerata asupan garam pada penelitian ini sebesar 16,77gram/hari. Pada analisa multivariat didapatkan delta penurunan tekanan darah tidakdipengaruhi 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 correlatesto high blood pressure. Some Randomized-Controlled-Trials stated that low saltintake may decrease blood pressure in adult population with or withouthypertension. Blood pressure variation in 24 hours is not static but dynamicallychanges. Increasing nocturnal blood pressure has significantly impacts, and becomeone of predictor of target organ damage, especially cardiovascular events andstroke. 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 associatedwith metabolic syndrome, due to important role of Renin Angiotensin AldosteroneSystem in pathophysiology of hypertension, whereas salt intake also has role in thatsystem. Only few of studies that had proved combination of ACE Inhibitors andlow 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 pressurein hypertension patient treated with ACE Inhibitors.Objectives : To know impact of low salt intake to nocturnal blood pressure inhypertension patient treated with ACE Inhibitors.Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreatedhypertension, divided into two groups (low salt intake (Na <15 grams/day) and highsalt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg andunderwent 24-hours sodium urine collection and home blood pressure monitoringperiodically.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 intakegroup. 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 saltintake group. Mean salt intake in this study was 16.77 grams/day. Multivariateanalyzes showed that the difference of decreasing nocturnal blood pressure was notinterfered 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 correlatesto high blood pressure. Some Randomized-Controlled-Trials stated that low saltintake may decrease blood pressure in adult population with or withouthypertension. Blood pressure variation in 24 hours is not static but dynamicallychanges. Increasing nocturnal blood pressure has significantly impacts, and becomeone of predictor of target organ damage, especially cardiovascular events andstroke. 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 associatedwith metabolic syndrome, due to important role of Renin Angiotensin AldosteroneSystem in pathophysiology of hypertension, whereas salt intake also has role in thatsystem. Only few of studies that had proved combination of ACE Inhibitors andlow 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 pressurein hypertension patient treated with ACE Inhibitors.Objectives : To know impact of low salt intake to nocturnal blood pressure inhypertension patient treated with ACE Inhibitors.Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreatedhypertension, divided into two groups (low salt intake (Na <15 grams/day) and highsalt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg andunderwent 24-hours sodium urine collection and home blood pressure monitoringperiodically.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 intakegroup. 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 saltintake group. Mean salt intake in this study was 16.77 grams/day. Multivariateanalyzes showed that the difference of decreasing nocturnal blood pressure was notinterfered 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 correlatesto high blood pressure. Some Randomized-Controlled-Trials stated that low saltintake may decrease blood pressure in adult population with or withouthypertension. Blood pressure variation in 24 hours is not static but dynamicallychanges. Increasing nocturnal blood pressure has significantly impacts, and becomeone of predictor of target organ damage, especially cardiovascular events andstroke. 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 associatedwith metabolic syndrome, due to important role of Renin Angiotensin AldosteroneSystem in pathophysiology of hypertension, whereas salt intake also has role in thatsystem. Only few of studies that had proved combination of ACE Inhibitors andlow 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 pressurein hypertension patient treated with ACE Inhibitors.Objectives : To know impact of low salt intake to nocturnal blood pressure inhypertension patient treated with ACE Inhibitors.Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreatedhypertension, divided into two groups (low salt intake (Na <15 grams/day) and highsalt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg andunderwent 24-hours sodium urine collection and home blood pressure monitoringperiodically.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 intakegroup. 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 saltintake group. Mean salt intake in this study was 16.77 grams/day. Multivariateanalyzes showed that the difference of decreasing nocturnal blood pressure was notinterfered 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 Latar belakang. Hipertensi merupakan salah satu kondisi yang paling banyakditemukan pada pelayanan kesehatan primer yang dapat meningkatkan mortalitas danmorbidita apabila tidak mendapatkan pengobatan yang tepat. Beberapa penelitianmenunjukkan respon penurunan tekanandarah pada ras kulit hitam berbeda dibandingras kulit putih dengan antihipertensi golongan penyekat EKA, hal ini ditunjangdengan perbedaan PRA pada kedua kelompok ras ini. Belum terdapat data tentangrespon tekanan darah pasien hipertensi ras melanesiadengan pemberian penyekatEKA yang ditunjang dengan pemeriksaan kadar PRA pada kelompok ras ini.Objektif. Menilai apakah terdapat perbedaan respon terapi terhadap penyekat enzimkonversi angiotensin (EKA) pada pasien hipertensi ras melanesia dan ras nonmelanesia.Metode. Penelitian ini adalah penelitian kohort prospektif yangdilakukan di kotaJayapura bulan September-November 2015terhadap 85 subyek usia 30 sampai 55tahun dengan hipertensi yang belum pernah diobati sebelumnya. Subyek terbagi atas2 grup yaitu ras Melanesia (n=34) dan ras Non Melanesia(n=51). Kedua grup tersebutdiberikan lisinopril dosis awal 5 mg. Pemeriksaan tekanan darah dilakukan pada awaldan diulangi setiap 7 hari selama 4 minggu berturut-turut.Hasil. Terdapat perbedaan respon tekanan darah pasien hipertensi ras Melanesia danras Non Melanesia. Perbedaan tekanan darah sistolik sebesar 24,5 ± 9,4 mmHg padasubyek 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±5,5mmHg 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 mmHgdan pada subek ras Non Melanesia sebesar 26,21±8,8 mmHg (p<0,001). ReratakadarPlasma 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 keduakelompok ras ini (p=0,564).Kesimpulan. Terdapat perbedaan penurunan tekanan darah (sistolik, diastolik dantekanan rerata arteri) dengan pemberian penyekat EKA pada kelompok ras Melanesiadan kelompok ras Non Melanesia dan hal ini tidak berhubungan bermakna denganrerata 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 healthcare that increase mortality and morbidity if it does not receive appropriate therapy.Several studies show that blacks response differently compared with white inconjunction with a decrease of blood pressure in response to administer ACEinhibitor. The studies supported by PRA differences in both group of race. There areno data ofblood pressure response in hypertensive patientsinMelanesian race byadministeringACE inhibitor supported withPRA levels examination in thisgroup ofrace.Objective. To compare therapeutic response ofangiotensin converting enzymeblockers (ACE)inhibitorinreducing blood pressure between MelanesianandNonMelanesian hipertensive patients.Method. This study is a prospective cohort study conducted in the city ofJayapura September to November 2015. We found85 subjects aged 30 to 55 yearsoldwith hypertensionnever be treated before. Subjects are divided into twogroups, 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 pressurechecks 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 hypertensivepatientofMelanesian race and Non Melanesiarace. Reduction ofsystolic bloodpressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject ofNon Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic bloodpressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of NonMelanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure insubjectMelanesian 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 theMelanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian racePRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationshipmean PRA levels in both these racial groups (p = 0.564).Conclusion. There aredifferences in blood pressure reduction (systolic, diastolicpressure and mean arterial pressure) with administer of ACE inhibitor inMelanesianand Non Melanesiagroup of race. There is no significant relation withaveragePRAlevels 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 healthcare that increase mortality and morbidity if it does not receive appropriate therapy.Several studies show that blacks response differently compared with white inconjunction with a decrease of blood pressure in response to administer ACEinhibitor. The studies supported by PRA differences in both group of race. There areno data ofblood pressure response in hypertensive patientsinMelanesian race byadministeringACE inhibitor supported withPRA levels examination in thisgroup ofrace.Objective. To compare therapeutic response ofangiotensin converting enzymeblockers (ACE)inhibitorinreducing blood pressure between MelanesianandNonMelanesian hipertensive patients.Method. This study is a prospective cohort study conducted in the city ofJayapura September to November 2015. We found85 subjects aged 30 to 55 yearsoldwith hypertensionnever be treated before. Subjects are divided into twogroups, 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 pressurechecks 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 hypertensivepatientofMelanesian race and Non Melanesiarace. Reduction ofsystolic bloodpressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject ofNon Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic bloodpressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of NonMelanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure insubjectMelanesian 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 theMelanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian racePRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationshipmean PRA levels in both these racial groups (p = 0.564).Conclusion. There aredifferences in blood pressure reduction (systolic, diastolicpressure and mean arterial pressure) with administer of ACE inhibitor inMelanesianand Non Melanesiagroup of race. There is no significant relation withaveragePRAlevels 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 healthcare that increase mortality and morbidity if it does not receive appropriate therapy.Several studies show that blacks response differently compared with white inconjunction with a decrease of blood pressure in response to administer ACEinhibitor. The studies supported by PRA differences in both group of race. There areno data ofblood pressure response in hypertensive patientsinMelanesian race byadministeringACE inhibitor supported withPRA levels examination in thisgroup ofrace.Objective. To compare therapeutic response ofangiotensin converting enzymeblockers (ACE)inhibitorinreducing blood pressure between MelanesianandNonMelanesian hipertensive patients.Method. This study is a prospective cohort study conducted in the city ofJayapura September to November 2015. We found85 subjects aged 30 to 55 yearsoldwith hypertensionnever be treated before. Subjects are divided into twogroups, 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 pressurechecks 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 hypertensivepatientofMelanesian race and Non Melanesiarace. Reduction ofsystolic bloodpressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject ofNon Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic bloodpressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of NonMelanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure insubjectMelanesian 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 theMelanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian racePRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationshipmean PRA levels in both these racial groups (p = 0.564).Conclusion. There aredifferences in blood pressure reduction (systolic, diastolicpressure and mean arterial pressure) with administer of ACE inhibitor inMelanesianand Non Melanesiagroup of race. There is no significant relation withaveragePRAlevels in both group of race. Another factors affectsresponses of reduction blood pressure with administer ofACEinhibitor may be considered."

"ABSTRAKLatar belakang: Hiperurisemia asimtomatik seringkali dianggap kondisi yang tidak berbahaya dan belum perlu ditatalaksana. Kadar asam urat yang tinggi merupakan faktor independen terjadinya peningkatan tekanan darah. Tekanan darah memiliki parameter fisiologis yang ditandai oleh fluktuasi dinamis dan kontinyu. Fluktuasi ini dinyatakan sebagai variabilitas tekanan darah (VTD). Pada kondisi normotensi variabilitas tekanan darah juga berubah-ubah. Beberapa penelitian telah menunjukkan variabilitas tekanan darah berperan dalam kejadian kardiovaskular. Agen anti hiperurisemia seperti allopurinol telah terbukti berperan dalam penurunan rerata tekanan darah. Meskipun demikian peran allopurinol terhadap variabilitas tekanan darah pada subyek hiperurisemia asimtomatik yang normotensi belum banyak diketahui.Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan allopurinol dengan perubahan variabilitas tekanan darah pada subyek hiperurisemia asimtomatik normotensiMetode: Sebanyak 37 subyek hiperurisemia asimtomatik yang normotensimenjalani pemeriksaan home blood pressure monitoring (HBPM)sebelum dan sesudah pemberian allopurinol 1x300 mg selama 8 minggu. Dilakukan analisa variabilitas tekanan darah pagi dan malam baik sebelum maupun sesudah terapi.Hasil: Pemberian allopurinol terbukti tidak bermakna dalam menurunkan variabilitas tekanan darah sistolik pagi dari 4.4±3.0 menjadi 3.8±2.1 (p 0,357), variabilitas tekanan darah sistolik malam dari 5.1± 2.7 menjadi 4.2± 2.2 (p 0,129), variabilitas tekanan darah diastolik pagi dari 4.3± 2.2 menjadi 4.0± 2.0 (p 0,531) dan variabilitas tekanan darah diastolik malam dari 4.1±1.5 menjadi 3.3±2.0 (p 0,063).Kesimpulan: Sesudah terapi allopurinol terdapat penurunan variabilitas tekanan darah sistolik dan diastolik pagi dan malam, meskipun secara statistik tidak bermakna

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ABSTRACTBackground:Asymptomatic hyperuricemia is often considered a harmless condition and does not need to be managed. High level of serum uric acid is an independent factor in an increase of blood pressure. Blood pressure has physiological parameters that are characterized by dynamic and continuous fluctuation. This fluctuation is expressed as blood pressure variability (BPV). In normotensive condition, BPVchanges dynamically. Several studies have shown that BPV plays a role in cardiovascular events. Antihyperuricemia agents, such as allopurinol, have been shown to decrease mean blood pressure. Howeverthe role of allopurinol in BPV in normotensive subjects has not been established yet in prior studies.Objective: The aim of this study is to evaluate the association of Allopurinol administration and changes in blood pressure variability in asymptomatic hyperuricemia subjects with normotension.Methods:A total of 37 normotensive asymptomatic hyperuricemia subjects underwent a home blood pressure monitoring (HBPM) before and after administration of allopurinol 1x300 mg for 8 weeks. Variability of blood pressure was analyzed both daytime and nighttime.Results: The administration of allopurinol proved not significant in reducing morning-time systolic blood pressure variability from 4.4±3.0 to 3.8±2.1 mmHg (p 0,357), night-time systolic blood pressure variability from 5.1±2.7 to 4.2±2.2 mmHg (p 0,129), morning-time diastolic blood pressure variability from 4.3±2.2 to 4.0±2.0 mmHg (p 0,531) and night-time diastolic blood pressure variability from 4.1±1.5 to 3.3±2.0 mmHg (p 0,063)Conclusion: After allopurinol administration, there was a decrease in the variability of morning-time and night-time systolic and diastolic blood pressure, although not statistically significant."

"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.

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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."

"Latar Belakang : Morbiditas pasca operasi bedah pintas koroner BPAK masih cukuptinggi. Hal ini disebabkan karena adanya peningkatan inflamasi 48 ndash; 72 jam pasca BPAK danpeningkatan pada sistem renin angiotensin dan aldosteron RAAS. Penyekat EKA diketahuidapat menghambat RAAS dan inflamasi. Namun belum ada penelitian yang membuktikanbahwa penyekat EKA dapat menurunkan inflamasi pada pasien pasca BPAKTujuan : Mengetahui efek captopril dalam menurunkan inflamasi yang diukur menggunakanhsCRP pada pasien yang menjalani BPAK elektif.Metode : Penelitian ini merupakan studi kohort prospektif. Dilakukan di Rumah SakitJantung dan Pembuluh Darah Harapan Kita RSJPDHK pada subyek yang menjalani BPAKelektif. Durasi penelitian dilakukan pada bulan Mei hingga Oktober 2016. Subyek dibagidalam dua kelompok yaitu kelompok yang mendapatkan captorpil pasca BPAK dan tanpacaptopril. Dilakukan pemeriksaan hsCRP serial sebanyak tiga kali yaitu sebelum operasi,hari ketiga pasca operasi dan sebelum pulang rawat.Hasil Penelitian : Terdapat total 85 subyek, 49 subyek pada kelompok mendapat captoprildan 36 subyek pada kelompok tanpa captopril. Pemeriksaan hsCRP sebelum operasi dan H 3pasca BPAK menunjukkan tidak ada perbedaan pada kedua kelompok. Pemeriksaan hsCRPH 6 pasca BPAK menunjukkan hsCRP pada kelompok yang mendapatkan captopril lebihrendah 31,4 mg/L 10,5 ndash; 154 vs 46,7 mg/L 10,3 ndash; 318 dengan nilai signifikansi P=0,018.Kesimpulan : Subyek yang mendapatkan captopril mempunyai tingkat inflamasi yang lebihrendah pada H 6 pasca BPAK yang dinilai dengan hsCRP dibandingkan kelompok yangtidak mendapat captopril.

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Background Postoperative morbidity of coronary artery bypass surgery CABG is fairlyhigh. This is due to increased of inflammatory response 48 ndash 72 hour after surgery andincreased of renin angiotensin aldosteron system RAAS. ACE inhibitors are known toinhibit inflammation and RAAS. However, no study has proved that ACE inhibitors canreduce inflammation in post operative CABG.

Objective To determine the effect of captopril in reducing hsCRP post CABG surgery.

Methods This is a cohort prospective study that was conducted in Harapan Kita Hospital, on post operative elective CABG subjects on May until October 2016. Subject divided intotwo groups, the group with captopril and the other is without captopril. High sensitive CRPwas measured 3 times day 0 before surgery, day 3 post CABG, day 6 post CABG.

Results There are total 85 subjects, 49 subjects with captopril and 36 subjects withoutcaptopril. There was no difference in hsCRP results before surgery and day 3 post CABG. Inday 6 post CABG, hsCRP examination in captopril group is lower than the group withoutcaptopril 31,4 mg L 10,5 ndash 154 vs 46,7 mg L 10,3 ndash 318 with P 0,018.

Conclusion Subjects with captopril has lower hsCRP at day 6 post CABG than the subjectswithout captopril."

"Latar Belakang : Disfungsi diastolik ventrikel kiri DDVK subklinis seringterjadi dan dianggap sebagai prediktor penting gagal jantung dan kematian jangkapanjang. Deteksi dini adanya DDVK pada pasien hipertensi sangat pentingdilakukan dan memiliki makna klinis yang sangat diperlukan dalam aspektatalaksana yang tepat, sehingga dapat mengurangi morbiditas dan mortalitaspasien. Setyawan dkk mengembangkan suatu sistem skor diagnostik DDVK studiDSS pada pasien hipertensi di RSUD Tarakan Kalimantan Timur. Sistem skordiagnostik ini memiliki daya kalibrasi dan diskriminasi yang baik. Sampai saat inibelum ada validasi eksternal pada studi DSS tersebut, sehingga perlu dilakukanuntuk dapat selanjutnya diimplementasikan secara klinis. Tujuan : Memvalidasi secara eksternal Diastolic Dysfuction Scoring System DSS untuk mendiagnosis DDVK pada pasien hipertensi. Metode : Penelitian merupakan studi potong lintang dengan metode validasieksternal penuh yang dilakukan di Desa Gunungsari, Kecamatan Pamijahan,Bogor menggunakan data primer Januari 2017 hingga Februari 2017, yangdiambil secara total sampling. Analisis data ditujukan untuk mendapatkan nilaikalibrasi dan diskriminasi. Hasil : Sampel akhir studi validasi ini berjumlah 100, kejadian DDVK pada studiini 41 . Setelah dilakukan penghitungan skor DSS pada semua sampel studi,didapatkan nilai kalibrasi yang baik menggunakan uji Hosmer Lemeshow p =0,999 ; nilai hasil uji baik bila p>0,05 , sementara nilai diskriminasi didapatkanAUC yang kurang baik AUC = 0,594; 95 CI = 0,480 ndash; 0,708. Didapatkanobserved/expected sebesar 2,56, sensitivitas kurang 22 , dan spesifitas yangbaik 88. Kesimpulan : Studi DSS secara eksternal mempunyai kalibrasi yang baik dandiskriminasi yang kurang untuk memprediksi kejadian DDVK pada populasihipertensi di Desa Gunung Sari, Kecamatan Pamijahan, Bogor.

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Background : Subclinical left ventricular diastolic dysfunction is considered asimportant progression predictor and mortality due to heart failure. Diastolicdysfunction occurred before heart failure in hypertensive patients with preservedejection fraction, so that early diagnosis of diastolic dysfunction diagnosis is veryimportant. Several factors has been known related with left ventricular diastolicdys function. Setyawan dkk in 2016 developed Diastolic Dysfuction ScoringSytem DSS with good calibration and discrimination. However this score neverbeen externally validated.

Objective : To validate externally DSS study to diagnose left ventricular diastolicdysfunction in hypertensive population.

Methods : This is a cross sectional study with fully external validation methodthat performed at Gunungsari village, Pamijahan, Bogor using primary data fromJanuary 2017 until February 2017, which taken by total sampling method. Dataanalysis is intended to develop the calibration and discrimination level.

Results : The final samples were 100, with 41 sample have diastolicdysfunction. Callibration value with Hosmer Lemeshow showed good result withp 0.99 and poor discrimination AUC 0,594 95 CI 0,480 ndash 0,708 . We gotobserved expected ratio 2,56, fair sensitivity 22 , and good specificity 88.

Conclusion : DSS study externally have good callibration and poordiscrimination to diagnose left ventricle diastolic dysfunction in hypertensivepopulation in Gunung Sari village, Pamijahan, Bogor"

"ABSTRAKLatar Belakang: Hiponatremia ditemukan pada 15-20 admisi rumah sakit. Hiponatremia berhubungan dengan adverse outcome pada pasien gagal jantung. Penggunaan akuaretik dipertimbangkan untuk tatalaksana hiponatremia pada gagal jantung. Adverse outcomes akibat hiponatremia berdampak terhadap pembiayaan, dan merupakan target potensial untuk intervensi. Studi ini bertujuan menilai efektivitas klinis tatalaksana hiponatremia pada gagal jantung serta menganalisis biaya medis antar metode tatalaksana. Metode: Penelitian ini merupakan studi potong lintang pada pasien dengan gagal jantung dekompensasi akut dengan hiponatremia pada Januari 2014 ndash; Mei 2017. Hasil Penelitian: Total subjek 128 pasien, dengan 71 55.5 subjek mendapatkan terapi konvensional ditambah antagonis reseptor AVP. Terdapat perbedaan bermakna p = 0.041 kenaikan natrium median kelompok antagonis reseptor AVP 4 -8 ndash; 26 dan tanpa antagonis reseptor AVP 3 -16 ndash; 16 , dan perbedaan bermakna p < 0.0001 lama masa rawat median 10.50 3-40 hari pada kelompok antagonis reseptor AVP dan 6 3-71 hari pada kelompok tanpa antagonis reseptor AVP . Analisis biaya parsial tidak menunjukkan perbedaan bermakna pada biaya rerata harian antar kedua kelompok. Kesimpulan: Terdapat perbedaan kenaikan kadar natrium darah di hari ketiga pengobatan dan lama masa rawat antar metode tatalaksana hiponatremia pada gagal jantung dekompensasi akut. Tidak terdapat perbedaan biaya bermakna antar metode tatalaksana hiponatremia pada gagal jantung dekompensasi akut.

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ABSTRACTBackground Hyponatremia is found in 15 20 of hospital admissions and is associated with adverse outcomes in heart failure, where aquaretics may be considered in its management. Adverse outcomes due to hyponatremia affects funding, and is a potential target for intervention to decrease expenses. We aim to evaluate the clinical effectiveness of hyponatremia treatment methods in heart failure and analyze medical costs between them. Method This is a cross sectional study among acute decompensated heart failure patients with hyponatremia in NCCHK from January 2014 until May 2017. Result 128 subjects were analyzed, with 71 55.5 subjects receiving conventional therapy and AVP receptor antagonist and 57 44.5 receiving conventional therapy only. There was a significant difference in sodium increase 4 8 ndash 26 in AVP receptor antagonist patients and 3 16 ndash 16 in those without, p 0.041 , and in length of stay 10.50 3 40 days in AVP receptor antagonist patients and 6 3 71 in those without, p 0.0001 . Cost analysis showed no significant difference in average daily cost. Conclusion There is a significant difference in sodium increase after three days of therapy and in length of stay. There is no significant cost difference with the addition of AVP receptor antagonist."