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"ABSTRAK Pengelolaan pasien hipertensi di rumah sakit masih dominan pada upaya farmakologi.Konseling keperawatan (KP) sebagai upaya non farmakologi belum optimal. Pasienhanya mengandalkan obat dokter dan tidak mengubah gaya hidup sehat. Asuhankomprehensif dibutuhkan untuk menghindari dampak seperti penyakit jantung, stroke,gagal ginjal dan kematian dini. Besarnya biaya perawatan merupakan masalah serius.Konseling keperawatan diharapkan dapat mengubah gaya hidup menjadi lebih sehat.Tujuan penelitian untuk mengetahui prediktor pelaksanaan konseling keperawatan padapasien hipertensi. Metode survey crossectional dengan kuesioner pada 200 perawat.Analisis menggunakan uji chi-square, regresi logistik berganda. Ada hubungan yangsignifikan antara kemampuan konseling p value=0.001, pemahaman informasi pvalue=0.001, dukungan dan sistem kualitas p value=0.000, kondisi lingkungan pvalue=0.000 dengan pelaksanaan konseling keperawatan. Umur p value= 0,250, jeniskelamin p value= 0,57, pengalaman kerja p value= 0,177 dan pendidikan terakhir pvalue=0,583, tidak terdapat hubungan signifikan. Lingkungan dan dukungan sistemkualitas merupakan prediktor utama. Kondisi lingkungan dan dukungan yang baik, 8 kalilebih baik pada konseling keperawatan. lingkungan yang didukung dengan infrastrukturdan fasilitas yang baik sangat mendukung terlaksananya konseling keperawatan.

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ABSTRACT

Hypertensive Patients in hospitals in East Java, Indonesia

Counsellor :Agung Waluyo, Mustikasari, Ede Surya Darmawan

Management of hypertensive patients in hospitals is still dominant in pharmacological

efforts. Nursing counseling (KP) as a non-pharmacological effort is not optimal. Patients

only rely on doctor's medication and do not change their healthy lifestyle.

Comprehensive care is needed to avoid impacts such as heart disease, stroke, kidney

failure, and premature death. The cost of treatment is a serious problem. Nursing

counseling is expected to change lifestyle to be healthier. The aim of the study was to

determine the predictors of the implementation of nursing counseling in hypertensive

patients. Crossectional survey method with questionnaires on 200 nurses. Analysis using

the chi-square test, multiple logistic regression. There is a significant relationship

between expertise and skills p-value = 0.001, giving information p-value = 0.001,

support and quality systems p-value = 0.000, environment p-value = 0.000 with the

implementation of nursing counseling. Age p value= 0,250, gender p-value = 0,583,

work experience p value= 0,177 and education p-value=0,583 there is no significant

relationship. Environment and quality system support are the main predictors. Good

environmental conditions and support, 8 times better in nursing counseling. the

environment which is supported by good infrastructure and facilities strongly supports

the implementation of nursing counseling"

"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."

"Slow deep breathing (SDB) adalah tindakan nonfarmakologis untuk menurunkan tekanan darah pasien hipertensi primer. Penelitian ini bertujuan untuk mengetahui efektifitas SDB terhadap penurunan tekanan darah pasien hipertensi primer. Metode penelitian ini menggunakan desain Randomized Clinical Trial dengan pretest dan post test control group. Sampelnya 142 responden, meliputi 33 responden kelompok rendah garam (RG), 37 responden kelompok SDB, 39 responden kombinasi kelompok SDB dan RG; dan 33 responden kelompok kontrol. Sampel diambil dengan cara randomisasi. Hasil penelitian menunjukan penurunan tekanan darah secara bermakna terutama pada kelompok SDB. Tekanan darah sistolik menurun 28,59 mmHg (P value=0,002) dan tekanan darah diastolik 16,92 mmHg (P value=0,007). Analisis dengan uji Tukey diketahui tekanan darah sistolik yang berbeda secara bermakna yaitu antara SDB dan kelompok kontrol (P value=0,001). Tekanan darah diastolik yang berbeda secara bermakna, yaitu: RG dan SDB-RG (P value=0,046); RG dan kelompok kontrol (P value=0,003); SDB dan SDB-RG (P value=0,038) serta SDB dan kelompok kontrol (P value=0,005). Penelitian ini merekomendasikan penerapan SDB untuk membantu menurunkan prevalensi hipertensi sehingga meminimalkan komplikasi yang mungkin timbul.

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Slow deep breathing is a nonpharmacology therapy to reduce blood pressure in patients with primary hypertension. The purpose of this study was to determine the effectiveness of slow deep breathing exercise to reduce blood pressure in patients with primary hypertension in Atambua East Nusa Tenggara. The method of this research was a quantitative research: a randomized clinical trial design with pretest and post test control group. The sample was 142 respondents, which consisted of 33 respondents in the lower salt (RG) group, 37 respondents in the slow deep breathing (SDB) group, 39 respondents in the combination of SDB-RG group; and 33 respondents in the control group. The method of sampling used a randomization.

The results showed that there were differences in the reduction of systolic blood pressure in SDB group for 28.59 mm Hg and diastolic blood pressure for 16.92 mmHg. The result of Anova analysis showed that there was a significant decrease on average of systolic blood pressure (p = 0.002) and diastolic blood pressure (p = 0.007). Further analysis by Tuckey test of systolic blood pressure found that between SDB group and control group were significantly different, however the other groups was not significant. (P = 0.001). After undergoing further Tukey analysis we found that the systolic blood pressure of four groups has significant differences. The SDB and controlling groups have P value=0,001 differences. RG and the controlling groups have P value=0,003 differences. SDB and SDB-RG groups have P value=0,038 differences. And SDB and controlling groups have P value=0,005 differences. This research would like to suggest applied non-pharmacological actions particularly toward SDB groups in order to decrease the prevalence of hypertension. This will minimize consequences caused by this problem."

"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.

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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."

"Hipertensi adalah penyakit yang banyak dijumpai di masyarakat. Masalah psikososial yang sering ditemukan pada klien hipertensi adalah ansietas. Dampak negatif dari ansietas akan mengganggu produktivitas dan kualitas hidup manusia. Untuk mengelola masalah ansietas di masyarakat dibutuhkan penatalaksanaan keperawatan dengan menggunakan pendekatan Community Mental Health Nursing. Proses penatalaksanaan keperawatan menggunakan pendekatan stres adaptasi Stuart. Tujuan dari karya tulis ilmiah ini adalah: 1) mengetahui karakteristik klien ansietas, 2) mengetahui gambaran ansietas 3) mengetahui efek terapi keperawatan spesialis untuk klien ansietas. Hasil karya tulis ilmiah ini adalah: 1) karakteristik klien ansietas yang berpengaruh adalah; usia, tingkat pendidikan, pekerjaan, status pernikahan, dan stressor klien yaitu: predisposisi, presipitasi, respon terhadap stressor, kemampuan mengatasi masalah dan mekanisme koping. 2) kombinasi terapi yang paling tepat untuk meningkatkan kemampuan klien dan keluarga dalam mengelola ansietas adalah: terapi relaksasi progresif, thought stopping, terapi kognitif, psikoedukasi keluarga, dan terapi kelompok suportif. Berdasarkan hasil ini perlu direkomendasikan bahwa terapi relaksasi progresif, thought stopping, terapi kognitif, psikoedukasi keluarga, dan terapi kelompok suportif dapat dijadikan standar terapi spesialis keperawatan jiwa dan perlu disosialisasikan pada seluruh tatanan pelayanan kesehatan khususnya di komunitas.

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Hypertension is a disease that is prevalent in community. Psychosocial problems are often found in hypertensive clients is anxiety. The negative impact of anxiety would interfere with productivity and quality of human life. To manage the problem of anxiety in the community is required to use the nursing management of Community Mental Health Nursing approach. Management of the nursing process approach Stuart stress adaptation.

The purpose of this scientific paper are: 1) investigate the characteristics of client anxiety, 2) know the description of anxiety 3) determine the effects of therapeutic nursing specialists to client anxiety. The results of this scientific paper are: 1) characteristics of the client's anxiety of influence are: age, education level, occupation, marital status, and stressors the client is: predisposition, precipitation, the response to stressors, the ability to solve problems and coping mechanisms. 2) the most appropriate combination of therapies to enhance the ability of clients and families in managing anxiety is: progressive relaxation therapy, thought stopping, cognitive therapy, psikoedukasi family, and supportive group therapy.

Based on these results need to be recommended that the progressive relaxation therapy, thought stopping, cognitive therapy, psikoedukasi family, and supportive group therapy can be used as standard therapy nursing specialists need to be socialized to people and the whole structure of health services especially in the community."

"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.

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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."

"Latar Belakang. Hipertensi merupakan salah satu masalah kesehatan dunia dan merupakan salah satu faktor risiko penyakit kardiovaskular yang berhubungan dengan proses aterosklerosis dan aterotrombosis. Pengukuran tekanan darah di klinik atau rumah sakit saat ini masih dianggap sebagai metode referensi dalam mendiagnosis dan evaluasi pasien hipertensi, tetapi disebabkan adanya fenomena white-coat 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 pembuluh darah. Pemeriksaan ketebalan tunika intima media arteri karotis dimaksudkan untuk melihat kerusakan yang terjadi akibat efek fenomena white-coat pada pembuluh darah yang mencerminkan terjadinya proses aterosklerosis dini. Tujuan dari penelitian ini adalah menilai hubungan antara kejadian fenomena white-coat pada pasien hipertensi dalam pengobatan dengan ketebalan tunika intima media arteri karotis. Metode. Studi potong lintang dengan pengambilan pasien hipertensi dalam pengobatan secara konsekutif, mulai bulan Januari - Mei 2014 di poli rawat jalan RS Jantung dan Pembuluh Darah Harapan Kita, Jakarta. Pasien menjalani pemeriksaan OBP saat kontrol dan HBP dilakukan selama 4 hari berturut-turut dengan memakai alat tensimeter osilometri yang tervalidasi. Pemeriksaan ketebalan tunika intima media arteri karotis dilakukan pada semua pasien yang masuk dalam kriteria inklusi untuk mendapatkan nilai rerata ketebalan kompleks tunika intima. Hasil. Didapatkan 219 subyek penelitian yang masuk kriteria inklusi. Uji statistik Mann Whitney digunakan untuk mengetahui hubungan pasien hipertensi yang mengalami fenomena white-coat dengan ketebalan tunika intima media arteri karotis. Hasil yang didapat, tidak terdapat perbedaan rerata yang bermakna secara statistik ketebalan tunika intima media arteri karotis antara pasien hipertensi yang mengalami fenomena white-coat dan yang tidak (A. Karotis kanan 0,7 ± 0,5 vs 0,8 ± 0,4 mm, nilai p = 0,153 ; A. Karotis kiri 0,8 ± 0,4 vs 0,7 ± 0,4 mm, nilai p = 0,900 ; A. Karotis kanan dan kiri 0,7 ± 0,4 vs 0,8 ± 0,3 mm, nilai p = 0,260). Dari hasil uji bivariat terhadap seluruh faktor perancu didapatkan variabel obat antihipertensi golongan enzym penyekat angiotensin dan usia terbukti sebagai perancu dalam penilaian hubungan antara fenomena white-coat dengan rerata ketebalan tunika intima media arteri karotis. Kesimpulan. Penelian ini menunjukkan bahwa tidak terdapat perbedaan rerata yang bermakna secara statistik ketebalan tunika intima media arteri karotis antara pasien hipertensi yang mengalami fenomena white-coat dan yang tidak.

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Background. Hypertension is one of the most important public health problems worldwide and a major risk factor for all forms of atherosclerotic and atherothrombotic CVD. Office blood pressure monitoring nowadays still considered as a method of reference for diagnosing an evaluating hypertensive patients, but due to white coat phenomenon, the information for the real blood pressure status is unclear. Hypertension itself was related to target organ damage and one of them is vascular damage related to atherosclerosis. Evaluation of carotid intima media thickness can represent early atherosclerotic process that happened in organ vascular caused by white-coat phenomenon.

Our objective was to analyze the relationship between white-coat phenomenon in hypertensive patients with carotid intima media thickness.

Method. This is a cross sectional, consecutive study. Data was collected from January ? May 2014 in 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 consecutive days with the same validated electronic device. B-mode ultrasound of carotid arteries was performed to measured mean of carotid intima media thickness.

Results. Two hundred and nineteen hypertensive patients on therapy were enrolled in this study. Mann Whitney statistic test was used to determine the relationship of independent variables in hypertensive patients with white-coat phenomenon with carotid intima media thickness and found that there is no significant difference between hypertensive patients with white-coat phenomenon and no white-coat phenomenon with mean carotid intima media thickness (Right Carotid artery 0.7 ± 0.5 vs 0.8 ± 0.4 mm, p value = 0.153 ; Left Carotid Artery 0.8 ± 0.4 vs 0.7 ± 0.4 mm, p value 0.900 ; Right and left Carotid Artery 0.7 ± 0.4 vs 0.8 ± 0.3 mm, p value 0.260). From bivariate analysis results, obtained on all confounding variables, ACE-inhibitor and age proved as confounding in the assessment of the relationship between hypertensive patients with white-coat phenomenon and mean carotid intima media thickness.

Conclusions. This study showed that there is no significant difference of mean carotid intima media thickness in hypertensive patients with white-coat and no white-coat phenomenon."

"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."

"[ABSTRAKPrevalensi dan mortalitas gagal ginjal kronis pada masyarakat urban di indonesia mengalamipeningkatan dari tahun ke tahun. Penulisan karya ilmiah ini bertujuan untuk menganalisis asuhankeperawatan dengan pendekatan Keperawatan Kesehatan Masyarakat Perkotaan pada areaKeperawatan Medikal Bedah pada klien dengan gagal ginjal kronis dengan komplikasi hipertensi.Perawat dalam melakukan asuhan keperawatan melakukan tindakan preventif baik primer,sekunder, ataupun tersier. Masalah keperawatan yang ditemukan meliputi kelebihan volumecairan, penurunan curah jantung, nyeri akut, dan risiko perubahan nutrisi kurang dari kebutuhantubuh. Manajemen keperawatan terkait hipertensi yang dilakukan meliputi modifikasi gaya hidupmelalui diet, teknik relaksasi, dan aktivitas. Setelah dilakukan asuhan keperawatan pada pasiengagal ginjal kronis, terdapat penurunan nilai tekanan darah pasien meskipun belum mencapaitarget yang dianjurkan. Perawat dapat memberikan asuhan keperawatan menggunakan pendekatankeperawatan kesehatan masyarakat perkotaan untuk dapat memperkirakan perilaku berisiko terkaitkomplikasi yang dapat terjadi, seperti hipertensi dan penyakit kardiovaskular lainnya, serta tingkatkepatuhan terhadap terapi yang diberikan. Asuhan keperawatan tersebut dilakukan gunamendukung upaya pencegahan komplikasi dan peningkatan kualitas hidup pasien dengan gagalginjal kronis.

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ABSTRACTThe prevalence and mortality of chronic renal failure in urban society in Indonesia has increasedfrom year to year. This paper aimed to analyze the nursing care with the approach of the UrbanPublic Health Nursing in the Medical Surgical Nursing setting in clients with chronic renal failurewith complication of hypertension. Nurses performed preventive action both primary, secondary,or tertiary. Various nursing problems were revealed including fluid volume excess, decreasedcardiac output, acute pain, and risk for imbalanced nutrition: less than body. The application ofnursing management related hypertension included lifestyle modification, diet, relaxationtechniques, and activity. The result of implementation of nursing intervention to the patients,showed that there was a decrease in the patient's blood pressure despite not reaching therecommended targets. Nurses can provide nursing care using urban nursing health care approachto be able to estimate the risk behaviors of patients related complication that can happen, likehypertension,and other cardiovascular disease and the level of adherence to therapy. The nursingcare is done in order to support efforts to prevent complications and improve the quality of life ofpatients with chronic renal failure.;The prevalence and mortality of chronic renal failure in urban society in Indonesia has increasedfrom year to year. This paper aimed to analyze the nursing care with the approach of the UrbanPublic Health Nursing in the Medical Surgical Nursing setting in clients with chronic renal failurewith complication of hypertension. Nurses performed preventive action both primary, secondary,or tertiary. Various nursing problems were revealed including fluid volume excess, decreasedcardiac output, acute pain, and risk for imbalanced nutrition: less than body. The application ofnursing management related hypertension included lifestyle modification, diet, relaxationtechniques, and activity. The result of implementation of nursing intervention to the patients,showed that there was a decrease in the patient's blood pressure despite not reaching therecommended targets. Nurses can provide nursing care using urban nursing health care approachto be able to estimate the risk behaviors of patients related complication that can happen, likehypertension,and other cardiovascular disease and the level of adherence to therapy. The nursingcare is done in order to support efforts to prevent complications and improve the quality of life ofpatients with chronic renal failure., The prevalence and mortality of chronic renal failure in urban society in Indonesia has increasedfrom year to year. This paper aimed to analyze the nursing care with the approach of the UrbanPublic Health Nursing in the Medical Surgical Nursing setting in clients with chronic renal failurewith complication of hypertension. Nurses performed preventive action both primary, secondary,or tertiary. Various nursing problems were revealed including fluid volume excess, decreasedcardiac output, acute pain, and risk for imbalanced nutrition: less than body. The application ofnursing management related hypertension included lifestyle modification, diet, relaxationtechniques, and activity. The result of implementation of nursing intervention to the patients,showed that there was a decrease in the patient's blood pressure despite not reaching therecommended targets. Nurses can provide nursing care using urban nursing health care approachto be able to estimate the risk behaviors of patients related complication that can happen, likehypertension,and other cardiovascular disease and the level of adherence to therapy. The nursingcare is done in order to support efforts to prevent complications and improve the quality of life ofpatients with chronic renal failure.]"