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Ayuthia Putri Sedyawan
Perbandingan efek lisinopril dan amlodipin terhadap kekakuan pembuluh arteri pada pasien hipertensi yang belum pernah diobati = aortic stiffness in native hypertension amlodipin versus lisinopril administration ashalina study
"[ABSTRAK
Latar belakang. Hipertensi adalah faktor risiko kardiovaskular yang penting. Kekakuan arteri meningkat seiring dengan peningkatan usia, hipertensi, diabetes mellitus, aterosklerosis, dan lainnya. Kekakuan arteri dapat diukur secara non-invasif dengan menggunakan alat carotid-femoral pulse wave velocity (CF-PWV), dimana alat ini mengukur kecepatan gelombang nadi yang berjalan dari arteri karotis komunis ke arteri femoralis. Obat antihipertensi telah diketahui memiliki kemampuan terhadap kekakuan arteri, namun berbeda efektifitasnya.
Tujuan. Melihat perbandingan efek pemberian penghambat enzim pengubah angiotensin dan penyekat kanal kalsium terhadap kekakuan arteri pada pasien hipertensi yang belum pernah diobati sebelumnya.
Metode. Uji klinis acak dengan tersamar ganda, dilakukan di RS Pusat Jantung dan Pembuluh Darah Harapan Kita (Maret-Mei 2015) terhadap 54 subyek usia 30-50 tahun. Subyek dibagi menjadi dua grup, grup lisinopril (n=27) dan amlodipin (n=27). Tekanan darah dan CF-PWV diukur sebelum dan setelah intervensi.
Hasil. Terdapat penurunan tekanan darah dan sesudah terapi untuk kedua grup. Delta penurunan CF-PWV untuk kedua intervensi menujukkan hasil yang signifikan (P value <0.001). Lisinopril memiliki penurunan delta CF-PWV yang lebih signifikan dibandingkan amlodipin. (P value <0.001 IK 95% 0.2 - 0.5).
Kesimpulan. Penelitian ini membuktikan adanya perbedaan bermakna terhadap CF-PWV pada grup yang diberikan lisinopril dan amlodipin, dimana lisinopril memiliki delta penurunan PWV yang lebih signifikan.
ABSTRACT
Background. Hypertension is a well-recognized cardiovascular risk factors. Arterial stiffness increases with age, hypertension, diabetes mellitus, atherosclerosis, etc. Arterial stiffness can be assessed noninvasively by carotid-femoral pulse wave velocity (CF-PWV) measurement, that is, the velocity of the pulse wave to travel a given distance between carotid and femoral artery. Antihypertensive drugs have been implicated in arterial stiffness diminishment but vary in effectiveness.
Objective. To examine the difference in arterial stiffness reduction in young native hypertensive subjects that was given ace-inhibitor or calcium channel blocker.
Methods. A double blind randomized clinical trial was conducted in National Cardiovascular Centre Harapan Kita to 54 subjects (30-50 years old), from March to May 2015. Subjects were divided into lisinopril 5mg (n=27) and amlodipine 5mg (n=27) groups. Blood pressure and CF-PWV were measured before and 4 weeks post therapy.
Results. Blood pressure reduction was found before and after treatment for both groups. CF-PWV for lisinopril and amlodipine showed significant reduction (p-value <0.001). Lisinopril had more significant decrease in CF-PWV (P value <0.001 CI 95% 0.2 - 0.5).
Conclusion. There was a statistically significant difference in CF-PWV reduction between lisinopril and amlodipin administration to patients with native hypertension, with lisinopril having the larger effect., Background. Hypertension is a well-recognized cardiovascular risk factors.
Arterial stiffness increases with age
subjects with diabetes mellitus,
and hypertension
and is also enhanced in
atherosclerosis,
and end-stage renal disease.
Arterial stiffness can be assessed noninvasively with the use of carotid-femoral
pulse wave velocity (CF-PWV) measurement, that is, the velocity of the pulse
wave to travel a given distance between carotid and femoral artery.
Antihypertensive drugs have been implicated in arterial stiffness diminishment
but vary in their degree of effect. The calcium channel blocker having its
“destiffening” effect have been widely known to reduce arterial stiffness.
However, the renin-angiotensin system inhibitors proved to be superior to all
other antihypertensive drugs in reducing arterial stiffness.
Objective. The aim of this study was to examine the difference in arterial stiffness
reduction in native hypertensive subjects that was given ace-inhibitor or calcium
channel blocker for four weeks, by measuring the CF-PWV.
Methods. A double blind randomized clinical trial was conducted in National
Cardiovascular Centre Harapan Kita (NCCHK) to 54 subjects with native
hypertension between the age of 30-50 years old, from March to May 2015.
Subjects were divided into two groups: lisinopril 5mg (n=27) and amlodipine 5mg
(n=27). Blood pressure and CF-PWV were measured before and after 4 weeks of
therapy. Statistical analysis was done using bivariat and multivariat analisis to
determine the significance of arterial stiffness reduction.
Results. There was a reduction in blood pressure (systole, diastole, mean arterial
pressure) before and after the treatment for both groups. However although it was
clinicaly significant, statistically it was not (P value >0.05). Nonetheless, CFPWV
for
lisinopril
and
amlodipin
showed
significant
reduction
with
both
p-value
were
<0.001 (2.09±0.280, CI 95% 1.80-2.2 and 1.77±0.340, CI 95% 1.6-1.9).
When both drugs were compared using multivariate analysis, lisinopril was
proved to have a more significant decrease in CF-PWV (P value <0.001 CI 95%
0.2 - 0.5).
Conclusion. This study proved that there was a statistically significant difference
in CF-PWV reduction between lisinopril and amlodipin administration to patients with native hypertension, with lisinopril having the larger effect. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Teuku Istia Muda Perdan
Hubungan kadar serum ST2 dengan fibrosis dini miokard pada penderita disglikemia = Association between serum ST2 levels and early myocardial fibrosis in disglycemic patients
"ABSTRAK
Latar belakang: disglikemia adalah keadaan intoleransi glukosa berupa peningkatan kadar gula darah yang berhubungan dengan risiko penyakit kardiovaskular. Seiring dengan waktu, pada akhirnya diabetes akan menimbulkan kerusakan pada target organ, salah satu yang penting adalah pada sistem organ kardiovaskular, dapat berupa penyakit jantung koroner, kardiomiopati diabetes, penyakit serebrovaskuler, dan penyakit arteri perifer. Diabetes juga meningkatkan risiko terjadinya gagal jantung. Pada kardiomiopati diabetes, proses fibrosis yang masih reversibel sudah mulai terjadi bahkan ketika penderita masih asimtomatik. Pemeriksaan baku emas untuk mendeteksi terjadinya fibrosis miokard secara dini adalah pemeriksaan histopatologi jaringan miokardium melalui biopsi. Akan tetapi pemeriksaan ini sangat invasif dan tidak nyaman bagi subjek. Pemeriksaan yang kemudian berkembang adalah pencitraan menggunakan Cardiac Magnetic Resonance Imaging (CMRI). Akan tetapi pemeriksaan ini cukup mahal, dan tidak tersedia pada semua fasilitas kesehatan. Sementara itu, ST2 adalah penanda enzim jantung yang menggambarkan derajat proses fibrosis yang sedang terjadi pada miokard, terutama pada keadaan gagal jantung. Pemeriksaan menggunakan penanda enzim dapat menjadi alternatif dengan keuntungan lebih murah, dapat terjangkau luas dan mudah tersedia. Tujuan: Mengetahui hubungan antara kadar ST2 serum dengan fibrosis miokard interstisial pada penderita disglikemia. Metode: Pasien disglikemia yang lolos kriteria eksklusi berupa komorbid kardiovaskular akan menjalani pemeriksaan kadar ST2 serum dan T1 relaxation time menggunakan Cardiac MRI. Selanjutnya dilakukan analisis hubungan antara kadar ST2 serum dan T1 relaxation time. Hasil penelitian: Sebanyak 34 pasien diikutsertakan ke dalam penelitian ini. Didapatkan kisaran nilai kadar ST2 serum antara 12.40-53.22 ng/dL (median 19.95 ng/dL). Rerata nilai T1 relaxation time didapatkan sebesar 443.39 ± 113.35 ms. Terdapat korelasi bermakna antara kadar ST2 serum dengan fibrosis diffuse miokardium (Spearman correlation r = -0,547, p < 0.01). Pada analisa multivariat hubungan antara kadar ST2 serum dan T1 relaxation time tidak dipengaruhi oleh faktor perancu yang telah ditetapkan (r = -0,44, p = 0,033). Kesimpulan: Hasil penelitian ini menunjukkan kadar ST2 serum berkolerasi dengan fibrosis diffuse miokardium pada populasi disglikemia.ABSTRACT
Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population."
Fakultas Kedokteran Universitas Indonesia, 2015
T55720
UI - Tugas Akhir  Universitas Indonesia Library
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Yusak Alfrets Porotuo
Respon tekanan darah pasien hipertensi ras Melanesia dan ras non Melanesia dengan pemberian penyekat enzim angiotensin = Blood pressure response in hypertensive patients Melanesian race and non Melanesian race with angiotensin converting enzyme inhibitors
"ABSTRAK
Latar belakang. Hipertensi merupakan salah satu kondisi yang paling banyak
ditemukan pada pelayanan kesehatan primer yang dapat meningkatkan mortalitas dan
morbidita apabila tidak mendapatkan pengobatan yang tepat. Beberapa penelitian
menunjukkan respon penurunan tekanandarah pada ras kulit hitam berbeda dibanding
ras kulit putih dengan antihipertensi golongan penyekat EKA, hal ini ditunjang
dengan perbedaan PRA pada kedua kelompok ras ini. Belum terdapat data tentang
respon tekanan darah pasien hipertensi ras melanesiadengan pemberian penyekat
EKA yang ditunjang dengan pemeriksaan kadar PRA pada kelompok ras ini.
Objektif. Menilai apakah terdapat perbedaan respon terapi terhadap penyekat enzim
konversi angiotensin (EKA) pada pasien hipertensi ras melanesia dan ras non
melanesia.
Metode. Penelitian ini adalah penelitian kohort prospektif yangdilakukan di kota
Jayapura bulan September-November 2015terhadap 85 subyek usia 30 sampai 55
tahun dengan hipertensi yang belum pernah diobati sebelumnya. Subyek terbagi atas
2 grup yaitu ras Melanesia (n=34) dan ras Non Melanesia(n=51). Kedua grup tersebut
diberikan lisinopril dosis awal 5 mg. Pemeriksaan tekanan darah dilakukan pada awal
dan diulangi setiap 7 hari selama 4 minggu berturut-turut.
Hasil. Terdapat perbedaan respon tekanan darah pasien hipertensi ras Melanesia dan
ras Non Melanesia. Perbedaan tekanan darah sistolik sebesar 24,5 ± 9,4 mmHg pada
subyek 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±5,5
mmHg 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 mmHg
dan pada subek ras Non Melanesia sebesar 26,21±8,8 mmHg (p<0,001). Reratakadar
Plasma 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 kedua
kelompok ras ini (p=0,564).
Kesimpulan. Terdapat perbedaan penurunan tekanan darah (sistolik, diastolik dan
tekanan rerata arteri) dengan pemberian penyekat EKA pada kelompok ras Melanesia
dan kelompok ras Non Melanesia dan hal ini tidak berhubungan bermakna dengan
rerata 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 health
care that increase mortality and morbidity if it does not receive appropriate therapy.
Several studies show that blacks response differently compared with white in
conjunction with a decrease of blood pressure in response to administer ACE
inhibitor. The studies supported by PRA differences in both group of race. There are
no data ofblood pressure response in hypertensive patientsinMelanesian race by
administeringACE inhibitor supported withPRA levels examination in thisgroup of
race.
Objective. To compare therapeutic response ofangiotensin converting enzyme
blockers (ACE)inhibitorinreducing blood pressure between MelanesianandNon
Melanesian hipertensive patients.
Method. This study is a prospective cohort study conducted in the city of
Jayapura September to November 2015. We found85 subjects aged 30 to 55 years
oldwith hypertensionnever be treated before. Subjects are divided into two
groups, 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 pressure
checks 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 hypertensive
patientofMelanesian race and Non Melanesiarace. Reduction ofsystolic blood
pressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject of
Non Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic blood
pressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of Non
Melanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure in
subjectMelanesian 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 the
Melanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian race
PRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationship
mean PRA levels in both these racial groups (p = 0.564).
Conclusion. There aredifferences in blood pressure reduction (systolic, diastolic
pressure and mean arterial pressure) with administer of ACE inhibitor in
Melanesianand Non Melanesiagroup of race. There is no significant relation with
averagePRAlevels 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 health
care that increase mortality and morbidity if it does not receive appropriate therapy.
Several studies show that blacks response differently compared with white in
conjunction with a decrease of blood pressure in response to administer ACE
inhibitor. The studies supported by PRA differences in both group of race. There are
no data ofblood pressure response in hypertensive patientsinMelanesian race by
administeringACE inhibitor supported withPRA levels examination in thisgroup of
race.
Objective. To compare therapeutic response ofangiotensin converting enzyme
blockers (ACE)inhibitorinreducing blood pressure between MelanesianandNon
Melanesian hipertensive patients.
Method. This study is a prospective cohort study conducted in the city of
Jayapura September to November 2015. We found85 subjects aged 30 to 55 years
oldwith hypertensionnever be treated before. Subjects are divided into two
groups, 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 pressure
checks 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 hypertensive
patientofMelanesian race and Non Melanesiarace. Reduction ofsystolic blood
pressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject of
Non Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic blood
pressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of Non
Melanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure in
subjectMelanesian 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 the
Melanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian race
PRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationship
mean PRA levels in both these racial groups (p = 0.564).
Conclusion. There aredifferences in blood pressure reduction (systolic, diastolic
pressure and mean arterial pressure) with administer of ACE inhibitor in
Melanesianand Non Melanesiagroup of race. There is no significant relation with
averagePRAlevels 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 health
care that increase mortality and morbidity if it does not receive appropriate therapy.
Several studies show that blacks response differently compared with white in
conjunction with a decrease of blood pressure in response to administer ACE
inhibitor. The studies supported by PRA differences in both group of race. There are
no data ofblood pressure response in hypertensive patientsinMelanesian race by
administeringACE inhibitor supported withPRA levels examination in thisgroup of
race.
Objective. To compare therapeutic response ofangiotensin converting enzyme
blockers (ACE)inhibitorinreducing blood pressure between MelanesianandNon
Melanesian hipertensive patients.
Method. This study is a prospective cohort study conducted in the city of
Jayapura September to November 2015. We found85 subjects aged 30 to 55 years
oldwith hypertensionnever be treated before. Subjects are divided into two
groups, 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 pressure
checks 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 hypertensive
patientofMelanesian race and Non Melanesiarace. Reduction ofsystolic blood
pressure of 24.5 ± 9.4 mmHg in subject Melanesian race and on the subject of
Non Melanesian 34.5 ± 13.5 mmHg (p < 0.001). Reduction ofdiastolic blood
pressure of subjectsMelanesians of 13.3 ± 5.5 mmHg, and on the subject of Non
Melanesia 22.6 ± 9.3 mmHg (p<0.001). Reduction ofmean arterial pressure in
subjectMelanesian 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 the
Melanesian race at 1.48 [1.86] ng/ml/h and on the subject of nonMelanesian race
PRA average level of 1.1 [1.47] ng/ml/hr. There was no significant relationship
mean PRA levels in both these racial groups (p = 0.564).
Conclusion. There aredifferences in blood pressure reduction (systolic, diastolic
pressure and mean arterial pressure) with administer of ACE inhibitor in
Melanesianand Non Melanesiagroup of race. There is no significant relation with
averagePRAlevels in both group of race. Another factors affectsresponses of reduction blood pressure with administer ofACEinhibitor may be considered."
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Makalah dan Kertas Kerja  Universitas Indonesia Library
cover
Hervin Ramadhani
Korelasi kadar ST2 terlarut (sST2) dengan miokardial longitudinal strain speckle tracking dua dimensi untuk menilai disfungsi ventrikel kiri subklinis pada subjek stenosis aorta berat = Asscociation of the biomarkers soluble ST2 and subclinical left ventricular systolic dysfunction assessed by myocardial global longitudinal strain in patients severe aortic stenosis
"ABSTRAK
Latar belakang.
Pada pasien SA fraksi ejeksi ventrikel kiri dapat normal bahkan supra normal untuk
jangka waktu yang lama walaupun proses remodeling ventrikel kiri sudah mulai terjadi..
Ekokardiografi speckle tracking dua dimensi (EST) mempunyai kelebihan untuk
digunakan dalam menilai penurunan fungsi kontraktilitas miokard subklinis, dimana
keadaan tersebut dapat mempengaruhi prognosis pasien SA. sST2 merupakan biomarker
yang relatif baru, dapat meningkat pada regangan otot jantung (myocardial stretch),
fibrosis, inflamasi, dan injuri miokard, apakah berhubungan dengan disfungsi dini
ventrikel kiri masih belum diketahui.
Tujuan. Mengetahui korelasi sST2 terhadap nilai GLS EST pada pasien SA berat dengan
FEVK normal
Metode. Merupakan studi potong lintang. Evaluasi dilakukan pada 29 pasien stenosis
aorta berat dengan fraksi ejeksi normal yang datang ke poliklinik RS Jantung Harapan
Kita periode Februari 2015 sampai November 2015. Dilakukan pengambilan figur
ekokardiografi untuk menilai severitas SA dan untuk perhitungan nilai global longitudinal
strain speckle tracking kemudian dilakukan pengambilan sampel darah di laboratorium
RS Jantung Harapan Kita untuk menilai sST2.
Hasil Penelitian. Dua puluh sembilan subjek ikut dalam penelitian ini dengan rerata usia
adalah 59.7±12.1 tahun. Fungsi intrinsik ventrikel kiri pasien SA berat pada penelitian ini
mengalami penurunan dengan nilai rerata GLS -11±4.5%. Hasil uji korelasi menunjukan
terdapat korelasi positif dengan kekuatan korelasi sedang yang bermakna (r=0.429,
p=0.02). Analisis multivariat tetap menunjukkan adanya hubungan antara kadar sST2
dengan nilai GLS EST (r=0,282 p=0.036).
Kesimpulan. Terdapat korelasi sST2 dengan global longitudinal strain speckle tracking
pada pasien SA berat dengan fraksi ejeksi normal.ABSTRACT
Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Chorniansyah Indriyanto Rahayu
Pengaruh asupan garam terhadap tekanan darah nokturnal pada pasien hipertensi yang mendapatkan terapi penyekat EKA = Effects of salt intake to nocturnal blood pressure in hypertensive patients administered Angiotensin Converting Enzyme (ACE) inhibitors
"ABSTRAK
Latar Belakang : Hipertensi merupakan faktor resiko utama penyakit kardiovaskular,
terutama sindrom koroner akut dan stroke. Peningkatan konsumsi garam berhubungan
dengan kenaikan tekanan darah. Beberapa studi randomized-controlled trial (RCT)
menyatakan bahwa konsumsi rendah garam dapat menurunkan tekanan darah pada
populasi dewasa dengan atau tanpa hipertensi. Variabilitas tekanan darah selama 24 jam
bersifat dinamis. Peningkatan darah nokturnal memiliki makna klinis yang cukup besar,
merupakan salah satu prediktor dari penyebab kerusakan target organ, terutama kejadian
kardiovaskular dan stroke. Asupan garam dapat mempengaruhi variasi tekanan darah 24
jam, yang dalam hal ini dapat juga berpengaruh pada hipertensi nokturnal. Obat penyekat
EKA merupakan obat hipertensi lini pertama yang sering digunakan, terutama pada usia
muda dan hipertensi yang disertai sindrom metabolik, mengingat peranan Sistem Renin
Angiotensin memiliki peranan yang sangat penting dalam patofisiologi hipertensi. Asupan
garam juga memiliki peranan pada patofisiologi terjadinya hipertensi dalam sistem Renin
Angiotensin. Sedikit studi yang meneliti perpaduan obat penyekat EKA dengan asupan
rendah garam dalam menrunkan kejadian hipertensi. Oleh karena itu, Menarik untuk diteliti
pengaruh asupan garam dengan tekanan darah nokturnal pada pasien yang mengkonsumsi
obat penyekat EKA.
Tujuan : Menilai pengaruh asupan garam dengan tekanan darah nokturnal pada pasien
hipertensi yang mendapatkan terapi penyekat EKA.
Metode : Pasien poliklinik berusia 30 ? 50 tahun yang terdiagnosis hipertensi dan belum
pernah mendapatkan anti-hipertensi sebelumnya, dibagi menjadi 2 kelompok (asupan
rendah garam (Na <15 g/hari) dan asupan tinggi garam ≥15 g/hari). Kedua kelompok akan
diberikan lisinopril dan dilakukan pemeriksaan natrium urin 24 jam dan home blood
pressure monitoring..
Hasil Penelitian : Sebanyak 80 pasien hipertensi pasien hipertensi yang belum
mendapatkan terapi diikutsetakan dalam penelitian ini, yang terdiri dari 37 pasien
kelompok rendah garam dan 43 pasien kelompok tinggi garam. Kelompok pasien dengan
asupan rendah garam memliki delta penurunan darah nokturnal sistolik (p<0,001),
diastolic (p<0,001), dan rerata arteri (p<0,001) yang lebih besar dibandingkan pada
kelompok asupan tinggi garam. Rerata asupan garam pada penelitian ini sebesar 16,77
gram/hari. Pada analisa multivariat didapatkan delta penurunan tekanan darah tidak
dipengaruhi oleh usia, jenis kelamin, dislipidemia, IMT, dan durasi tidur.
Kesimpulan : Penelitian ini membuktikan asupan rendah garam dapat mempengaruhi efektivitas terapi penyekat EKA dalam menurunkan tekanan darah nokturnal. ABSTRACT
Background : Hypertension is one of important risk factor of cardiovascular
disease, especially acute coronary syndrome and stroke. High salt intake correlates
to high blood pressure. Some Randomized-Controlled-Trials stated that low salt
intake may decrease blood pressure in adult population with or without
hypertension. Blood pressure variation in 24 hours is not static but dynamically
changes. Increasing nocturnal blood pressure has significantly impacts, and become
one of predictor of target organ damage, especially cardiovascular events and
stroke. Salt intake may interferes both 24 hours blood pressure variation and
nocturnal blood pressure. Angiotensin Converting Enzyme(ACE) Inhibitors is first
drug of choice anti-hypertensive therapy, especially in young age and associated
with metabolic syndrome, due to important role of Renin Angiotensin Aldosterone
System in pathophysiology of hypertension, whereas salt intake also has role in that
system. Only few of studies that had proved combination of ACE Inhibitors and
low salt intake in decreasing blood pressure in hypertension population. Therefore,
it is so important to know the impact of low salt intake to nocturnal blood pressure
in hypertension patient treated with ACE Inhibitors.
Objectives : To know impact of low salt intake to nocturnal blood pressure in
hypertension patient treated with ACE Inhibitors.
Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreated
hypertension, divided into two groups (low salt intake (Na <15 grams/day) and high
salt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg and
underwent 24-hours sodium urine collection and home blood pressure monitoring
periodically.
Results : There are 80 ambulatory patients diagnosed as untreated hypertension,
consist of 37 patients in low salt intake group and 43 patients in high salt intake
group. Low salt intake group has lower nocturnal systolic (p<0.001), diastolic
(p<0.001), and mean arterial (p<0.001) blood pressure compared with high salt
intake group. Mean salt intake in this study was 16.77 grams/day. Multivariate
analyzes showed that the difference of decreasing nocturnal blood pressure was not
interfered by age, sex, dyslipidemia, BMI, and sleep duration.
Conclusion : This study has proved that low salt intake may interfere ACE Inhibitors therapy effectiveness in decreasing nocturnal blood pressure.;Background : Hypertension is one of important risk factor of cardiovascular
disease, especially acute coronary syndrome and stroke. High salt intake correlates
to high blood pressure. Some Randomized-Controlled-Trials stated that low salt
intake may decrease blood pressure in adult population with or without
hypertension. Blood pressure variation in 24 hours is not static but dynamically
changes. Increasing nocturnal blood pressure has significantly impacts, and become
one of predictor of target organ damage, especially cardiovascular events and
stroke. Salt intake may interferes both 24 hours blood pressure variation and
nocturnal blood pressure. Angiotensin Converting Enzyme(ACE) Inhibitors is first
drug of choice anti-hypertensive therapy, especially in young age and associated
with metabolic syndrome, due to important role of Renin Angiotensin Aldosterone
System in pathophysiology of hypertension, whereas salt intake also has role in that
system. Only few of studies that had proved combination of ACE Inhibitors and
low salt intake in decreasing blood pressure in hypertension population. Therefore,
it is so important to know the impact of low salt intake to nocturnal blood pressure
in hypertension patient treated with ACE Inhibitors.
Objectives : To know impact of low salt intake to nocturnal blood pressure in
hypertension patient treated with ACE Inhibitors.
Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreated
hypertension, divided into two groups (low salt intake (Na <15 grams/day) and high
salt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg and
underwent 24-hours sodium urine collection and home blood pressure monitoring
periodically.
Results : There are 80 ambulatory patients diagnosed as untreated hypertension,
consist of 37 patients in low salt intake group and 43 patients in high salt intake
group. Low salt intake group has lower nocturnal systolic (p<0.001), diastolic
(p<0.001), and mean arterial (p<0.001) blood pressure compared with high salt
intake group. Mean salt intake in this study was 16.77 grams/day. Multivariate
analyzes showed that the difference of decreasing nocturnal blood pressure was not
interfered by age, sex, dyslipidemia, BMI, and sleep duration.
Conclusion : This study has proved that low salt intake may interfere ACE Inhibitors therapy effectiveness in decreasing nocturnal blood pressure.;Background : Hypertension is one of important risk factor of cardiovascular
disease, especially acute coronary syndrome and stroke. High salt intake correlates
to high blood pressure. Some Randomized-Controlled-Trials stated that low salt
intake may decrease blood pressure in adult population with or without
hypertension. Blood pressure variation in 24 hours is not static but dynamically
changes. Increasing nocturnal blood pressure has significantly impacts, and become
one of predictor of target organ damage, especially cardiovascular events and
stroke. Salt intake may interferes both 24 hours blood pressure variation and
nocturnal blood pressure. Angiotensin Converting Enzyme(ACE) Inhibitors is first
drug of choice anti-hypertensive therapy, especially in young age and associated
with metabolic syndrome, due to important role of Renin Angiotensin Aldosterone
System in pathophysiology of hypertension, whereas salt intake also has role in that
system. Only few of studies that had proved combination of ACE Inhibitors and
low salt intake in decreasing blood pressure in hypertension population. Therefore,
it is so important to know the impact of low salt intake to nocturnal blood pressure
in hypertension patient treated with ACE Inhibitors.
Objectives : To know impact of low salt intake to nocturnal blood pressure in
hypertension patient treated with ACE Inhibitors.
Methods : There are 30 ? 50 years old ambulatory patients diagnosed as untreated
hypertension, divided into two groups (low salt intake (Na <15 grams/day) and high
salt intake (≥15 grams/day). Both of groups were administered Lisinopril 10mg and
underwent 24-hours sodium urine collection and home blood pressure monitoring
periodically.
Results : There are 80 ambulatory patients diagnosed as untreated hypertension,
consist of 37 patients in low salt intake group and 43 patients in high salt intake
group. Low salt intake group has lower nocturnal systolic (p<0.001), diastolic
(p<0.001), and mean arterial (p<0.001) blood pressure compared with high salt
intake group. Mean salt intake in this study was 16.77 grams/day. Multivariate
analyzes showed that the difference of decreasing nocturnal blood pressure was not
interfered by age, sex, dyslipidemia, BMI, and sleep duration.
Conclusion : This study has proved that low salt intake may interfere ACE Inhibitors therapy effectiveness in decreasing nocturnal blood pressure."
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library