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Abstrak :
Hipertensi merupakan salah satu penyakit kronis yang paling banyak terjadi. Penurunan resistensi perifer oleh vasodilator memiliki peranan dalam menurunkan tekanan darah. Inhibitor angiotensin I-converting enzyme (ACE) selain dapat menurunkan efek vasokonstriksi juga mengurangi degradasi bradikinin yang berperan dalam pembentukan vasodilator kuat NO (nitrat oksida). Pencegahan penurunan aktivitas NO oleh radikal bebas dapat mendukung efek vasodilatasi NO. Daun kersen (Muntingia calabura L.) ditemukan memiliki efek hipotensi melalui jalur NO. Penelitian ini dilakukan untuk menguji secara in vitro penghambatan aktivitas ACE dari ekstrak etanol 96% daun kersen menggunakan ACE kit-WST dan menguji kapasitas antioksidan dengan metode FRAP, senyawa fenolik total, dan flavonoid total dari fraksi n-heksana, etil asetat, dan n-butanol. Hasil pengujian menunjukkan ekstrak etanol memiliki aktivitas penghambatan ACE dengan IC50 sebesar 1,25 μg/mL. Nilai EC50 antioksidan fraksi n-heksana, etil asetat, dan n-butanol adalah 7,47 μg/mL, 1,84 μg/mL, dan 5,02 μg/mL, secara berturut-turut. Fraksi etil asetat merupakan fraksi dengan nilai kapasitas antioksidan, senyawa fenolik total, dan flavonoid total tertinggi. Senyawa fenolik total dan flavonoid total memiliki korelasi terhadap EC50 antioksidan (r=-0,967 dan r=-0,908) tidak signifikan (p>0,05). Ekstrak etanol daun kersen memiliki aktivitas penghambatan ACE dan fraksi kaya senyawa fenolik dan flavonoid memiliki aktivitas antioksidan paling tinggi.

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Hypertension is one of the most common chronic diseases. Peripheral resistance reduction by vasodilator has big role in reducing the blood pressure. Angiotensin I-converting enzyme(ACE) inhibitors minimize the degradation of bradykinin which is important for NO(nitric oxide) activation. Prevention of reduction activity of NO by free radical will support the vasodilation effect. Jamfruit leaf (Muntingia calabura L.) was reported to have excellent hypotensive effect and antioxidant activity. This research was aimed to test in manner of in vitro the inhibitory activity of ACE from jamfruit leaves ethanol extract using ACE kit-WST and antioxidant activity using FRAP assay, total phenolic compound, and total flavonoid from n-hexane, ethyl acetate, and n-butanol fractions. The result showed that Jamfruit leaf extract had ACE inhibitory activity with IC50 value was 1.25μg/mL. Antioxidant EC50 value of n-hexane, ethyl acetate, and n-butanol fractions were 7.47 μg/mL, 1.84 μg/mL, and 5.02 μg/mL successively. Ethyl acetate fraction was fraction with highest antioxidant activity, total phenolic compound and total flavonoid. Total phenolic compound and total flavonoid values had correlation with EC50 antioxidant (r=-0,967 and r=-0,908) with no significancy (p>0,05). Ethanol extract of jamfruit leaves had ACE inhibitory activity and its phenolic and flavonoid-rich fraction had higher antioxidant activity.

Abstrak :
[ABSTRAK
Latar Belakang : Continous ambulatory peritoneal dialysis (CAPD) telah menjadi alternatif selain hemodialisis untuk pengobatan penyakit ginjal tahap akhir. Fibrosis peritoneum merupakan penyebab utama terjadinya kerusakan membran peritoneum. Mekanisme fibrosis peritoneum belum diketahui secara pasti, namun ditengarai transforming growth factor ? β (TGF ?β) berhubungan erat terhadap terjadinya fibrosis peritoneum. Tujuan : Tujuan penelitian ini adalah untuk mengetahui pengaruh kombinasi ACE inhibitor (ACEI) dan calcium channel Blocker (CCB) terhadap penurunan ekspresi TGF ? β dan fibrosis peritoneum tikus jantan yang telah dilakukan CAPD. Metode Penelitian : Penelitian eksperimental, post test only control group design. Tiga puluh tikus Dawley spraque dibagi menjadi lima kelompok yaitu kelompok kontrol (kelompok 1) dan kelompok perlakuan dengan pemberian masing-masing cairan CAPD 4,25% (kelompok2) lisinopril 1,44 mg oral dan CAPD (kelompok 3) diltiazem CD 6,48 mg oral dan CAPD (kelompok 4) lisinopril 1,44 mg dan diltiazem CD 6,48 mg oral dan CAPD (kelompok 5). Setelah 4 minggu tikus dikorbankan dengan cara dislokasi cervical kemudian diperiksa ekspresi TGF ? β dan terjadinya fibrosis pada peritoneum tikus, selanjutnya dibuat sediaan histopatologi dan diwarnai dengan hematoksilin eosin serta imunohistokimia menggunakan antihuman TGF-ß. Hasil : Dua puluh peritoneum tikus berhasil diperiksa. Rerata skor TGF-β kelompok kontrol 1,8, kelompok CAPD 2, kelompok lisinopril dan CAPD 1,8, kelompok diltiazem CD dan CAPD 1,8, kelompok lisinopril dan diltiazem CD dan CAPD 1,7 (p=0,959). Rerata skor fibrosis peritoneum kelompok kontrol 1,1, kelompok CAPD 2,6, kelompok lisinopril dan CAPD 1,2, kelompok diltiazem CD dan CAPD 1,3, kelompok lisinopril dan diltiazem CD dan CAPD1,5 (p=0,268) Simpulan : Kombinasi lisinopril dan diltiazem mempunyai kecenderungan menurunkan ekspresi TGF ? β lebih baik dibandingkan lisinopril maupun diltiazem yang diberikan secara terpisah tetapi tidak bermakna secara statistik. Kombinasi lisinopril dan diltiazem mempunyai kecenderungan mengurangi fibrosis peritoneum tetapi tidak bermakna secara statistik dan tidak lebih baik dibandingkan lisinopril maupun diltiazem bila diberikan secara terpisah.

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ABSTRACT
Background : Continuous ambulatory peritoneal dialysis (CAPD) has been an alternative other than hemodialysis for end stage kidney disease treatment. Peritoneal fibrosis is the most serious cause of the damage in membrane peritoneum. Mechanism of fibrosis peritoneum is not exactly known yet, transforming growth factor ? β(TGF ? β) is closely related with the existence of fibrosis peritoneum. Purposes : The purpose of this study is to evaluate the effect of combination between ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducing expression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD. Research Method : Experimental study, post test only control group design. Thirsty Dawley spraque rats are divided into five groups control group ( Group 1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3) diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD 6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression of TGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosin staining and immunology with anti human-TGF-β. Result : Twenty peritoneal of rats can be examined. Mean score TGF-β control group is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CD and CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7 (p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is 2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3, lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268) Summary : Combination of lisinopril and diltiazem lower the expression of TGF ? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically not significant. Combination of lisinopril and diltiazem lower the peritoneal fibrosis but statistically not significant and it doesn?t better than lisinopril or diltiazem. Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been an alternative other than hemodialysis for end stage kidney disease treatment. Peritoneal fibrosis is the most serious cause of the damage in membrane peritoneum. Mechanism of fibrosis peritoneum is not exactly known yet, transforming growth factor ? β(TGF ? β) is closely related with the existence of fibrosis peritoneum. Purposes : The purpose of this study is to evaluate the effect of combination between ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducing expression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD. Research Method : Experimental study, post test only control group design. Thirsty Dawley spraque rats are divided into five groups control group ( Group 1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3) diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD 6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression of TGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosin staining and immunology with anti human-TGF-β. Result : Twenty peritoneal of rats can be examined. Mean score TGF-β control group is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CD and CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7 (p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is 2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3, lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268) Summary : Combination of lisinopril and diltiazem lower the expression of TGF ? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically not significant. Combination of lisinopril and diltiazem lower the peritoneal fibrosis but statistically not significant and it doesn?t better than lisinopril or diltiazem. Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been an alternative other than hemodialysis for end stage kidney disease treatment. Peritoneal fibrosis is the most serious cause of the damage in membrane peritoneum. Mechanism of fibrosis peritoneum is not exactly known yet, transforming growth factor ? β(TGF ? β) is closely related with the existence of fibrosis peritoneum. Purposes : The purpose of this study is to evaluate the effect of combination between ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducing expression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD. Research Method : Experimental study, post test only control group design. Thirsty Dawley spraque rats are divided into five groups control group ( Group 1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3) diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD 6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression of TGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosin staining and immunology with anti human-TGF-β. Result : Twenty peritoneal of rats can be examined. Mean score TGF-β control group is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CD and CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7 (p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is 2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3, lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268) Summary : Combination of lisinopril and diltiazem lower the expression of TGF ? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically not significant. Combination of lisinopril and diltiazem lower the peritoneal fibrosis but statistically not significant and it doesn?t better than lisinopril or diltiazem. Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been an alternative other than hemodialysis for end stage kidney disease treatment. Peritoneal fibrosis is the most serious cause of the damage in membrane peritoneum. Mechanism of fibrosis peritoneum is not exactly known yet, transforming growth factor ? β(TGF ? β) is closely related with the existence of fibrosis peritoneum. Purposes : The purpose of this study is to evaluate the effect of combination between ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducing expression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD. Research Method : Experimental study, post test only control group design. Thirsty Dawley spraque rats are divided into five groups control group ( Group 1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3) diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD 6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression of TGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosin staining and immunology with anti human-TGF-β. Result : Twenty peritoneal of rats can be examined. Mean score TGF-β control group is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CD and CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7 (p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is 2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3, lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268) Summary : Combination of lisinopril and diltiazem lower the expression of TGF ? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically not significant. Combination of lisinopril and diltiazem lower the peritoneal fibrosis but statistically not significant and it doesn?t better than lisinopril or diltiazem. Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.;Background : Continuous ambulatory peritoneal dialysis (CAPD) has been an alternative other than hemodialysis for end stage kidney disease treatment. Peritoneal fibrosis is the most serious cause of the damage in membrane peritoneum. Mechanism of fibrosis peritoneum is not exactly known yet, transforming growth factor ? β(TGF ? β) is closely related with the existence of fibrosis peritoneum. Purposes : The purpose of this study is to evaluate the effect of combination between ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducing expression of TGF ? β and fibrosis peritoneum in a male rat treated with CAPD. Research Method : Experimental study, post test only control group design. Thirsty Dawley spraque rats are divided into five groups control group ( Group 1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3) diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD 6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression of TGF ? β and peritoneal fibrosis are conducted by histopatology with hematoxillineosin staining and immunology with anti human-TGF-β. Result : Twenty peritoneal of rats can be examined. Mean score TGF-β control group is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CD and CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7 (p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is 2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3, lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268) Summary : Combination of lisinopril and diltiazem lower the expression of TGF ? β and fibrosis peritoneum better than lisinopril or diltiazem but statistically not significant. Combination of lisinopril and diltiazem lower the peritoneal fibrosis but statistically not significant and it doesn?t better than lisinopril or diltiazem. Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis., Background : Continuous ambulatory peritoneal dialysis (CAPD) has been an alternative other than hemodialysis for end stage kidney disease treatment. Peritoneal fibrosis is the most serious cause of the damage in membrane peritoneum. Mechanism of fibrosis peritoneum is not exactly known yet, transforming growth factor – β(TGF – β) is closely related with the existence of fibrosis peritoneum. Purposes : The purpose of this study is to evaluate the effect of combination between ACE inhibitor (ACEI) dan Calcium channel blocker (CCB) in reducing expression of TGF – β and fibrosis peritoneum in a male rat treated with CAPD. Research Method : Experimental study, post test only control group design. Thirsty Dawley spraque rats are divided into five groups control group ( Group 1), CAPD liquid 4,25% (group 2), lisinopril 1,44 mg oral and CAPD (group 3) diltiazem CD 6,48 mg oral and CAPD (group 4) lisinopril 1,44mg + diltiazem CD 6,48 mg oral and CAPD (group 5). After 4 weeks, rats sacrificed. Expression of TGF – β and peritoneal fibrosis are conducted by histopatology with hematoxillineosin staining and immunology with anti human-TGF-β. Result : Twenty peritoneal of rats can be examined. Mean score TGF-β control group is 1,8, CAPD group is 2, lisinopril and CAPD group is 1,8,diltiazem CD and CAPD group is 1,8, lisinopril and diltiazem CD and CAPD group is 1,7 (p=0,959) .Mean score peritoneal fibrosis control group is 1,1, CAPD group is 2,6, lisinopril and CAPD group is 1,2, diltiazem CD and CAPD group is 1,3, lisinopril and diltiazem CD and CAPD group is 1,5 (p=0,268) Summary : Combination of lisinopril and diltiazem lower the expression of TGF – β and fibrosis peritoneum better than lisinopril or diltiazem but statistically not significant. Combination of lisinopril and diltiazem lower the peritoneal fibrosis but statistically not significant and it doesn’t better than lisinopril or diltiazem. Key words: ACE inhibitor, calcium channel blocker, TGF-β, peritoneal fibrosis.]

Abstrak :
Angiotensin converting enzyme inhibitor (ACEi) merupakan obat yang dapat mengontrol hipertensi. Penelitian secara in vivo melaporkan bahwa stres oksidatif berperan dalam patogenesis hipertensi. Daun jarum tujuh bilah (Pereskia sacharosa Griseb.) secara tradisional telah digunakan sebagai antihipertensi dan antioksidan. Tujuan penelitian ini adalah mengetahui penghambatan aktivitas ACE dari ekstrak etanol Pereskia sacharosa Griseb., aktivitas antioksidan metode FRAP dari ekstrak dan fraksi, menentukan kadar fenolik total dan flavonoid total fraksi, serta melihat korelasinya dengan aktivitas antioksidan. Ekstraksi dilakukan secara maserasi dengan etanol 80% dan fraksinasi dilakukan dengan metode partisi cair-cair. Uji penghambatan ACE secara in vitro dari ekstrak menggunakan ACE Kit-WST Dojindo dan diperoleh nilai IC50 3,448 μg/mL. Uji aktivitas antioksidan menggunakan metode FRAP dari fraksi n-heksana, etil asetat, dan n-butanol diperoleh EC50 berturut-turut 91,270; 15,085; dan 36,070 μg/mL. Penapisan fitokimia menunjukkan ekstrak etanol daun Pereskia sacharosa Griseb. mengandung alkaloid, fenol, flavonoid, glikosida, steroid, tanin, dan saponin. Fraksi n-butanol memiliki kadar fenolik total dan flavonoid total tertinggi yaitu 8,456 ± 0,151 mg EAG/g ekstrak dan 3,858 ± 0,285 mg EK/g ekstrak. Terdapat korelasi yang kuat antara kadar fenolik total pada fraksi dan aktivitas antioksidannya dengan metode FRAP. ......Angiotensin converting enzyme inhibitors (ACEi) are drugs that can control hypertension. In vivo studies have reported that oxidative stress plays a role in the pathogenesis of hypertension. Jarum tujuh bilah (Pereskia sacharosa Griseb.) leaves have been used traditionally as antihypertensive and antioxidant. The purpose of this study was to determine the inhibition of ACE activity of the ethanolic extract of Pereskia sacharosa Griseb., antioxidant activity of the extract and fractions using FRAP method, determine the total phenolic and total flavonoids content its fractions and its correlation with antioxidant activity. Extraction was done by maceration with 80% ethanol and fractionation performed by liquid-liquid partition. In vitro inhibition of ACE activity assay of the extract using ACE Kit-WST Dojindo had IC50 value of 3.448 μg/mL. Antioxidant activity using FRAP method of the n-hexane, ethyl acetate, and n-butanol fractions had EC50 value of 91.270; 15.085; and 36.070 μg/mL respectively. Phytochemical screening showed that ethanolic extract of Pereskia sacharosa Griseb. leaves contained alkaloids, phenols, flavonoids, glycosides, steroids, tannins, dan saponins. n-butanol fraction had the highest total phenolic content and total flavonoids content with 8.456 ± 0.151 mg GAE/g extract and 3.858 ± 0.285 mg QE/g extract. There was a high correlation between total phenolic content of the fraction with their antioxidant activity using FRAP method.

Abstrak :
Angiotensin Converting Enzyme ACE Inhibitor merupakan salah satu golongan obat hipertensi sehingga perlu dikonsumsi dalam jangka waktu yang lama, selain itu adanya kemungkinan pasien memiliki komorbiditas juga tinggi sehingga terdapat kemungkinan meningkatnya potensi interaksi obat. Tujuan penelitian ini adalah untuk menganalisis interaksi obat golongan ACE Inhibitor pada pasien hipertensi di Rumah Sakit Karya Bhakti Pratiwi periode Juli ndash; Desember 2016. Jenis penelitian ini adalah deskriptif-analitik dengan metode cross sectional pada data resep dan rekam medis pasien rawat inap periode Juli ndash; Desember 2016 yang mendapat obat hipertensi golongan ACE Inhibitor dengan satu atau lebih item obat lain, termasuk antihipertensi lainnya yang dipilih dengan metode purposive sampling. Analisis dilakukan terhadap 120 lembar resep dari 71 pasien. Berdasarkan penelitian ini dapat disimpulkan bahwa obat-obat ACE Inhibitor memiliki potensi interaksi dengan obat lain pada 75 lembar resep 53,96 dengan total kasus interaksi sebanyak 139 kasus terdiri dari 52 kasus interaksi mayor dan 87 kasus interaksi moderat. Hasil uji Mann Whitney menunjukkan adanya hubungan antara polifarmasi dengan potensi interaksi obat p < 0,05 dan tidak ada hubungan antara jenis kelamin serta patofisiologi dengan potensi interaksi obat p > 0,05 dari uji Chi-Square. Hubungan usia dengan potensi interaksi obat juga tidak bermakna signifikan berdasarkan hasil uji Kruskal-Wallis p > 0,05. ...... Angiotensin Converting Enzyme ACE Inhibitor as an antihypertensive drugs need to be consumed for long periods of time and there might be comorbidities among the patients so that increased the risk of drug interaction. This study aimed to analyse the drug interaction of ACE Inhibitor in hypertensive patients at Karya Bhakti Pratiwi period of July ndash December 2016. This was an analytical descriptive cross sectional study on prescriptions and medical records of hospitalized patients period July ndash December 2016 who got ACE Inhibitor with one or more other drugs, include other antihypertensive drugs, which were selected by purposive sampling method. The analysis was conducted on 120 prescriptions from 71 patients. This study concluded that ACE Inhibitor had a potential drug interactions with other drugs on 75 prescriptions 53,96, with total of 139 cases, consisiting of 52 cases of major interaction and 87 cases of moderate interaction. Mann Whitney test showed that there was a significant relationship between polypharmacy with potential drug interactions p 0,05 and there was no significant relationship between gender and patofisiology with potential drug interactions p 0,05 on Chi Square test. There was no significant relationship between age with potential drug interactions based on Kruskal Wallis test p 0,05.

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

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

Abstrak :
Latar Belakang: Infeksi COVID-19 merupakan penyakit dengan komplikasi multi-organ, salah satunya komplikasi kardiovaskular. Dengan kejadian gagal jantung akut sebagai komplikasi COVID-19 dengan mortalitas dan morbiditas yang tinggi, perlu dilakukan identifikasi faktor-faktor yang berhubungan dengan terjadinya gagal jantung akut pada pasien COVID-19, khususnya pada derajat sedang – berat. Tujuan : Mengetahui prediktor gagal jantung akut pada pasien COVID-19 yang dirawat, khususnya derajat sedang – berat Metode : Metode penelitian bersifat kohort retrospektif. Luaran primer adalah kejadian gagal jantung akut saat perawatan. Terdapat 15 faktor klinis dan laboratoris yang dianalisis secara bivariat dan multivariat. Hasil: Dari total 208 subjek sesuai kriteria inklusi dan eksklusi, sebanyak 73 subjek (35%) mengalami episode gagal jantung akut saat perawatan. Riwayat gagal jantung kronik memiliki risiko 5,39 kali (95% IK: 1,76 – 16,51; p = 0,003) mengalami kejadian gagal jantung akut. Pasien dengan nilai TAPSE < 17 mm memiliki risiko 4,25 kali (95% IK: 1,13 – 16,07; p= 0,033) mengalami gagal jantung akut. Sedangkan pemakaian ACE-i/ARB memiliki risiko 0,16 kali (95% IK: 0,05 – 0,51; p = 0,002) untuk mengalami gagal jantung akut intraperawatan dibandingkan kelompok tanpa pemakaian ACE-i/ARB. Kesimpulan: Riwayat gagal jantung kronik, TAPSE < 17 mm, dan pemakaian ACE-i/ARB diidentifikasi sebagai prediktor kejadian gagal jantung akut pada pasien COVID-19. ......Introduction: COVID-19 infection is a disease with multi-organ complications, including cardiovascular organ. As heart failure is one of COVID – 19 complications that has high morbidity and mortality, we need to identify factors that can predict acute heart failure in COVID – 19, especially in moderate to severe patients. Objective : to determine predictors of acute heart failure in hospitalized COVID -19 patients Method : This was a retrospective cohort study. The primary outcome was acute heart failure that happened during hospitalization. There were total of 16 clinical (age, sex, body mass index, hypertension, diabetes, smoking history, coronary artery disease, chronic kidney disease, chronic heart failure, chronic obstructive pulmonary disease, PaO2/FiO2 ratio, non-cardiogenic shock at admission, use of ACE-inhibitors/ARBs during hospitalization, ejection fraction, TAPSE) as well as 6 laboratory parameters (neutrophil - lymphocyte ratio, platelet - lymphocyte ratio, eGFR, D-Dimer, procalcitonin, CRP) that were used in statistical analysis. Result: From total of 208 subjects with moderate – severe COVID-19, 73 (35%) had acute heart failure. The median time of developing heart failure is 4 ( 1 - 27) days. On multivariate analysis, patients with history of chronic heart failure exhibited a 5.39-fold higher risk of acute heart failure compared with no history of chronic heart failure (95% CI: 1.76 – 16.51; p = 0.003). The risk of acute heart failure was multiplied by 4.25 in patients that was presented with TAPSE <17 mm (95% CI: 1.13 – 16.07; p= 0.033). In contrast, use/continuation of ACE-inhibitors/angiotensin receptor blockers during hospitalization showed reduced risk of acute heart failure (16% of the risk developing acute heart failure compared with patients with no use of ACE-inhibitors/angiotensin receptor blockers). In subjects developing acute heart failure, the mortality rate was 67%, compared with 57% in subjects without acute heart failure (p = 0,028). Conclusion: History of chronic heart failure, TAPSE <17 mm, and the use of ACE-inhibitors/angiotensin receptor blockers were identified as predictors of acute heart failure in hospitalized COVID-19 patients.