Studi Ketercapaian Tujuan Terapi pada Pasien Hipertensi Geriatri dan Perbandingan Beberapa Obat Antihipertensi
Abstract
Prevalensi penderita hipertensi kelompok geriatri di Indonesia mencapai 22,3% pada tahun 2018. Ketercapaian tujuan penurunan tekanan darah merupakan faktor utama dalam pencegahan kejadian penyakit kardiovaskular. Tujuan penelitian ini untuk mengetahui studi profil ketercapaian tujuan terapi dan perbandingan obat pada pasien geriatri dengan hipertensi. Penelitian ini merupakan studi observasional-longitudinal dengan pengambilan data secara retrospektif melalui rekam medis pasien rawat jalan pada 1 Januari 2021–30 Juni 2022. Kriteria inklusi meliputi pasien geriatri (≥60 tahun) yang didiagnosis hipertensi dan tersedia data tekanan darah pada hari ke-1 dan hari ke-30 sampai ke-40, kriteria eksklusi meliputi perubahan dosis atau jenis obat antihipertensi pada pasien. Data dianalisis menggunakan metode relative risk (RR, CI 95%). Penelitian ini melibatkan sebanyak 103 pasien, di mana jenis kelamin perempuan (53,43%), usia 60–74 tahun (87,38%) dan hipertensi tahap 1 (70,88%) mendominasi. Nilai ketercapaian tujuan terapi (<130/90 mmHg) mencapai 62,14%. Obat-obatan yang digunakan meliputi amlodipin, ramipril, kandesartan, valsartan, dan furosemid. Hasil perbandingan pengobatan monoterapi (ACE-I, ARB, CCB) tidak berbeda bermakna (p>0,05) dalam penurunan pencapaian tujuan terapi, begitupula dengan perbandingan obat kombinasi (CCB+ARB, ACE-I + loop diuretics, CCB+ACE-I). Meskipun demikian, CCB (amlodipin) atau CCB+ACE-I (amlodipin+ramipril) menunjukkan ketercapaian tujuan terapi lebih tinggi mencapai 76,90% dan 83,30%, secara berturut-turut. Selain itu, monoterapi CCB, dan kombinasi CCB+ACE-I mampu menurunakan risiko ketidaktercapaian tujuan terapi sebesar 53,85% (RR 0,4615; 95% CI: 0,1383-1,5406), dan 70.83% (RR 0,2917; 95% CI: 0,0436-1,9516). Kombinasi Penggunaan CCB (amlodipin) sebagai monoterapi dan CCB+ACE-I (amlodipin+ramipril) sebagai kombinasi direkomendasikan pada pasien geriatri dengan hipertensi.
Keywords
Full Text:
PDF (Bahasa Indonesia)References
Gabb G. What is hypertension? Aust Prescr. 2020 ; 43(4):108-9.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S Lip G. Y. H. ESC Scientific Document Group. ESC/ESH Guidelines for the management of arterial hypertension. European heart journal. 2018; 39(33): 3021–104.
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, Ramirez A, Schlaich M, Stergiou GS, Tomaszewski M, Wainford RD, Williams B & Schutte A. E. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020; 75(6): 1334–57.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr Jones DW, Materson BJ, Oparil S, Wright JT, Jr Roccella EJ, National Heart Lung and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure & National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289(19): 2560-72.
Indonesian Society of Hypertension. Konsensus Penatalaksanaan Hipertensi 2019. Jakarta. Perhimpunan Dokter Hipertensi Indonesia.
Whelton PK, Carey RM, Aronow WS, Casey DE, Jr Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S Jamerson, KA Jones, DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Jr Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Sr Williamson, JD, Wright JT, Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension.2018; 71(6), 1269–324.
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nature reviews. Nephrology.2020; 16(4): 223–37.
Astutik E, Puspikawati SI, Dewi DMSK, Mandagi AM, Sebayang SK. Prevalence and Risk Factors of High Blood Pressure among Adults in Banyuwangi Coastal Communities, Indonesia. Ethiop J Health Sci. 2020 Nov; 30(6): 941-50.
World Health Organization. Hypertension. 2023. Available at https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed at May 5 2023.
Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018 May;34(5): 575-84.
Hussain MA, Mamun AA, Reid C, Huxley RR. Prevalence, Awareness, Treatment and Control of Hypertension in Indonesian Adults Aged ≥40 Years: Findings from the Indonesia Family Life Survey (IFLS). PLoS One. 2016 Aug 24;11(8): e0160922.
Connelly PJ, Currie G, Delles C. Sex Differences in the Prevalence, Outcomes and Management of Hypertension. Curr Hypertens Rep. 2022 Jun; 24(6): 185-92.
Muka T, Oliver-Williams C, Kunutsor S, Laven J.S.E, Fauser B.C.J.M, Chowdhury R, Kavousi M, Franco OH. Association of Age at Onset of Menopause and Time Since Onset of Menopause with Cardiovascular Outcomes, Intermediate Vascular Traits, and All-Cause Mortality: A Systematic Review and Meta-analysis. JAMA Cardiol. 2016;1:767–76.
Lima R, Wofford M, Reckelhoff JF. Hypertension in postmenopausal women. Curr Hypertens Rep. 2012 Jun; 14(3): 254-60.
Nagappa B, Thekkur P, Majella MG, Nair D, Ramaswamy G, Chinnakali P. Failure to achieve goal blood pressure and its associated factors among hypertensive patients registered in a primary health centre in South India. J Family Med Prim Care. 2018 Jan-Feb;7(1):81-6.
Zhu J, Chen N, Zhou M, Guo J, Zhu C, Zhou J Ma, M & He L. Calcium channel blockers versus other classes of drugs for hypertension. The Cochrane database of systematic reviews. 2022; 1(1): CD003654.
Jamerson K, Weber MA, Bakris GL, Dahlof B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ. Benazepril plus amlodipin or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008; 359: 2417–28.
DOI: https://doi.org/10.15416/ijcp.2023.12.2.98
Refbacks
- There are currently no refbacks.
Indonesian Journal of Clinical Pharmacy is indexed by
