Tesis

Hubungan Variabilitas Tekanan Darah Jangka Pendek Berupa Penurunan Tekanan Darah Jangka Pendek Dan Lonjakan Tekanan Darah Pagi Hari Diukur Dengan Pemeriksaan Tekanan Darah Ambulatori Terhadap Luaran Kardiovaskular = Correlation ofShort-term Blood Pressure Variability in form of Nocturnal Blood Pressure Falls and Morning Blood Pressure Surge Measured with Ambulatory Blood Pressure Monitoring and Cardiovascular Outcomes.

Latar Belakang: Variabilitas Tekanan Darah (VTD) didefinisikan sebagai rerata variasi tekanan darah sepanjang hari dikur dengan Pemeriksaan Tekanan Darah Ambulatori (PTDA). VTD yang berlebihan berpotensi memicu kejadian kardiovaskular terutama pada pasien kardiovaskular dengan resiko tinggi. VTD jangka pendek digunakan sebagai stratifikasi resiko namun masih terdapat ketidak jelasan VTD manakah yang lebih bermakna untuk melihat luaran kariovaskular terutama pada pasien hipertensi dengan penyakit kardiovaskular Tujuan: Mengetahui hubungan VTD dengan luaran kardiovaskular pada populasi hipertensi dengan penyakit kardiovaskular yang melakukan pemeriksaan PTDA di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita Metode: Sebuah penelitian kohort retrospektif dengan subjek penelitian hipertensi dengan penyakit kardiovaskular yang melakukan PTDA Hasil: Dari total 197 subjek yang memenuhi kriteria inklusi terdapat hipertensi sustained sebesar 139 (70,6%). VTD berupa riser sebesar (30.5%), non-dipper (43.1%), dipper (23.9%) dan extreme dipper (2%). Sedangkan untuk lonjakan tekanan darah pagi hari didapatkan sebanyak (50.8%). Selama pemantauan terjadi luaran kardiovaskular sebesar 16,2%. Analisis multivariat menggunakan cox regression menunjukan bahwa variabilitas tekanan darah tidak memiliki hubungan yang bermakna terhadap luaran kardiovaskular Kesimpulan: Variabilitas tekanan darah berupa penurunan tekanan darah malam hari, lonjakan tekanan darah pagi hari dan weighted Standard deviation tidak berhubungan degan luaran kardiovaskular pada pengamatan minimal 1 tahun
Kata Kunci: Hipertensi, Variabilitas tekanan darah, Penyakit kardiovaskular


Background: Short-term blood pressure variability (BPV) is defined as the average variation in blood pressure throughout the day as measured by the ambulatory blood pressure monitoring (ABPM). Excessive BPV has potential to trigger cardiovascular events, especially in high-risk cardiovascular patients. Short-term BPV has been used as risk stratification, but it is still unclear which subset of BPV is more significant to predict cardiovascular (CV) outcomes, especially in hypertensive patients with cardiovascular disease. Objective: We sought to investigate correlation between short-term BPV and cardiovascular outcomes in the hypertensive population with cardiovascular disease. Methods: Retrospective cohort study was conducted in NCC Harapan Kita, involving hypertensive patient with cardiovascular disease underwent 24-hours ABPM. Inclusion criteria were hypertensive patient with left ventricular hyperthrophy (LVH), documented coronary artery disease (CAD), pre-existing heart failure and atrial fibrillation. Data of 197 eligible patient were collected from electronic medical record and followed up from the ABPM examination for at least 1 year or until an event occur. The event is defined as a composite of all-cause mortality, acute coronary syndrome, stroke, heart failure requiring hospitalization, or need of coronary revascularization. Result: Out of 197 subjects who met the inclusion criteria, 139 (70.6%) had sustained hypertension. Subset of BPV identified as risers (30.5%), non-dippers (43.1%), dippers (23.9%) and extreme dippers (2%). The morning blood pressure surge (MBPS) was observed in 50.8%. During follow up with median duration of 25 months (1 to 85 months), 32 subjects (16.2%) had cardiovascular outcomes. Multivariate analysis using Cox regression shows that none of the subset of blood pressure variability have significant correlation with cardiovascular outcomes. Conclusion: In this study short-term BPV is not correlated with cardiovascular outcomes at 1 year follow up. The result suggested that in hypertensive patient with CV disease, the time to secondary events may need longer period.
Keywords: hypertension, blood pressure variability, cardiovascular disease