HUBUNGAN ANTARA MIKROALBUMINURIA DENGAN INDEKS MASSA VENTRIKEL KIRI. PADA PASIEN HIPERTENSI ESENSIAL NON DIABETIK (Correlation between A/ficroalbuininuria and Left Ventricular Mass Index in Non-Diabetic Essential Hypertensive patients)

LIMANTORO, CHARLES (2003) HUBUNGAN ANTARA MIKROALBUMINURIA DENGAN INDEKS MASSA VENTRIKEL KIRI. PADA PASIEN HIPERTENSI ESENSIAL NON DIABETIK (Correlation between A/ficroalbuininuria and Left Ventricular Mass Index in Non-Diabetic Essential Hypertensive patients). Masters thesis, Program Pendidikan Pasca sarjana Universitas Diponegoro.

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Abstract

BACKGROUND Microalbuminuria (MA) has been reported as an important and independent predictor not only for diabetic complications but also a powerful independent risk factor of cardiovascular morbidity and mortality in diabetics, hypertensive non-diabetics and.elderly general populations. Left Ventricular Hypertrophy (LVH) defined as increased Left Ventricular Mass Index (LVMI), has been shown to predict increased cardiovascular morbidity and mortality. Cohort prospective studies have shown that high-normal albuminuria could predict increased risks of cardiovascular events. It has been suggested that Albumin Creatinine Ratio (ACR) level less than those traditionally used by diabetologist as thresholds for microalbuminuria, may also be clinically relevant to the association with increased LVMI in essential hypertensive patients. OBJECTIVES The purpose of our study is to explore the association between microalbuminuria and left ventricular mass index in non-diabetic essential hypertensive patients. DESIGN AND METHODS Cross-sectional anal itic study was held at outpatients clinic of Internal Medicine Dr Kariadi General Hospital. We studied men and women, stage I-III hypertensive patients, aged between 41-69 years, which were newly-diagnosed and never been treated or not on any antihypertensive therapies for the last I year. Presence and severity of hypertension were determined on the basis of office blood pressure measurements. Exclution criteria included fever, strenous physical activity, abnormal urinalysis, increased values of plasma creatinine, diabetes mellitus, heart failure, infarct myocard, aorta insuficiency, mitral insuficiency, ventricular septal defect, aorta coarctation. Albumin Creatinine Ratio was evaluated from second morning urine. Left ventricular mass was assessed by M-mode echocardiography, Penn Convention formula was used, and then indexed for body surface area. RESULTS Thirty eight samples, 16 (42%) male and 22 (58%) female were included. Mean age for male was 51 ± 7.01 years, female was 50.9 ± 6.86 years. Body Mass Index 24.7 ± 3.14 kg/m2. The average values of office blood pressure was 159.9 ± 12.27 / 99.6 ± 8.00 mmHg. ACR was 13.8 ± 9.37 pig/nig and the LVMI was 105.5 ± 34.27 g/m2. Moderate positive significant relationship was observed between ACR and LVMI (r = 0.5, p = 0.004). ACR was also significantly related to age and office systolic and diastolic blood pressure. Linear regression analysis also demonstrate a significant association between (log) ACR and LVMI. CONCLUSIONS The present findings show a significantly continuous relationship between microalbuminuria and LVMI in non-diabetic essential hypertensive patients which were newly diagnosed and never been treated or not on any antihypertensive therapies for the last 1 year. Microalbuminuria is significantly associated with increased Left Ventricular Mass Index, and (log) ACR values can be used to predict LVMI in non-diabetic essential hypertensive patients. LATAR BELAKANG Mikroalbuminuria (MA) telah diketahui merupakan suatu prediktor independen dan penting, tidak hanya untuk komplikasi-komplikasi diabetik, tetapi juga suatu faktor risiko independen yang kuat untuk morbiditas dan mortalitas kardiovaskuler pada populasi diabetik, hipertensi non diabetik dan populasi umum usia lanjut. Hipertropi Ventrikel Kiri (LVH) didefinisikan sebagai peningkatan Indeks Massa' Ventrikel Kiri (LVMI), telah terbukti dapat memprediksi peningkatan morbiditas dan mortalitas kardiovaskuler. Berbagai penelitian prospektif kohort telah menunjukkan bahwa nilai MA yang normal-tinggi juga dapat memprediksi peningkatan risiko kejadian kardiovaskuler. Diduga bahwa nilai Rasio Albumin Kreatinin (ACR) yang lebih rendah daripada yang uniumnya digunakan oleh kalangan ahli diabetes, tampaknya juga memiliki relevansi klinis dalam hubungannya dengan peningkatan LVMI pada pasien-pasien hipertensi esensial. TUJUAN Tujuan penelitian ini ialah mencari asosiasi antara MA dan LVMI pada pasien-pasien hipertensi esensial non-diabetik. RANCANGAN DAN METODE Penelitian analitik belah lintang dilakukan terhadap pasien-pasien rawat jalan di poliklinik Penyakit Dalam RSUP Dr.Kariadi. Kami mempelajari pasien-pasien hipertensi stadium pria maupun wanita, usia antara 41-69 tahun, yang baru saja didiagnosis hipertensi dan belum pernah diterapi atau pasien lama yang sudah tidak pemah minum obat anti-hipertensi lagi minimal I tahun terakhir. Tekanan darah langsung diukur di Poliklinik. Kriteria eksklusi meliputi demam, akti vitas fisik berat, diabetes melitus, urinal Isis yang abnormal, insufisiensi renal, gagal jantung, infark miokard, insufisiensi aorta, insufisiensi mitral, defek septum ventrikel, koarktasio aorta. Rasio Albumin Kreatinin diperiksa dari urin pagi hari yang kedua. Massa Ventrikel Kiri diperiksa dengan ekokardiografi mode M, digunakan rumus dari Konvensi Penn, kemudian dibuat index dengan luas permukaan HASIL Tiga puluh delapan sampel, 16 (42%) pria dan 22 (58%) wanita diikutkan dalam penelitian. Usia rata-rata pria adalah 51 ± 7.01 tahun, rerata usia wanita adalah 50.9 ± 6.86 tahun. Indeks Massa Tubuh 24.7 ± 3.14 kg/m2. Nilai rerata tek°anan darah adalah 159.9 ± 12.27 / 99.6 ± 8.00 mmHg. Nilai rerata ACR adalah 13.8 th 9.37 pg/mg dan nilai rerata LVMI adalah 105.5 ± 34.27 g/m2. Didapatkan korelasi positif derajat sedang yang bermakna antara ACR and LVMI (r = 0.5, p = 0.004). ACR juga memiliki korelasi positif yang bermakna dengan usia dan tekanan darah sistolik dan diastolik. Analisis regresi linear menunjukkan adanya asosiasi yang bermakna antara (log)ACR dengan LVMI. KESIMPULAN Hasil penelitian ini menunjukkan adanya suatu hubungan kontinyu antara mikroalbuminuria dan LVMI pada pasien-pasien hipertensi esensial non-diabetik, yang baru terdiagnosis dan belum pernah mendapat terapi atau pasien hipertensi lama yang sudah tidak minum obat lagi dalam I tahun terakhir. Mikroalbumintiria berhubungan bermakna dengan Indeks Massa Ventrikel Kiri, dan nilai (log)ACR dapat digunakan untuk memprediksi LVMI pada pasien hipertensi esensial non-diabetik.

Item Type:Thesis (Masters)
Subjects:R Medicine > R Medicine (General)
Divisions:Postgraduate Program > Master Program in Biomedical Science
ID Code:12312
Deposited By:Mr UPT Perpus 1
Deposited On:30 May 2010 12:49
Last Modified:30 May 2010 12:49

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