Sjughiarto, Mohammad Afies (2017) Perbedaan Respon Terapi Antihipertensi Berbasis Angiotensin Ii Receptor Blocker (Arb) Terhadap Regresi Massa Ventrikel Kiri Pada Pasien Hipertensi Dengan Polimorfisme Reseptor ß2-Adrenergik Gln27glu Dan Gln27gln (Wildtype) Di Rumah Sakit Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.
Abstract
Latar Belakang : Polimorfisme reseptor β2-Adrenergic Receptors (β2-AR) Gln27Glu diketahui memicu respon hipertropik berlebihan terhadap katekolamin dan berhubungan kuat dengan terjadinya HVK pada pasien hipertensi. Pemberian Angiotensin II receptors blocker (ARB) pada pasien-pasien HVK dengan polimorfisme reseptor β2-AR Gln27Glu mungkin dapat menekan respon hipertropik katekolamin melalui inhibisi reseptor AT1 pada saraf-saraf simpatis di jantung dan meregresi massa HVK. Tujuan : Untuk mengetahui perbedaan respon terapi berbasis ARB terhadap regresi HVK pada pasien hipertensi dengan polimorfisme reseptor β2-AR Gln27Glu dan Gln27Gln (wildtype) Metode : Dengan kohort prospektif pre dan post test, 39 pasein yang memenuhi kriteria inklusi (laki-laki, hipertensi baru terdiagnosis atau tidak minum obat antihipertensi selama lebih dari 2 minggu,usia 30-75 tahun, ras Asia) menjalani prosedur Ambulatory Blood Pressure Monitoring (ABPM) 24 jam, pemeriksaan ekokardiografi untuk menilai HVK sebelum dan setelah 6 bulan pemberian terapi antihipertensi berbasis ARB dan regimen selama follow-up dioptimalisasi berdasarkan tekanan darah office. Polimorfisme Gln27Glu reseptor β2-AR diperiksa dengan menggunakan analisis Restriction Fragment Length Polymorphism (RFLP). Data dianalisis dengan Uji t berpasangan. Hasil : Diantara pasien hipertensi, frekuensi Gln27Gln ditemukan sebanyak 84.6% sedangkan pada pasien hipertensi dengan HVK ditemukan sebanyak 81.25%. Pada kelompok pasien dengan genotipe Gln27Gln, setelah 6 bulan pemberian terapi berbasis ARB, tekanan darah sistolik dan diastolik 24 jam mengalami penurunan, masing-masing 11 mmHg (p=0.028) dan 8 mmHg (0.015), nilai LVMi mengalami penurunan dari169±42.98 g/m2 menjadi 110.61±57.3 gr/m2 (p=0.03) dan nilai LV Mass dari 293±76.4 gr menjadi 187.4±70.84 gr (p=0.02). Pemberian beta-blocker pada terapi berbasis ARB menunjukkan regresi LVMI dari 137,11 ± 37,58 menjadi 72,56 ± 28,59 (p=0.011) dan perubahan LVMass dari 243,22 ± 72,69 menjadi 141,22 ± 36,87 (p=0.01) setelah 6 bulan. Kesimpulan : Pengobatan dengan antihipertensi berbasis ARB selama 6 bulan menunjukkan penurunan tekanan darah dan regresi HVK pada kelompok dengan genotipe Gln27Gln. Penambahan beta-blocker pada ARB menghasilkan regresi HVK yang signifikan dibandingkan pemberian tunggal ARB
English Abstract
Background: β2-Adrenergic receptor (β2-AR) Gln27Glu polymorphism is known drives an exaggerated hypertrophic response to catecholamines and is strongly associated with LVH in hypertensive patients. Angiotensin II receptor blocker (ARB) may suppress the catecholamine hypertrophic response by inhibition of AT1 receptors ganglionic post sympathetic nerves in the heart and regress LV-mass in hypertensive patients with β2-AR polymorphism Gln27Glu Objective: To know the difference of ARB response to LVH regression in hypertensive patients with β2-AR Gln27Glu receptor polymorphism and Gln27Gln (wildtype) Methods: with prospective cohort study, 39 patients by inclusion criteria (male, newly diagnosed hypertension or no taking antihypertensive medication for more than 2 weeks, age 30-75 years, Asian race) underwent Ambulatory Blood Pressure Monitoring (ABPM ) 24 hours, echocardiographic examination to assess LVH before and after 6 months of ARB-based antihypertensive therapy and optimize a regimens during follow-up based on office blood pressure. Polymorphism receptors β2-AR Gln27Glu examined using Restriction Fragment Length Polymorphism (RFLP) analysis. Data were analyzed using paired t test. Results: Among hypertensive patients and LVH, the Gln27Gln was found in 84.6% and 81.25%, respectively. After 6 months of ARB-based treatment, in the group LVH with Gln27Gln genotype, 24 hours systolic and diastolic blood pressure decreased, 11 mmHg (p = 0.028) and 8 mmHg (0.015 ), respectively and revealed a reduction of LVMi values of 59 gr / m2 from 169 ± 42.98 g / m2 at baseline (p =0.03) and the LV Mass values of 106 gr from 293 ± 76.4 gr (p = 0.02). Left ventricular hypertrophy patients with Gln2Glu revealed significant RWT reductions, these changes indicate a deterioration towards eccentric hypertrophy. After 6 months follow-up, adding beta-blocker to ARBs therapy in the Gln27Gln (wild-type) showed a significant decreased in LVMI from 137.11 ± 37.58 to 72.56 ± 28.59 (p = 0.011)) and LVMass decreased from 243.22 ± 72.69 to 141.22 ± 36.87 (p = 0.01) but not in Valsartan nor Telmisartan group. Conclusions: Treatment with ARB-based antihypertensive for 6 months revealed a significant decreased of blood pressure and regression of LVH in Gln27Gln genotype. Adding beta-blocker to ARBs produced a significant regression of LVH compared to ARB alone
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.132/SJU/p/2017/041705267 |
| Uncontrolled Keywords: | GENETIC POLYMORPHISMS, HYPERTENSION, ANGIOTENSN II, ADRENERGIE BETA BLOKERS |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.1 Diseases of cardiovascular system > 616.13 Diseases of blood vessels > 616.132 Hypertension |
| Divisions: | S2/S3 > Magister Ilmu Biomedis, Fakultas Kedokteran |
| Depositing User: | Nur Cholis |
| Date Deposited: | 19 Jul 2017 07:34 |
| Last Modified: | 30 Dec 2020 14:17 |
| URI: | http://repository.ub.ac.id/id/eprint/367 |
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