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Made by:
Yohanes Mario, 0706259993
Supervised by:
Dr. Yoga Iwanoff Kasmir, SpPD
Consultant of Rheumatology
Made by:
Yohanes Mario, 0706259993
Supervised by:
Dr. Yoga Iwanoff Kasmir, SpPD
Consultant of Rheumatology
ORIGINALITY STATEMENT
This paper is truly from my work
And all the source that i take and refer to are true
Name
: Yohanes Mario
NPM
: 0706259993
Date
: 3 September 2011
Signature
ANTIPLAGIARISM STATEMENT
I, who sign under, truly state that this report was authored without any
plagiarism according to the valid rule in Universitas Indonesia.
In the later day, if we are proved for plagiating, i will take full responsibility
and accept any penalty from Universitas Indonesia.
Yohanes Mario
follow-up (matched hazard ratio {HR} when uncontrolled hypertension was compared with
uncontrolled hypertension,
Conclusion: uncontrolled hypertension have a bigger role than controlled hypertension to make
heart failure
Clinical Scenario
Male, 39 years old came to the Cipto Mangunkusumo hospital with chief complaint dyspnea
since 10 hours before came to hospital. Dyspnea come on effort, dyspnea do not come in night,
dyspnea minimized by rest. Several hours before patient went to a general hospital in Jakarta. He
diagnosed as chronic renal failure. He got some medicine and he felt better. He was sent to
CiptoMangunkusumo Hospital to take approriate treatment. On anamnesis we didnt find
hemoptoe, cough with secretion, febrile, chest pain, nausea and vomit. The patient suffered from
hypertension since 2001 and didnt get medicine, diabetes mellitus since 2009. We didnt find
limbs paresthesia on anamnesis but we found visual disturbance. He said that he suffer from
visual disturbance 1 year ago. We found hypertension and asthma in his family root, but we
didnt find diabetes mellitus. In clinical examination we find that everything in normal limit
except jugular vein pressure 5-1 H20 and edema pretibial.
Introduction
Heart failure (HF) is a clinical syndrome in which an abnormality of cardiac structure or function
is responsible for the inability of the heart to eject or fill with blood at a rate commensurate with
the requirements of the metabolizing tissues. HF results in a constellation of clinical
manifestations, including, in various combinations, circulatory congestion, dyspnea, fatigue, and
weakness. The severity of the clinical manifestations are commonly described according to
criteria developed by the New York Heart Association. HF is a major public health problem in
industrialized nations. It appears to be the only common cardiovascular condition that is
increasing in prevalence and incidence in North America and Europe. In the United States, HF is
responsible for almost 1 million hospital admissions and 50,000 deaths annually. Since HF is
more common in the elderly, its prevalence is likely to continue to increase as the population
ages1.
Rapid elevation of arterial pressure, as may occur in abrupt discontinuation of antihypertensive
medication in patients with hypertension, may result in cardiac decompensation.Cardiac
compensation for the excessive workload imposed by increased systemic pressure is at first
sustained by concentric left ventricular hypertrophy, characterized by an increase in wall
thickness. Ultimately, the function of this chamber deteriorates, the cavity dilates, and the
symptoms and signs of heart failure appear2
Clinical question
Are patient with uncontrolled hypertension more likely to develop heart failure than patient with
controlled hypertension?
Methods
Search strategy
Table 1 search strategy used in pubmed and embase conducted on 3rd September,
2011
A pubmed and embase search were conducted on 3rd September, 2011. We use following
Medical Subject Heading: uncontrolled hypertension , prolonged hypertension, congestive
heart failure, heart failure. The search result are shown in table 1.
Selection criteria
The first filtering based on free article and pay article. The second filtering based on in- and
exclusion criteria. Studies about elderly male population, and published in the last 2 years were
included. Study about, RCT study, therapy, female, and published before 2010 were excluded.
After that, screening title were conducted. After reading the abstract there was one article that
suitable with the query.
Critical appraisal
The only article was appraised by consensus by all authors using validity, importance and
applicability question. The result was shown in table 3.
Discussion
Uncontrolled hypertension was associated with increased risk of other cardiovascular morbidity
and mortality. These findings highlight the importance of hypertension control, in particular the
control of SBP, in reducing the incidence of HF and other adverse outcomes in older adults with
hypertension. This is important as hypertension has the highest attributable risk for incident HF,
and can often be easily controlled3.
The limitation of this study are patients with uncontrolled hypertension defined using the average
of three baseline BP recording, which may be less reliable than 24-hour recording. However, the
higher pre-match prevalence of LVH in our study suggests that those with uncontrolled
hypertension may have had their BP uncontrolled for a long period of time. It is possible that
participants with controlled hypertension at baseline may have developed uncontrolled
hypertension during follow-up and those with uncontrolled hypertension at baseline had their BP
controlled during follow-up. However, such regression dilution is likely to underestimate the true
association and not pose a threat to the validity of our findings5
REFERENCE
1. Kasper et al. Harrisons Principle of Internal Medicine. 16th ed. Philadelphia:
McGrawHill; 2005. Part 8, page 1367
2. Kasper et al. Harrisons Principle of Internal Medicine. 16th ed. Philadelphia:
McGrawHill; 2005. Part 8, page 1467
3. Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, Gardin
JM,Rutledge JE, Boineau RC. Predictors of congestive heart failure in the elderly: the
Cardiovascular Health Study. J Am Coll Cardiol 2000;35:16281637. [PubMed:
10807470]
4. Port S, Demer L, Jennrich R, Walter D, Garfinkel A. Systolic blood pressure and
mortality. Lancet 2000;355:175180. [PubMed: 10675116]
5. Clarke R, Shipley M, Lewington S, Youngman L, Collins R, Marmot M, Peto R.
Underestimation of risk associations due to regression dilution in long-term follow-up of
prospective studies. Am J Epidemiol 1999;150:341353. [PubMed: 10453810] Iyer et al.
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