e4 Journal of Hypertension Vol 35, e-Supplement 3, November 2017
Objective: This research aims to determine the relationship among invasive cen-
tral pressure, peripheral pressure, and CAD severity on patients undergoing Diag-
nostic Coronary Angiography in Dustira Hospital.
Methodology: We studied 155 patients (aged 33–86, mean 57.08; 63.2% men).
Parameters were central and brachial pressure measures (SBP, DBP, MAP, PP),
pressure gradients, and PP ratio. Difference between central and brachial mea-
sures, relationship to CAD severity, variability of central pressure in various bra-
chial BP classification groups, and agreement of 3 proposed central aortic systolic
pressure (CASP) cut-offs from previous studies were analyzed.
Results: Central and peripheral SBP and PP were significantly different
(SBP:144.9 ± 29.9vs 158.5 ± 29.9, p < 0.01, PP:66.7 ± 23.5 vs 69.6 ± 22.0,
p = 0.04). Patients with severe CAD had higher central and peripheral measures
compared to its milder counterparts, but only central PP was significantly associ-
ated with CAD severity (p = 0.04). Brachial BP classification using ESC 2013 cri-
teria showed 82% central BP overlap between normal and high-normal peripheral
pressure group, and 34% overlap between normal and stage 1 hypertension group.
Furthermore, there were strong agreement between proposed CASP cut-off from
ASCOT study and Williams et al (Cohen’s k 0.873, p < 0.001).
Conclusions: There were significant differences between central and peripheral
BP measurement. Central PP were significantly associated with CAD severity.
Brachial BP could not accurately infer central pressure. There was strong agree-
ment between proposed central pressure cut-offs.
Keywords: Brachial pressure, central pressure, DCA, hypertension, pulse pressure.
27 THE EFFECT OF BLOOD PRESSURE VARIABILITY ON TIME
TO FIRST CORONARY ARTERY DISEASE ONSET
Hadi M.W.1, Lukito A.A.1,2, Thengker A.1, Christiani A.1. 1Department of Cardio-
vascular, Siloam Hospitals Lippo Village, Tangerang, Indonesia, 2Faculty of Medicine,
Pelita Harapan University, Tangerang, Indonesia
Background: Blood pressure variability (BPV) was considered as a random fluc-
tuation of someone’s BP. The results of BPV studies were contradicting, including
the association between BPV and CAD risk. This study aims to know the associa-
tion between BPV and CAD.
Method: In this cross-sectional study, all medical records of hypertensive pa-
tients in our institution from 2010 until 2015 who routinely taken follow up visits
were collected, then the BPV using standard deviation (SD) and average reading
variability (AVR) of these patients in each follow up visit were calculated. AVR
is defined as an average of absolute differences consecutive readings. The time to
first CAD diagnosis or event after being diagnosed with hypertension in months
was calculated. Diagnosis of CAD were based on positive (>50% stenosis) coro-
nary CTA, catheterization, or ACS.
Result: There were 134 subjects who met the inclusion criteria, 52.3% were
male. The subjects were 33–91 years old (mean 58.8 ± 12.9) and 31% were
elderly (65 years old or more). Twelve out of 134 subjects (9%) with hyper-
tension had CAD (mean 39.58 ± 41.60 months). The BPV data included sys-
tolic SD (mean 15.36 ± 4.85 mmHg), diastolic SD (mean 8.39 ± 3.49), sys-
tolic AVR (mean 14.45 ± 5.08 mmHg), and diastolic AVR (mean 7.63 ± 3.75
mmHg). Bivariate analysis using Pearson’s test showed statistically significant
correlation between systolic SD (p < 0.01, r 0.74) & systolic AVR (p < 0.05,
r 0.69) and CAD.
Conclusion: This study found 9% of hypertensive subjects developed CAD in
about 40 months. The higher SD & AVR of systolic BPV are, the shorter time to
first CAD diagnosis or event in people with hypertension.
28 TOTAL CHOLESTEROL LEVEL WEAKLY CORRELATE WITH
BLOOD PRESSURE IN JATINANGOR
Mariya Ulfah1, Hadyana Sukandar2, Afiatin3, Yulia Sofiatin2, Rully M.A. Roesli3.
1Faculty of Medicine, 2Department of Public Health,3Department of Internal
Medicine, Faculty of Medicine, UniversitasPadjadjaran / Dr. Hasan Sadikin Gen-
eral Hospital, Bandung, Indonesia
Background: Hypertension is related to cardiovascular complication and cause a
high number of mortality. The prevalence of hypertension in Jatinangor is higher
than national prevalence which is 25.8%. One of the risk factors of hypertension
is hypercholesterolemia.
Objective: This study aimed to investigate correlation between total cholesterol
level and blood pressure in the residents of Jatinangor.
Method: Across-sectional analytical study was conducted. The study popula-
tion was residents of Jatinangor included in ‘Primary and Secondary Prevention
of Hypertension in Jatinangor’. This study was conducted in August-November
2016. Spearman’s rank test was used to correlate total cholesterol level with both
systolic and diastolic blood pressure.
Result: From the total of 107 subject, 75 were female (70.1%), 32 were male
(29.9%) with mean age 59.1 years old. Mean systolic blood pressure was
147,52 mmHg (SD = 29,711) and diastolic blood pressure was 86,63 mmHg
(SD = 15,076). Mean cholesterol level was 193,07 mg/dL (SD = 42,062). The
correlation was considered as significant in systolic blood pressure (r = 0.297;
p = 0.004), while the correlation with diastolic blood pressure was not significant
(r = 0.145; p = 0.136). There was significant correlation between total cholesterol
level and systolic blood pressure in the sex male and female were 0.19 and 0.381.
Conclusion: Statistically significant weak correlation is found between total
cholesterol level and systolic blood pressure and the correlation is more signifi-
cant in female.
Keywords: Diastolic Blood Pressure, Systolic Blood Pressure, Total cholesterol
level
29 PREVALENCE AND CHARACTERISTICS OF
HYPERTENSION PATIENTS AMONG THE EMPLOYEE OF
MAJALENGKA PUBLIC HOSPITAL IN 2016
Masganjar Nugraha, Poundra Adhisatya Pratama, Dody Muhamad Turmudzi.
Majalengka Public Hospital, Majalengka, Indonesia
Background: Hypertension is the main health problem because of its high preva-
lence and capability in increasing the risk of cardiovascular disease (CVD). In
Indonesia, there was 26.5% population that suffer from hypertension in 2013.
Little is known about the prevalence and risk factor of hypertension in special
group of health workers.
Objective: This study aimed to investigate prevalence and characteristics of hyper-
tension among the employee of Majalengka Public Hospital, West Java, Indonesia.
Method: A random sample of 250 employees was selected using simple random
sampling method. Data was collected using interviews and clinical examinations
included body height and weight measurement, and blood pressure measure-
ments which is performed with a digital spyghmomanometer. Socio-demograph-
ics, risk factors for hypertension, and treatment adherence were recorded.
Result: In this study 250 subjects participated, 25.2% were males and 74.8%
females. The prevalence of hypertension was 17.2%. Most subject aged 41–50,
present in 41.9%. Lack of exercise, unhealthy diet, and smoking were prevalent
risk factors of hypertension, present in 65.1%, 48.8%, and 27.9% of subjects, re-
spectively, while obesity was present in 14.0%. Irregular follow-up were found in
32.6% subjects, and 58.1% were not adherent to the treatment. Many hypertension
subjects were not achieving targeted blood pressure, present in 62.8%.
Conclusion: Hypertension prevalence was quite high. Body Mass Index (BMI)
and smoking were main variables that needs practical interventions. Correction of
obesity and cessation of smoking may have positive effects in reducing hyperten-
sion prevalence in health worker population.
30 THE RELATIONSHIP BETWEEN CARDIOVASCULAR EVENTS
AND ITS ONSET TIME TO MORNING BLOOD PRESSURE
SURGE IN ESSENTIAL HYPERTENSION
Melissa Lenardi1, Andreas Budi Wijaya2, Sylvia3, Furqan Hidayatullah4. 1Cipu-
tra Hospital Citra Garden City, Jakarta, Indonesia, 2Aisyiyah Islamic Hospital
Malang, Jawa Timur, Indonesia, 3Labuha Public Hospital, Halmahera Selatan,
Indonesia, 4Faculty of Medicine, Brawijaya University Malang, Jawa Timur,
Indonesia
Background: Hypertension becomes the strongest risk factor for cardiovascu-
lar events, such stroke and acute coronary syndrome (ACS), as seen in RSUD
Labuha. Blood pressure variability, especially Morning Blood Pressure Surge
(MBPS) phase, might influence the onset time of cardiovascular events. Hyper-
tensive mouse model shows Ccl19 overexpression, which responsible for exhibit-
ing similar MBPS as seen in human essential hypertension. We aimed to inves-
tigate the relationship between cardiovascular events in RSUD Labuha and its
onset time, which might related to MBPS. Human and mouse Ccl19 were also
compared bioinformatically to elucidate probable involved mechanisms in human
essential hypertension.
Method: Observational cross-sectional study was held on 131 reports at Emer-
gency Department of RSUD Labuha in 2016. Cardiovascular event was classified
into three group based on its onset time; Morning (04.00–10.00), Noon (10.00–
19.00), and Night (19.00–04.00). Data was analyzed using Chi-Square. Bioinfor-
matical analysis was performed using Pymol, BLAT-UCSC Genome Browser, and
EMBL-Pairwise Sequence Alignment.

Result: 92 of 131 patients experiencing cardiovascular event were analyzed based
on its onset time. Samples from this study were 46.6% male and 53.4% female.
31.3% patients were diagnosed with stroke, 38.9% with ACS and 69.5% with
other cardiovascular events. While 22.2% patients had diabetes, 96.2% had hy-
pertension, 47.3% had history of smoking, 9.2% experience kidney failure and
16.8% had dyslipidemia. Most events (54 (41.2%) subjects) were occurring in the
morning, followed by noon onset in 21 (16.0%) subjects and night in 17 (13.0%)
subjects. However, there were no significant differences between cardiovascular
events and its onset time (p = 0.294).
Conclusions: MBPS might increase risk for cardiovascular events occur in the
morning in RSUD Labuha, but statistically not significant. Exaggerated MBPS in
hypertensive mouse was related to high level of Ccl19, in association with Ccl19
gene polymorphism (SNP). Mouse Ccl19 (AA22–63) has 77.8% similarity, in
comparison with human Ccl19 (AA356–1127).
Keyword: MBPS, Ccl19, Cardiovascular Events, Hypertension.
31 INFLUENCE OF NIGHT SHIFT CLINICAL ROTATION
TOWARDS DIURNAL VARIATION OF BLOOD PRESSURE OF
THE CLINICAL CLERKS COMPARED WITH PRECLINICAL
STUDENTS
Michael Jonatan1, Ricardo Adrian Nugraha1, Tan Nicko Octora1,
Firas Farisi Alkaff2, Rina Yudiwati3, Irfiansyah Irwadi4, Fundy Sinar Ikrar Prihatanto5,
Nancy Margarita Rehatta5. 1Faculty of Medicine Universitas Airlangga -
Surabaya, 2Department of Psychiatry, Faculty of Medicine Universitas
Airlangga - Surabaya, 3Department of Biomedics, Faculty of Medicine Universitas
Airlangga - Surabaya, 4Department of Physiology, Faculty of Medicine Univer-
sitas Airlangga – Surabaya, 5Department of Anesthesiology, Faculty of Medicine
Universitas Airlangga - Surabaya
Corresponding email: michael.jonatan-13@fk.unair.ac.id
Background: As health workers, being in the best state of health are very im-
portant, especially for clinical clerks who work in emergency ward. There is little
rigorous evidence that clinical clerks often have disturbed sleeping duration and
circadian pattern of blood pressure (BP), with more frequent non-dipping, com-
pared to preclinical students. Night shift rotation was believed to play some parts
in these problems.
Objective: The aim of this study was to explore the influence of night shift ro-
tation in clinical clerks towards diurnal variation in daytime and nighttime BP,
compared to preclinical students who didn’t get night shift rotation.
Method: Prospective cohort study with purposive samples from medical students
in Universitas Airlangga was held in 2014–2016. Total of 124 medical students,
divided into 69 clinical clerks (C) and 55 preclinical students (PS) aged between
19 and 24 years, were included. Based on a multidisciplinary collaboration, the
participants were investigated between 2014–2015 (baseline) and 2015–2016
(follow-up). They were analyzed according to their total sleep duration. BP were
measured with Omron HEM-7200 Home Blood Pressure Monitoring (HBPM) at
baseline and minimum 5 times/week during follow-up.
Results: Average age for C group vs PS group was 23.08 vs 20.19 (p = 0.002,
95% CI). Other variables (gender ratio, race, body weight, BMI, baseline BP) were
made constant. Average sleeping duration for PS group was 52.13 hours in a week
and for C group (with  2 night shift rotation in a week) was only 46.66 hours
(p = 0.003, 95% CI). The result for daytime BP weren’t statistically different
(p = 0.320, 95% CI), however, we found significant difference in nighttime BP
(p = 0.001, 95% CI). There is an inverse correlation between sleeping duration and
nighttime BP in C groups (p = 0.001, r = −5.213, 95% CI).
Conclusion: There is a different pattern of blood pressure in clinical clerks, com-
pared to preclinical students. Night shift rotation with lack of sleeping duration,
are believed to have major part in increasing nighttime BP in clinical clerks.
Keywords: Night Shift Rotation, Circadian Rhythm, Clinical Clerks, Preclinical
Student, Diurnal Variation of Blood Pressure.
32 CORRELATION BETWEEN LEFT ATRIAL VOLUME INDEX
AND SPATIAL QRS-T ANGLE IN HYPERTENSIVE HEART
DISEASE PATIENTS
Michael Tanaka, Chaerul Achmad, Teddy Arnold Sihite, Augustine Purnomowati,
Toni Mustahsani Aprami. Department of Cardiology and Vascular Medicine, Fac-
ulty of Medicine Universitas Padjadjaran, dr. Hasan Sadikin Hospital, Bandung,
Indonesia
Background: Hypertension causes left ventricular remodeling that can manifest
as diastolic dysfunction. Left atrial size has been known as an accurate diastolic
Abstracts e5
function parameter that shows left ventricular filling pressure chronically. Remod-
eling also causes ventricular heterogenity and alters the depolarization and repo-
larization process as shown by the wide spatial QRS-T angle. Objective of this
study wasto assess correlation between left atrial volume index (LAVI) and spatial
QRS-T angle in hypertensive heart disease patients.
Methods: This cross-sectional study was conducted in dr. Hasan Sadikin hospital
Bandung from June to September 2016 with hypertensive heart disease patients as
the subject. LAVI was calculated by echocardiography using biplane area length
method and indexed to body surface area. Spatial QRS-T angle was measured
from standard surface ECG using Kors regression matrix method. Pearson’s corre-
lation was used to analyze the correlation between LAVI and spatial QRS-T angle.
Results: Thirty seven hypertensive heart disease patients were included in this
study (70.3% female, mean age 58 ± 9 years old). Mean LAVI was 26.96 ± 7.95 ml/
m2 and median spatial QRS-T angle was 28.52°(2.21–118.25°). There was a cor-
relation between LAVI and spatial QRS-T angle (r = 0.479; p = 0.001). Left
ventricular hypertrophy with typical strain showed in ECG had higher LAVI and
wider spatial QRS-T angle. This was the first study that analyzed the correlation
between LAVI and spatial QRS-T angle in hypertensive heart disease patients.
Conclusion: Left atrial volume index was significantly correlated with spatial
QRS-T angle in hypertensive heart disease patients.
Keywords: left atrial volume index, spatial QRS-T angle, hypertensive heart disease.
35 SMOKING IS NOT THE SOLE RISK FACTOR OF THE HIGH
PREVALENCE OF HYPERTENSION IN JATINANGOR
Naldo Nathanael1, Diah Dhianawaty D2, Lynna Lidyana3, Yulia Sofiatin4, Rully
M.A. Roesli3. 1Faculty of Medicine, 2Department of Biochemistry and Molecular
Biology, 3Departmentof Psychiatry, 4Department of Public Health, 5Department
of Internal Medicine, Faculty of Medicine, UniversitasPadjadjaran, Bandung
Background: Smoking is one of the risk factors for hypertension. Smoking habit
in Indonesia is among the worst all over the world. The prevalence of hypertension
in Jatinangor sub-district, Sumedang Regency is 37.8% and much higher than the
prevalence of hypertension both in Indonesia (25.8%) and West Java (29.4%).
This study was conducted to determine whether smoking, either active or pas-
sive smokers, was the significant risk factor for the presence of hypertension in
Jatinangor.
Method: This study is an analytic cross sectional design. Data was collected
through interview and physical examination on 3 villages in Jatinangor in 2014,
as a part of ‘Epidemiology if Hypertension and Albuminuria in Jatinangor’ study.
The variables were smoking status, blood pressure status, and other demographic
information. Chi-square analysis was use to analyse.
Result: A total of 898 subjects were collected. The prevalence of hypertension
among active smokers was 34.9%, and among passive smokers was 40.1%, and
among non-smokers was 25%. The analysis using chi-square showed no signifi-
cant association (p value 0.195) between smoking and hypertension, and that re-
sult did not change after stratification based on sex, age group, and area of living.
Conclusion: Smoking, either active or passive smoker, is not a significant risk
factor that contributes to the number of hypertension in Jatinangor.
Keywords: hypertension, Jatinangor, risk factor, smoking
37 THE IMPORTANCE OF GLYCEMIC CONTROL IN AFFECTING
OUTCOMES OF HOSPITALIZED HYPERTENSIVE PATIENTS
Irnizarifka, Donny S. Syamsul, Rarsari Soerarso, Nani Hersunarti, Bambang Budi
Siswanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine,
Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta
Indonesia
Introduction: Hypertension and diabetes are two of the leading risk factors for
atherosclerosis and its complications, especially heart. There is substantial overlap
between diabetes and hypertension in etiology and disease mechanisms. Obesity,
inflammation, oxidative stress, and insulin resistance are thought to be the com-
mon pathways. The presence of both hypertension and diabetes mellitus confers
a higher risk of cardiovascular–renal disease than the presence of either condition
alone. In addition, the presence of both hypertension and diabetes mellitus makes
the management of both diseases difficult and complicated.
Objective: To assess the extent of diabetic involvement towards adverse events
and LOS of hypertensive hospitalized patients.
Method: This cross-sectional study analyzes hypertensive samples which were
hospitalized at National Cardiovascular Center Harapan Kita Indonesia from 2015
until mid-2016. Samples were taken consecutively among non-new ACS patients