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Riwayat Pendidikan
• 1991 – 1997 S1 Kedokteran Umum FK UNDIP
• 2002 – 2006 S2 Spesialisasi Jantung & Pembuluh darah FK UI
• 2008 – 2009 Intervention Cardiology & Electrophisiology Fellow,PJNHK.
• 2010 Asan Medical Center,Seoul, North Korea
• 2011 CRTD-Device Course IJN, Kualalumpur.
Riwayat Pekerjaan
• Juni 2007 – 2008 Cardiologist @ Klinik Kardiovaskular Hospital Cinere
• Agustus 2009 – Interventional and Electrophysiologist Cardiologist @ Klinik Kardiovaskular Hospital Cinere
• 2010 – Interventional Cardiologist and Electrophysiologist @ RS Mitra Keluarga BekasiTimur
PERKI Bekasi-Karawang’2018 Workshop
• EKG: LVH
• Foto Toraks : CTR 53%
• Lab: Ureum 29, Creatinin 0.79, eGFR 89, SGOT/SGPT .
20/23, GD sewaktu 110 mg%, LDL-C. 132 mg%, ACR. 132.6
mg/g, Urin lengkap: albumin (-)
Burden of Hypertension
77.9 million (1 in 3) US adults 20 years of
age and older have hypertension.
69% of people who have a first heart
attack, 77% of those who have a first
stroke, and 74% of those who have heart
failure have a BP >140/90 mmHg.
Hypertension is associated with shorter
overall life expectancy.
10%
11%
Heart disease
16% Hypertension
63%
Stroke
Other CVD
-5
-10
-13
-17
-20
-27
-30 -28
Adherence on treatment
3
0
N= 9141 4288 2282 1032
SBP 145 133 125 116
DBP 82 76 72 68
Thiazide-type
diuretic
ACE-I
or ARB CCB
-2
-5
-5
-7 -7 -7
-10 -9 -9 -9
Absolute -12
Risk Reduction -15
(%) -15
-17
-20
-25
-26
-30
Stroke CHD Heart Failure
Side
effect
Not
understand Costly
instruction medication
Rx not Transportation
covered issues
Lack of
communi-
cation
1,00 0.87
1,0 (0.73-1.03)
0,8
0.50
0,6 (0.35-0.69)
0,4
0,2
0,0
Low (<40%) Medium (40-70%) High (≥80%)
Adherence within 6 months after diagnosis
Estimated by Cox proportional models
Modified formulation
2nd generation
eg, nifedipine GITS
1 Ca2+
Extra-Cellular Space
1 Highly selectivity on
vascular
Irbesartan
Valsartan
Lisinopril
Captopril
Felodipine
Nifedipine GITS
Amlodipine
Lercanidipine
0 20 40 60 80 100
T/P Ratio (%)
1. Hernandez RH et al. Blood Press Monit. 2001;6(1):47-57. 4. Zannad F et al. Am J Hypertens. 1996;9(7):633-643.
2. McClellan KJ et al. Drugs. 2000;60(5):1123-1140. 5. Gradman AH, et al. Circulation. 2005;111:1012-1018.
3. Diamant M et al. J Hum Hypertens. 1999;13(6):405-412. 6. Hermida RC et al. Hypertens. 2003;42(3):283-290.
Lercanidipine: Controlling BP over 24 hours
160
SYSTOLIC
140
BP (mmHg)
120
100
DIASTOLIC
80
60 Baseline
49
50 Lercanidipine 10 mg/day
40
30
21 19
20
12 11
10 6,6
3.0 0,6 0,3 1,2 1,2
0
Overall Headache Palpitations Asthenia Ankle edema Flushing
35 32,8 Amlodipine
30 28,9 Felodipine
Isradipine
25
22.0 Lacidipine
20 Nifedipine
17,6
15,1
16,2 Nitrendipine
15 13,8 14,2
Lercanidipine
9,3
10 8,6 8,2
5,7
5 3,9
2,2
0
Drop outs due to AEs Edema
-0,15
-0,3 75
-0,3
% of Patients
-0,6
50
-0,9
25
9
-1,2 -1,1
1
-1,25 0
Lercanidipine Lercanidipine
-1,5
Day 0 Day 14 10 mg/day 20 mg/day
160
5,9 * *
*
150 * *
*
mg/dl
5,6
%
* *
140
5,3
130
5
120 Lercanidipine Lercanidipine
Lercanidipine Lercanidipine 10 mg/day 20 mg/day
10 mg/day 20 mg/day
N = 38 patients
*p < 0.001 vs. baseline.
-3
-5
-6
mg/day
mmHg
-9 -10
-12
-11,9 -15
-12,7
-15
-14,8
-17,4
-16,2 -20
-18
-19,7
SBP DBP
follow-up range was 9–12 months
• EKG: LVH
• Foto Toraks : CTR 53%
• Lab: Ureum 29, Creatinin 0.79, eGFR 89, SGOT/SGPT . 20/23,
GD sewaktu 110 mg%, LDL-C. 132 mg%, ACR. 132.6 mg/g,
Urin lengkap.albumin (-)
Apa yang akan diberikan?
77,9 75,8
80 76
69
70
60 57
54,4
49,1 48,3
50
40
30
20
10
0
Awareness Treatment Control
Total population White Black Hispanic