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Alvin Nursalim
Faculty of Medicine University of Indonesia
Health Professions Medicine & Pharmacology

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ARB dibandingkan non-ARB dalam Menurunkan Komplikasi Kardiovaskular pada Pasien Hipertensi dengan Risiko Tinggi: Laporan Berbasis Bukti Alvin Nursalim; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol. 33, No. 2 April - Juni 2012
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v33i2.59

Abstract

Background: High risk hypertensive patients have an increased risk of developing cardiovascular complication. It is better to use a proven cardio protective drugs to reduce blood pressure in high risk hypertensive patients. Angiotensin II receptor Blocker (ARB) is one type of antihyper-tensive drugs with cardioprotective effect for hypertensive patients withoutother risk factor. Whether cardioprotective effect of ARB also apply for a more specific population such as high risk hypertensive patients need to be investigated.Aim: To determine the efficacy of ARB compared to non-ARBs in preventing cardiac event in a more specific population, such as high risk hypertensive patients.Methods: A search was conducted on PubMed and Cochrane. The selection of title and abstract was done using inclusion and exclusion criterias. Three original articles were found and used as the evidence tor the clinical question. The selected studies were critically appraised for validity, importance and applicability.Result: According to Sawada et al, the blood pressure lowering effect was similar between valsartan and non-ARB groups. The cardiovascular events in valsartan group is lower compared to non-ARB groups (relative risk: 0.54, 95% confidence interval 0.4-0.7, p< 0.001). The administration of valsartan as compared to non-ARB, also reduce the occurence of angina pectoris (Relative risk: 0.52, 95% Confidence Interval 0.31–0.86, P=0.01058). Cohn JN et al showed that there was no significant differences in the candesartan group in terms of total death and primary endpoints. The only significant finding in this article was the lower rate of diabetes mellitus in the candesartan group.Conclusion: Valsartan, as compared to non-ARB, reduce cardic event in high risk hypertensive patients.
Dabigatran dibandingkan Warfarin untuk Pencegahan Stroke pada Pasien dengan Atrial Fibrilasi: Laporan Berbasis Bukti Alvin Nursalim; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol. 32, No. 4 Oktober - Desember 2011
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v32i4.86

Abstract

Background. Atrial fibrillation (AF) increases the risk of having stroke as high as five fold. Anticoagulant administration such as vitamin K antagonist has been used regularly to reduce the occurence of stroke. Despite the high efficacy, warfarin has several limitations, including a narrow therapeutic window, multiple food and drug interactions, and the need for frequent laboratory monitoring. Dabigatran, an oral thrombin inhibitor, displays some positive characteristics as the solution to warfarin’s limitations.Aim. To determine the efficacy of dabigatran compared to warfarin for stroke prevention in patients with atrial fibrillation.Methods. A search was conducted on PubMed and Google. The selection of title and abstract was done using inclusion and exclusion criteria. Five original articles were found, but only one study was used. The selected study was critically appraised for its validity, importance and applicability.Result. The administration of 150 mg of dabigatran was superior to warfarin with respect of stroke. The relative risk reduction was 36% in the 150 mg dabigatran group. The rate of stroke was 1.01% per year in the group that received 150 mg dabigatran, as compared with 1.57% per year in the warfarin group (relative risk 0.64; 95% confidence interval, 0.51 to 0.81, p<0.001). The administration of dabigatran increased the risk of gastrointestinal bleeding.Conclusion. In patients with atrial fibrillation, dabigatran given at a dose of 150 mg, as compared with warfarin, was associated with lower rate of stroke. Dabigatran administration requires closed gastrointestinal monitoring.
Co-Authors Yoga Yuniadi