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Evidence Based Case Reports

Systematic Review in Cohort Study

Made by:
Yohanes Mario, 0706259993

Supervised by:
Dr. Yoga Iwanoff Kasmir, SpPD
Consultant of Rheumatology

Department of Internal Medicine
Faculty of Medicine University of Indonesia
September 2011

Evidence Based Case Reports Systematic Review in Cohort Study COMPARISON OF THE INCIDENCE OF HEART FAILURE BETWEEN PATIENTS WITH UNCONTROLLED HYPERTENSION AND PATIENTS WITH CONTROLLED HYPERTENSION Made by: Yohanes Mario. Yoga Iwanoff Kasmir. 0706259993 Supervised by: Dr. SpPD Consultant of Rheumatology Department of Internal Medicine Faculty of Medicine University of Indonesia Jakarta September 2011 .

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 : .

i will take full responsibility and accept any penalty from Universitas Indonesia. who sign under. if we are proved for plagiating. truly state that this report was authored without any plagiarism according to the valid rule in Universitas Indonesia.ANTIPLAGIARISM STATEMENT I. Jakarta. In the later day. 3 September 2011 Yohanes Mario .

published before 2011. Result: from a journal by Anand Iyer. Compliance of patient to take medicine that control hypertension is prevention from complication. Aim: knowing the difference of hypertensive heart disease incidence between patients with uncontrolled hypertension and patients with controlled hypertension. Total Word Count: 1123 words Abstract: Background: Diagnosis of hypertension is made from systolic above 140 mmHg and diastolic above 90 mmHg. Uncontrolled hypertension is the trigger to make hypertensive heart disease spread among the patient with hypertension. The disease is determined by prolonged hypertensive condition. published at 2011 as inclusion criteria. class 2007 Summary Box Heart failure is a disease that affect the heart and make heart failure. Method: Pubmed and embase were conducted to search all the study about the role of uncontrolled hypertension in hypertensive heart disease. RCT study. Y* * Faculty of Medicine Student. Conclusion: uncontrolled hypertension have a bigger role than controlled hypertension to make heart failure . we found that incident HF developed in 23% and 26% of participants with controlled and uncontrolled hypertension respectively during 13 years of follow-up (matched hazard ratio {HR} when uncontrolled hypertension was compared with uncontrolled hypertension. There are only one article from pubmed that approriate to the clinical question. One of the hypertension complication is heart failure. University of indonesia. therapeutic study are excluded.Evidence Based Case Report COMPARISON OF THE INCIDENCE OF HEART FAILURE BETWEEN PATIENTS WITH UNCONTROLLED HYPERTENSION AND PATIENTS WITH CONTROLLED HYPERTENSION Mario. We use uncontrolled hypertension or prolonged hypertension. male. heart failure or congestive heart failure. animal study. Journals that don’t give the information that appropriate to the clinical question. BS et all about Uncontrolled Hypertension and Increased Risk for Incident Heart Failure in Older Adults with Hypertension: Findings from a PropensityMatched Prospective Population Study.

the function of this chamber deteriorates. The patient suffered from hypertension since 2001 and didn’t get medicine. The severity of the clinical manifestations are commonly described according to criteria developed by the New York Heart Association. He got some medicine and he felt better. fatigue. as may occur in abrupt discontinuation of antihypertensive medication in patients with hypertension. HF results in a constellation of clinical manifestations. We didn’’t find limbs paresthesia on anamnesis but we found visual disturbance. may result in cardiac decompensation. including.Clinical Scenario Male. In clinical examination we find that everything in normal limit except jugular vein pressure 5-1 H20 and edema pretibial.000 deaths annually. HF is a major public health problem in industrialized nations. circulatory congestion. in various combinations. and the symptoms and signs of heart failure appear2 . diabetes mellitus since 2009. febrile. Dyspnea come on effort. It appears to be the only common cardiovascular condition that is increasing in prevalence and incidence in North America and Europe. but we didn’t find diabetes mellitus. In the United States. HF is responsible for almost 1 million hospital admissions and 50. the cavity dilates. Rapid elevation of arterial pressure. He was sent to CiptoMangunkusumo Hospital to take approriate treatment. nausea and vomit. and weakness. Several hours before patient went to a general hospital in Jakarta. Ultimately. Since HF is more common in the elderly. On anamnesis we didn’t find hemoptoe. He said that he suffer from visual disturbance 1 year ago. dyspnea do not come in night. We found hypertension and asthma in his family root. 39 years old came to the Cipto Mangunkusumo hospital with chief complaint dyspnea since 10 hours before came to hospital. dyspnea minimized by rest. its prevalence is likely to continue to increase as the population ages1.Cardiac compensation for the excessive workload imposed by increased systemic pressure is at first sustained by concentric left ventricular hypertrophy. chest pain. cough with secretion. dyspnea. characterized by an increase in wall thickness. He diagnosed as chronic renal failure. 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.

“prolonged hypertension”. “heart failure”. The search result are shown in table 1.and exclusion criteria. After reading the abstract there was one article that suitable with the query. After that. Studies about elderly male population. female. 2011 A pubmed and embase search were conducted on 3rd September. RCT study. screening title were conducted. and published in the last 2 years were included. The second filtering based on in. . and published before 2010 were excluded. 2011. “ congestive heart failure”.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. Study about. We use following Medical Subject Heading: “ uncontrolled hypertension” . therapy. Selection criteria The first filtering based on free article and pay article.

The result was shown in table 3.Critical appraisal The only article was appraised by consensus by all authors using validity. . importance and applicability question.

in particular the control of SBP. which may be less reliable than 24-hour recording. These findings highlight the importance of hypertension control. 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. This is important as hypertension has the highest attributable risk for incident HF. in reducing the incidence of HF and other adverse outcomes in older adults with hypertension.Table 3 critical appraisal Discussion Uncontrolled hypertension was associated with increased risk of other cardiovascular morbidity and mortality. However. The limitation of this study are patients with uncontrolled hypertension defined using the average of three baseline BP recording. 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 . and can often be easily controlled3.

Because geriatric patient have another comorbid like diabetes mellitus. We recommend for another study to make RCT study that observe the role of aggresive lowering SBP to <140 mm Hg in reducing cardiovascular morbidity and mortality. . kidney insufficiency. However. Currently there is no randomized clinical trial based evidence suggesting that aggressive lowering of SBP to <140 mm Hg may provide additional benefit in terms of reducing cardiovascular morbidity and mortality4. we recommend to make prognostic study to measure the ratio of those confounder. such regression dilution is likely to underestimate the true association and not pose a threat to the validity of our findings5 Conclusion and Recommendation From this systematic review we can conclude that keeping the blood tension controlled are a prevention from heart failure. and another else which can be a confounder.controlled during follow-up. Those comorbid can be confounder for uncontrolled hypertension to make heart failure.

Clarke R. page 1367 2. [PubMed: 10675116] 5. 2005. Part 8. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. 2005.150:341–353. Gottdiener JS. 16th ed. Peto R. Harrison’s Principle of Internal Medicine. Youngman L. Page 10J . Port S. J Am Coll Cardiol 2000.35:1628–1637. Collins R. Kitzman DW. Systolic blood pressure and mortality. Philadelphia: McGrawHill. Gardin JM.Rutledge JE. Lewington S. Jennrich R. Harrison’s Principle of Internal Medicine. Tracy RP. Am J Epidemiol 1999. [PubMed: 10807470] 4.REFERENCE 1. Polak JF. Shipley M. Kasper et al. Philadelphia: McGrawHill. 16th ed. Kasper et al. [PubMed: 10453810] Iyer et al.355:175–180. Part 8. Underestimation of risk associations due to regression dilution in long-term follow-up of prospective studies. Marmot M. page 1467 3. Garfinkel A. Lancet 2000. Demer L. Aurigemma GP. Boineau RC. Arnold AM. Walter D.