English Summary
Therapy of Essential Hypertension
dr. M. Rachmat Soelaeman
Sub-division for renaj diseases hypertension, Department of jnternaj
medicine, Facujty of Medicine, Padjadjaran University, Hasan Sadikin
Hospita
l, Bandung.
All hypertension should be regarded as essential hypertension unless
proven otherwise. The first thing to do in the therapy of hypertension
is to recognize and to avoid or reduce all predisposing factor/risk
factors.
Drug therapy starts with diuretics; other drugs (vasodilator, beta-
blocker etc.) are added if the blood pressure can not be satis-
factorily controlled with diuretics alone. However, patients suffering
from malignant hypertension or accelerated hypertension should
be admitted to hospital and rigorous therapy should be started
immediately.
A scheme for the therapy of hypertension used in Hasan Sadikin
Hospital / Faculty of Medicine, Padjadjaran University is presented
by the author. (CDK No. 19, 1980 p.6.)
Essential Hypertension, Pathogenesis, Pathophysiology
the
Role of Beta-blockers
dr. Enday Sukandar
Sub-division for renaj diseases hypertension, Department of jnternaj
Medicine, Facujty of Medicine, Padjadjaran University, Hasan Sadikin
Hospital, Bandung.
Based on its pathophysiology, essential hypertension can be classified
into 3 stages : labile essential hypertension, fixed essential hyper -
tension, and malignant essential hypertension; the stages of the
disease being related to plasma renin activity. Renin is suspected
to have a vasculotoxic effect; thus, plasma renin determination
can be used as an indicator of future cardiovascular complications
(stroke myocard infarction).
Essential hypertension with low renin activity shows a good
response to diuretics; Essential hypertension with normal renin
activity responds to diuretics and antirenin; while essential hyper-
tension with high renin activity responds to antirenin, i.e. beta-
blockers.
The mechanism responsible for lowering blood pressure in the
therapy with beta-blockers is quite complex; several hypothesis
are hereby presented.
Beta - blockers are divided into 2 groups according to their
cardioselectivity and intrinsic sympathomimetic activity.
The "trio" combination, vasodilator, beta-blocker and diuretic,
is very effective against refractory malignant essential hypertension.
(CDK No.19, 1980 p.9.)
Screening test for the Diagnosis of Renovascular Hypertension
dr. Sukandar E , dr. Luhulima , dr. Sukotjo S
, dr. Taufik S.
Sub-division for renaj diseases hypertension, Department of
jnternaj Medicine; " Department of Nuc%ar Medicine;
Depart-
ment of Radio%gy, Facujty of Medicine, Padjadjaran University
,
Hasan Sadikin Hospital, Bandung.
Renovascular hypertension was suggested in 10 severe hyper-
tensive patients with an average age of 25,0 years. Reduced renal
perfusion was found in all 10 patients on renography and scinti-
graphy. Stenotic lesions involving the renal arteries were suspected
in 6 out of 10 patients on selective renal arteriography. Hypo-
kalaemia with serum potassium levels less than 3,5 meq/L was
found in 5 out of 6 patients with stenotic lesions. Renin assays
were not done. Renography and scintigraphy can be used as
screening tests for the diagnosis of renovasculaz hypertension.
(CDK No.19, 1980 p.16.)
High Blood Pressure as a Community Problem
dr. A. Guntur Hermawan
Facujty of Medicine, Sebejas Maret University, Surakarta
Nowadays as a result of the advancement of technology, mortality
due to infectious diseases is declining, while that due to cardio-
vascular diseases tends to increase.
Among those cardiovascular
diseases, one which needs pazticular attention is high blood pressure.
In this article the author reviews some aspects of high blood pressure
as a community problem (CDK No.19, 1980 p.22.)
Hypertensive Heart Disease
dr. Benjamin Widjajakusuma
Sub - division for cardiovascujar diseases,
Department of jnternaj
Medicine, Facujty of Medicine, Padjadpran University, Bandung.
This article discusses the pathophysiology of left ventricular hyper-
trophy and heart failure as complications of hypertension.
Heart failure does not necessarily follow hypertension, especially
chronic hypertension.
Hypertension itself accelerates atherogenic
processes in the coronary vessels and favours the development of
heart failure if uncontrolled. However, when heart failure is already
established, adequate therapy can be expected to improve ventricular
work.
Enlargement of the left atrium on ECG examination and S4
sounds on auscultation, point towazds an early abnormality in the
left ventricle, before ECG, radiologic clinical examinations reveal
plain left ventricular hypertrophy. (CDK No.19, 1980 p.24.)
The Role of Beta-blockers in Cardiovascular diseases
dr. Abidin A. Prawirakusumah
Sub-division for Cardiovascujar Diseases, Department of jnternaj
Medicine, Facujty of Medicine, Padjadjaran University , Hasan Sadikin
Hospital
, Bandung.
The author reviews the role of beta-blockers in cardiovascular diseases,
Beta-blockers are effective for the therapy of tachyarrhythmia cordis,
angina pectoris intennediate syndrome, acute myocardiac infarction,
hypertension, thyrotoxicosis thyroid heart disease, hyperdynamic
beta-adrenergic states, dissecting thoracic aortic aneurism, idiopathic
hypertrophic subaortic stenosis (IHSS) and pheochromocytoma.
However, side effects contraindications must be kept in mind
in using beta-blockers.
(CDK No.19, 1980 p.27.)
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Cermin Dunia Kedokteran No. 19, 1980
Iron Deficiency Anemia in Pregnancy
dr. Muh. Dikman Angsar
Department of Obstetrics
Gynecojogy, Faculty of Medicine,
Airlangga University, Surabaya.
Iron deficiency anemia is a disorder most frequently encountered
in pregnancy. The signs of this type of anemia are often obscured
by the resemblance to the physiological ( normal ) changes in
pregnancy.
To enable the physicians to recognize an early sign of iron
deficiency anemia, the author reviews the physiological changes of
the hematologic system during pregnancy, the iron requirements
in health disease, the effects of anemia on the mother child
and the symptoms and therapy. (CDK No.19, 1980 p.33.)
Disseminated Intravascular Coagulation
dr. E. Anggraeni
Widyaputri
Department of lnternaj Medicine, Facu
lty of Medicine, Padjadjaran
University, Hasan Sadikin Hospita
l, Bandung.
Disseminated intravascular coagulation (DIC) is a pathological syn-
drome resulting from the formation of thrombin, subsequent acti-
vation and consumption of certain coagulant proteins, and production
of fibrin thrombi.
There are two distinct modes of presentation of DIC :
-- acute DIC : which develops rapidly; the patfent often presents
a multiside bleeding diatheses which can range from oozing to
catastrophic life-threatening haemorrhage
-- chronic DIC : which waxes and wanes over periods of months
and thrombotic complications predominate
Conditions initiating patients to DIC are :
-- the release of coagulant materials to the circulation
-- diffuse endothelial injury
-- diffuse platelet aggregation
Abnormalities in all three screening tests (prothrombin time,
fibrinogen concentration and platelet count) establish the diagnosis
of DIC in the absence of haemo-dilution or severe hepatic dys-
function.
When only two screening tests are abnormal at any given time,
confirmatory tests (to measure the FDP) may be required to
diagnose DIC
The spectrum of pathological findings in DIC include fibrin
thrombi, frequently found in the kidney.
There is universal agreement that identification and treatment
of all precipitating factors are the keystones of management of DIC.
The use of coagulation factors and heparin remains controversial,
so do the other variety of therapies.
Further advances in the management of DIC depend on the
results of prospective, randomized controlled trials of alternate thera-
peutic regimens, which may be conducted in the future.
(CDK No.19, 1980 p.36.)
Slow and rapid acetylator of isoniazide (INH) in Jakarta
community
B. Soehazto, Andi Sutianto, Darmadi Yanti Mariana, Bella N. Toha
A study to determine the frequency of rapid and slow acetylator
of isoniazide (INH) was performed on 158 subjects among 12
ethnic groups in Jakarta community. The rate of acetylation of
INH was determined by spectrophotometric method according to
Eidus et al.
Fifty percent of the subjects were found as rapid acetylator;
47,47 % as slow acetylator and 2,53 % were intermediate acetylator.
(CDK No.19, 1980 p.39.)
Bioavailability and Therapeutic Equivalence
dr. B. Setiawan PhD.
Department of Pharmaco%gy, University of jndonesia, Jakarta
There are 4 factors, each of which has an effect on therapeutic
equivalence, i.e. the drug, the patient s body, the causes of the
disease and the environment. The ideal parameter to measure thera-
peutic equivalence is of course the therapeutic effect itself. However
this is difficult to measure. Furthermore, what is actually needed
is a method which is practical, cheap, easy to perform , sensitive,
reliable, and able to predict therapeutic equivalence.
Of the 3 methods available, i.e. (i) measurement of disintegration
dissolution time, (ii) ) measurement of bioavailability, and (iii)
measurement or drug concentration in plasma or serum, bioavai-
lability turned out to be the best to predict therapeutic equivalence
(CDK No.19, 1980 p.41.)
Traumatic hyphaema
dr. Admadi Soeroso
Department of Opthalmo%gy, Sebelas Maret University, Mangku-
bumen General Hospital, Surakarta.
Traumatic hyphaema is an ocular emergency which needs special
attention to avoid resulting blindness. There are several methods
of management for traumatic hyphaema, but these are still a matter
of controversy.
This article reviews the controversy. The author himself suggests
that the management of traumatic hyphaema should start with
conservative treatments (total bed rest, eye patching.
use of
drugs). Surgery of the eye is only performed when conservative
treatments fail (CDK No.19, 1980 p.44.)
Cermin Dunia Kedokteran No. 19, 1980
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