Abstract

Persistensi penggunaan obat antihipertensi pada pasien hipertensi sangat diperlukan mengingat hasil utama terapi hipertensi adalah mencegah kejadian penyakit kardiovaskular seperti infark miokard, dan stroke yang berujung pada kematian. Penelitian ini bertujuan mengetahui pengaruh jenis terapi dan jenis obat antihipertensi terhadap persistensi. Penelitian ini menggunakan desain studi kohort retrospektif dan menggunakan sumber data sekunder pasien hipertensi rawat jalan peserta asuransi kesehatan PT Askes di RSUD Panembahan Senopati Bantul. Metode pengukuran persistensi adalah metode the gaps between refill dengan tenggang waktu pengambilan obat selama 30 hari. Data dianalisis menggunakan uji kai kuadrat, Kaplan-Meier, dan Cox regression. Jumlah subjek yang ikut dalam penelitian ini adalah 304 pasien hipertensi yang menggunakan obat antihipertensi pertama kali (tanggal indeks diagnosis 1 Juli 2007 hingga 31 Desember 2008). Setelah pengamatan 4,5 tahun, hampir separuh subjek yang mendapat monoterapi (57,6%) dan kombinasi terapi (53,8%) tidak persisten menggunakan obat antihipertensi. Ketidakpersistenan penggunaan obat antihipertensi lebih besar pada kelompok monoterapi daripada kelompok kombinasi, tetapi perbedaan tersebut tidak signifikan (RR = 0,94; 95% CI = 0,73 - 1,21). Penggunakan diuretik (85,7%) dan kombinasi obat diuretik + ACE inhibitor (84,6%) cenderung tidak persisten dibandingkan subjek yang menggunakan ACE inhibitor (58,4%). Perbedaan ini bermakna secara statistik (RR = 1,47; 95% CI = 1,05 - 2,01 dan RR = 1,45; 95% CI = 1,10 - 1,91). Persistensi dipengaruhi oleh jenis obat antihipertensi yang digunakan, yaitu ACE inhibitor. Persistence of the use of antihypertensive drugs in hypertensive patients greatly needed. Considering the primary outcome of treatment for hypertension is to reduce or prevent the occurrence of cardiovascular events such as myocardial infarction, stroke resulting in the risk of death. This study aims to determine whether persistence is influenced by the type of treatment or type of antihypertensive drugs. This study was designed with retrospective cohort study using database of prescribing claimed of subjects under health insurance (PT Askes) in Panembahan Senopati hospitals using antihypertensive drugs. Persistency measurement method used is the method of the gaps between refilling. The grace period taking the drug for 30 days. Further data were analyzed using the chi square test, Kaplan-Meier, and Cox regression. This cohort study involving 304 patients using antihypertensive medications first (index diagnosis 1 July 2007 until 31 December 2008). After observation for 4,5 years found almost half of the subjects receive monotherapy (57,6%) or combination therapy (53,8%) are not persistent in the use of antihypertensive medications. Not persistent greater in the monotherapy compare to combination therapy group. However, this difference did not reach significance (RR = 0,94; CI 95% = 0,73 - 1,21). Subject were using a diuretic (85,7%) and ACE inhibitor + diuretic combination (84,6%) tends not to be persistent compare to subject using ACE inhibitors (58,4%). This difference was statistically significant (RR = 1,47; CI 95% = 1,05 - 2,01 and RR = 1,45; CI 95% = 1,10 - 1,91). Overall, persistence is influenced by the type antihypertensive drugs used, the ACE inhibitors.

References

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