Tatalaksana Farmakologi Hipertensi pada Hiperaldosteronisme Primer
DOI:
https://doi.org/10.55175/cdk.v46i7.463Kata Kunci:
Hiperaldosteronisme Primer, Hipertensi, Patofisologi, tatalaksanaAbstrak
Hipertensi secara umum menurut etiologinya dibagi menjadi primer dan sekunder. Hiperaldosteronisme primer merupakan salah satu penyebab hipertensi sekunder yang memiliki terapi spesifik dan sangat mungkin disembuhkan. Hiperaldosteronisme primer memiliki efek multiorgan antara lain penurunan sensitivitas insulin pada otot dan jaringan lemak, gangguan fungsi sistolik dan hipertrofi otot jantung, inflamasi ginjal dan aterosklerosis. Diagnosis melalui tiga tahapan yaitu skrining, tes konfirmasi dan analisis subtipe. Tatalaksana meliputi non-farmakologi, medikamentosa dan pembedahan. Obat golongan antagonis mineralokortikoid seperti spirolonakton dan eplerenon merupakan pilihan utama untuk hiperaldosteronisme primer.
Based on its etiology, hypertension can be subdivided into primary and secondary. Primary hyperaldosteronism is secondary hypertension with specific treatment and may be curable. The disease is associated with renal, metabolic, brain and cardiovascular complications. Primary hyperaldosteronism affects multi organs such as reduced insulin sensitivity on muscle and adipose tissue, systolic dysfunction, myocardial hypertrophy, inflammation in the kidney and atherosclerosis. Diagnosis of primary hyperaldosteronism consists of three steps i.e. case-finding, a confirmatory test, and subtype evaluation. The management comprises non-pharmacology, medication, and surgery. Mineralocorticoid antagonists such as spironolactone and eplerenone are the drug of choice for primary hyperaldosteronism.
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Referensi
Stewart PM. Mineralocorticoid hypertension. Lancet. 1999; 353:1341-7
Rahajeng E, Tuminah S. Prevalensi hipertensi dan determinannya di Indonesia. Maj Kedokt Indon. 2009; 59(12):580-7
Onusko E. Diagnosing secondary hypertension. Am Fam Phys. 2003; 67:67-75.
Doi SAR, Abalkhail S, Al-Qudhaiby MM, Al-Humood K, Hafez MF, Al-Shoumer KAS. Optimal use and interpretation of the aldosterone renin ratio to detect aldosterone excess in hypertension. J Hum Hypertens. 2006; 20:482-489.
Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F and Stowasser M. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008; 93(9):3266-81
Takeda Y. Effects of eplerenone, a selective mineralocorticoid receptor antagonist, on clinical and experimental salt-sensitive hypertension. Hypertens Res. 2009; 32:321-4
Mattsson C, Young Jr WF. Primary aldoteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol. 2006; 2:198-208
Calhoun DA. Aldosteronism and hypertension. Clin J Am Soc Nephrol. 2006; 1:1039-45
Sowers JR, Connell AW, Epstein M. Narrative review: The emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension. Ann Intern Med. 2009; 150(11):776-83
Foo R, O’Shaughnessy KM, Brown MJ. Hyperaldosteronism: recent concepts, diagnosis, and management. Postgrad Med J. 2001; 77:639-44
Funder JW. The role of aldosterone and mineralocorticoid receptors in cardiovascular disease. Am J Cardiovasc Drugs. 2007;7(3):151-57
Stowasser M. New perspectives on the role of aldosterone excess in cardiovascular disease. Clin Experiment Pharmacol Physiol. 2001; 28:783-91
Giacchettii G, Turchi F, Boscaro M, Ronconi V. Management of primary aldosteronism: its complications and their outcomes after treatment. Curr Vasc Pharmacol. 2009; 7:244-9
Weiner ID, Wingo CS. Endocrine causes of hypertension-Aldosterone. Dalam: Floege J, Johnson RJ, Feehally J.(eds). Comprehensive Clinical Nephrology. Edisi 4. Elsevier Saunders. Missouri. 2010.
Kline, GA, Prebtani APH, Leung AA, Schiffrin EL. Primary aldosteronism: a common cause of resistant hypertension. Canad Med Assoc J. 2017; 189:E773-E778
Stowasser M. Update in primary aldosteronism. J Clin Endocrinol Metabolism. 2015; 100:1-10
Hsueh WA. New insights into the medical management of primary aldosteronism. Hypertension. 1986; 8:76-83
Luther JM. Aldosterone in vascular and metabolic dysfunction. Curr Opin Nephrol Hypertens. 2016; 25(1):16-21
Leenen FHH. Actions of circulating angiotensin II and aldosterone in the brain contributing to hypertension. Am J Hypertens. 2014; 27(8):1024-32
Li J, Zhang S, Ren M, Wen Y, Yan L, Cheng H. High-sodium intake aggravates myocardial injuries induced by aldosterone via oxidative stress in Sprague-Dawley rats. Acta Pharmacol Sinica. 2012; 33:393-400
Ravi S, Bermudez OI, Harivanzan V, Chui KHK, Vasudevan P, Must A, et al. Sodium intake, blood pressure, and dietary sources of sodium in an adult South Indian Population. Ann Global Health. 2016; 82(2):234-42
Pimenta E, Calhoun DA. Primary aldosteronism: diagnosis and treatment. The J Clin Hypertens. 2006; 8:887-93
Young Jr WF. Minireview: Primary aldosteronism - changing concepts in diagnosis and treatment. Endocrinol. 2003; 144(6):2208-13
Young WF. Primary aldosteronism: renaissance of syndrome. Clin Endocrinol. 2007; 66:607-18
Nishikawa T, Omura M, Satoh F, Shibata H, Takahashi K, Tamura N, et al. Guidelines for the diagnosis and treatment of primary aldosteronism – The Japan Endocrine Society 2009 -. Endocrine J. 2011; 58(9):711-21
Campbell DJ, Nussberger J, Stowasser M, Jan Danser AH, Morganti A, Frandsen E. Activity assays and immunoassays for plasma renin and prorenin: Information provided and precautions necessary for accurate measurement. Clin Chemistr. 2009; 55:867-77
Ling LF, Chai P. Eplerenone a review. Med Progr. 2007; 6:291-6
The RALES Investigators. Effectiveness of Spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (The Randomized Aldactone Evaluation Study [RALES]). Am J Cardiol. 1996; 78(8):902-7
Pitt B, Williams G, Remme W, Martinez F, Lopez-Sendon J, Zannad F, et al. The EPHESUS trial: eplerenone in patients with heart failure due to systolic dysfunction complicating acute myocardial infarction. Eplerenone Post-AMI Heart Failure Efficacy and Survival Study. Cardiovasc Drugs Ther. 2001; 15(1):79-87
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