Oleh Admin Kalbe Medical pada January 04, 2012 07:36

Allopurinol Menurunkan Tekanan Darah pada Pasien Hipertensi

Pemberian allopurinol pada pasien-pasien yang baru terdiagnosis mengidap hipertensi dan belum mendapatkan terapi anti-hipertensi ternyata efektif menurunkan tekanan darah. Temuan ini terungkap lewat penelitian yang dilakukan oleh dr. Daniel I. Feig dan rekan dari Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, Amerika Serikat. Hasil penelitian ini juga telah dipublikasikan dalam Journal of American Medical Association.

Para ahli berpendapat bahwa hipertensi pada umumnya disertai dengan hiperurisemia, dan hiperurisemia memainkan peranan yang penting pada patofisiologi terjadinya hipertensi. Hiperurisemia merupakan salah satu prediktor terjadinya hipertensi dan umum terjadi pada pasien-pasien yang baru terdiagnosis mengidap hipertensi esensial (new-onset essential hypertension). Pada penelitian hewan coba, peningkatan asam urat yang terjadi akibat pemberian penghambat urikase menyebabkan peningkatan tekanan darah sistemik. Untuk itu, dilakukan penelitian untuk mengetahui apakah penurunan asam urat disertai dengan penurunan tekanan darah pada pasien dewasa dengan hiperurisemia dan hipertensi yang baru terdiagnosis.

Penelitian yang dilakukan adalah penelitian acak, tersamar ganda, dengan kontrol plasebo, silang, antara bulan September 2004 - Maret 2007, melibatkan 30 pasien remaja berusia 11-17 tahun, yang baru terdiagnosis mengidap hipertensi esensial tingkat I, belum mendapat terapi anti-hipertensi apa pun, serta memiliki kadar asam urat serum ≥6 mg/dL. Para subjek penelitian diterapi di Pediatric Hypertension Clinic at Texas Children’s Hospital di Houston, Texas, Amerika Serikat. Metode eksklusi berlaku bagi pasien yang menyandang hipertensi grade II atau dengan penyakit ginjal, kardiovaskular, gastrointestinal, hati, atau endokrin. Pasien dalam penelitian ini diterapi dengan allopurinol 200 mg dua kali sehari selama 4 minggu dan plasebo dua kali sehari selama 4 minggu berikutnya, dengan periode washout 2 minggu antar-terapi. Outcome primernya adalah perubahan tekanan darah saat diperiksa di klinik dan perubahan tekanan ambulatorik (pemeriksaan tekanan darah 24-jam).

Hasil penelitian memperlihatkan bahwa perubahan TDS (tekanan darah sistolik) dan TDD (tekanan darah diastolik) lebih besar dengan terapi allopurinol dibandingkan dengan terapi plasebo.

Tabel 1. Perbandingan efek terapi allopurinol dengan plasebo terhadap tekanan darah.

Allopurinol

Plasebo

Nilai p (*)

Perubahan rata-rata TDS hasil pemeriksaan di klinik (mm Hg), 95%CI

-6,9 (−4,5 - −9,3)

-2,0 (0,3 - −4,3)

=0,009

Perubahan rata-rata TDD hasil pemeriksaan di klinik (mm Hg), 95%CI

-5,1 (−2,5 - −7,8)

-2,4 (0,2 - −4,1)

=0,05

Perubahan rata-rata TDS ambulatorik 24 jam (mm Hg), 95%CI

-6,3 (−3,8 - −8,9)

0,8 (3,4 - −2,9)

=0,001

Perubahan rata-rata TDD ambulatorik 24 jam (mm Hg), 95%CI

−4,6 (−2,4 - −6,8)

−0,3 (2,3 - −2,1)

=0,004

(*)=allopurinol vs plasebo

Para ahli penelitian juga menyampaikan bahwa 20 dari 30 peserta penelitian mencapai tekanan darah normal dengan terapi allopurinol, baik untuk tekanan darah hasil pemeriksaan di klinik maupun tekanan darah ambulatorik. Sementara itu, hanya 1 pasien mencapai tekanan darah normal dengan terapi plasebo (p <0,001).

Simpulannya, pada pasien yang baru terdiagnosis mengidap hipertensi grade I, terapi dengan allopurinol menghasilkan penurunan tekanan darah. Hasil penelitian ini memperlihatkan pendekatan terapi potensial baru untuk hipertensi meskipun kemungkinan efek samping tetap menjadi salah satu pertimbangan utama. Penelitian dengan skala lebih besar dan durasi lebih lama perlu dilakukan untuk mengonfirmasi temuan ini. (YYA)

           

Reference:

1. Hyperuricemia in primary and renal hypertension. N Engl J Med. 1966;275(9):457-64.

2. Effect of Allopurinol on Blood Pressure of Adolescents With Newly Diagnosed Essential Hypertension A Randomized Trial. JAMA. 2008;300(8):924-32.

3. Allopurinol improves endothelial function in sleep apnoea: a randomised controlled study. Eur Respir J 2006;27:997–1002.

4. Serum uric acid in essential hypertension: An indicator of renal vascular involvement. Ann Intern Med. 1980;93(6):817-21.

Image: Illustration

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