Pengaruh Ketepatan Terapi dan Kepatuhan terhadap Hasil Terapi Hipertensi Di Poliklinik Penyakit dalam RSUP Dr. Sardjito Yogyakarta

Hipertensi merupakan salah satu penyebab kematian. Komplikasi pembuluh darah yang disebabkan hipertensi dapat menyebabkan kematian jantung koroner, infark jantung, stroke, dan gagal ginjal. Pemberian obat antihipertensi tunggal maupun kombinasi sangatlah penting bagi pasien tergantung pada tekanan darah dan ada tidaknya komplikasi. Penelitian ini bertujuan untuk melihat gambaran penggunaan obat antihipertensi di poliklinik penyakit dalam instalasi rawat jalan RSUP Dr. Sardjito Yogyakarta, ketepatan terapi dan hasil terapi serta pengaruh kepatuhan dalam menurunkan tekanan darah. Penelitian dilakukan dengan rancangan studi observasional dengan pengambilan data secara prospektif, kemudian dilakukan analisis terhadap data yang diperoleh untuk melihat ketepatan terapi dan kepatuhan pasien hipertensi. Penilaian keberhasilan terapi  The Seventh Report of Joint National Committee (JNC VII) on Detection, Evaluation, and Treatment of High Blood Pressure tahun 2003, sedangkan penilaian kepatuhan menggunakan kuisoner new 8-item self report Morisky Medication Adherence Scale (MMAS). Berdasarkan penelitian, obat antihipertensi yang digunakan adalah terapi tunggal dan kombinasi. Penggunaan terapi tunggal sebesar (20%) yang terbanyak adalah golongan CCB (8%) sedangkan penggunaan terapi kombinasi sebesar (80%) yang paling banyak adalah golongan ARB dengan CCB sebesar (55%). Dari 100 pasien rawat jalan yang termasuk kriteria inklusi ada (93%) mendapatkan tepat terapi antihipertensi, dan (7%) mendapatkan tidak tepat terapi antihipertensi, sedangkan (91%) mendapatkan tepat dosis antihipertensi, dan 9% mendapatkan tidak tepat dosis antihipertensi. Penilaian tekanan darah pasien yang mendapatkan (tepat obat dan dosis) dan tekanan darahnya mencapai target terapi masing-masing sebesar (68%) dan (68%). Pasien yang mendapatkan (tepat obat dan dosis) tetapi tekanan darah tidak tercapai masing-masing sebesar (25%) dan (23%). Sedangkan pasien yang mendapatkan (tidak tepat obat dan dosis) tetapi tekanan darahnya tercapai masing-masing sebesar (6%) dan (6%). Pasien yang mendapatkan (tidak tepat obat dan dosis) dan tekanan darah tidak mencapai target terapi masing-masing sebesar (1%) dan (3%). Berdasarkan kepatuhan pasien dalam mengkonsumsi obat antihipertensi (50%) dengan tingkat kepatuhan tinggi, (41%) tingkat kepatuhan sedang dan (9%) tingkat kepatuhan rendah. Dari uji analisis chi-square angka signifikansi 0,002 (p<0,05) didapatkan adanya perbedaan yang signifikan antara kepatuhan dengan hasil penurunan tekanan darah sehingga dapat disimpulkan bahwa kepatuhan yang tinggi dapat menurunkan tekanan darah. Kata Kunci : Hipertensi, Ketepatan Terapi, Kepatuhan Abstract Hypertension is considered as one of the leading causes of death. Complication in blood tissue that is caused by hypertension and that is becoming the leading cause of death might include several diseases such as coronary artery disease (CAD), hearth attack, and stroke and kidney failure. The therapy of antihypertensive drug either in monotherapy or in combination therapy plays a very essential role for patients in which the therapy in this case must be given in consideration of the blood pressure and possibility of complication. This research is aimed to observe a description of antihypertensive drug treatment in policlinic of internal disease of RSUP Dr, Sardjito Yogyakarta, accurate treatment and treatment result and effect of medication adherence in decreasing blood pressure. This research is performed using a design of observational study supported by data prospectively taken in order to observe the accurate treatment and medication adherence of the hypertensive patient. The assessment for the therapy achievement was performed using The Seventh Report of Joint National Committee (JNC VII) on Detection, Evaluation, and Treatment of High Blood Pressure in 2003, meanwhile, the assessment for medication adherence was done by using questionnaire of new 8-item self report Morisky Medication Adherence Scale (MMAS). Based on the research, it is found that the antihypertensive drug could be in monotherapy and in combination therapy. The use of monotherapy was at (20%) in which it was mostly dominated by CCB category at (8%), while the use of combination therapy was at (80%) mostly dominated by the category of ARB and CCB, namely at (55%). Of 100 out-patients including the inclusion criteria, it was (93%) of them that had the accurate treatment of antihypertension and (7%) of them that did not get the accurate treatment of antihypertension. Again, it was at (91%) that had the accurate dosage of antihypertension and (9%) had no the accurate dosage of antihypertension. In the assessment of blood pressure, the number of the patients obtaining (the accurate medicine and dosage) with the blood pressure that could achieve the target of therapy was at (68%) and (68%). On the other hand, the number of the patients obtaining (the accurate medicine and dosage) but with the blood pressure not achieving the target of therapy was at (25%) and (23%). Furthermore, those obtaining (inaccurate medication and dosage) with the achievement of the blood pressure to the target of the therapy was at (6%) and (6%). It was only (1%) and (3%) for the patients not obtaining (inaccurate medication and dosage), not achieving the target of the therapy. Based on the medication adherence of patients in taking antihypertensive drug was at (50%) with a high level of adherence, (41%) with medium level and (9%) with low level.  From the test of chi-square analysis and from the significant level of 0,002 (p<0,05) it is found a significant difference between adherence and the result of the decrease of blood pressure. Thus, it can be concluded that a high adherence can decrease the blood pressure.  Key words : Hypertension, Accurate Treatment, Adherenc