Dr.

Ika Prasetya Wijaya SpPD-KKV, FINASIM, FACP, FICA

www.ipwijaya@gmail.com Samarinda: 5 Januari 1968

Pendidikan :
S1 : FKUI 1992
Spesialis 1 : FKUI 2003
Spesialis 2 : KIPD/FKUI 2011
Fellow INASIM : PAPDI 2010
Fellow ACP : ACP, AS 2015
FELLOW ICA : ICA, 2015
Pekerjaan:
KETUA Divisi Kardiologi, Departemen Ilmu Penyakit Dalam FKUI-RSUPNCM 2014
Editor Acta Medica Indonesiana/Indonesian Journal of Internal Medicine

Organisasi:
WAKIL KETUA UMUM PB PAPDI 2015-sekarang
Wakil Ketua PAPDI Cabang Jakarta 2010- sekarang
Ketua I PB IKKI 2009-sekarang

CRE/062/Aug10-Aug11/MF
Peneliti dan Pengembangan:
Tim Karotis FKUI RSCUPNCM
Anggota Tim Stem Cell FKUI RSUPNCM
Tim Transplan Ginjal RSCM
Role of Adrenoreceptor Blocker in
Cardioprotection

HOPECARDIS 2016
 The Autonomic Nervous System
Differences between Sympathetic & Parasympathetic

Location of Preganglionic Cell Bodies

Parasympathetic
Sympathetic

Craniosacral
Thoracolumbar
Brain: CN III, VII, IX, X
T1 – L2/L3 levels of
the spinal cord Spinal cord: S2 – S4
J Clin Hypertens. 2005;7:409–416
 SYMPATHETIC CONTROL IN BLOOD
PRESSURE

 Chronic elevation of BP /HT - is a major health problem

 In most cases : root cause of the disease remains unknown
 Mounting evidence : many forms of hypertension are initiated by

Elevated of Sympathetic Tone

Similar number of heart beats during
lifetime across species

HR : 6 beats/min HR : 240 beats/min

Life expectancy : Life expectancy :
177 years 5 years
Life Expectancy & Heart Rate in the Animal Kingdom

1000
Mouse
Hamster
Heart rate (bpm log scale)

500
Monkey
200 Rat Cat
Marmot
100 Dog Giraffe Human
Tiger Horse
50
Ass Lion
Elephant Whale
20

0 10 20 30 40 50 60 70 80 90
Life expectancy, yrs
Levine HJ. JACC 1997;30(4):1104-6.
 Heart Rate in the General Population
People with higher resting heart rates have lower survival probability

All causes of mortality – Men

Survival probability in men

1
0.95 HR <60
0.9 P=0.0001 60 ≤ HR ≤ 80
0.85
0.8 80 < HR ≤ 100
0.75
0.7 HR >100
0.65
0.6
0.5
0.4
0.3
0.2
0.1 n=19,836
0.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Follow-up (yrs)

Adapted from Benetos A. Hypertension.1999;33:44-52.

 Heart Rate in Hypertension

Increase HR will increase death due to CHD,CVD and all cause

Resting HR as a determinant of Ischemia in Stable Angina
Increased resting HR will increase likely hood of development of ischemia

Likelyhood of development of
ischemia %
20

16

12

0
<60 60-69 70-79 80-89 >89
Heart rate at rest, bpm (Holter)

Andrews TC et al. Circulation.1993;88:90-100.

Increased HR is directly harmful for the Heart

 Heart Rate
 Diastolic duration

 Cardiac work

 Perfusion of coronary arteries

 Oxygen supply  Oxygen needs

 Oxygen
supply/needs
ratio

Palatini P. Eur Heart J supplements 1999 (Suppl B):B3-B9

 Antihypertensive Drug Classes: Action Sites
Blood
Pressure = Cardiac
Output  Total Peripheral
Resistance
-Blockers -Blockers
ACE Inhibitors
Antihypertensive

(reduction of HR)
ARB
Drug Classes

Direct renin
inhibitors
1-Blockers
Non-DHP 2-Agonists
CCBs All CCBs
Diuretics Diuretics
Sympatholytics
Vasodilators

ACE = angiotensin-converting enzyme; AT1 = angiotensin type 1;

CCBs = calcium channel blockers; DHP = dihydropyridine
J Clin Hypertens. 2005;7:409–416
Role of beta blockade in interupted for cardiovacular
continuum
Sympathetic stimulation and effect in CV risk
1-year survival following MI by β blocker & diabetic status.

Eur Heart J. 1990;11:43–50

Adrenoreceptorblocker roles

Harmful effect
Distribution of Beta-Receptors
Beta - 1 Beta - 2
Myocardium (B-1 > B-2) Smooth Muscle
- blood vessels
Kidney (renin release) - bronchi
- genitourinary system
Skeletal Muscle
- metabolism
- glycogenolysis
- contraction
Fat Tissue
- lipolysis
- lipoprotein lipase
Liver
- glycogenolysis
- gluconeogenesis
Pancreas
- insulin release
Sympathetic nerve terminals
Eye
Selectivity comparison among BB
Conclusions

 Elevated sympathetic tones increase risk of cardiovascular

 Reduction of HR is needed for cardioprotection, especially in
hypertensive patients
 Adrenoreceptor blocker prevent harmful effect of sympathetic
elevation, and give cardioprotection
 Selective Beta 1 blocker could be a drug of choice since it
inhibit sympathetic activity with no influence in lipid and
glucose metabolism