Effect of Captopril Rapid Uptitration to Plasma Aldosterone level in Patients with Acute Myocardial Infarction

Background: Acute myocardial infarction is a myocardial necrosis associated with acute myocardial ischemia of which the incidence keeps increasing over time. Appropriate management of acute myocardial infarction is very important in order to determine the efficacy of the therapy and also to prevent further complications due to acute myocardial infarction. Captopril is essential in the management of acute myocardial infarction to inhibit the renin-angiotensin-aldosterone system whereby aldosterone may increase the probability of heart failure and increase mortality up to approximately 10 times compared to patients with acute myocardial infarction without heart failure. The administration of captopril should be uptitrated the doses in order to obtain optimal results, however there is no such fixed standard on how fast the doses of captopril should be uptitrated in order to obtain a more optimal effect, especially in order to suppress the plasma aldosterone level. This study examined the effect of rapid uptitration of captopril in the first 3 days of treatment of patients with acute myocardial infarction on plasma aldosterone levels compared to the increase in the captopril standard uptitration.Subjects and Method: This is an experimental research with Randomized Controlled Trial (RCT). 28 patients with Acute Myocardial Infarction on Cardiovascular Intensive Care Unit (ICVCU) and Cardiovascular wards of RSUD Dr. Moewardi hospital Surakarta were sequentially involved as research subjects and then randomly divided into a control group who received standard captopril uptitration and treatment group who received captopril rapid uptitration. The blood plasma was taken on the first day before the administration of captopril and on the last day of treatment. The plasma aldosterone level was tested by ELISA. Independent t-tests were carried out for data that qualified the normality test and mann whitney test if not qualified in the normality test with kolmogorov smirnov. It was considered statistically significant if the value of p < 0.05.Results: Plasma Aldosterone levels in treatment group was lower than control group and statistically significant (1133.54 ± 748.81 pg/dl vs 512.16 ± 444.81 pg/dl; p = 0.013 )Conclusion: Treatment with captopril rapid uptitration can decrease aldosterone plasma levels lower than captopril with standard uptitration in patient with acute myocardial infarction.Keywords: Acute myocardial infarction, plasma aldosterone, captopril, captopril rapid uptitation.Correspondence: Verry Gunawan Sohan. Master Program of Family Medicine, Sebelas Maret University, Surakarta.Indonesian Journal of Medicine (2016), 1(3): 160-168https://doi.org/10.26911/theijmed.2016.01.03.0