Hypertension : Dominant Risk Factor on Stroke Occurence Analytical Observational Study in Sultan Agung Islamic Hospital Semarang during January 1 , 2012-August 31 , 2013

Introduction: Stroke ranks as the first cause of disabilities and the third cause of death in the world. Many factors associated with stroke. Objective: this study aimed at evaluating the factors associated with stroke. Study Design: This study was an analytical observational study using cross sectional design. Samples were obtained from medical records of 263 patients who were admitted in neurology’s ward of Sultan agung Islamic hospital during 1 January 2012-31 August 2013. Samples categorized in 2 groups: 97 hemorrhagic’s stroke patients and 166 non hemorrhagic’s stroke patients with simple random sampling technique. This study were conducted by analyzing 5 variables such as gender, age, hypertension, diabetes mellitus and total cholesterol levels. Results: Logistic regression test using SPSS showed that hypertension was the most dominant factor associated with stroke (p=0.001; PR=1.707; CI=1.249–2.433). Conclusion: Hypertension was the most dominant risk factor for stroke.


INTRODUCTION
According to PERDOSSI (2011) stroke is clinical symptoms on brain functions which happen focally or globally.Stroke can cause death within 24 hours or more without any clear evidence other than the vascular causes.Stroke is the first cause of disabilities and the third cause of death in the world (Dewanto et al, 2009)

METHOD
This research was observational analytic study with cross sectional design.Variables for this research consist of independent variables such as gender, age, hypertension, diabetes mellitus, and total cholesterol level, while the dependent variable is stroke.
Population of the study are all inpatients stroke of neurology's ward of Sultan Agung Islamic Hospital during 1 January 2012-31 August 2013 recorded in their medical records.Samples of the study are 263 stroke patients consisted of 97 haemorragic stroke's patients and 166 non haemorragic stroke's patients.Inclusion criteria of the study were: patient with complete medical records including identity (name, gender, age), health status (blood pressure, total cholesterol laboratory result).Exclusion criteria of the study were patients with medical history such as tumor, trauma, and central nervous system infection.
Statistical analysis used for this study is Chi Square and followed by logistic regression to determine which independent variable is the most dominant risk factors of the dependent variable.

RESULT
This study was conducted in Sultan Agung Islamic Hospital from 27 September 2013 to 3 January The chi square resulted that blood pressure has effect on stroke with significance level of p<0,01.Furthermore, variables included into multivariate analysis were age, blood pressure, diabetes mellitus and total cholesterol level because the significance levels were p<0,25.Those four variables can be analyzed by logistic regression.Hypertension, diabetes mellitus, and total cholesterol level and all of the combinations can be distributed and presented on table 2.
Based on variable distribution from table 2, it is clear that hypertension is solely the main cause of stroke, followed by hypertension combined with high level of total cholesterol.Based on Regression Logistic analysis table, the logistic regression analysis was using backward conditional and resulted that hypertension is the most dominant factor affecting the stroke with p value of p=0,001 with RP=1,707 berarti RP > 1 and because the interval confidence not include score 1, we can conclude that hypertension is a risk factor for stroke.On the other side, both age and diabetes mellitus variables were scored as decreasing factors of stroke and becoming protective factors because the RP<1 and the convidence interval not include score 1.

DISCUSSION
This research showed that hypertension is the most dominant factor affecting stroke.Meanwhile age, gender, and high level of total cholesterol are not affecting stroke.Based on the data collected from medical records, hypertension type II were found in most patients, which cause non haemorragic stroke up to 54,7%.Hypertension can trigger the development of aterosclerotic plaque in large blood vessel which can cause constriction of blood vessels' diameter.Unstable plague is easily ruptured and parted.A parted plague increase the risk of clogging in the blood vessel of the brain (Pinzon and Asanti, 2010).
Data analysis of risk factor, gender on stroke showed that gender is not a risk factor for stroke.It is the evidence that between male and female who has stroke has the same risk.Other study also explained the similar condition.(Misbach, 2011;Pinzon dan Asanti, 2010).Pre menopause women has lower risk of stroke than man.Furthermore, after menopause risk factor for women are similar to men (Martono dan Kusumawardani, 2009).It is clear than men are more prone to aterosclerosis than women.Aterosclerosis are rare to be found in pre menopausal women unless they have DM, hyperlipidymia and hypertension.After menopause, ateroclerosis on women will increase because the decreasing of esterogen (Kumar dkk, 2007).
In this study there was no effect on age for stroke, stroke occured during the age of 40-65 years old (76,4%).Other research stated that for 51-65 years old are more prone to stroke (Nastiti, 2012).Stroke can occur in any ages, but for older ages the risks of impairments and deaths are higher (Wahyu, 2009).This study describes that age alone is not the risk factor, but when it co-occurs with hypertension and other risk factors, stroke is likely  (Corwin, 2009).Data analysis resulted that there is no effect of diabetes for stroke.Same result also reported by Nastiti (2012).From 152 stroke patients,113 of the patients (74,0%) have no history of DM.Thus, because DM as risk factor for stroke can occur if there are other factors affecting such as ethnicity and hypertension.
This research also showed that total level of high cholesterol has no effect on stroke.Low level of cholesterol weaken intracerebral arterial endothelium and can cause bleeding if patients experience hypertension (Misbach, 2011).Other study reported that total cholesterol has no effect on repeated stroke (Siswanto, 2004).Based on this study, it is known that patients who have hypertension and high level of total cholesterol is higher than high level of total cholesterol alone.Hyperlipidemic and other factors such as hyper tension can cause endotel lesions.Endothelium lesions trigger chronic inflammation in arterial walls and cause aterosclerosis.Total serum of cholesterol component that cause increasing of the risk is LDL cholesterol (Kumar et al, 2007).

CONCLUSION
Result of the study conclude that hypertension is the most dominant factor of stroke in Sultan Agung Islamic Hospital during 1 January 2012-31 August 2013.

Dominant Risk Factor on Stroke Occurence
Hypertension:

Table .
Descriptive and Chi Square test for independent variables towards stroke 2014 by collecting data from the period of 1 January 2012 to 31 Agustus 2013.The result of descriptive analysis and chi square test are presented on table 1. http://jurnal.unissula.ac.id/index.php/sainsmedika

Table .
Distribution of hypertension, Diabetes Mellitus, and High Cholesterol Level on Haemorragic Stroke and Non Haemorragic Stroke