Heart failure has been known as an increasing health burden worldwide and the prevalence is expected to rise more than 23 million in 2030. Chronic heart failure has characteristic of ventricular dysfunction which will cause dyspnea, fatique, and finally some limitation in functional capacity and reduced quality of life. Recent advances in treatment of chronic heart failure may give us option of wide variety of modalities from pharmacologic and nonpharmacologic therapy with invasive and noninvasive approaches. Each has its own benefit and risk. Structural heart disease of heart failure indicates non reversible damage. Thus, treatment will aim to prevent symptoms and improve quality of life. Enhanced external counterpulsation (EECP) was a non-invasive treatment originally to reduce symptom of refractory angina.2-4 In the newest European Society of Cardiology (ESC) guideline for management of stable coronary artery disease 2013, EECP had been approved as class IIa-recommended treatment for refractory angina.

Aim: to investigate the efficacy of enhanced external counterpulsation (EECP) therapy to improve functional capacity in patients with chronic heart failure (CHF). Methods: a double-blind random clinical trial was performed in 99 patients with CHF who had received EECP therapy at Jade Cardiovascular Clinic, Manado, North Sulawesi, Indonesia between January 2014 and June 2015. Subjects were categorized into 2 groups, i.e. 49 subjects had sham EECP therapy and 50 subjects had EECP therapy. All subjects performed six-minute walking test (6MWT) before and after receiving EECP therapy. Results: there was no significant difference between both groups regarding the basic characteristics of patients with CHF. The 6MWT result before EECP therapy showed that there were 30 patients (61.2%) with walk distance of <300 meter in the sham EECP group; while in the group receiving EECP therapy, we found 34 patients (68%); p=0.24. Post-EECP therapy, there were 33 patients (67.3%) with walk distance of <300 meters in EECP sham group; while in the group receiving EECP alone, there was only 1 patient (2%); p <0.01.The 6MWT walk distance in sham group before EECP therapy was 252.65 (SD 97.55) meters and it was 243.65 (SD 86.96) meters following the EECP therapy; p=0.18. In EECP group, the 6MWT walk distance before therapy was 256.88 (SD 85.56) meters and after EECP therapy the walk distance was 449.46 (SD 92.08) meters; p<0.01. Conclusion: EECP therapy is effective to improve functional capacity in patients with CHF.Key words: chronic heart failure, six-minute walk test, enhanced external counterpulsation (EECP) therapy.

Aim: to analyze the occurrence of chronic obstructive pulmonary disease (COPD) and its association with the polymorphisms of -308G/A, -238G/A of TNFα gene and +252A/G LTα gene polymorphism in smokers. Methods: cross-sectional study, comparing the genetic group of people who have COPD and who do not have COPD with the same smoking history. The study was conducted from January 2011 to March 2012 at several health centers; such as Adam Malik Hospital, Pirngadi Hospital, Tembakau Deli Hospital, Siti Hajar Hospital in Medan and several health centers in the city of Medan. Examination of lung function was done using spirometry and the existence of genetic polymorhisms in the TNFα and LTα gene was performed using polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). Results: of the total of 227 samples that met inclusion criteria and after equalizing the age and history of smoking, 186 subjects were enrolled, of which, 93people as COPD group and 93 people as non-COPD group. Analysis of the association between the -308G/A polymorphism with the COPD revealed the odds ratio (OR) 0.436 (95% CI 0.224-0.850, p=0.014). Polymorphism at -238G/A of the TNFα gene showed the OR 2.094 (95% CI 0.608 - 7.211, p=0.241). Polymorphism at +252A/G LTα gene showed OR 1.256 (95% CI 0.694 - 2.272; p=0.450). The findings indicated that polymorphism at -308G showed a protective factor whereas the -238G/A of the TNFα and +252A/G of the LTα genes did not show any significant association with the COPD. Conclusion: polymorphism -308 TNFα gene shown to be a protective factor for the occurrence of COPD. Polymorphism -238 TNFα gene and +252 LTα gene did not show any significant association with COPD.Key words: chronic obstructive pulmonary disease, TNFα gene, LTα gene, polymorphism.

Aim: to determine the incidence of in-hospital arrhythmias in patients with acute coronary syndrome (ACS) andto determine the influence of hyperglycemia at admission (HA) on in-hospital arrhythmias complicating ACS. Methods: a retrospective cohort study was conducted using secondary data from medical records of patients with ACS who were admitted to ICCU RSCM, between January 1st-December 31st, 2014. Hyperglycemia at admission was defined when the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias encompassed atrial arrhythmia, supraventricular tacchycardia (SVT), high grade AV block (HAVB), and ventricular arrhythmia, during the first seven days of hospitalization. Results: there were 232 subjects in this study. The prevalence of HA was 50.43%. The incidence of in-hospital arrhythmia was 21.55% (95% CI 16.26-26.84). In bivariate analysis, there was significant association between HA and in-hospital arrhythmia (RR 1.75; 95% CI 1.04-2.93). Therewere no association between type of ACS, diabetes mellitus (DM), obesity, and hypertension, with the in-hospital arrhythmias. In multivariate analysis, the adjusted OR of HA was 2.85 (95% CI 1.35-6.02), and DM was the confounding variable. Conclusion: the incidence of in-hospital arrhythmias in patients with ACS was 21.55% (95% CI 16.26-26.84). Hyperglycemia at admission may increase the risk of in-hospital arrhythmia in patients with ACS.Key words: hyperglycemia at admission; in-hospital arrhythmia; acute coronary syndrome

Aim: to identify the seroprevalence and its association with socio-demographic factors of Helicobacter pylori infection. Methods: a cross-sectional study was performed in 111 patients with dyspepsia (according to ROME III) who got treatment at Kalibaru Primary Health Care, North Jakarta from January to February 2015. Patients aged over 18 years and no history of gastrectomy were interviewed and 3 cc venous blood was drawn. Bioramps Laboratories’s Immunochromatography Diagnostic Test (Bio M Pylori®) was used to diagnose patient with Helicobacter pylori infection. Chi Square were used to analyzed socio-demographic and T test were used to analyze age. Variables with p<0.25 were analyzed by logistic regression. Results: seroprevalence of Helicobacter pylori of 111 dyspepsia patients who got treatment in Kalibaru Primary Health Care in this study was 22.5% (95% CI 14.8% - 30.2%). There is no relation between age and Helicobacter pylori infection (p=0.270). Higher socio-economic class was related to lower risk Helicobacter pylori infection (OR 0.2; 95% CI 0.02 – 1.71). Higher crowding index was related to higher risk Helicobacter pylori infection (OR 1.2; 95% CI 0.37 – 4.49). Lower clean water index was related to higher risk Helicobacter pylori infection (OR 1.5; 95% CI 0.57 – 4.04). Lower sanitation status was related to higher risk Helicobacter pylori infection (OR 2.5; 95% CI 1.01 – 6.19). Conclusion: seroprevalence of Helicobacter pylori infection in patient with dyspepsia in Kalibaru village was 22.5%. There is an association between sanitation and Helicobacter pylori infection.Key words: seroprevalence, Helicobacter pylori, sanitation.

Aim: to find whether ST2 can be used to determine clinical improvement in patients with NYHA III and IV heart failure. Methods: this is a longitudinal, pre and post-test study without a control group. Study subjects are 23 NYHA III and IV heart failure patients. ST2 was tested at the start and end of hospital treatment. Results: of 23 heart failure patients, 70% were classified as NYHA III while 30% were NYHA IV. There were more male subjects than females (51.4% vs. 48.6%). Median age for NYHA III heart failure patients was 52 years and mean age for NYHA IV heart failure patients was 58 years. Heart failure was mostly caused by coronary artery disease (52%). ST2 levels did not correlate with age, length of care, sex and cause of heart failure. ST2 levels in NYHA IV heart failure patients (58.82±37.36 ng/mL) tended to be higher than the one in NYHA III group (30.75 [14.4-84.5] ng/mL), but the difference was statistically not insignificant (p=0.89). ST2 levels at the start of treatment was significantly higher than at the end (31.4 [14-129.2] ng/mL vs. 18.4 [7.6-77.8] ng/mL), p=0.001. This shows that clinical improvement is associated with significant reduction of ST2 levels. Conclusion: ST2 can be used as a marker to determine clinical improvement in NYHA III and IV heart failure.Key words: ST2, heart failure, NYHA III and IV

Aim: to evaluate the participant rate of the new universal health coverage (UHC) and its impact on the hypertensive subjects from the rural area in the Sleman-District of Yogyakarta during the early implementation. Methods: this epidemiological survey of the new UHC implementation was included as an analytical crosssectional study done with cluster random sampling. The subject criteria were aged 30-85 year, not in pregnancy, and signed the informed-consent. Subjects were grouped based on the health coverage disparity and analyzed with chi-square statistics for the hypertension prevalence, awareness, therapy, and control. The additional variables of BMI, education, occupation, income, smoking, diet control, physical activity, and health facilities were grouped into binomial data and analyzed based-on the health coverage disparity. Results: of 926 total subjects, 602 (65.0%) subjects had the health coverage including 9.2% of the new UHC. The groups of with and without health coverage were not significantly different in hypertension prevalence, the profile of age, blood pressure, and the proportion of the other variables (p>0.05) except for smoking and physical activities. In the high blood pressure sub-group (n=446), the subjects without health coverage had lower proportion of the hypertension awareness p<0.02; OR: 0.60 (CI95%:0.39-0.91) and therapy p<0.03; OR: 0.50 (CI95%:0.27-0.94), but not in the blood pressure control (p>0.05). Conclusion: the participant rate of new UHC was relatively low at 9.2%. Among the subgroup with ≥140/90mmHg blood pressure, the subjects without health coverage were more likely to have lower hypertension awareness and suboptimal therapy than those with the health coverage program.Key words: universal health coverage, hypertension, awareness, therapy.

Aim: to investigate the MACE-free survivals difference between hyperuricemic and normouricemic patients and to determine its role as risk factor for MACE occurrence in hospitalized acute coronary syndrome patients. Methods: retrospective cohort study with survival analysis approach was conducted in 251 patients with acute coronary syndrome who were treated in ICCU Cipto Mangunkusumo Hospital during period from January 2009 to December 2011. Clinical data, laboratory results, electrocardiography result, echocardiography result, and coronary angiography were collected. Patients were observed and followed on major adverse cardiac event during 7 days of hospitalization in ICCU. Major adverse Cardiac Event is an event as a complication occur after acute coronary syndrome such as cardiogenic syock, acute heart failure, stoke, reinfarct during early ward treatment, sudden cardiac death, repeat PCI during ward ulang and perform coronary artery bypass graft (CABG) surgery. Difference in survival is shown in Kaplan-meier curve and difference in survival between groups were tested with Log-rank test, and multivariate analysis with Cox proportional hazard regression to calculate adjusted HR on major adverse cardiac event with confounding variables as covariates. Results: there was a significant difference in survival between hyperuricemia group and non-hyperuricemia group (Log-rank test (p<0.001)) with crude HR 2.7 (CI 95% 1.6–4) and adjusted HR 2.67 (CI 95% 1.6-4.3).There was significant difference in survival between hyperuricemia group (mean survival 6.05 days with SE 0.2 (CI 95% 5.6-6.4) and non-hyperuricemia group (mean survival 7.33 days with SE 0.1 (CI 95% 7.0-7.6). Conclusion: survival of patients suffering from ACS with hyperuricemia is worse compared to those without hyperuricemia during ICCU hospitalization.Key words: hyperuricemia, acute coronary syndrome, major adverse cardiac event, survival

Haemophilic arthropathy is the most prevalent joint disorder in haemophilia. This disorder is characterized by chronic synovitis and progressive destruction of joint cartilage. We report a case of arthroscopic synovectomy to reduce bleeding frequency in haemophilic arthropathy of the knee. Patient was a 15 years old male with haemophilic arthropathy of the left knee. We performed an arthroscopic synovectomy under tightly regulated factor VIII replacement therapy. There were villous synovial hypertrophy at all part of the joint, multiple bone and cartilage defect, and also anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) deficiency found intraoperatively. After 6 month follow up, subjective complain and bleeding frequency decreased significantly. The visual analog scale improved from 5-6 to 1-2, and the International Knee Documentation Committee Score increased from 49 to 66. Bleeding frequency decreased from 4-8 times per month to less than 1 time per month. Arthroscopic synovectomy performed in this case could reduce the pain, decrease the frequency of bleeding, and improve patient’s functional outcome.Key words: arthroscopic synovectomy, haemophilic arthropathy, haemophilia, anterior cruciate ligament, posterior cruciate ligament.

We report a patient with supraclavicular lymph node metastasis from an undetectable adenocarcinoma of the transverse colon, who presented with cough and was diagnosed with typhoid fever, bronchitis as well as liver metastasis. There were an abdominal fullness, weight loss, constipation, pencil-like stool with mucous and blood, low-grade fever, bone ache, and tea-color urine. The first colonoscopy revealed lymphocytic ileitis and microscopic findings also showed lymphocytic ileitis. Abdominal USG and CT revealed liver metastasis of unknown origin. Based on the clinical sign and symptoms, we suspected that colorectal carcinoma was the primary site. Then, the second colonoscopy was performed and it revealed a small polyp, which was followed with a biopsy and the result supported a well-differentiated colon adenocarcinoma. Similar result was also revealed by the histopathological evaluation. This is an unusual case of liver and supraclavicular lymph node metastasis arising from a small polyp adenocacinoma of the transverse colon.Key words: liver metastase, colorectal carcinoma, lymph node.

Endothelial progenitor cells (EPCs) are cell derived from bone marrow and the cells circulate in peripheral blood. These cells have characteristics similar to stem cells, but their ability to proliferate and differentiate is more limited. EPC discovery has changed the old paradigm in the field of vascular biology and it brings huge implications in medicine as EPCs can mediate the processes of vasculogenesis and maintain the vascular integrity. Increasing amount of EPC in the circulation is important since it has positive correlation with reendothelialization and neovascularization and they are closely linked to cardiovascular health. Thus, EPC could potentially be used for treatment of disease caused by endothelial dysfunction.Key words: endothelial progenitor cell, endothelial dysfunction, vasculogenesis, reendothelialization.

Primary hyperparathyroidism is a medical condition caused by overactive of parathyroid gland. It is most commonly caused by solitary adenoma of the parathyroid gland. Other causes of this condition are hyperplasia, multiple adenomas, and parathyroid cancer. Primary hyperparathyroidism has some metabolic consequences in the calcium metabolism. Hypercalcemia in patient with primary hyperparathyroidism will resulted to the most important comorbidity that is chronic deposition of calcium in the kidney forming nephrolithiasis or other urolithiasis. It is not uncommon, patient with parathyroid adenoma come to health care professionals with the chief complain of recurrence nephrolithiasis.

Aim: to review the role of ursodeoxycholic acid in acute viral hepatitis. Methods: following literature searching according to the clinical question on Pubmed and Cochrane Library. After filtered with our inclusion and exclusion criteria, one meta-analysis and two randomized clinical trials are obtained. Through critical appraisal, it was concluded that the articles meet the criteria for validity and relevance. Results: the article found that there is a positive effect of ursodeoxycholic acid on the activity of serum transaminases and cholestasis indexes. However, there is insufficient evidence to support or to refute effects of  ursodeoxycholic acid on disease’s course as well as the viral load. Conclusion: better method of clinical trials are needed to obtain a valid and applicable result for daily practice.Key words: ursodeoxycholic acid, acute viral hepatitis

Indonesia as one of the largest tropical and agricultural countries in the world shared the particularly high burden cases of snakebite. In the last decade, World Health Organization (WHO) has listed snakebite as one of the neglected tropical disease. The clinical manifestations of snakebite could vary according to the type of venoms ranging from mild to life threatening condition. Appropriate first aid treatment and comprehensive management of snakebite cases are warranted to reduce mortality and morbidity rates.Key words: snakebite, neglected tropical disease, Indonesia, treatment, antivenom

Aim: to get a recommendation on the best frailty syndrome diagnostic tools, that will be able to be practiced on a daily setting in Indonesia. Methods: this is a cross-sectional study with diagnostic test approach, conducted to patients in the Geriatric Outpatient Clinic of Cipto Mangunkusumo National Referral Hospital on May-June 2013. Each subject underwent a frailty evaluation using CHS, SOF, FI-CGA and FI-40 scoring systems. Then, we calculate the sensitivity, specificity, PPV, NPV, LR+ and LR- of each scoring system compared to FI-40. Results: the proportion of frail, pre-frail and fit according to FI-40 are 25.3%,71% and 3.7% respectively. In terms of differentiation frail to non-frail, CHS had 41.2% sensitivity, 95% specificity, PPV 73.7%, NPV 82.7%, LR+ 8.41 and LR- 0.62. SOF scoring system had 17.6% sensitivity, 99.5% specificity, PPV 92.3%, NPV 78.1%, LR+ 35.2 and LR- 0.83. Furthermore FI-CGA had 8.8% sensitivity, 100% specificity, PPV 100%, NPV 76.4%, LR+ ∞ and LR- 0.91. Conclusion: There is no better scoring system that could be implemented to screen for frailty syndrome other than FI-40 items. However, other scoring systems could be used as a good diagnostictool for the syndrome.Key words: elderly patient, frailty syndrome, CHS index, SOF index, FI-CGA, FI-40.

Aim: to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods: we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results: we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion: there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure.Key words: overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms.

Aim: to evaluate potential improvement effect for probiotic E. coliNissle 1917 in the management of refractory IBS in an Iranian population. Methods: a double blind placebo controlled approach as been used in the current clinical trial. 139 confirmed IBS patients were included into the study, and were given probiotic E.coli Nissle 1917 for 6 weeks. 11 items Birmingham IBS Symptom Questionnairehas been used for evaluation of changes in the symptoms every 2 weeks. Results: sixty eight subjects (49%) were males. Mean±SD age of the participants was 38±13.3 years. 49(35.3%) of the patients were diarrhea-predominant. The total scores showed no significant difference between the intervention vs. control group(-6.7±6.8 vs. -6.7±6.5, respectively; p=0.95); neither did any of the questionnaire items any significant alterations in the two groups. After stratification of patients based on their IBS type, diarrhea-predominant patients showed a positive response to the probiotic improving their sleep (p=0.05&0.03 at weeks 2&6, respectively). Patients with constipation-predominant IBS showed no response to the probiotic; while patients with diarrhea-constipation mixed IBS showed unfavorable response to the probiotic in the need for strain to pass a motion compared to the placebo (p=0.03&0.02 at weeks 4&6, respectively). Conclusion: probiotic therapy with E.coliNissle 1917 was not able to induce significant improvement in the symptoms of patients with non-categorized IBS. Nevertheless, when IBS patients were recategorized to subgroups according to their main symptoms, evaluation of the efficacy of the probiotic on some individual items in the symptom list reached the significance level. Prospective clinical trials are recommended to confirm our findings.Key words: probiotic Escherichia Coli Nissle 1917, irritable bowel syndrome, double blind randomized controlled trial.

Aim: to determine factors associated with In-Stent Restenosis (ISR) in patients following Percutaneous Coronary Intervention (PCI). Methods: a retrospective cross-sectional study was conducted using secondary information from medical records of post-PCI patients who underwent follow-up of angiography PCI between January 2009 and March 2014 at The Integrated Cardiovascular Service Unit, Cipto Mangunkusumo Hospital, Jakarta. Angiographic ISR was defined when the diameter of stenosis ≥50% at follow-up angiography including the diameter inside the stent and diameter with five-mm protrusion out of the proximal and distal ends of the stent. Results: there were 289 subjects including 133 subjects with and 156 subjects without ISR. The incidence of ISR in patients using of bare-metal stent (BMS) and drug-eluting stent (DES) were 61.3% and 40.7%, respectively. Factors associated with ISR are stent-type (OR=4.83, 95% CI 2.51-9.30), stent length (OR=3.71, 95% CI 1.99-6.90), bifurcation lesions (OR=2.43, 95% CI 1.16-5.10), smoking (OR=2.30, 95% CI 1.33-3.99), vascular diameter (OR=2.18, 95% CI 1.2-3.73), hypertension (OR=2.16, 95% CI 1.16-4.04) and diabetes mellitus (OR=2.14, 95% CI 1.23-3.70). Conclusion: stent type, stent length, bifurcation lesions, smoking, vascular diameter, hypertension and DM are factors associated with ISR in patients following PCI.Key words: bare-metal stent; drug-eluting stent; in-stent restenosis.

Aim: to evaluate the use of alpha-1-acid glycoprotein (AAG) for diagnosing hepatocellular carcinoma (HCC), and to combine with alpha fetoprotein (AFP) as part of routine examination in liver cirrhosis patients. Methods: this is a diagnostic study using cross-sectional design. A hundred and six patients were included in this study. Baseline data such as age, gender, AFP, AAG, peripheral blood count, AST and ALT were consecutively collected from liver cirrhosis patients with or without HCC. Serum AAG were measured quantitatively using immunoturboditimetric assay and AFP with enzyme immune assay (EIA). Statistical analysis were done using SPSS 13.0. Data comparisons between group were done using Mann-Whitney test. Diagnostic performance for each marker alone was compared to the surrogate use of both markers (combined parallel approach) in HCC cases. Results: receiver operating characteristic (ROC) analysis showed that area under the curve for AFP AAG combination was 88.1% and higher than AFP only (86.2%) or AAG only (76.5%) with sensitivity of 83%, 73% and 44%, respectively, at specificity of >80%. Conclusion: our study showed that combination of AFP and AAG is superior than either marker alone in diagnosing HCC in liver cirrhosis patients. Combination of AFP and AAG may be used to prompt early diagnosis screening of HCC.Key words: alpha fetoprotein, alpha-1-acid glycoprotein, biomarker, liver cancer

Aim: to assess the effectiveness, safety and tolerability of amlodipine/valsartan (Aml/Val) single-pill combination (SPC) in hypertensive patients in a real-world setting. Methods: the Indonesian subset of the EXCITE (clinical EXperience of amlodIpine and valsarTan in hypErtension) study, which was a multinational, prospective, observational, open study in hypertensive patients treated with Aml/Val SPC for 26 weeks. Aml/Val SPCs (5/80, 5/160, 10/160 mg) were administered as monotherapy or as add-on therapy to other antihypertensive medications in patients not controlled by prior monotherapy. The effectiveness outcomes were (1) mean decrease in sitting systolic blood pressure and diastolic blood pressure (msSBP and msDBP) from baseline to week 26; (2) proportion of patients achieving BP goal (<140/90 mmHg for nondiabetics, or <130/80 mmHg for diabetics); (3) proportion of patients who were responders (achieving BP goal or BP reduction of >20/10 mmHg). The safety variables were the incidence of AEs and SAEs, and the incidence of edema. Results: a total of 500 patients from Indonesia received Aml/Val SPC, 487 patients were analyzed for efficacy (by LOCF), and 464 patients completed the study. At study end (week 26), the overall msSBP and msDBP(95% CI) reductions from baseline were -33.7(-35.2, -32.1) mmHg and -14.8 (-15.7, -13.8) mmHg, respectively. Among the 487 patients, 52.4% achieved BP goal and 80.5% were responders (LOCF). Among 464 patients who completed the study, 53.7% achieved BP goal and 84.5% were responders. Aml/Val SPC was effective in decreasing BP in Indonesian patients. AEs, including SAEs, were reported in 11.4% patients, with SAEs in 1% of patients, and death in 0.8% of patients. SAEs and deaths were considered unrelated to the study drug. Edema was reported by 9.4% of patients atbaseline, and in 3.7% patients at end of study. Effectiveness, tolerability and compliance were rated good and very good in 90.8%, 92.2%, and 89.2% of patients, respectively, according to the investigators. Conclusion: Aml/Val SPC was effective for BP reductions and well tolerated in hypertensive patients, not adequately controlled by monotherapy, in a daily clinical setting in Indonesia.Key words: Aml/Val, single-pill combination, daily clinical, EXCITE study.