Jakarta, 17 October 2019, Bayer Indonesia support Indonesian Society of Hypertension (InaSH) or PERHI for Fighting Hypertension Movement (Gerakan Peduli Hipertensi) by conducting a series of public education through media about hypertension and risk of critical organ damage and mortality.

Angel Michael Evangelista, President Director of Bayer Indonesia, says, “Hypertension is a global health problem that leads to the increase of morbidity and mortality, as well as increasing health expenses, including in Indonesia. Efforts to lower prevalence of hypertension in Indonesia require sustainable commitment from all parties. Therefore, Bayer strongly supports Indonesian Society of Hypertension (InaSH) in conducting Fighting Hypertension Movement (Gerakan Peduli Hipertensi). Bayer conducts a series of public education through media by presenting Expert Physicians in hypertension and its complications to critical organs.”

Hypertension can be the cause of critical organ damage, such as brain, heart, kidney, eyes, large blood vessels (aorta) and peripheral blood vessels¹ which can lead physical disability and mortality. In Indonesia, with a population of 256 million people, prevalence of hypertension is increasing to 34.1% in 2018 compared to 27.8% in 2013. Meanwhile prevalence of chronic kidney disease based on survey of population with the age of ≥ 15 years old and based on doctor’s diagnosis is 3.8% or approximately 10 million people, and prevalence of population who have or currently having dialysis among population with the age of ≥ 15 years old is 19.3% or approximately 1.9 million people². Indonesian Renal Registry (IRR) 2017 data shows that hypertension is the main cause of kidney failure, hence requiring patients to undergo dialysis. Uncontrollable hypertension is a risk factor of Chronic Kidney Disease (CKD). Meanwhile, progressive kidney disease can worse uncontrollable hypertension due to volume expansion and increased peripheral resistance of blood vessels. Related to CKD, hypertension can be a cause of CKD, but it can also be hypertension as a result of CKD.

Dr. Tunggul D. Situmorang, Sp.PD-KGH,FINASIM, Chairman of Indonesian Society of Hypertension (InaSH) says, “High blood pressure is closely related to kidney failure. Both of these diseases are related in two ways: First, high blood pressure is the main cause of Chronic Kidney Disease. As time goes by, high blood pressure can damage blood vessels in the body. Such condition diminishes blood supplies to critical organs, such as the kidney. High blood pressure also damages the small filtering unit in the kidneys (nephron) which causes the screening process in the kidneys to be disrupted, so that the kidney's function as a filter and removal of toxins from metabolic waste will be disrupted resulting in the accumulation of toxins and fluids in the blood and throughout the body. Excess fluid in blood vessels would pile up and increase even higher blood pressure. Second, high blood pressure can lead to Chronic Kidney Disease (CKD). Healthy kidneys play critical role in maintaining long-term blood pressure through hemodynamic mechanisms (regulating the amount of fluid and salt) and hormonal mechanisms (renin-angiotensin system). Unhealthy kidneys will have less function in regulating blood pressure. As a result, blood pressure would increase. If someone suffers from Chronic Kidney Disease, high blood pressure bears the risk of worsening their kidney disease and can potentially cause cardiovascular disease”.

Measurement of kidney function means that how capable (capacity) of the kidneys are cleaning a certain substance (e.g. creatinine) in one minute. Therefore, the measurement is milliliters/minute (ml/min). Decreased kidney function has levels based on the capacity which called Glomerular Filtration Rate (GFR) in milliliters / minute. GFR is an indicator of kidneys condition. A person with normal functioning kidneys has a GFR of ≥ 90 ml/min. Kidneys with mild damage has a GFR between 60 – 89 ml/min, moderate damage has a GFR between 30 – 59 ml/min, severe damage has a GFR between 15 – 29 ml/min, and kidney failure has a GFR < 15.3 ml/min. IRR 2017 data shows patients in productive age range (25 – 54 years old) who are active in doing dialysis is 54.9% out of total number of patients of 77,892 people¹.

Dr. Tunggul D. Situmorang continues, “Kidney failure is one of troublesome organ’s disability caused by hypertension which can be prevented. Patients with kidney failure would normally lose their productive days, and experience decreasing quality of life even a high risk of death. Therefore, people with hypertension must control and achieve the blood pressure target to normal continuously and be compliant to the treatment and should not stop their hypertension medications even when their blood pressure seem steady and normal.”

Related to the hypertension management and initiation of hypertension medicines and targeted blood pressure in details are mentioned on the 2019 Hypertension Management Consensus by InaSH. Dr. Tunggul explained, "Patients with CKD (with or without diabetes), lifestyle modification and antihypertensive medicines are recommended when clinical blood pressure is ≥ 140/90 mmHg. Target blood pressure are around 130-139 / 70 – 79 mmHG. Hypertension management is different for each individual and should consider the tolerance and effects on kidney function, electrolytes and the presence of other risk factors / diseases that accompany it. In general, combination therapy is recommended from the beginning of treatment with choices of a combination of Calcium Channel Blocker (CCB) and RAS or thiazide diuretics”.

The facts show that hypertension is generally not alone, but accompanied with other risk factors, or other conditions/diseases, such as diabetes, cholesterol, and others. Therefore, the treatment of hypertension does not only focus on lower blood pressure, but furthermore, need to treat other risk factors. The decision of medicine type selection must refer to existing clinical evidence (Evidence Base Medicine = EBM), which is concluded into The Guidelines or Consensus.

There are certainly other deciding factors, such as the experience of clinical doctors and other non-medical factors. The main objective of hypertension management if to achieve maximum reduction of morbidity and mortality. Many studies using reliable methods have been carried out to ensure the potency, safety and tolerability of antihypertensive medicines. For example is the use of Calcium Channel Blocker type, in this case is Nifedipine with OROS technology, be it as a single medication or combined with other antihypertensive medicine, is able to deliver effective and safe treatment of hypertension that is proven to be tolerable through the daily medication practice, in a wide spectrum among hypertension patients⁴.

Nifedipine with OROS technology is Nifedipine using Osmotic-controlled Release Oral delivery System technology, OROS, which allows Nifedipine to stay in the body for 24 hours and maintain normal blood pressure throughout the day.

 
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References:
_{1.    https://www.indonesianrenalregistry.org/data/IRR%202017%20.pdf
2.    Konsensus Penatalaksanaan Hipertensi 2019
3.    Riset Kesehatan Dasar 2018
4.    www.kidney.org
5.    https://www.ncbi.nlm.nih.gov/pubmed/21591818}

About Bayer

Bayer is a global enterprise with core competencies in the life science fields of health care and nutrition. Its products and services are designed to benefit people by supporting efforts to overcome the major challenges presented by a growing and aging global population. At the same time, the Group aims to increase its earning power and create value through innovation and growth. Bayer is committed to the principles of sustainable development, and the Bayer brand stands for trust, reliability and quality throughout the world. In fiscal 2018, the Group employed around 117,000 people and had sales of 39.6 billion euros. Capital expenditures amounted to 2.6 billion euros, R&D expenses to 5.2 billion euros. For more information, please visit www.bayer.com or www.bayer.co.id.

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Fact Sheet
 
Nifedipine with OROS technology (Osmotic-Controlled Release Oral Delivery System)

Nifedipine is Dihydropyridine (DHP) Calcium Channel Blocker (CCB) that is indicated for hypertension treatment.

Nifedipine with OROS technology uses Osmotic-controlled Release Oral delivery System technology, a sophisticated technology that allows Nifedipine to be released continuously in 24 hours^1-2.  Nifedipine with OROS technology efficacy as antihypertensive medicine and its safety profile have been shown in a wide scale and in clinical study.^3-5 Nifedipine OROS tablet consists of Nifedipine layers and active osmotic granule layer that is wrapped with semi-permable outer layer that does not dissolve in water¹. The outer layer has small pores and once consumed, the medicine will absorb the water to create suspension/nifedipine solution in the polymer/medicine’s shell. Once the polymer grows and osmotic pressure increases, medicine suspension is slowly thrusted out (in 24 hours) through the pores on the tablet¹.

OROS technology is not utilized in generic Nifedipine formulation.

Nifedipine OROS is effective and stable in reducing blood pressure⁴ :

Based on INSIGHT study – with 6321 hypertension patients administered with co-amilozide or Nifedipine OROS⁴:
•    58% of patients treated with Nifedipine OROS reached targeted blood pressure recommended in the guidelines: < 140/90 mmHg⁴
•    69% of patients retain the single therapy of Nifedipine OROS after 48 months⁴

References:

_{1.    Grundy JS, et al. Clin Pharmacokinet. 1996;30:28-51.
2.    Meredith PA, et al. Integr Blood Press Control. 2013;6:79-87.
3.    Mancia G, et al. J Hypertens 2002;20:545-53.
4.    Brown M, et al. Lancet 2000;356:366-72.
5.    Mancia G, et al. Hypertension 2003;41:431.-6}
 

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