Jakarta, 26th of August 2019 – In 2000, there are approximately 26% of the world population, or equal to 972 million people, that suffer from hypertension, and its prevalence is predicted to increase to 29% by 20252. In Indonesia, hypertension prevalence in 2018 was 34.1%, based on the measurement to the population with the age of ≥18 years old. Estimated number of hypertension case in Indonesia is 63,309,620 people, with the mortality number of 427,218 deaths. The percentage breakdown of hypertension by age is 3-44 years old (31.6%), 45-54 years old (45.3%), and 55-64 years old (55.2%)³.

Many people who suffer from hypertension are not aware of his health condition due to the absence of symptoms, therefore hypertension is often called as the “silent killer”. Hypertension or high blood pressure is a risk factor to the failure of critical organ such as brain, heart, kidney, eyes, large blood vessels (aorta) and peripheral blood vessels1. If not well controlled, death is not the only risk factor, increasing risk of physical disability due to the development of diseases and the damage of critical organ is also another risk factor. For example, hypertension can cause to approximately 50 percent of ischemic stroke (clogging) while also increasing the risk of hemorrhagic stroke (hemorrhage)⁴. Stroke is the main cause of death and chronic long-term paralysis. Most of the people who suffer from stroke also suffer from high blood pressure or hypertension. High blood pressure damages the artery in the body, creating a condition, where artery grows thicker and rigid, and able to break or cause cloggings. The same condition happens in the brain due to high blood pressure hence higher risk of stroke. Therefore, managing high blood pressure is crucial to reduce the risk of stroke⁵.

Dr.Tunggul D.Situmorang,Sp.PD-KGH,FINASIM, Chairman of Indonesia Hypertension Specialists Association (Perhimpunan Dokter Hipertensi Indonesia - PERHI) explains, “Someone is diagnosed with hypertension when she/he has systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg in at least 3 times of measurement by using the right instrument and method, with 1 minute interval, under calm circumstances, where the person rest well in the clinic or health facility. When “in doubt”, patient is recommended to self-measure his/her blood pressure at home (Home Blood Pressure Monitoring = HBPM) and if there is the facility, patient is also recommended to measure BP for 24 hours by using the special equipment (Ambulatory Blood Pressure Monitoring = ABPM). Patients need to understand that primary hypertension is not fully curable, but it can be well managed to remain under normal conditions.”

To control hypertension in order to achieve targeted blood pressure, the work begins with lifestyle changes, which is maintaining healthy lifestyle, ideal weight, and reducing consumption of salt. Patients compliance in treatment, correct and regular blood pressure measurement, are crucial in controlling hypertension.

Dr. Tunggul also explains that according to the Consensus of Hypertension Treatment Management 2019, for patients with blood pressure ≥ 140 mmHg / ≥ 90 mmHg, medicine will need to be administered to lower blood pressure. In Indonesia, all types of medicines to control blood pressure are available, namely: Calcium Channel Blocker (CCB), Diuretic, Beta Blocker, Alpha Blocker, Anti Converting Enzyme Inhibitor (ACE inhibitor), Angiotensinogen Receptor Blocker (ARB), Central Blocker, Aldosteron Antagonist and others. Currently, according to the guidelines, use of anti- hypertension drug is recommended to be combined since the beginning of the treatment, hence targeted blood pressure can be achieved. It is proven that blood pressure control according to the target is able to prevent 35 – 40% of stroke, 20 – 25% of coronary heart disease and >50% of cardiac failures. 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 anti-hypertension 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 anti-hypertension 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 patients⁶.

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.

Hypertension is a global health problem that contributes to morbidity, mortality, and health cost burden, including in Indonesia. According to WHO, there is an estimation of 1.13 billion people in the world who suffer from hypertension, and less than 1 out of 5 people with hypertension check their health condition to the Doctor7. In Indonesia, with population of 265 million people, hypertension prevalence increased to 34.1% in 2018, compared to 27.8% in 20133. IRR (Indonesian Renal Registry) 2017 data shows that hypertension is also the main cause of kidney failure, causing patients to go through dialysis. Out of 34.1% prevalence, it is known that 8.8% is diagnosed with hypertension, where 32.3% of the diagnosed patients do not take medicine regularly and 13.3% do not take medicine at all. The biggest reason for not taking the medicine regularly or not taking it at all is that they feel healthy. This can happen because many patients believe that they are cured from hypertension once their blood pressure is stable, and then tend to stop its treatment³.

Hypertension is also the main factor of cardiovascular disease. According to World Economic Forum 2015, in 2012 – 2025, Indonesia spend approximately USD 4.47 trillion or equal to USD 17,863 per capita for Non-Communicable Diseases (cardiovascular, cancer, chronic lung disease, diabetes and mental health)^8,9.

Therefore, educating the public regarding hypertension from prevention angle (preventive) is important. There is a need to initiate a sustainable movement, such as Anti Hypertension Movement (Gerakan Peduli Hipertensi – GPH) by all layers of communities and policy makers, particularly the media, considering physical disability and death as its risk potentials, along with heavy economic burden, not only for the patients and the family, but also to the country.

***

References:
_{1.    Consensus of Hypertension Treatment Management 2019
2.    Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Lancet. 2005 Jan 15-21;365(9455):217-23.
3.    Riset Kesehatan Dasar (National Health Survey) 2018
4.    https://www.world-heart-federation.org/resources/stroke-and-hypertension/
5.    https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-high-blood-pressure-can-lead-to-stroke
6.    https://www.ncbi.nlm.nih.gov/pubmed/21591818
7.    http://ish-world.com/downloads/pdf/global_brief_hypertension.pdf
8.    http://www.healthdata.org/sites/default/files/files/policy_report/2019/GBD_2017_Booklet.pdf
9.    http://www3.weforum.org/docs/WEF-The-Economics-of-non-Disease-Indonesia-2015.pdf}

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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 anti-hypertension 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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