09 December 2019

Fighting Hypertension Movement (Gerakan Peduli Hipertensi): “Watch Your Blood Pressure in the Morning and in the Evening, Risk of Stroke Awaits”

  • Hypertension is the main cause of stroke in Indonesia1
  • Home blood pressure monitoring (HBPM) can prevent stroke2
  • The first 60 minutes is the golden time for stroke patients to save their lives and from paralysis.

Jakarta, 10 December 2019

 

Bayer together with Indonesian Society of Hypertension (InaSH) in today’s Hypertension movement bring dr. Eka Harmeiwaty, SpS, a neurologist, to explain about the correlation between hypertension and stroke, and the benefit of home blood pressure monitoring (HBPM) in preventing stroke.

 

Indonesia is the 4th most populated country in the world (267,670,543 lives). Indonesia’s Ministry of Health Basic Health Survey in 2018 showed that diagnosis-based stroke prevalence in population aged ≥ 15 was 10.85%3. According to World Health Organization in 2016, stroke is ranked 2nd as the non-communicable disease that cause mortality and ranked 3rd as the cause of paralysis in the whole world. Hypertension is the main cause of stroke globally, including Indonesia. Therefore, preventing and treating hypertension is the utmost efforts to be done.

 

“Hypertension is the most common risk factor that causes ischemic and hemorrhagic strokes. Hypertension prevalence among adults in Indonesia increased from 25.8% in 2013 to 34.1% in 2018, meaning that there are 3 of 10 people in Indonesia aged 18 years old who are suffering from hypertension”, explained Dr. Eka. Furthermore, she added,” Based on the Indonesian Stroke Registry that was conducted in 18 hospitals in 2014, it showed 5,411 stroke patients: 67% of them were suffering from ischemic stroke and 33% of them suffering from hemorrhagic stroke1. This number differs to global data which mentioned that 80 - 85% of stroke incidents were ischemic and 15 - 20% of them were hemorrhagic.

 

Referring the relation between hypertension and stroke, Dr. Eka explained,” Hypertension causes ischemic and hemorrhagic strokes through different mechanism. High blood pressure damages blood vessels’ elasticity in the brain, blood vessel wall thickens and ease the formation of plaque. Such condition narrows the lumen of blood vessel and causes clot. As a result, brain does not receive oxygen and nutrition supplies and caused damage and death of neurons in the brain. Furthermore, chronic hypertension causes the thinning of smaller artery blood vessels, and forms bubbles that can burst at any time. Blood that bursts from the vessel will pressure surrounding neurons and causes damages. The body has the ability to absorb blood, hence when hemorrhage is not wide, the recovery is better than blockage stroke. But when the hemorrhage is wide, it can be fatal.”

 

Stroke symptoms are always sudden, although the progressivity can be in stages or immediately fatal. Symptoms occurred depends on the brain function that is damaged, however, most common symptoms are extreme paralysis in one side, tingling sensation, and droopy face. Stroke symptoms can be in difficulty speaking, problem memorizing, vision impairment, difficulty swallowing, nasal voice, problem staying balance and coordinated.  Behavior changes is to be expected due to stroke and it is often perceived as mental health disturbance. One third of stroke patients recover, one third suffered from life paralysis, and one third of them passed away.

 

 

Home blood pressure monitoring (HBPM) can help prevent stroke

 

Hypertension Management Consensus by the Indonesian Society of Hypertension (InaSH) in 2019, mentioned that someone is diagnosed with hypertension when their Systolic Blood Pressure ≥ 140 mmHg and/or Diastolic Blood Pressure ≥ 90 mmHg when measured in the clinic or healthcare facility.

 

Dr. Eka explained, “Many patients and families ask on why hypertension patients can have stroke even if they are treatment compliant. In my opinion, there are many factors such as blood pressure variations. Blood pressure is varied daily caused by the circadian pattern. Physical activities and emotional state affect blood pressure variations. Blood pressure dramatic increase that happens in the middle of the night or in the dawn, and high blood pressure in the morning, are conditions that often happen and a risk of stroke.

 

“Blood pressure variations cannot be known only through routine examination or doctor’s visits. Therefore, hypertension patients are encouraged to measure their own blood pressure at home, or also called as Home Blood Pressure Monitoring (HBPM).HBPM is easy to administer, especially when using a digital instrument. Aside to understand blood pressure variations, home blood pressure monitoring (HBPM) is very useful to have clear diagnosis on hypertension, especially to detect whether it is a white coat hypertension, fake hypertension, and hidden hypertension,” Dr. Eka added.

 

Fake hypertension is indicated with high blood pressure result when measured in a clinic or a hospital, but HBPM shows average normal blood pressure, which is ≤ 135/85 mm Hg.  The limit for hypertension with HBMP is indeed lower than clinic measurement. Hidden hypertension is the state where the blood pressure is normal when measured in the clinic, but average home monitoring is ≥135/85 mmHg. Hidden hypertension is very dangerous since there are high risk of stroke and its complications such as heart failure and kidney failure.

 

HBMP can be used to monitor blood pressure in hypertension patient who is treated and untreated; assessing treatment effectiveness, and as the basis for dosage adjustment. By administering HBMP, hopefully patient’s awareness will increase and medicine consumption compliance will be better.

 

Dr. Eka added that to prevent stroke, morning blood pressure target with HBMP is <135/85 mmHg.   HBMP is best administered in the morning and in the evening. One hour after waking up in the morning, after patient urinated, before breakfast and before taking the medicine. If the patient exercises, then it should be done 30 minutes after exercise. Meanwhile in the evening, blood pressure monitoring is administered before going to bed. It is best to be administered minimum 2 times a day, with interval of 1-2 minutes. Hypertension diagnosis is the average of both measurements in at least 3 consecutive days or more (highly recommended for 7 consecutive days). Day 1 measurement is waived and not included in the average calculation. During measurement, patient should not talk or chat, and it is highly advised to use a validated measurement tool. Blood pressure is measured from the arm, not on the writs, except for people with obesity, if there is no cuff with the right size.”

 

“Hypertension management is very important to avoid stroke and to prevent repetitive stroke (secondary prevention) 25% of stroke that occurred is a repetitive stroke. A number of studies showed that anti-hypertension medication can reduce risk of stroke and the repetitive stroke for post-stroke patient with blood pressure ≥ 140/90 mmHg. There are a number of anti-hypertension medication groups recommended to prevent both primary and secondary strokes, since it is able to reduce blood pressure variations and it works in 24 hours or more, namely Calcium Channel Blocker (CCB) group. One of the medicines under CCB classification to prevent stroke and repetitive stroke is Nifedipine with OROS technology. Using Osmotic Controlled Release Oral Delivery System (OROS)technology, the medicine should only be consumed once a day and medicine release dosage is steady for 24 hours.”

 

Meaningful 60 minutes

 

For first aid to people suffer from stroke attack, Dr. Eka said, “It is important to know if someone is experiencing stroke caused by blockage, because when treated immediately in 4.5 hours post attack, s/he can survive from death and paralysis. Therefore, we are advised to immediately take a stroke patient to a hospital so that thorough examination and treatment can be administered accordingly. Stroke patients who arrive in the hospital in less than 60 minutes show good treatment result, where 25% of them can quickly recover.”

 

Community is also expected to be able to recognize various stroke symptoms. The easiest one is by using the Face Arms Speech Time (FAST) method. F is for face, to pay attention to patient’s face if it is droopy or asymmetrical. A is for arm, to see if there are weaknesses in one of the arms or hands. S is for speech to assess if there is any difficulty speaking. If such symptoms are seen, do not waste time and immediately contact medical personnel to get assistance in T or time.

 

--END--

 

References:

  1. https://n.neurology.org/content/88/16_Supplement/P3.263
  2. Konsensus Penatalaksanaan Hipertensi 2019
  3. Riset Kesehatan Dasar Indonesia 2018
 

 

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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 continously in 24 hours1-2.  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 absorp 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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