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Hypertension Update - in Depth Review of JNC 8 - Focus On CCB Dr. Dadang, SPJP (K) PDF
Hypertension Update - in Depth Review of JNC 8 - Focus On CCB Dr. Dadang, SPJP (K) PDF
Dadang Hendrawan
Hypertension :
Prevalence & Complication
q Prevalence :
q 1 Bio in the World and
q 25.8% in Indonesia1,2
1. WHO News Release April 2013. ; 2. RISKESDAS 2013 Depkes RI ; 3. James PA et al. JAMA 2014;311:507–20 2
Hypertension:
A Risk Factor for Cardiovascular Disease
Coronary Peripheral artery Cardiac
Stroke
disease disease failure
50
45.5
45
40
JNC-8 2014
ESH/ESC 2013
• BP target for general population <140/90
mmHg.1,2
4
JNC-8, 2014 guidelines on initial antihypertension treatment
β-blockers (BB) not recommended for initial BP treatment because of a higher rate of the primary composite
outcome of CV death, MI, or stroke compared with the use of an ARB
5
Antihypertension treatment of choice
Patient needs antihypertension that can provides :
Effective reduction BP, Has good BPV and has cardiovascular and renal protection.
Reduction BP Antihypertension
as recomended treatment that :
• can reduction BP as
Which
Consider BPV recommended
antihypertension
control • can control BPV
Treatment to
as a goal better
choose ?
• Has Cardiovascular
Benefit for and Renal
Cardiovascular Protection
and Renal
• There are a lot of class of antihypertension, which one can provide the
patient needs and can reach a goals as antihypertension treatment ?
6
Early SBP control leads to improved outcomes
Ca++
Ca++ antagonist
Decreased contraction
Amlodipine 0.66
J Hypertens Suppl. 1995 Aug; 13(2)-5109-12.Pracyical relevance of the 24-hour trough peak ratio of antihypertensive drugs
10
Nifedipine GITS/OROS different with other Nifedipine
Nifedipine GITS/OROS have a smooth and gradual mechanism of action with Oral Osmotic Delivery System, has better concentration profile than other Nifedipine
BP reduction profile
Nifedipine GITS/Adalat OROS resulting
in smooth onset and a sustained anti-
hypertensive effect over a 24-hour
period …
… without cardio-acceleration
14
Nifedipine GITS/OROS vs Amlodipine
Nifedipine GITS/OROS provides minimal side effect than Amlodipine
Decreased SA
Pedal
Overall Headache Dizziness GI Flushing &/or AV Hypotension
Oedema
Conduction
Nifedipine ≈ 10 + + + + 0 + +
GITS
Amlodipine ≈ 15 2+ + + + 0 + 2+
15
Nifedipine GITS/OROS
Nifedipine GITS/OROS 60 mg has a better efficacy vs Valsartan 160 mg and has the same effectiveness in
reducing BP vs combination Nifedipine GITS/OROS 30 mg + Valsartan 80 mg.
-5
-10
SBP Reduction
N30+V80
-15
N60
V160
-20
-25
-30
8 weeks
• Focus Study
16
Benefit of Nifedipine GITS/OROS
in Cardivascular protection
Nifedipine GITS/OROS reduces CV risk
1. Brown MJ. et al. European Hear Journal Supplement. 2001;3(Supplement B) B20-B26 2. Sierra C, et al. Expert Rev Cardiovasc Ther 18
2008 Sep;6(8): 1055-62 3. ENCORE Investigators. Circulation 2003;107:422–8.
Nifedipine GITS/OROS benefit in Cardiovascular
Insight Study : Nifedipine GITS/OROS significantly reduces the risk of stroke, coronary disease, All cardiovascular events, Cardiovascular Death
All
Coronary Cardiovascular Cardiovascular
Stroke Disease Death
Events
0
-10
-13%
-15
-20
-23%
-25
-26%
-30
-30%
-35
Brown MJ. et al. European Hear Journal Supplement. 2001;3(Supplement B) B20-B26
19
Nifedipine GITS/OROS benefit in Cardiovascular
ACTION Study
Nifedipine GITS/OROS significantly reduces the risk of adverse outcomes in hypertensive patients
Risk reduction: 38% new-overt heart failure, 33% stroke, 16% angiography
Hypertensive patients (BP ≥140/90 mmHg; n=3977) and normotensive patients (n=3684) treated with nifedipine GITS 30-60 mg/day or placebo.
Rate in number of events/100 patient-years of follow-up ‘at risk’.
Lubsen J, et al. J Hypertens 2005;23:641-8.
20
Antiatherosclerotic Effects of Nifedipine
Carotid Arteries:
Lumen
Vesel
Change
Coronary Arteries:
Endothelial
Function Study
Nifedipine GITS/OROS benefit in endothelial
ENCORE Study :
Nifedipine GITS/OROS improves coronary endothelial function
10
10.0
0
5
Placebo Nifedipine GITS/OROS
Difference between % change at baseline and % change at month 6; Highest dose of acetylcholine administered at baseline and
at month 6; p-value vs placebo
24
Conclusion
o Nifedipine GITS/OROS has minimal BPV better than other CCBs (Amlodipine and
Nifedipine standard) that can reduce the risk of organ damage.
o Nifedipine GITS/OROS has stable drug release than Nifedipine standard with Once
Daily dose.
o Nifedipine GITS/OROS has better efficacy in reduction BP with minimum SNS
activation than amlodipine.
o Nifedipine GITS/OROS has well-established safety and tolerability profile
o Nifedipine GITS/OROS provide benefit in Cardiovascular and Renal Protection
25
Thank you!