HYPERTENSION

◂ Hypertension is one of the major

cardiovascular risk factors for the
cardiovascular disease continuum (CVDC).
◂ The three main factors determine BP: renal
sodium excretion (and the resultant impact
on plasma and total body volume), vascular
tone and cardiac performance.
◂ The renin-angiotensin-aldosterone system
(RAAS), is involved in regulating arterial BP.

Chrysant SG. World J Cardiol 2010 March 26; 2(3): 43-49.

Schellack N, Naicker P. S Afr Pharm J 2015;82(2):17-25.
 HYPERTENSION

Hypertension
Hypertension

Stroke Heart Failure

Peripheral
Vascular
Retinopathy Disease Renal Failure

Chobanian AV, et al. JAMA. 2003;289:2560-2572.

 HYPERTENSION

ESC. European Heart Journal 2013; 34: 2159–

2219.
HYPERTENSION
HYPERTENSION & Metabolic Syndrom

It is diagnosed when any three of

the following five risk factors are present:
• High blood glucose
• High blood pressure
• Low levels of HDL cholesterol in the
blood
• High levels of triglycerides in the blood
• Large waist circumference or “apple
shaped” body
 Challenges in Hypertension Treatmen
• Chronic diseases
• High incidence in elderly
• No symptoms/”silent killer”
• Long-term treatment
• High cost treatment
• Patient Compliance
• Severe Complications

Source: http://www.depkes.go.id/article/view/19051700002/hipertensi-penyakit-paling-banyak-diidap-masyarakat.html
 Challenges in Hypertension Treatmen
Reasons of low patient compliance:
• Patient feels healthy (59,8%),
• BP is not regularly checked (31,3%),
• Traditional treatment (14,5%),
• Other treatment (12,5%),
• Forget to take the medicine (11,5%),
• Unable to buy the medicine (8,1%),
• Side effects (4,5%).

Source: http://www.depkes.go.id/article/view/19051700002/hipertensi-penyakit-paling-banyak-diidap-masyarakat.html
 How to Improve Compliance?
• Patient & family education
• Lifestyle modification
• Diary book/pill card
• Patient counseling:
• patient motivation,
• patient feels,
• regimen of the dose,
• self physical examination,
• cost therapy, etc

Source: http://www.depkes.go.id/article/view/19051700002/hipertensi-penyakit-paling-banyak-diidap-masyarakat.html
 How to Improve Compliance?
Role of pharmacist:
• Patient education
• Monitoring patient
• Support patient compliance/counseling
• Recommend generic medications
• Screening of AE

Source: http://www.depkes.go.id/article/view/19051700002/hipertensi-penyakit-paling-banyak-diidap-masyarakat.html
Drugs to be preferred in specific conditio
 Possible antihypertensive-drug combinatio

ESC. European Heart Journal 2013; 34: 2159–2219.

 HYPERTENSION
The role of Angiotensin Receptor Blockers in hypertension
management

ARB

Kaplan’s Clinical Hypertension, 2010

 TELMISARTAN

◂ Telmisartan showed high binding

affinity towards AT1 receptor, the
carboxylate group may have profound
role in binding between the ligand and
the receptor.
 TELMISARTAN

Telmisartan shows the longest half-life (t ½), the greatest volume

distribution, and lack of CYP metabolism amongst other ARB-agents
 TELMISARTAN

Treatment with telmisartan 40 to 160mg

once daily (4 weeks) significantly reduced
supine diastolic and systolic BP compared
with placebo.

Antihypertensive effects of telmisartan in patients with mild to moderate

hypertension. Patients were randomised to receive placebo (n = 46) or telmisartan
20mg (n = 47), 40mg (n = 47), 80mg (n = 44), 120mg (n = 45) or 160mg (n = 44)
once daily for 4 weeks in a double-blind manner. DBP = diastolic blood pressure;
SBP = systolic blood pressure.[11] * p < 0.05 vs corresponding placebo value.
 Telmisartan achieved
a greater effect than
valsartan on BP during
the early morning
period in patients with
hypertension.

White WB, et al. Am J Hypertens 2004;17:347–353.

 TELMISARTAN VS AMLODIPINE

Treatment with telmisartan was associated with a consistently greater

reduction of blood pressure on an hourly basis and also during last 4
hours before dosing compared with patients receiving amlodipine.
White BW. J Clin Hypertens. 2002;4:20–25
 Effect of Telmisartan on
Left Ventricular
Hypertrophy

Telmisartan reduced new onset of Left Ventricular Hypertrophy (LVH) by

37% than placebo
Verdecchia P, et al. Circulation 2009;120:1380-1389.
Indikasi:
Terapi untuk hipertensi esensial.

Kontraindikasi:
• Hipersensitif terhadap zat aktif atau
komponen lain dalam sediaan.
• Kehamilan trimester kedua dan ketiga.
• Ibu menyusui.
• Gangguan obstruksi biliaris.
• Gangguan hati berat.
• Penggunaan telmisartan bersama dengan
produk yang mengandung aliskiren
dikontraindikasikan untuk pasien diabetes
melitus atau gangguan ginjal (GFR <60
ml/menit/1,73 m2).

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Dosis dan cara pemberian:
Dewasa:
• Dosis rekomendasi telmisartan 40 mg sekali sehari.
• Pada beberapa pasien, dosis harian sebesar 20 mg sudah dapat
memberikan efek.
Jika target tidak tercapai:
• Dosis dapat ditingkatkan hingga maksimum sebesar 80 mg sekali sehari.
• Telmisartan dapat digunakan bersama dengan obat diuretik golongan
thiazide seperti hydrochlorothiazide, yang memberikan efek aditif dalam
menurunkan tekanan darah apabila dikombinasikan dengan telmisartan.
• Efek antihipertensi maksimum umumnya dicapai 4-8 minggu setelah
dimulainya terapi.
• Telmisartan dapat diberikan bersama atau tanpa makanan.

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 Telmisartan
Bioequivalen dengan originator

Telmisartan OGB Dexa terbukti bioekivalen dengan

originator, sehingga efikasi, keamanan dan kualitas setara
dengan originator.

Telmisartan OGB Dexa terbukti bioekivalen dengan originator, sehingga efikasi,

keamanan dan kualitas setara dengan originator.