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Heart failure poses a global health challenge affecting millions of individuals, and access to guideline-directed medical therapy is often limited. This limitation is frequently attributed to factors such as drug availability, slow adoption, clinical inertia, and delayed diagnosis. Despite international recommendations promoting the use of guideline-directed medical therapy for heart failure management, personalized approaches are essential in settings with resource constraints. In India, crucial treatments like angiotensin II receptor blocker neprilysin inhibitors and sodium-glucose co-transporter 2 inhibitors are not fully utilized despite their established safety and efficacy. To address this issue, an expert consensus involving 150 specialists, including cardiologists, nephrologists, and endocrinologists, was convened. They deliberated on patient profiles, monitoring, and adverse side effects and provided tailored recommendations for guideline-directed medical therapy in heart failure management. Stressing the significance of early initiation of guideline-directed medical therapy in patients with heart failure, especially with sodium-glucose co-transporter 2 inhibitors, the consensus also explored innovative therapies like vericiguat. To improve heart failure outcomes in resource-limited settings, the experts proposed several measures, including enhanced patient education, cardiac rehabilitation, improved drug access, and reforms in healthcare policies. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major public health problem in India, affecting a significant proportion of the population. Drug utilization research is important for assessing the rationality of drug treatment and for identifying areas for improvement. This study examined the drug utilization pattern of antihypertensive drugs in hypertensive patients at an Outpatient Department (OPD) in Udaipur, Rajasthan, India, based on JNC-8 classification. Materials and Methods: The observational cross-sectional study included 300 hypertension patients aged above 25 attending the hypertension clinic. Exclusions were made for inpatients, age < 25, uncertain diagnosis, pregnant/lactating mothers, and patients subsequently admitted after OPD visits. Results: The majority of affected patients were above 60 years old, with most having hypertension for 2-5 years, often accompanied by Type II Diabetes Mellitus. Oral administration was the primary drug delivery route. On average, patients received 1.93 antihypertensive drugs per encounter (range: 1 to 4), with an average of 5.82 drugs per encounter (range: 1 to 12). Losartan (72%) and amlodipine (46%) were the most prescribed drugs, with Angiotensin Receptor Blockers (ARBs) being the most prescribed drug class (79.3%), followed by Calcium Channel Blockers (CCBs) at 46.6%. The most common therapy was a two-drug combination (44.6%), followed by single-drug therapy (33%). Approximately 26.3% of prescriptions indicated potential drug interactions. Conclusions: This study provides valuable baseline data on the prescribing pattern of antihypertensive drugs. Rational prescribing practices are being followed, with the majority of patients being prescribed a combination of two or three antihypertensive drugs. However, there is a need to educate patients about the risks associated with uncontrolled high blood pressure and the benefits of lifestyle changes. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD), also known as chronic renal insufficiency, progressive kidney deterioration, or nephropathy, is an illness, in which the kidneys fail to function properly. When prescription and over-the-counter medications are combined, the risk of adverse drug reactions and interactions increases, which are the main causes of hospitalizations and mortality. The aims and strategies for reducing the incidence, morbidity, mortality, and health costs of CKD in India are outlined in this new chapter. Aim: A cross-sectional observational study to estimate the pattern of discharge prescription pattern in patients of CKD associated with hypertension and diabetes mellitus. Methodology: 100 patients with CKD and comorbidities of hypertension, diabetes, or both were included in observational cross-sectional research done at the Nephrology Department of Dhiraj Hospital. The laboratory findings, as well as their comorbidity, discharge prescription medicines, and comorbidity, were all documented and examined. Results: Calcium channel blockers (CCBs) were the most often recommended antihypertensive medication for hypertensive patients with CKD. Diuretics were the least often given class of antihypertensive medicine. In antidiabetic medication, class sulfonylurea and dipeptidyl peptidase-4 inhibitors had similar prescription rates which are the highest prescribing medication for diabetes mellitus with CKD. Biguanides were the least prescribed class of drugs. Conclusion: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers are widely used to treat hypertensive patients with CKD; but due to chances of arrhythmia, CCBs are prescribed. This research might aid in the identification of educational and quality-improvement opportunities to minimize medication-related errors and increase benefits in this population. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major public health problem in India, affecting a significant proportion of the population. Drug utilization research is important for assessing the rationality of drug treatment and for identifying areas for improvement. This study examined the drug utilization pattern of antihypertensive drugs in hypertensive patients at an Outpatient Department (OPD) in Udaipur, Rajasthan, India, based on JNC-8 classification. Materials and Methods: The observational cross-sectional study included 300 hypertension patients aged above 25 attending the hypertension clinic. Exclusions were made for inpatients, age < 25, uncertain diagnosis, pregnant/lactating mothers, and patients subsequently admitted after OPD visits. Results: The majority of affected patients were above 60 years old, with most having hypertension for 2-5 years, often accompanied by Type II Diabetes Mellitus. Oral administration was the primary drug delivery route. On average, patients received 1.93 antihypertensive drugs per encounter (range: 1 to 4), with an average of 5.82 drugs per encounter (range: 1 to 12). Losartan (72%) and amlodipine (46%) were the most prescribed drugs, with Angiotensin Receptor Blockers (ARBs) being the most prescribed drug class (79.3%), followed by Calcium Channel Blockers (CCBs) at 46.6%. The most common therapy was a two-drug combination (44.6%), followed by single-drug therapy (33%). Approximately 26.3% of prescriptions indicated potential drug interactions. Conclusions: This study provides valuable baseline data on the prescribing pattern of antihypertensive drugs. Rational prescribing practices are being followed, with the majority of patients being prescribed a combination of two or three antihypertensive drugs. However, there is a need to educate patients about the risks associated with uncontrolled high blood pressure and the benefits of lifestyle changes. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy and inappropriate prescribing are risk factors for adverse clinical outcomes in older people. Screening tools can identify potential medicine-related patient safety incidents for the elderly on multiple medicines and with chronic diseases. Methods: In this prospective observational study, details of demography, diagnosis, history of constipation/peptic ulcer disease, over-the-counter medications, and clinical and laboratory findings were noted. Information obtained was reviewed and analyzed with the help of STOPP/START and Beers 2019 criteria. At 1 month follow-up, improvement was assessed with the help of a structured questionnaire. Results: As per the criteria, modification in drugs was recommended for 213 drugs; it was actually performed for 27.73% and 48.71% drugs as per Beers and STOPP/START criteria, respectively. Glimepiride was replaced with short-acting sulfonylureas because of hypoglycemia, and angiotensin receptor blockers were stopped because of hyperkalemia as per Beers criteria. Statins were started in 19 patients by START criteria. Overall general health improvement was observed at 1 month, but an increase in anxiety, tension, worry, depressed feel, and insomnia was observed in initial days of the coronavirus disease 2019 pandemic. Conclusions: In view of polypharmacy in the prescriptions, the combination of prescribing criteria need to be considered while prescribing medications to the elderly to get optimum therapeutic benefits and improvement in the quality of life. The quality of primary care of the elderly can also be improved by use of screening tools such as STOPP/START and Beers criteria by a primary/family physician. Prescription evaluation by a trained pharmacologist/physician for possible drug/food/disease interactions and for therapy modification can be incorporated for routine geriatric care at a tertiary care center. Clinical trial registry of India registration number: CTRI/2020/01/022852 [ABSTRACT FROM AUTHOR]

Objectives To evaluate the prescribing pattern of antihypertensive drugs and its compliance to the recommendations of Joint National Committee 8 (JNC 8) guidelines and assess the impact of pharmacist led patient counselling on hypertension management. Methods A prospective study was carried out for a period of one year (September 2020–October 2021) among 150 hypertensive patients of various departments in a tertiary care hospital, Kerala, India. All the cases were prospectively analysed to study the pattern of antihypertensive use and patients were counselled with a patient information leaflet. Key findings Out of 150 patients, 53% were women and 47% were men. Majority of patients were aged 60 years and above (66.0%). Diabetes mellitus (26%) was the most common co-morbidity associated with hypertension. About half of the patients had received dual therapy (49%) followed by monotherapy (31.3%), triple therapy (18%) and quadruple therapy (2%). Calcium channel blockers (59.8%) were the most frequently prescribed drug class followed by angiotensin II receptor blockers (30.5%) either alone or in combination for effective control of blood pressure. Cilnidipine (8.7%) was the most commonly used antihypertensive drug followed by telmisartan (8%). It was observed that 80% of prescriptions were adherent to JNC 8 hypertension treatment recommendations. There was a significant difference (P < 0.001) in the knowledge-awareness scores before (18%) and after (52%) patient counselling. Conclusion The study represents the utilisation pattern of antihypertensive drugs. The adherence of antihypertensive medication use to JNC 8 guidelines was high level at the study site but needs to improve further. The study concludes that pharmacist-led counselling plays a vital role in improving patients' knowledge and awareness towards hypertension management. [ABSTRACT FROM AUTHOR]

Background: Prevalence of hypertension and scanty of evidences related to the clinical efficacy and safety of antihypertensive regimens among post menopausal women were almost negligible in India. So, the aim of the present study was aimed to evaluate the efficacy of antihypertensive as monotherapy in hypertensive postmenopausal women. Materials and Methods: A prospective observational study was conducted in Department of General Medicine at Karuna Medical College Hospital, Palakkad, Kerala for a period of November 2019 to October 2020. The patients were divided in to four groups according to the class (Angitensin Receptor Blockers (ARBs) or Calcium Channel Blockers (CCBs) or Diuretics or Beta Blockers) as monotherapy and their BP values were noted. Results: A total of 250 post menopausal hypertensive women were enrolled in this study. The patients achieved the goal on ARBs with 78% and CCBs with 69.5% was higher compared than BB (54.3%) and Diuretics (45.7%). ARBs and CCBs treated patients showed statistically significant differences in reduction of systolic blood pressure, Diastolic blood pressure, Pulse Pressure and Mean Arterial Pressure in hypertensive women. Conclusion: The twothirds of hypertensive post menopausal women are not being achieved the BP goal; those have more risk for cardiovascular disease and stroke. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension is a progressive cardiovascular condition arising from complex aetiologies. Progression is strongly associated with functional and structural abnormalities that lead to multi-organ dysfunction. Stroke and myocardial infarction are two of the major complications of hypertension in India. Various anti-hypertensive drugs, such as calcium channel blockers (CCBs), beta-blockers, diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been the medications of choice for disease management and are known to be effective in reducing the complications of hypertension. CCBs, such as amlodipine, are also currently being used and proven to be effective, although their beneficial effects in the management of complications of hypertension like stroke and myocardial infarction (MI) have yet to be proven. Therefore, the aim of this systematic review was to evaluate the effect of amlodipine on stroke and MI in hypertensive patients. Methods: A systematic search of English electronic databases was performed for studies with sufficient statistical power that were published between 2000 andl 30 August 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A total of 676 papers were screened, and 13 were found eligible to be included in the meta-analysis. Studies that included patients who suffered from MI or stroke and were under amlodipine treatment were included in the analysis. The odds ratio and the risk ratio of amlodipine compared to active control/placebo were noted from the studies and statistically analyzed. Results: Amlodipine had a significant effect in reducing stroke and MI in hypertensive patients. Similar to results published in reports, this systematic review proved that the hazard ratio for amlodipine was < 1 for stroke (0.69–1.04) and MI (0.77–0.98), showing that amlodipine accounted for better prevention of stroke and MI. Conclusion: In the pooled analysis of data from 12 randomised controlled trials and one double-blinded cohort study measuring the effect of CCBs, we found that the CCB amlodipine reduced the risk of stroke and MI in hypertensive patients. Superior results for amlodipine were found in ten of the 13 studies included in this meta-analysis. [ABSTRACT FROM AUTHOR]

Objectives. To assess mean systolic and diastolic blood pressure (SBP and DBP) levels in patients ≥50 years with uncontrolled hypertension (HTN) and evaluate the correlation between BP and stroke risk. It also assessed therapeutic drug classes prescribed in these patients. Methods. A cross-sectional, observational study was conducted at 176 outpatient centers across India, including patients aged ≥50 years with elevated SBP (≥140 mmHg). The relationship between stroke risk, calculated using Stroke Riskometer™, and mean SBP, mean DBP, and other risk factors was evaluated using Pearson correlation coefficient and logistic regression analysis. Results. The study included 3791 patients (men, 60.0%; mean age: 62.1 ± 8.3 years; mean BMI: 27 kg/m2) with mean SBP 157.3 ± 12.8 mmHg and mean DBP 89.8 ± 9.7 mmHg. Five-year stroke risk in 33.9% and 10-year stroke risk in 70% patients were moderate to severe. A ~4% increase in both 5- and 10-year stroke risk with each 1 mmHg increase in mean SBP (p < 0.0001) was seen. However, mean DBP did not exhibit any significant correlation with 5-year (p = 0.242) or 10-year (p = 0.8038) stroke risk. There was a positive correlation between mean SBP and patient age, comorbid diabetes, and smoking and alcohol habits (p < 0.0001). Comorbid diabetes and smoking increased 5- and 10-year stroke risk by 2- to 5-fold. Irrespective of the risk category, most patients received antihypertensive therapy with an angiotensin receptor blocker. Conclusion. Findings corroborate an association between stroke risk and mean SBP. These real-world clinical findings indicate that efforts are required to improve primary prevention of stroke and reduce the prevalence of recurrent stroke in India. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the association between antihypertensive drug use and new-onset diabetes (NOD) in patients with hypertension (HTN). Materials and Methods: A retrospective observational study was conducted in a tertiary care hospital located in south India. Patients diagnosed with HTN and HTN with diabetes between January 2012 and December 2016, were identified and studied. Medical records of these patients from Medical Record Department were evaluated by medical record review method, and relevant data were recorded in a case record form. Statistical evaluation by chi-square method and odds ratio (OR) was carried out to appraise the incidence of NOD in patients taking antihypertensive medications. Results: A total of 1250 patients with HTN were screened, and based on inclusion and exclusion criteria, 952 patients were enrolled in the study; among which, 537 were patients with HTN and 415 were patients with diabetic HTN. The majority of the patients with HTN and patients with diabetic HTN were from the age-group of above 60 years. The most commonly prescribed drugs observed in our study population were amlodipine in 94 (22.7%) patients. OR was calculated and it was observed that the combination therapy has a fivefold risk for the development of NOD in patients with HTN, followed by Angiotensin II receptor blockers (2.06) (confidence interval [CI]: 1.56-2.73), diuretics (1.33) (CI: 0.95-1.85), non-Dihydropyridine calcium channel blockers (DHP CCBs) (1.3) (CI: 0.51-3.30), vasodilators (1.13) (CI: 0.40-3.15), and Angiotensin converting enzyme inhibitors (1.06) (0.68-1.64). Conclusion: Patients on non-DHP CCBs, diuretics, and combination antihypertensives showed more chances of developing NOD. [ABSTRACT FROM AUTHOR]