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Cardiovascular diseases (CVDs) are responsible for 17.5 million deaths globally, and India is more susceptible to coronary artery disease (CAD) than its western counterparts because of certain challenges such as suboptimal management, increased healthcare costs, and physicians undermining the extent of limitation in angina patients. All of these could be resolved by employing strategies starting with accurate diagnosis to timely implementation of aggressive management techniques to contain morbidity and mortality. Pan India, experts from the field of cardiology came together in order to discuss risk stratification and aggressive management of chronic coronary syndromes (CCS). The expert consensus laid down a path of recommendations considering the prevailing healthcare service infrastructure, local evidence-based studies and key international guidelines. With the wide diversity in terms of geographical distribution in India and the risk factors presented across various divisions of the population, risk stratification is necessary for prompt identification and subsequent management of CCS. In this consensus, various risk stratification techniques such as risk stratification based on ventricular function, electrocardiogram (ECG), stress echocardiography (ECHO), the Duke treadmill score (DTS), and myocardial perfusion imaging (MPI) were discussed. After risk stratification, the consensus focused on aggressive management of CVDs with therapeutic optimization for various types of patient profiles such as revascularization for stable angina and angina with comorbidities (diabetes and renal failure), apart from emphasis on various medications and their roles in ameliorating disease symptoms.

Atrial fibrillation (AF) is considered as one of the most common cardiac arrhythmias worldwide and is always associated with a significantly increased risk of stroke and thromboembolism. VKAs (Warfarin & Acenocoumarol) are highly effective in reducing the risk of stroke in patients with AF, but bleeding issues & disutility sparked the development of direct oral anticoagulants (DOACs) or NOACs (Novel oral anticoagulants). These drugs, offer the convenience of once or twice daily dosing without the need for laboratory monitoring of coagulation activity (PT/ INR) or routine dose adjustment. Various clinical trials proved their non-inferiority to warfarin (VKA) in reducing the risk of stroke or systemic embolism, and each was associated with markedly lower rates of ICH than well-adjusted warfarin. Yet there are no direct head-to-head comparative trials for the efficacy & safety of NOACs. In this review we try to provide patient centric approach to assist Indian physicians in selecting right OAC therapy for SPAF with respect to best possible evidence and recommendations available worldwide.

Ayurved advocates that drug should be collected with proper classical methods. In Ayurvedic texts, specific time, season and procedures or methods have been highlighted for getting better potency, efficacy and therapeutic properties of drug by describing the standard methods of drug collection and preservation in details. Now a day, due to lack of proper traditional knowledge and time very few people bother to follow all these methods of collection given by Acharya. Hence, the potency of medicines is of question. Aragvadha (Cassia fistula Linn.) has been popular as a common drug of choice treatment since ancient time. Classic text like Charaka Samhita has quoted the classical and particular method for the collection and preservation of Aragvadha Phalamajja (Cassia fistula Linn.). Acharya Charaka has quoted this collection method of Aragvadha Phalamajja(Cassia fistula Linn.)as follows- The good qualities of collected pods should be kept covered in river bed sand for seven days. After seven days these pods should be removed and kept in sunlight for some time. And thereafter, fruit pulp (phalamajja) should be extracted and stored in a clean vessel. Therefore, study of classically collected Aragvadha Phalamajja (Cassia fistula Linn.) and Market sample of Aragvadha Phalamajja (Cassia fistula Linn.) was carried out.

Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.

Introduction The renoprotective effects of dihydropyridine calcium channel blockers (CCBs) have been established as non-inferior to other classes of antihypertensive drugs. Studying their effect on renal outcome parameters, specifically for amlodipine as monotherapy, in real-world settings can further help in expanding its usage among Indian patients. This study was performed to assess the effects of amlodipine and other dihydropyridine CCBs (cilnidipine, benidipine and azelnidipine) on renal parameters and effectiveness in blood pressure reduction in Indian patients. Methods The retrospective data of adult patients (> 18 years) with essential hypertensive who were prescribed amlodipine (n = 92), cilnidipine (n = 91), benidipine (n = 70) or azelnidipine (n = 71) as monotherapy were analyzed. The renal outcomes, serum creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), microalbumin, urine albumin-to-creatinine ratio (UACR), sodium and potassium levels, and mean changes in BP were analyzed from baseline to 12 months. Appropriate statistical methods were used to determine the significance (p value 0.05). No significant changes were observed in BUN, sodium or potassium levels. Overall, for all CCBs, the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were reduced from baseline to the end of the study (p = 0.002). At the end of the study, the average dose of amlodipine was 7.25 mg, and the average reduction in SBP and DBP per mg dose was 1.54 and 0.57 mmHg. The corresponding numbers for the other CCBs were as follows: cilnidipine, 14.28 mg, 0.26 and 0.01; benidipine, 5.71 mg, 0.41 and 0.11; azelnidipine, 15.88 mg, 0.13 and 0.06. Conclusion Amlodipine and other CCBs demonstrated good efficacy and similar effects on renal parameters from baseline to end of study. Amlodipine also showed higher potency by demonstrating greater BP reduction at a lower dose. Thus, amlodipine can remain a preferred choice among CCBs, even with the advent of the newer CCBs. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-021-00224-8.

Aim Ensuring adherence to guideline-directed medical therapy (GDMT) is an effective strategy to reduce mortality and readmission rates for heart failure (HF). Use of a checklist is one of the best tools to ensure GDMT. The aim was to develop a consensus document with a robust checklist for stabilized acute decompensated HF patients with reduced ejection fraction. While there are multiple checklists available, an India-specific checklist that is easy to fill and validated by regional and national subject matter experts (SMEs) is required. Methodology A total of 25 Cardiology SMEs who consented to participate from India discussed data from literature, current evidence, international guidelines and practical experiences in two national and four regional meetings. Results Recommendations included HF management, treatment optimization, and patient education. The checklist should be filled at four time points- (a) transition from intensive care unit to ward, (b) at discharge, (c) 1st follow-up and (d) subsequent follow-up. The checklist is the responsibility of the consultant or the treating physician which can be delegated to a junior resident or a trained HF nurse. Conclusion This checklist will ensure GDMT, simplify transition of care and can be used by all doctors across India. Institutions, associations, and societies should recommend this checklist for adaptability in public and private hospital. Hospital administrations should roll out policy for adoption of checklist by ensuring patient files have the checklist at the time of discharge and encourage practice of filling it diligently during follow-up visits.

The prevalence of hypertension in the young adult population is rising in India. Increased arterial stiffness due to RAAS activation and increased sympathetic overactivity due to stress have been implicated as primary factors for the same. This study was aimed to understand the Indian clinician's perspective on approach to management of hypertension in young adults.A cross sectional observational survey using a structured questionnaire was conducted online with 2287clinicians (cardiologists, diabetologists, consultant physicians and family physicians).The prevalence of hypertension was 10-30% as per opinion of 64.8% clinicians. The top three risk factors for hypertension in young were perceived to be smoking, mental stress and obesity. Around 57.4% respondents opined that both increased heart rate and systolic blood pressure were markers of sympathetic overactivity. More than 60% respondents across specialities preferred ARBs to treat hypertension in young adults. Amongst the ARBs, telmisartan was the preferred ARB bygt;80% respondents. Metoprolol was the preferred beta blocker by almost 64% respondents. The objective of selection of beta-blocker by majority of clinicians due to sympathetic overactivity. Telmisartan and Metoprolol single pill combination achieved the BP goal in 40-60% of patients as reported by 41.3% of the physicians. The combination therapy was well tolerated in young hypertensive patients.Initiation of an early and appropriate antihypertensive treatment in young population may lower the burden of cardiovascular disease in this population. ARBs and beta -blockers were the preferred class of anti-hypertensive drugs in the cohort of young hypertensive patients .

A rising burden of coronary artery disease (CAD) in India is a major cause of concern, with angina being the leading manifestation. Hence a questionnaire to sensitize the clinicians about stable angina management and to assist in risk stratification is imperative.To evaluate the content and face validity of a modified questionnaire adapted from the 7-item Seattle Angina Questionnaire (SAQ).A panel of six experts in the field of evidence-based practice reviewed and rated the modified instrument for content clarity and relevance based on the 4-point ordinal scale. Face validity was assessed based on the trichotomous rating of "disagreed", "agree" or "neutral". Items on which ≥75% of patients "disagreed" were subjected to further review and revision.A total of six experts and 51 patients participated in the content and face validity, respectively. As no question received a score ≤2 by two or more experts for either content clarity or relevance, no modification in the questionnaire was required post content validation. During face validation, all patients agreed that the questions correctly measured the specific area of cardiovascular health status and response options correctly captured the answers provided. Demographic and baseline data of the patients were collected.The newly developed 5-item questionnaire demonstrated content and face validity, suggesting it to be a potential instrument to improve management decision and care of angina patients in India.

The concept of SGLT2-inhibition, once regarded as a non-physiological approach to glycemia control, now finds a foundational relevance in risk-modification for cardiovascular, kidney, and metabolic outcomes, spanning beyond type-2 diabetes. Major studies have proven meaningful improvements in various clinical outcomes, with different SGLT2-i agents. Apart from glycosuria, SGLT2-inhibition is associated with several patho-physiological effects, which may contribute to the clinical benefits seen with these agents. This narrative review is an attempt to appraise the different patho-physiological effects mediated by SGLT2-inhibition, based on contemporary evidence. The review classifies these effects in the acronym of EUPHORIA, and grades the possible relevance of each effect, in improving clinical outcomes.

Introduction: Selective beta-1 blockers (s-BBs) are used in the management of hypertension (HT) in specific subsets. Studies comparing the potency of blood pressure (BP) lowering with different s-BBs are sparse. The objective of this meta-analysis was to evaluate the efficacy of bisoprolol compared to other s-BBs (Atenolol, Betaxolol, Esmolol, Acebutolol, Metoprolol, Nebivolol) in HT patients by examining their effect on BP, heart rate (HR) and metabolic derangements, by examining the evidences reported in observational studies. Methods: Electronic databases like PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov, Surveillance, Epidemiology and End Results Program and 12 PV databases were systematically searched from inception to October 2019. Observational studies that compared bisoprolol with other s-BBs in patients with HT were evaluated in accordance with the PRISMA guidelines. Pooled data were calculated using random-effects model for meta-analysis in terms of mean difference (MD) and 95% confidence interval (95% CI) for each outcome. Outcomes of interest were BP, HR and lipid profile. Results: Four observational studies which compared bisoprolol with other s-BBs (nebivolol and atenolol) were included in this meta-analysis. Significant reduction was observed in office diastolic BP [MD: -1.70; 95% CI: -2.68,-0.72; P P P P P P Conclusion: Our results suggests that bisoprolol is superior to other s-BBs in reducing BP and HR. Bisoprolol also had a favourable effect on lipid profile shown by increase in HDL cholesterol. This meta-analysis emphasizes the efficacy of bisoprolol over other s-BBs, which aids clinical decision making in treatment of patients with HT.

Background: This is the first detailed Indian electronic medical record (EMR)-based real-world observational study to understand the clinical characteristics, associated comorbidities/risk factors and treatment(s) of CAD patients across India.Methods: EMR data of adult Indians (aged ≥ 18 years) diagnosed with CAD was retrospectively analyzed.Results: The majority of the participants had stable IHD (93%), were men (68.5% in ACS, 59.8% in stable IHD), most common age group was 40-64 years in ACS (56.6%) and stable IHD (51.4%). Both are common in metros (ACS 52%, 62% stable IHD). There is a high frequency of hypertension (38.2% in ACS, 59% in stable IHD) and diabetes mellitus (32.3% in ACS, 57.6% in stable IHD). Most common treatments are antiplatelet drugs and lipid-lowering drugs (96%).Conclusions: In India, stable IHD is the most prevalent form in vast majority of patients. The patients with CAD are mostly males, are mainly located in metros and majority fall between the age group of 40-64. The major comorbidities are hypertension and diabetes mellitus. Sociodemographic and clinical characteristics for CAD in India may not be similar to what is reported from the west. There is a significant difference in drug usage and adherence to guidelines in India for CAD.

Cor triatriatum sinister is a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atria into 2 chambers. It is even rarer when present at an adult age. Symptoms and presentation of the patient depend on the size of the opening into the membrane through which 2 chambers of left atrium communicate with each other. Cor triatriatum sinister rarely remains asymptomatic till adulthood. In adults symptoms of Cor triatriatum sinister mimic the symptoms of mitral stenosis. Corrective surgery is the choice of treatment, but when it present as an emergency case especially at an early age, balloon dilatation of the membrane opening is done. Elective balloon dilatation of membrane opening at an early age diagnosed with Cor triatriatum sinister followed by corrective surgery at an adult age can be a safer option compared to direct corrective surgery at an early age. We present a case of a 25-year-old female who was diagnosed first time at this age as cor triatriatum sinister and treated successfully with corrective surgery.

Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Cough is one of the common adverse effects in patients receiving angiotensin-converting enzyme inhibitors (ACEIs). This review presents the current evidence on incidence and mechanisms of cough associated with ACEIs use, and proposes a practical approach for managing the same for optimal cardiovascular (CV) risk reduction. The incidence of dry cough in patients receiving ACEIs vary among individual ACEIs, and is the lowest with perindopril. Cough is thought to originate from multiple mechanisms, bradykinin theory is the most commonly appealed hypothesis. The strategies for optimal management could be temporarily discontinuation of ACEI upon a reported incidence of cough and reintroduction after its remission. However, studies have reported disappearance of cough despite continuing treatment. Another important approach could be adding calcium channel blockers to ACEIs. Switching to alternative drugs such as angiotensin receptor blockers should be suggested in case intolerable symptoms recur and after exclusion of all other possible causes of cough.

Background: Hypertension is the leading cause for the ever-increasing burden of mortality due to stroke and cardiovascular diseases (CVD). Treatments are complicated due to comorbidities and can lead to patient noncompliance. Patients with low existing cardiovascular risk are prone to have higher lifetime cardiovascular risk, which timely assessment necessary.Methods: A digital cross-sectional survey questionnaire about knowledge, attitude and practice habits regarding cardiovascular risk assessment was administered to 400 physicians and cardiologists across India. The questionnaire assessed various topics such as practice of hypertension diagnosis and treatment based on guidelines, cardiovascular risk calculators, occurrence of comorbidities and patient awareness on cardiovascular risk prevention.Results: Out of the 400 physicians, 398 completed the survey. About 52% physicians considered presence of multiple risk factors as vital for having cardiovascular risk. American college of cardiology/American heart association (ACC/AHA) calculator was preferred by 51.6% study participants. Cardiovascular risk estimation was vital for treatment-related decision-making according to 71% participants, while only 7.7% participants calculated cardiovascular risk in >90% of their patients. Approximately 44% survey participants calculated cardiovascular risk in hypertensive patients with 2 additional risk factors, while 5.6% calculated it in >70% hypertensive patients without comorbidities. About 46.6% participants reported that 30%-50% of their patients were on fixed-dose combinations of two antihypertensive medications.Conclusions: Findings from the study indicate predisposition of medical professionals towards having a risk assessment tool designed for the Indian population to timely assess and forestall long-term effects of cardiovascular risk in hypertensive patients.

Morning blood pressure surge (MBPS) is a part of diurnal blood pressure (BP) variability. It has been correlated with increased cardiovascular (CV) risk. An increase in BP after waking is a physiological phenomenon; however, a marked and rapid MBPS is associated with increased CV risk. There is mounting evidence suggesting significant associations between MBPS and cardiac, cerebral, renal, and vascular damage. The difference between BP readings 2 h after rising and the average of all readings during sleep can be the most reliable approach for assessing the MBPS. There is no consensus over the definition, pathophysiological mechanisms, and treatment strategy of MBPS. There is a need for better understanding of this phenomenon. This Chapter discusses up-to-date data on MBPS with special emphasis on its definition, etiology, clinical outcomes, diagnostic evaluation, and treatment strategy. Home BP monitoring can be a useful tool in the assessment of MBPS. Control of morning hypertension can be considered as a cornerstone in 24-h BP control. Specific treatment for controlling morning hypertension includes the selection of a specific class of antihypertensive drugs, such as inhibitors of sympathetic activity or the renin angiotensin system and appropriate timing of dosing. Exaggerated MBPS can be treated with long-acting drugs, with the bedtime administration. Control of the MBPS would lead to effective CV protection in patients with hypertension.

Background: Azilsartan, a potent angiotensin type 1 receptor blocker (ARB) has limited data on the efficacy and safety in hypertensive subjects in India. Methods: Retrospective audit based on data from the prescribing physicians on efficacy of Azilsartan monotherapy or in combination with other antihypertensive drugs. Office blood pressure (BP) measurement prior to initiation of Azilsartan, at 1 st and 2nd follow-up visits were recorded. Two-tailed paired t -test and nonparametric Wilcoxon signed-rank test were used for statistical analysis. Results: Data of 1397 patients was collected of which 844 patient were eligible for analysis at baseline. Mean age was 54.7 years. Azilsartan was started as monotherapy in 64.6% patients and as an add-on to antihypertensive therapy in 35.4% patients. Significant reduction of 19.6 mm Hg in mean Systolic BP (baseline: 162.6 + 15.6 mm Hg to visit 1: 143 + 13.7 mm Hg, p+ 15.6 mm Hg to visit 2: 132.4 + 10.7, p+ 10 mmHg to visit 1 at mean day 36 : 86.2 + 7.1 p+ 10 mmHg to visit 2 at mean day 71: 81.9 + 5.7 p Conclusion: Azilsartan alone or with other antihypertensive drugs significantly reduced BP in Indian hypertensive patients in a real world setting. Azilsartan was well tolerated without any major or serious adverse events.

This real-world, observational, prescription event monitoring study was conducted to evaluate safety and efficacy of indigenous tenecteplase (TNK-tPA) in Indian patients presenting with ST elevation myocardial infarction (STEMI).This is a multi-centric, observational, prescription event monitoring study. Data was collected for 7,668 patients from 1,307 investigator sites across India from January 2011 to February 2016.Overall, 76.71% patients were hypertensive, 47.97% patients were diabetic, 42.01% had dyslipidemia, 24.35% had ischemic heart disease and 40.82% patients were smokers. The overall rate for achieving clinically successful thrombolysis by TNK was 93.34%. Delayed administration of tenecteplase yielded lower success rate (84.66%) as against those patients who received tenecteplase within 3 hours of symptoms (94.34%). 93.2% patients had chest pain resolution after pharmacological fibrinolysis. Overall 91.1% patients had 50% resolution of ST elevation at 90 minutes and mean time for 50% ST resolution was 72.06 minutes. Overall 53 patients died (mortality of 0.69%) before discharge. The incidence of bleeding (excluding stroke) was 1.77%, any stroke without ICH was 0.18% and any ICH was 0.38%.The findings of this study further reinforce the safety and efficacy of indigenous TNK-tPA in Indian patients presenting with STEMI, including high-risk sub-groups. The study also highlights the importance of early reperfusion therapy.

Background Current international guidelines on dyslipidemia are not concordant on various aspects of management. Also, there are no uniformly accepted Indian guidelines. We, therefore, performed a physician survey to understand lipid management practices in India. Methods An anonymous survey questionnaire was administered to gauge physicians’ self-reported behavior regarding lipid management aspects. Results were expressed in terms of percentages based on the number of responses obtained. Results A total of 404 physicians participated in the survey. Eighty-eight percent respondents ordered a lipid profile before starting statin therapy, and 80% preferred to set lipid targets, though the tools used for calculating cardiovascular risk varied. Atorvastatin was preferred over rosuvastatin in primary prevention (72.9 vs. 32.4%), secondary prevention (54.6 vs. 46.7%), diabetic patients (56.3 vs. 40.3%) and post-ACS (78.3 vs. 34%). High-intensity statins were preferred by 73.7% of respondents in post-ACS cases. Fifty percent doctors chose not to use a statin in diabetic patients, irrespective of their LDL-C levels. The most preferred drug option for managing atherogenic dyslipidemia and moderate hypertriglyceridemia was statin-fibrate combination (55.1%) and fibrates (35.4%), respectively. Sixty-three percent doctors preferred to prescribe statins in patients with moderately high LDL-C and normal triglycerides, without CHD or CHD risk equivalents. Around 28% of doctors preferred not to use pharmacotherapy for managing isolated low HDL. Of the participants, 73% used fibrates in ≤20% of their dyslipidemic patients, with fenofibrate being the most preferred (90.5%). Ezetimibe was mainly used in patients with uncontrolled LDL-C despite statin therapy (52.4% respondents). Most preferred approaches to manage statin intolerance included reducing statin dose (39%) and stopping and restarting statins at a lower dose (34.5%). Fifty-two percent of doctors chose not to alter pre-existing therapy in patients who had LDL-C levels at goal but elevated non-HDL-C levels. Conclusion This is the first survey in India that provides useful insights into Indian physicians’ self-reported perspectives on managing dyslipidemia in routine clinical practice. Despite concordance with the currently available guidelines in certain aspects, there is incongruence in managing specific dyslipidemia problems. Further continuing medical education and the development of evidence-based, India-specific lipid guidelines can help reduce some of these differences. Electronic supplementary material The online version of this article (doi:10.1186/s12944-017-0519-1) contains supplementary material, which is available to authorized users.

Objective Despite antihypertensive treatment, most hypertensive patients still have high blood pressure (BP), notably high systolic blood pressure (SBP). The EFFICIENT study examines the efficacy and acceptability of a single-pill combination of sustained-release (SR) indapamide, a thiazide-like diuretic, and amlodipine, a calcium channel blocker (CCB), in the management of hypertension. Methods Patients who were previously uncontrolled on CCB monotherapy (BP≥140/90 mm Hg) or were previously untreated with grade 2 or 3 essential hypertension (BP≥160/100 mm Hg) received a single-pill combination tablet containing indapamide SR 1.5 mg and amlodipine 5 mg daily for 45 days, in this multicenter prospective phase 4 study. The primary outcome was mean change in BP from baseline; percentage of patients achieving BP control (BP

Objective: To study the efficacy and safety of single intravenous bolus administration of indigenously developed tenecteplase (TNK-tPA) in the management of patients with ST-elevation myocardial infarction (STEMI) in clinical practice. Methods: Observational, prescription-event monitoring study. Results: Data of 15,222 patients who had STEMI and received weight adjusted TNK injection was analyzed. Overall 95.43% patients had clinically successful thrombolysis (CST). In the different subgroups, hypertensives, diabetics, smokers and hyperlipidemic patients had CST rates comparable to the general patient data. CST rates were significantly lower in the elderly patients (>70 years; 92.11%; p 6 h after onset of chest pain; 85.38%; p 70 years, diabetes, hyperlipidemia and history of IHD were associated with a higher incidence of heart failure, myocardial re-infarction or ventricular tachyarrhythmias. However, incidence of ICH and bleeding other than ICH was comparable amongst all patient subgroups. Conclusion: This study confirms the safety and efficacy of indigenous tenecteplase in Indian patients with STEMI, including high risk subgroups. It also highlights the fact that delayed treatment denotes denial of benefits of pharmacologic reperfusion therapy.

target designed trials was compared in monotherapy and combination arms. (Mean mg SEM of azilsartan monotherapy 57 9, Mean mg SEM of azilsartan combination 70 10; p1⁄40.45). Study designs include multicentric, randomised, cross over, open label, parallel group, non-inferiority trials. 11 trials utilised ABPM parameters for evaluation. The no. of RCCTs with monotherapy comparator arms include amlodipine (1), chlorthaildone (2), ramipril (1), valsartan (3), candesartan (3). Azilsartan at its maximal and most effective dosages has superior efficacy to the monotherapy comparator arms, improved sleep trough surge and prewaking surge to a greater extent than candesartan. Combination with diuretics resulted in greater reduction of clinic sBP for chlorthalidone (-35.1 mm Hg) Vs hydrochlorothiazide combination (-29.5 mm Hg). Overall, in a titrate to target approach azilsartan demonstrates long term safety and stable BP improvements Conclusions: Contemporary evidence based perspectives across the published RCCTs reflect that azilsartan provides a 24 hour potent and sustained antihypertensive effect, which may play a role in its superior blood pressure lowering efficacy, in grade I-II essential hypertension compared with other drugs, including ramipril, candesartan, valsartan or olmesartan, without an increase of side effects. The fixed-dose combination of azilsartan and chlorthalidone is demonstrated to be more effective than other potent combinations of ARBs plus hydrochlorothiazide, with a good tolerability profile.

Background: Efficacy of Fixed-dose combination of olmesartan and amlodipine on central aortic pressure and Aortic pulse wave velocity (PWV), which are independent predictors of adverse cardiovascular events in hypertension is lacking. Aim of this study was to correlate the effects of fixed-dose combination therapy with olmesartan 20mg and amlodipine 5mg on central aortic blood pressure (CBP) indices in mild to moderate hypertensive subjects with controlled office BP. Methods: Twenty seven patients with brachial systolic BP 140 mmHg and/or diastolic BP 90 mmHg on three office readings who received fixed-dose combination therapy with olmesartan 20mg and amlodipine 5mg for atleast 12 weeks were included. CBP was measured with Periscope using standard cuff BP measurements and proprietary software utilizing a validated transfer function to convert the brachial waveform. Statistical analysis was done with SPSS version 10. Results: Average age of the study group was 47 years. Carotid femoral pulse wave velocity was 1210.2 454.5 cm/sec. Average brachial SBP, DBP and pulse pressure (PP) at the end of the study was 138.8 11.5, 75.9 9.6 and 62.1 12.8 mm of Hg. Average aortic SBP, DBP and pulse pressure (PP) at the end of the study was 121.5 13.8, 75.6 6.0 and 45.4 12.3 mm of Hg. Aortic augmentation pressure and aortic augmentation index noted were 13.7 9.1 mm of Hg and 28.1 10.7 respectively. A significant positive correlation was noted between brachial SBP and aortic SBP (r1⁄40.603, p < 0.001), brachial DBP and aortic DBP (r1⁄40.775, p < 0.001), brachial PP and aortic PP (r1⁄40.622, p

Current clinical guidelines recognize that the use of more than one agent is necessary to achieve target BP in the majority of patients. The ASCOT-BPLA trial demonstrated that the free combination of amlodipine and perindopril effectively controlled BP and was better than a beta-adrenoceptor antagonist (beta-blocker)/diuretic combination in reducing total mortality and cardiovascular outcomes.To evaluate the efficacy and tolerability of a fixed combination of perindopril and amlodipine in the clinical setting.The STRONG (SafeTyefficacy analysis of coveRsyl amlodipine in uncOntrolled and Newly diaGnosed hypertension) study was a prospective, observational, multicenter trial.This was a naturalistic, real-world, clinic-based, outpatient study involving 336 general practitioners/primary care physicians in 65 cities in India.Adults aged 40-70 years with newly diagnosed/untreated stage 2 hypertension (BP/=160/100 mmHg), hypertension uncontrolled with monotherapy (BP140/90 mmHg), or hypertension inadequately managed with another combination therapy.Fixed combination perindopril 4 mg/amlodipine 5 mg once daily for 60 days.The primary outcomes were the mean change in BP from baseline and the proportion of patients achieving adequate BP control (/=140/90 mmHg, or/=130/80 mmHg in patients with diabetes mellitus) in the intent-to-treat (ITT) population. Secondary analyses included incidence of adverse events (ITT) and treatment adherence rate (completers).In total, 1250 patients comprised the ITT population: 32.6% with newly diagnosed hypertension; 40.5% with hypertension uncontrolled with monotherapy; and 26.9% with hypertension inadequately managed with another combination therapy. Mean SBP/DBP decreased significantly from baseline (167.4 +/- 15.2/101.4 +/- 9.1 mmHg) over 60 days (-41.9 +/- 34.8/-23.2 +/- 21.8 mmHg; p0.0001). Target BP was achieved in 66.1% of patients in the total population, 68.3% of untreated patients, 68.4% of patients uncontrolled with monotherapy, and 59.9% of patients inadequately managed with combination therapy. In 161 patients with SBP180 mmHg at baseline (newly diagnosed: n = 50; uncontrolled on monotherapy: n = 53; inadequately managed on combination therapy: n = 58), BP was reduced by 63.2 +/- 32.5/29.0 +/- 21.9 mmHg (p0.0001) at day 60. The fixed combination was safe and well tolerated. All 1175 patients completing the 60-day study (94%) adhered to their treatment regimen.Fixed combination perindopril/amlodipine was found to be an effective and well tolerated antihypertensive treatment, with an excellent rate of treatment adherence in the clinical setting. Fixed combination perindopril/amlodipine is expected to be useful in the management of hypertension in primary healthcare, with a positive impact on treatment adherence.