A study of atenolol and nebivolol in prehypertension.

Background: Patients with prehypertension have an increased risk of cardiovascular disease. The coexistence of prehypertension with risk factors increases cardiovascular morbidity and mortality. That’s why it is important to treat pre-hypertensive patients having risk factors. The objective was to evaluate the effect of atenolol and nebivolol in pre-hypertensive patients. Methods: Pre-hypertensive patients having risk factors were selected, and non-pharmacological therapy was advised to all patients. Those patients who were not able to follow strictly non-pharmacological guidelines and remained pre-hypertensive were included in this study. Pre-hypertensive patients were divided into three groups. One group received atenolol 50 mg orally, once daily. Second group received nebivolol 5 mg orally, once daily. Third group received placebo orally, once daily. All groups received treatment for 1 month. Results: In the nebivolol group after 1 month of study, the mean reduction in systolic blood pressure (SBP) was 134.2±3.07-118.26±4.66 and mean reduction in diastolic BP (DBP) was 87.13±1.87-80.73±1.99. Reduction in SBP and DBP in the nebivolol group was significant (p≤0.0001). In the placebo, and atenolol group results were not significant. Conclusion: Nebivolol produces a significant reduction in SBP and DBP in pre-hypertensive patients. Atenolol and placebo did not show beneficial results.

Studies on the prescriptions of cardio vascular units.

Cardiovascular diseases (CVDs) are the major contributors to the global burden of chronic diseases. In India CVD is projected to be the largest cause of death and disability by 2020. Hypertension is the commonest CVD affecting at least 20% of adult population. It is one of the major chronic diseases resulting in high mortality and morbidity in today’s world. The prevalence of CVD in the state of Kerala was found in the cross section of the society by the research group in an earlier study on prevalence of hypertension. A plethora of new drugs are now available and the quality of life for these patients has considerably improved. In the present investigation, the prescribing attitude of various physicians was reviewed carefully. The available medical records and the prescriptions of the Cardiology unit were reviewed to study the prescribing pattern and drug therapy for CVD. The various aspects studied were; the diagnosis and preliminary investigations conducted for the patients, Mean Systolic Blood Pressure (SBP), Mean Diastolic Blood Pressure (DBP), the investigation reports of lipid profiles, Mean Total Cholesterol and Mean HDL Cholesterol levels, advises made with regard to other investigations like ECG, TMT, Echo etc and type of drugs prescribed including cases of combination therapy in first visit and subsequent revisits. Prevalence of diabetes was also studied in CVD patients. The prescribing pattern for hypertension reveals that single drug therapy was mostly preferred. The most commonly preferred and prescribed drugs (MCPP) were Amlodipine, Atenolol, and Losartan Potassium etc. However combination therapy (CT) was also observed. The most commonly preferred and prescribed combinations were Atenolol+Amlodipine, Enalapril+Hydrochlorothiazide, Frusemide+Spironolactone. The various classes of drugs include ACE inhibitors, Beta-Blockers, Nitrates, and Diuretics etc. Aspirin was prescribed for 40 to 50% of patients. Despite the proven benefits of Aspirin therapy in the primary and secondary prevention of CVD, the prescribing pattern still remains little suboptimal. The Biochemical investigation reports of the lipid profile reveal that a considerable number of patients were found to have dislipidemia. Statins and Fibrates were mostly prescribed for lowering low density Lipoprotein Cholesterol (LDL-C) and improving High density Lipoprotein Cholesterol (HDL-C) levels. The study reveals that there is a considerable extent of CVD risk factors in the studied cross section of the community.