Management Practices in Hypertension : Results of WIN-OVER — A Pan India Registry.

Hypertension is a common disease seen in clinical practice and is associated with high morbidity and mortality. Many patients require combination therapy for the management of hypertension. Objective: To evaluate co-morbidities, risk factors and management practices of hypertension in Indian population. Material and methods: A total of 1596 hypertensive adult patients received antihypertensive medications were studied in a cross-sectional, multi-centric, non-interventional, observational registry. Statistical analysis: Categories or nominal data was expressed as numbers with percentages. Continuous variables were analyzed by descriptive statistics using mean, SD, and range Chi square test was used for in between group comparison. Results: The study included 73.50% males and 26.50% females. Overweight (50.50%) and obesity (30.01%) was common in the hypertensive patients (n=903). A total of 54.76% patients had history of smoking. Alcohol use (33.08%), sedentary life style (32.96%) and history of tobacco chewing (17.92%) were the other lifestyle habits of hypertensive patients. Diabetes (36.03%) and dyslipidemia (39.79%) history was common in these patients. Family history of hypertension and diabetes was seen in 82.21% and 45.99% patients respectively. Most (89.16%) patients were treated with combination of antihypertensive agents. ARBs were the by far most commonly used agents (91.98%) followed by calcium channel blockers (68.23%) and diuretics (60.21%). ARB was the most (80.35%) preferred agent as monotherapy. ARB was also the most common agent as a component of dual therapy, four drug and five drug combinations. Conclusion: Most of the hypertensive patients need combination treatment with antihypertensive agents. ARBs are the most preferred agents as monotherapy for the management of hypertension. ARBs are also very commonly used as a component of combination therapy during hypertension management.

Practice of Indian Physicians Towards Use of Calcium Channel Blockers in the Management of Hypertension : A Paper Based Questionnaire Survey.

Hypertension is a prevalent condition. Improving blood pressure control would depend on understanding concerns and limitations of physicians. Objective: Understanding practice of calcium channel blockers use among physicians. Material and methods: A cross-sectional, observational paper based questionnaire survey among 218 Indian physicians. Results: According to 55.83% of physicians (n=218), prevalence of hypertension ranges between 21-40%. Sixty percent physicians get referred cases mostly from the general physicians (69.48%). More than 20% patients have concomitant illness according to 33.81% physicians, most common being diabetes (33.44%).According to 96.30% physicians, due to asymptomatic nature, hypertension remains undiagnosed, untreated and uncontrolled. Stress (32.35%), obesity (23.13%), physical inactivity (22.78%) and smoking (20.52%) are responsible for sympathetic over activity. Calcium channel blockers (CCBs) (37.19%), beta blockers (30.43%), angiotensin receptor blocker (ARB) (12.14%) and angiotensin converting enzyme (ACE) inhibitors (4.02%) are used as first choice in patients with sympathetic over activity. Ischemic event, stroke, heart failure and renal failure occur due to ignoring sympathetic over activity according to 30.91%, 25.39%, 20.97% and 22.30% physicians respectively. According to 51.63% of physicians, patient compliance to antihypertensive therapy is > 70%. Lack of awareness (40.5%) and dosage frequency (24%) are two most common reasons for noncompliance. According to 89.72% of physicians, the current CCBs primarily inhibit L-type calcium channels but cause sympathetic over activity. A total of 48.34% physicians, >10% patients complain of pedal edema with amlodipine. In physicians opinion, blockage of L and N type of calcium channels (56.47%), unique mode of action (11.76%), arteriolar and venous dilation (9.41%) and inhibition of reninangiotensin- aldosterone (RAS) system (7.06%) are responsible for less pedal edema with cilnidipine. A total of 98.7% and 99.54% physicians rated efficacy and safety of cilnidipine as “good-very good” compared to other CCB respectively. Conclusion: In hypertension, sympathetic over activity may cause many complications. As per the physicians opinion survey, cilnidipine because of its unique mechanism of action offers multiple benefits in hypertensive patients and can be preferred over amlodipine.

An Observational Study of Essentiale-L in the Treatment of Patients with Fatty Liver Disease.

Background: The most common forms of liver disease are alcoholic fatty liver disease and nonalcoholic fatty liver disease (NAFLD), which lead to cirrhosis, liver failure and death. Essential phospholipids play an important role in the management of these conditions. Polyenephosphatidylcholine (PPC) is a major active ingredient in essential phospholipids. It has a high bioavailability and affinity for cellular and subcellular membranes, and helps to maintain membrane fluidity and function. Essentiale-L comprises of PPC, which is a mixture of 94-96% of polyunsaturated phosphatidylcholine. It is prescribed in the management of viral hepatitis and fatty liver disease. Objective: There are only few recent clinical studies conducted in India regarding the role of Essentiale-L in the management of fatty liver disease therefore, we undertook this openlabel, nonrandomized, real clinical practice study, on adult patients diagnosed with fatty liver disease including NAFLD as well as alcoholic fatty liver disease (AFLD). Methods: All adult patients satisfying the inclusion and exclusion criteria were included in the study. Patients diagnosed with fatty liver disease including NAFLD as well as AFLD were treated for 90 days with Essentiale-L two capsules thrice-daily. Vital signs, adverse effects and laboratory evaluations (liver function tests, lipid profile and fasting blood glucose tests) were recorded at baseline (Day 0), Day 7, Day 21, Day 30, Day 60 and Day 90. Results: Essentiale-L showed a consistent improvement in both clinical as well as laboratory parameters in patients with fatty liver disease. The decrease in the liver enzyme levels from baseline was significant at Days 60 and 90 (p < 0.05). However, the decrease in serum total cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels was significant only at Day 90 (p < 0.05). The change in fasting blood glucose levels from baseline were not significant. Conclusion: Essentiale-L is a safe and effective option in patients with fatty liver disease. It can be safely recommended in patients with type 2 diabetes along with fatty liver disease since it did not alter the blood glucose levels significantly.