Clinical advantages of nebivolol in the treatment of hypertension / 中国药房

β-blocker is one of the commonly used anti-hypertensive drugs， and there are obvious differences in the selection of this class of drugs. Nebivolol is a third-generation β-blocker with a unique mechanism of action. This article summarizes the clinical application of nebivolol in anti-hypertensive treatment in recent years， and it is found that compared with other β-blockers， nebivolol has certain clinical treatment advantages. In addition to having a significant antihypertensive effect， it also has little impact on sexual function and heart rate of patients， and does not affect the blood glucose and lipid metabolism， so the drug is more suitable for some special groups of patients， including sexually active male hypertensive patients， hypertensive patients with complications such as type 2 diabetes mellitus and metabolic syndrome.

Correspondência de teor de dissulfeto de captopril com odor de enxofre em comprimidos de captopril 25 mg, provenientes de farmácias públicas (postos de saúde) e drogarias comerciais / Correspondence of captopril disulfide content with sulfur odor in 25 mg captopril tablets from public pharmacies (health clinics) and commercial drugstores

Introdução: O captopril (CP) é o medicamento de escolha para o tratamento da hipertensão arterial. Sua degradação leva à formação do dímero dissulfeto de captopril (DSCP), este associado a um odor forte no medicamento, podendo causar abandono do tratamento pelo paciente. Objetivo: Determinar DCSP, associar a percepção olfativa de odor de enxofre desprendido do produto e realizar a avaliação de bula de comprimidos de captopril 25 mg distribuídos pelos setores público e privado. Método: Foi verificado o desempenho do método de determinação do CP e DSCP pela Farmacopeia Brasileira 6a ed. por HPLC (DAD). Foram analisados 13 produtos de comprimidos de captopril 25 mg, sendo dois provenientes do setor público de lotes diferentes e mesmo fabricante e 11 do setor privado de diferentes fabricantes e lotes. Foram avaliados aspectos do comprimido quanto à percepção de odor, determinação de peso, identificação e teor de CP e de DSCP e análise do conteúdo da bula. Resultados: Dentre os 13, o medicamento vencido apresentou 4,4% de DSCP, os demais estavam de acordo com a especificação. Verificouse  correspondência do odor de enxofre perceptível com teor de DSCP acima de 0,5%. Considerando os textos de bula sobre odor de enxofre, as constatações foram: nenhuma informação (três produtos), odor característico (dois), leve odor de enxofre (um), leve odor de enxofre sem diminuir a eficácia (sete). Conclusões: As amostras apresentaram resultados satisfatórios para os ensaios realizados. Verificou-se falta de homogeneidade nas informações das bulas sobre o odor dos comprimidos. A percepção do paciente quanto ao odor de enxofre, mesmo dentro do limite tolerado de DSCP, pode levar a não aceitação do medicamento e consequente não adesão ao tratamento da hipertensão, além de gerar prejuízos ao SUS.

Introduction: Captopril (CP) is the drug of choice for the treatment of hypertension. Its degradation leads to the formation of captopril disulfide dimer (DSCP), associated with a strong odor in the drug, which can cause the patient abandonment of treatment. Objective: To determine DCSP, associate the olfactory perception of the sulfur odor given off by the product and carry out the evaluation of the package insert for captopril 25 mg tablets distributed in the public and private sectors. Method: The performance of CP and DSCP determination method of the Brazilian Pharmacopoeia 6 ed was verified by HPLC (DAD). Thirteen products of 25 mg captopril tablets were analyzed, 2 of which came from the public sector from different batches and the same manufacturer: the other 11 came from the private sector from different batches and manufacturers. The samples were analyzed regarding appearance, odor perception, identification, weight determination, CP and DSCP content (by HPLC) and package insert content. Results: Among the 13, the expired drug had 4.4% DSCP; the others were in accordance with the specification. Correspondence of perceptible sulfur odor was established for drugs with DSCP content above 0.5%. Considering the texts on sulfur odor in the package inserts, the findings were: none information (3 products), characteristic odor (2), slight sulfur odor (1), slight sulfur odor without decreasing effectiveness (7). Conclusions: The samples showed satisfactory results for the tests performed. There was a lack of homogeneity in the information in the package inserts about odor of the tablets. The patient's perception of sulfur odor, even within the tolerated limit of DSCP, can lead to non-acceptance of the drug and consequent non- adherence to the treatment of hypertension, in addition to causing damage to the SUS.

Adverse drug reaction risk assessment with prescribed renal risk drugs among hospitalized patients attending a teaching hospital in South India

Background: Renal impairment is the primary cause of mortality and morbid conditions in patients. Inappropriate drug use in patients who are with risk of renal damage causes harmful and deleterious effects. Adjusting doses based on renal function is necessary for renal risk drugs, primarily to avoid adverse reactions of medications. Aim of the present study was to assess the risk of incidence on ADRs with drugs lowering the renal function.Methods: This is a cross-sectional observational study conducted in General Medicine department. 230 Patients constituted the sample in the study. The study was conducted for a period of one year and prescriptions with renal risk drugs were evaluated. Changes in the renal functional tests were compared to the normal range and adverse drug responses were monitored.Results: A total of 230 patients who fulfilled the inclusion criteria were included in the study. The meanage of the study subjects were 50.9±15.2 respectively. 56.39% patients were men and 43.6% were women. Renal risk drugs included in the study are anti-hypertensive, antibiotics, and analgesics. Paracetamol (24.77%) followed by telmisartan (20.85%) are the predominantly prescribed renal risk drugs with high incidence of adverse drug reactions. Causality assessment by Naranjo ADR probability scale showed out of 211 ADRs, 51.6% were possible, 25.59% were doubtful, 21.8% were probable and 0.94% was definite.Conclusions: The current study signifies that patients under high risk of renal damage require continuous monitoring and optimized therapy for better disease management.

Medication adherence and its determinants amongst anti-hypertensive patients in a tertiary care hospital in Navi Mumbai

Background: Anti-hypertensive drugs can effectively control hypertension, subject to good adherence. Uncontrolled hypertension can lead to numerous complications, some even potentially fatal, such as myocardial infarction, atherosclerosis, thromboembolism, shock and stroke.Methods: A cross-sectional prospective study was conducted with the help of a pre-validated questionnaire during the course of 6 months in the medicine outpatient department and the inpatient department (wards) at a tertiary care hospital, Navi Mumbai in 200 hypertensive patients to calculate the correlation of the sociodemographic factors with adherence by the chi-squared test.Results: The overall percentage of adherence to antihypertensive medication was 34.8%. It was the highest (72.1%) in the younger age group, i.e., below 50 years. It was observed that as the age increases, the adherence to treatment decreases. Adherence rates were significantly higher among females and those individuals who had never attended school. Among the employed, 70.3% were adherent to their treatment and among the unemployed, 64.4% were adherent. The percentage of adherence was lower in alcohol consumers (9.5%) as compared to nonusers (76% and 32%, respectively).Conclusions: The clinician advising anti-hypertensive therapy should provide thorough counselling and stress on the issues created due to poor medication adherence as hypertension can be associated with severe outcomes. Treatments should be given in accordance with each patient’s lifestyles in mind such that they may continue taking their medications till the completion of their therapy.

A Review of the Effectiveness of Interventions on Medication Adherence Among Hypertension Patients

@#A majority of hypertensive patients will end up suffering uncontrolled hypertension, which is partly due to poor medication adherence. This paper aimed to review a range of interventions that could improve anti-hypertensive medication adherence. Literature search was conducted using PubMed, Scopus, Medline, and Science Direct databases, with publication dates confined to between October 2009 and October 2019. Eventually, only 11 studies were used for this study. It was found that interventions that are based on or include patient education, patient interviews, patient reminders, self-management and behavioural modifications have the potential to improve patients’ adherence to anti-hypertensive therapy. Most successful interventions involve patient reminder, self-management and behavioural intervention.

Analysis of prescription pattern of antihypertensive medication and adherence to Beers criteria in geriatric department of a tertiary care hospital in Mysuru

Background: The objective of the present study was to evaluate the prescription pattern of anti-hypertensive drugs and adherence to Beers’ criteria in geriatric department of JSS Hospital, Mysuru.Methods: An observational, prospective, cross-sectional study was carried out in geriatric department. The basic demographic information and prescriptions of geriatric patients were studied. Descriptive analysis was used to present the results, prescriptions were analysed and checked for adherence to Beers’ criteria.Results: Out of 485 patients, 82.68% received monotherapy, 15.87% received 2-drug combination therapy and 1.4% received 3-drug combination therapy. Among patients receiving monotherapy, angiotensin receptor blockers (49.06%) was the commonest antihypertensive class of drug prescribed. Telmisartan (38.96%) was the commonest drug prescribed. Among 2-drug combination therapy angiotensin converting enzyme inhibitor and Calcium channel blockers were combined commonly. In 3-drug combination therapy angiotensin converting enzyme inhibitor, beta blockers and diuretics were combined commonly. 99.3% of prescriptions were adhered to 2015 American Geriatrics Society Beers criteria.Conclusions: Almost 82% of the patients were treated with monotherapy. The trends in prescribing of anti-hypertensives were in favor of conventional ones such as Angiotensin receptor blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, diuretics, beta blockers and centrally acting alpha agonists. 99.3% of prescriptions were in accordance with the American Geriatrics Society 2015 Updated Beers criteria.

A Study of Prescribing Pattern in Patients of Hypertension

Introduction: Hypertension is a multi-factorial and complex disease that has both environmental and genetic determinants. It is the single most significant risk factor for heart diseases and kidney diseases. Hypertension is a leading contributor to global burden of morbidity and mortality. It is considered as a silent killer because most of the time it is asymptomatic and goes undetected. Hence, hypertensive patients should be prescribed properly. Objectives: To evaluate the prescribing pattern of anti-hypertensive drugs in patients of hypertension. Material and Methods: This was an observational, cross sectional study conducted over a period of 1 year on hypertensive patients attending the Cardiology out-patient department of Government Medical College and Rajindra Hospital, Patiala and fulfilling the inclusion and exclusion criteria. The prescriptions were evaluated. Results: 22% of prescriptions had monotherapy, amongst which beta-blockers were most commonly prescribed. Majority of prescriptions had two drug therapy (47%), among which ARB+ beta blockers (17%) were most frequently prescribed. Beta blockers +CCB (9%) was the most common Fixed Drug Combination (FDC) prescribed. ARB+beta blockers+diuretics (14%) and ACEI+ARB+beta blockers+diuretics (1%) were most commonly prescribed three drug combinations. Among four drug combinations, only ACEI+ARB+beta blockers+diuretics was prescribed to 1% patients. Hypolipidemic drugs (66%) were maximally co-prescribed. Conclusions: A high trend of polypharmacy was observed in hypertensive patients. So, emphasis is needed to reevaluate the prescribing trends in these patients.

Hypertensive disorder of pregnancy and its immediate outcome on neonates in a tertiary care hospital of Western Nepal

Background: Hypertensive disorders in pregnancy remain a major cause of maternal and neonatal morbidity and mortality worldwide. This study prospectively examined the immediate neonatal outcome of women with maternal hypertensive disorder of pregnancy (HPD).Methods: This is a prospective study conducted at NICU in Universal College of Medical Sciences Hospital over a period from 2nd February 2018 to 1st February 2019. Fifty-two mothers and their newborn were selected. Mothers with gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension and chronic hypertension were included.Results: Mean maternal age was 26.4 years. Mean gestational age was 34±4 weeks. 38 were male and 24 were female with male: female ratio 1.72:1. Thirty seven (71.2%) mothers needed lower uterine caesarian section, fourteen (26.9%) mothers delivered NVD and one (1.9%) forceps delivery. Low birth weight (<2.5kg) babies were 25 (48.1%%), very low birth weight (<1.5kg) were 9 (17.3%) and normal weight were 18 (34.3%). Intrauterine growth retardation (IUGR) were 18(30%). Perinatal asphyxia 10 (19.2%) were most common cause of admission, other cause of admission were sepsis and prematurity.Conclusions: Eclampsia is still a common and serious complication of pregnancy. Proper antenatal care, detection of preeclampsia with early management and timely referral of high risk patient, administered of MgSO4 in correct doses and properly timed caesarean section in selected cases would reduce the incidence of eclampsia associated maternal and perinatal morbidity and mortality in our facility.

Metrics of clonidine utilization in maintenance hemodialysis patients

Background: Clonidine is less frequently used by nephrologists. Data on clonidine prescribing trends in hemodialysis patients is sparse. We assessed the clonidine utilization metrics from the case records of patients undergoing maintenance hemodialysis.Methods: In this retrospective chart review, we analysed the clinical records of hemodialysis patients using clonidine. We evaluated the frequency of clonidine use, mean dose of clonidine and percentage of patients receiving a particular dose. Additionally, we also correlated dose of clonidine with anti-hypertensive pill count.Results: A total of 70 hemodialysis patients case records were screened. All 70/70 (100%) of them were hypertensive. Only 25/70 (35.74%) of patients were prescribed clonidine as an anti-hypertensive agent. The mean clonidine dose was 352±171 µg. Majority of patients 9/25 (36%) received 400 µg of clonidine. The dose of clonidine was prescribed in the order 400 µg (36%)>200 µg (32%)>600 µg (16%)>100 µg (8%)>300 µg (4%)=700 µg (4%). There was a statistically significant correlation in the strength of clonidine prescribed with increasing anti-hypertensive drugs (p<0.05).Conclusions: In our study, we observed that 80% of our hemodialysis patients were non responders to either systolic blood pressure or diastolic blood pressure or both. Oral clonidine use was observed in 35.74% of our hemodialysis patients. There was a linear trend showing an increased dose of clonidine with an increase in the anti-hypertensive pill count.

A comparative study on the adherence to anti-hypertensive medications in urban and rural areas of Hubballi

Background: Hypertension is a significant public health issue worldwide and can have deleterious effects on the health when it is not under control. Adherence to antihypertensive medications is thus necessary for better control of blood pressure and to reduce the risk of complications. There are various factors which support or hinder the patient’s adherence to anti- hypertensive treatment. Thus this study was done to reflect the factors influencing the adherence to antihypertensive drugs among urban and rural population.Methods: A community based cross sectional study was conducted in urban and rural field practice areas of Karnataka Institute of Medical Sciences, Hubballi. A semi-structured questionnaire was used for data collection among the known hypertensive patients. The data was entered in Microsoft Excel and analysed using SPSS software.Results: Most of the hypertensive patients were aged 45 and above (89.5%). A total of 73.5% of the participants were adherent to antihypertensive medications and adherence was more among urban (76%) as compared to rural population (71%). Knowledge regarding complications of uncontrolled hypertension was the major factor for adherence in both the areas. The mean systolic and diastolic blood pressure was controlled in patients who were adherent.Conclusions: There is a higher level of adherence to antihypertensive medications in urban population as compared to rural population of Hubballi. The findings suggest patient factors, clinical factors and socio-demographic factors play an important role in determining the adherence to the medication.

A comparative analysis of hydrochlorothiazide and chlorthalidone induced hyponatremia at the dose commonly prescribed in clinical practice

Background: Despite the differences in cardiovascular outcomes, pharmacokinetics, pharmacodynamics, the diuretics, chlorthalidone (CTD) and hydrochlorothiazide (HCTZ) are often considered as interchangeable. There is an on-going debate whether CTD should be preferred over HCTZ, because it appears to be more effective in the prevention of cardiovascular events. The relative difference in the incidence of hypokalemia and hyponatremia, is also a topic of debate. With this background, the study was carried out to compare the prevalence of hyponatremia between CTD and HCTZ used in the treatment of hypertension at the dose commonly prescribed in clinical practice.Methods: This was a cross sectional study carried out on a convenience sample of 74 adult patients with provisional diagnosis of hyponatremia or with a plasma sodium level of less than 135mmol/L and having a history of anti-hypertensive use of HTCZ or CTD in the dose range of 12.5-25mg/day and 6.25-12.5mg/day respectively. Chi square test and independent samples ‘t’ test were used analyse the results in GraphPad Prism 6.0.Results: HCTZ was found to be the preferred diuretic in hypertension, whereas CTD was preferred in the age group of 65-74 years. The symptoms indicative of hyponatremia as well as a lower plasma sodium level were more common in the HTCZ treated group. Patients of hypertension using CTD were less predisposed to hyponatremia (OR 0.804, 95% CI 0.207-3.12).Conclusions: Chlorthalidone, when used at a lower dose of 6.25-12.5mg/day for the treatment of hypertension cause a lesser risk of hyponatremia than hydrochlorothiazide.

A Study of Anti-hypertensive Drug Prescription Patterns in Hypertensive Post-menopausal women

Background: Drug prescription in menopause is complex as estrogen deficiency, hypertension (HT) and other risk factors, rapidly increase the risk of cardiovascular diseases (CVD) in post-menopausal women (PMW). Objectives: To evaluate the prescription trends of anti-hypertensive drugs in PMW. Methods: This was an observational, cross sectional study conducted over a period of 1 year, on hypertensive PMW. The prescriptions were evaluated for antihypertensive drug use patterns and also as per WHO core drug indicators. Results: 21.82% of prescriptions had monotherapy, amongst which angiotensin receptor blockers (ARB) (10%) and individually, telmisartan (5.45%) were most commonly prescribed. Majority of prescriptions had two drug therapy (44.09%), among which ARB + beta-blockers (BB) (20.91%) and individually, Telmisartan + Metoprolol (13.64%) were most frequently prescribed. ARB + Diuretic (DI) (9.55%) was the most common fixed drug combination (FDC) prescribed. ARB + BB + DI (10.45%), ARB + 2DI + BB (4.09%) and ARB + 2DI + BB + Calcium channel blocker (1.82%) were most commonly prescribed three, four and ≥five drug combinations, respectively. Hypolipidemic drugs (60.45%) were maximally co-prescribed. Percentage of drugs prescribed by generic name was 4.63% and from essential drug list was 32.62%. Conclusions: A high trend of polypharmacy was observed in hypertensive PMW. HT, being a multifactorial disease, deserves a multidisciplinary and a comprehensive approach in the care of this population subgroup. Knowledge of prescription pattern and thus the rational utilisation of drugs will help achieve better control rates of HT and hence curb down the burden of CVDs in PMW.

White-Coat Hypertension: the Neglected Subgroup in Hypertension

The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30–40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.

A Prospective Study of Various Anti Hypertensive Drugs on Reversal of Left Ventricular Hypertrophy in Hypertensive Bangladeshi Population.

Background: Regression of ventricular hypertrophy is the restoration of normal ventricular structure and physiology after the hypertrophy has developed. It has been clearly demonstrated that once left ventricular hypertrophy (LVH) is diagnosed, it represents a strong blood pressure independent risk factor for cardiovascular morbidity and mortality. Aims and Objectives: The aim of this study is to compare the effectiveness of different anti-hypertensive agents in reducing LVH in Bangladeshi population. Methods: A prospective observational study was carried out to detect the regression of left ventricular hypertrophy in hypertensive Bangladeshi population using high resolution M-mode echocardiographic study in 110 patients with clinically diagnosed hypertension were included in this study but later 15 patients failed to attend clinic for subsequent follow up. Hence, total number of patient was 95; The mean age (±SD) of these patients were 42 ± 5 and male-female ratio was 8.5:1.5. Out of these 95 patients, 20 were included in Beta-blocker(BB) group, 14 in Angiotensin converting enzyme inhibitor(ACEi) group, 20 in Beta-blocker(BB) + Diuretic(DD), 14 were recruited in Angiotensin enzyme inhibitor(ACEi) + Diuretics(DD) and 13 in Beta-blocker and ACEi group and 14 in BB + ACEI + Diuretic group. We followed these patients after 8 weeks, 6 months, 1 year and 2 years in our clinic. A baseline M-mode echocardiography was done to document LVH. During this follow up, we have measured IVSd, PWd, LVIDd and LVIDs and statistically analyzed SD and P-value for each group by using SPSS software. The duration of study was from 01.07.2005 to 30.06.2008. Results: Comparison of Beta blocker alone and ACEi alone group for LVH regression showed a P value of 0.59. Although this figure did not show a statistically significant value if we increase number of patients in both group we would expect a statistically significant P value in favour of ACEi. BB plus diuretics was compared with ACEi plus Diuretics which showed P value of 0.85. We also compared BB plus ACEi group with BB plus ACEi plus DD for LVH regression which showed a P value of 0.79. Conclusion: Among three groups of anti-hypertensive drugs, angiotensin converting enzyme inhibitor(ACEi) alone has been found to be most effective as compared to Beta blockers when used alone than in combination groups with (Beta blocker plus ACEi plus Diuretics or Beta blocker plus ACEi). Although, these figure was not found statistically significant a clear benefit has been shown in all groups in terms of LVH regression and essentially if the power or size if this is increased a statistically significant value of LVH regression value may be observed in all these groups.

Medication Adherence and the Occurrence of Complications in Patients with Newly Diagnosed Hypertension

BACKGROUND AND OBJECTIVES: In this retrospective cohort study, we sought to elucidate the relationship between medication adherence (MA) and the incidence of complications in patients with newly diagnosed hypertension. SUBJECTS AND METHODS: Using claims data from the National Health Insurance Service, we measured health outcomes based on levels of MA, analyzed the incidence of complications in patients with a good MA, and clarified factors that may affect or predict MA. RESULTS: In 2008, a total of 4294773 patients were diagnosed with hypertension and were subsequently prescribed anti-hypertensive medications. In the present study, we enrolled 564782 patients who met our inclusion/exclusion criteria. The 40-59% medication possession ratio (MPR) group had a 1.36 times higher risk of developing complications (95% confidence interval [CI]: 1.27-1.45) than did the MPR≥ 80% group, as revealed through Cox's proportional hazards analysis. Similarly, the <20% MPR group was 2.01 times more likely to develop complications than the good MA group (95% CI: 1.82-2.23). Overall, patients who had a lower level of MA had a higher risk of developing complications. CONCLUSION: Our results demonstrate that MA is tightly correlated with hypertension health outcomes. Improving MA could be one strategy for reducing the risk of cerebrovascular disease complications and the loss of productivity in these patients.

Comparative Quality Control Evaluation of Atenolol Tablets Marketed in Kuala Lumpur, Malaysia.

Background: The emergent of many pharmaceutical companies producing their own generic type of drugs after the patent of innovator drugs expired can improve the general healthcare delivery systems as well as decreasing the healthcare costs. But it also raises a few issues with one of it is the widespread of substandard and counterfeit product. Postsurveillance study to assess product parameter of various generics drug marketed is crucial. This kind of monitoring reduces a country’s economical burden on health issues from diseases due to fraudulent and substandard drugs usage. Purpose: The main objective of this study is to perform a comparative evaluation of the physicochemical properties of five commercially available leading brands of Atenolol tablets marketed in Kuala Lumpur. Method: The quality control parameters of five different brands of atenolol tablets were atenolol tablet assessed included uniformity of content, uniformity of weight, friability, crushing strength, disintegration and dissolution tests as well as content uniformity of the tablets. All the tablets were assessed for conformity with British Pharmacopoeia (BP) standards. Results: All the five brands of the tablets passed the British Pharmacopoeia (BP) standards for weight uniformity, disintegration, friability, content uniformity and hardness tests. Conclusion: The quality control parameters of all five top selling brands of atenolol tablets marketed in Kuala Lumpur analyzed passed all the BP and USP quality specifications and were physically and chemically equivalent.

Evaluation of prescribing patterns in diabetic and hypertensive patients in a South Delhi Hospital.

Background: Drug utilization studies (DUS) defined by World Health Organization as the marketing, distribution, prescription and use of drugs in a society, considering its consequences, either medical, social, and economic. The increasing importance of DUS as a valuable investigation resource in pharmacoepidemiology has been linking it with other health related areas, such as public health, pharmacovigilance, pharmacoeconomics, and pharmacogenetics. Methods: The study was a prospective DUS carried out in medicine OPD of Indian Institute of Technology Hospital, New Delhi, India in which a total of 595 prescriptions of hypertensive and diabetic patients were reviewed. All diabetic and/or hypertensive patients; irrespective of age, gender; who had least one drug in the prescription were included. Data were collected by screening of physician’s prescribing record and patient medication profile. Results: A total of 595 prescriptions were recorded. 57.31% were males as compared to 42.69% females. 54.62% patients were hypertensive (325 prescription); 14.78% patients were diabetic (88 prescription) whilst 30.58% had both the diseases. Of 507 prescriptions having antihypertensive drugs, combination therapy was utilized (40.8%) in the prescriptions and out of 270 prescriptions having antidiabetic drugs, 143 (52.96%) prescription were of combination therapy. Among antihypertensive drugs, angiotensin-converting enzyme inhibitors were the most frequently prescribed class of drugs (19.18%). The combination most commonly prescribed was amlodipine and atenolol (14.05%). Antidiabetic drugs made up for 11.05% of the total drugs prescribed. 28.78% of all hypoglycemic agents were sulfonylurea. Glimepiride and metformin combination was the most prescribed anti-diabetic drugs combination (16.16%). Conclusion: Both hypertension and diabetes are considered to be lifestyle diseases. Hence, apart from optimal and appropriate prescribing, there is a need for lifestyle modification to obtain improved outcomes. Combination therapy was observed in a high percentage of prescriptions. Though monotherapy is associated with improved compliance and fewer side effects, combination therapy is desirable for synergistic actions and to overcome complications.

Cost analysis study of oral antihypertensive agents available in Indian market.

Background: Hypertension is one of the major causes of morbidity, mortality and needs lifelong treatment. There is a wide range of variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to find out price variations in the oral antihypertensive drugs available either singly or in combination and number of manufacturing companies for each, also to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost. Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July October 2013 and “Indian Drug Review” September 2013. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was calculated. Results: Percentage price variation of the commonly used drugs found was amlodipine (5 mg): 1128.57%, atenolol (12.5 mg): 683.53%, enalapril (10 mg): 394.67%, telmisartan (20 mg): 288.33%. Among the combination therapy, amlodipine + atenolol (5 + 50 mg): 673.79%, amlodipine + losartan (5 + 50 mg): 284.61%, telmisartan + hydrochlorothiazide (40 + 12.5 mg): 293.85%, losartan + hydrochlorothiazide (50 + 12.5 mg): 384.62% variation. Conclusion: The average percentage price variation of different brands of the same oral antihypertensive drug manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.

Antihypertensive and vasorelaxant effects of ethanol extract of stem barks from Zanthoxylum rhoifolium Lam in rats.

Administration of ethanol extract of stem bark from Z. rhoifolium (EEtOH-ZR) induced hypotension associated with a dual effect in heart rate in normotensive rats. This response was highlighted in spontaneously hypertensive rats (SHR). In rat superior mesenteric artery rings, the cumulative addition of EEtOH-ZR (0.1–750 µg/mL) on a phenylephrine-induced pre-contraction (10-5 M) promoted a vasorelaxant effect by a concentration-dependent manner and independent of vascular endothelium. A similar effect was obtained on KCl-induced pre-contractions (80 mM). EEtOH-ZR attenuated contractions induced by cumulative addition of CaCl2 (10-6–3 × 10-2 M) in depolarizing medium without Ca2+ only at 500 or 750 µg/mL. Likewise, on S-(–)-Bay K 8644-induced pre-contractions (10-7 M), the EEtOH-ZR-induced vasorelaxant effect was attenuated. EEtOH-ZR (27, 81, 243 or 500 µg/mL) inhibited contractions induced by cumulative addition of phenylephrine (10-9 - 10-5 M) in endothelium-denuded preparations or by a single concentration (10-5 M) in a Ca2+-free medium. The involvement of K+ channels was evaluated by tetraethylammonium (3 mM); the EEtOH-ZR-induced vasorelaxation was not attenuated. Thus, calcium influx blockade through voltage-operated calcium channels (CaVL) and inhibition of calcium release from intracellular stores are probably underlying EEtOH-ZR-induced cardiovascular effects.

Estudio MULATA: muestra latinoamericana de pacientes con tensión arterial elevada / MULATA study: Latin American sample of high blood pressure patients

Introducción: Por prevalencia y trascendencia como factor de riesgo para enfermedad cardiovascular, la hipertensión arterial es una de las enfermedades de mayor importancia en la práctica médica. Este trabajo describe las características clínicas y sociodemográficas de una muestra de pacientes hipertensos con al menos un factor de riesgo cardiovascular adicional, en Argentina, Colombia y Venezuela. Metodología: Es un estudio de corte transversal, con recolección prospectiva de la información en una muestra por conveniencia de pacientes con hipertensión arterial que consultaron a los médicos participantes en cada uno de los tres países. Resultados: Se detectaron diferencias estadísticamente significativas en la distribución de los factores de riesgo cardiovascular (obesidad central, hipertensión arterial no controlada, tabaquismo y dislipidemia) entre las poblaciones de Colombia, Venezuela y Argentina. La población participante estuvo compuesta en su mayoría por mujeres (53,7%), la edad promedio fue de 59,3 +/- DE 13,6 años; 29% de los participantes en el estudio tenían cifras tensionales controladas en el momento de la evaluación. El manejo con dos medicamentos fue el más frecuente en la población total (40,6%) así como en los subgrupos, argentino (47,1%) y colombiano (46,4%), mientras que en la población venezolana el manejo más común fue monoterapia (45%). Los bloqueadores del sistema renina angiotensina II fueron los más utilizados en los tres países. Discusión: Los factores de riesgo cardiovascular susceptibles de ser modificados tienen diferencias geográficas que justifican cambios en su manejo. La hipertensión requiere no solamente manejo farmacológico, sino la intervención sobre estos factores.

Introduction: Due to its high prevalence and its importance as a risk factor for stroke, heart disease, and renal failure, hypertension is one of the most important diseases in common medical practice. The aim of this study was to describe the clinical and demographic characteristics of a sample of hypertensive patients, with at least one additional cardiovascular risk factor, in Argentina, Colombia and Venezuela. Methods: We performed a cross sectional study, with prospective data collection from a convenience sample of patients. Results: we found statistically significant differences in the distribution of cardiovascular risk factors (obesity, non-controlled hypertension, smoking and dyslipidemia) in the population of the different countries. There were slightly more women in our sample (53.7%), the average age was 59.3 (SD 13.6) years. In 29% of the patients hypertension was controlled. The most common practice in the whole sample was the use of two different drugs (40.6%). This was true both in Colombia (46.4%) and in Argentina (47.1%), while in Venezuela the use of monotherapy was more common (45%). Angiotensin II receptor antagonists are the most commonly used drug family in the three countries, either alone or in combination with other therapies. Discussion: Our population shows a poor control of blood pressure. Our patients need a more strict pharmacological therapy together with a strategy to identify and reduce all modifiable cardiovascular risk factors.