Atenolol And Nifedipine Combination Is Better Than Monotherapy: A New Era In Novel Drug Delivery For Hypertension

Hypertension is considered a major health problems globally affect millions of patient.Various study confirms that single drug treatment usually is not adequate to achieve blood pressure goal in most hypertensive patients.In this regard,consideration is given to combination therapy, which offers the potential advantages towards minimizing hypertension in a rapid manner and produces lower adverse effects.SLTs (Sublingual tablets) provides immediate action to enhanced absorption and bioavailability rate. Sublingual tablets are absorbed within the mucus membrane and directly reach in blood systemic circulation. The objective of this ongoing research focused on theatenolol (ATN)and nifedipine (NIF) combined drug deliveryin emergency condition of hypertension. Direct compression technique is used to formulate SLTsby taking different types and concentrations of superdisintegrantsCroscarmellose sodium (CCS) and Crospovidone (CP). Sublimating agents like camphor (CM) and thymol (TY)) also added for better result. FTIR and DSC analysis confirms the ccompatibility results between drug and superdisintegrants.Formulated tablets are evaluated for different parameters and found satisfactory. Formulation F6 considered as the best formulation. The disintegration shows 13 sec and dissolution profile shows 97.36% drug release at 10 min. Formulation F6 shows better pharmacokinetic activity and antihypertensive activity in compare to pure drug and marketed formulation.A combination of ATN and NIF produces rapid disintegration and dissolution property during an emergency and is a lifesaving approach in hypertension treatment.

ANESTHESIA FOR RENAL TRANSPLANT SURGERY IN ADULTS

Renal transplant surgery may be associated with important perioperative complications. In this scenario, the anesthetic technique should provide optimal conditions for the surgical team, guarantee hemodynamic stability and kidney perfusion, and adequate analgesia. Preoperative evaluation should always be performed. In the intraoperative period, standard monitoring is sufficient in most cases. General balanced anesthesia, alone or in combination with spinal anesthesia or peripheral block, is the technique of choice. Management of blood pressure during the surgery is crucial. Before reperfusion, a mean arterial blood pressure of 65 mmHg is recommended, increasing to 80–90 mmHg when reperfusion is imminent until the end of surgery. Vasopressors, such as ephedrine, may be necessary to achieve blood pressure targets. Mannitol and furosemide are commonly used to increase urine output. In the postoperative period, analgesia should be ensured.

COMPARISON OF INTRAVENOUS LABETALOL AND ORAL NIFEDIPINE IN MANAGEMENT OF BLOOD PRESSURE IN PATIENTS WITH SEVERE PREGNANCY INDUCED HYPERTENSION

ABSTRACT:It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a significant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more effective. OBJECTIVE: To compare the mean time to achieve blood pressure control of oral Nifedipine with intravenous Labetalol for management of severe pregnancy induced hypertension. METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group–B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational definition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying t- test and consider significant at p value <5%.RESULTS: Patients were ranged between 20-40 years. Mean age of the patients was calculated as 26.98+4.54 and 27.36+4.43 years in group-A and B respectively. Gestational age shows that 64%(n=32) in Group-A 74%(37%) in Group–B were between 20-30 weeks of gestation while 36%(n=18) in Group-A were between 31-40 weeks of gestation mean±SD was calculated as 28.92+4.91 and 28.94+4.72 weeks in Group-A and B respectively. Mean time to achieve B.P control in group A was 31.24+5.62 and in group B 45.5+4.63 with p value <0.05. CONCLUSION: Mean time to achieve blood pressure control was shorter with oral Nifedipine when compared to I/V Labetalol for management of female presenting with severe pregnancy induced hypertension.

Long-term phase 3 study of esaxerenone as mono or combination therapy with other antihypertensive drugs in patients with essential hypertension

This study investigated the long-term antihypertensive effects of esaxerenone, a novel nonsteroidal mineralocorticoid receptor blocker, alone or in combination with a calcium channel blocker (CCB) or a renin–angiotensin system (RAS) inhibitor, in Japanese patients with essential hypertension. Patients were treated with esaxerenone starting at 2.5 mg/day increasing to 5 mg/day if required to achieve blood pressure (BP) targets as a monotherapy or with a CCB or RAS inhibitor. After the first 12 weeks of treatment, an additional antihypertensive agent could be added if required to achieve the target BP; the total treatment period was 28 or 52 weeks. The primary endpoint was a change from baseline in sitting BP. Of the 368 enrolled patients, 245 received monotherapy, and 59 and 64, respectively, took a CCB or RAS inhibitor concurrently. Mean changes from baseline in sitting systolic/diastolic BP (95% confidence intervals) at weeks 12, 28 and 52 were −16.1 (−17.3, −14.9)/−7.7 (−8.4, −6.9), −18.9 (−20.2, −17.7)/−9.9 (−10.7, −9.2), and −23.1 (−25.0, −21.1)/−12.5 (−13.6, −11.3) mmHg, respectively (all P < 0.0001 vs baseline). Similar BP reductions at these weeks were observed between all patient subgroups stratified by age, and the observed decreases in 24-h ambulatory BP were consistent with the efficacy observed in sitting BP. Esaxerenone was also well-tolerated with a rate of hyperkalemia at 5.4% (serum potassium ≥5.5 mEq/L), indicating a good safety profile for treatment over the long-term or in combination with a CCB or RAS inhibitor. In conclusion, esaxerenone may be a promising treatment option for patients with hypertension.

Suboptimal Adherence to Antihypertensive Treatment: Causes and Management

Suboptimal adherence to antihypertensive treatment is very common and is associated with poor control of blood pressure and increased risk for cardiovascular events. Therefore, frequent evaluation of compliance is essential in all hypertensive patients. Simplifying treatment regimens, using fixed-dose combinations and long-acting agents improves adherence, facilitates achievement of treatment targets and reduces cardiovascular morbidity and healthcare expenditures. Accordingly, physicians should be educated to implement these changes in hypertensive patients, particularly in those who require multiple antihypertensive agents to achieve blood pressure controls and in those who receive additional medications for comorbidities.