Calcium Channel Blockers Group Research Articles

Cost Analysis of Antihypertensive Therapy in the Hypertensive Patients

BackgroundHypertension is an established chronic disease with a huge economic burden to society so choosing cost effective medication is essential. Several medications are available and the decision lies in the prescriber so the generation of evidence suggesting cost-effective medication is essential. The objective of the study was to explore cost effective treatment of hypertension.MethodsA descriptive cross-sectional study was carried out among hypertensive patients of 20-69 years of age taking antihypertensive medicines for more than one year. Four commonly prescribed drug groups were included: calcium channel blocker, angiotensin receptor blocker, diuretics plus calcium channel blocker, and angiotensin receptor blocker plus calcium channel blocker. The direct medical cost, direct non-medical cost and overall cost of each class of antihypertensive medicine group was estimated as the median cost of that class. The cost-effectiveness relationship was described as a ratio of annual median cost to proportion of patients with controlled hypertension for each pharmacological group.ResultsAngiotensin receptor blocker was the group with lowest annual overall median cost (8915 NPR). Cost effectiveness relationship of calcium channel blocker group was the lowest (10537.83) followed by angiotensin receptor blocker (15115.25) and calcium channel blocker plus angiotensin receptor blocker (21305.69).Conclusions Calcium channel blocker was the most cost effective group of antihypertensive drugs. The direct medical costs accounted for high amount of costs for hypertensive patients in all four groups.

Effects of calcium channel blockers on perioperative ischemic events in hypertensive patients with intracranial aneurysms undergoing neurointervention

BackgroundAlthough calcium channel blockers (CCBs) are useful in stroke prevention, their specific role in preventing stroke in hypertensive patients with intracranial aneurysms undergoing endovascular stent placement remains unclear.MethodsWe retrospectively examined...

The role of T-type calcium channels in elderly human vascular function: A pilot randomized controlled trial.

Endothelial dysfunction develops with age and may precede cardiovascular disease. Animal data suggest that T-type calcium channels play an important role in endothelial function, but data from humans are lacking. This study included 15 healthy, sedentary, elderly males for a double blinded, randomized controlled trial. For 8weeks, they were given 40mg/day of either efonidipine (L- and T-type calcium channel blocker (CCB)) or nifedipine (L-type CCB). Vascular function was evaluated by graded femoral arterial infusions of acetylcholine (ACh; endothelium-dependent vasodilator) and sodium nitroprusside (endothelium-independent vasodilator) both with and without co-infusion of N-acetylcysteine (NAC; antioxidant). We measured leg blood flow and mean arterial pressure and calculated leg vascular conductance to evaluate the leg vascular responses. Despite no significant change in blood pressure in either group, we observed higher leg blood flow responses (Δ 0.43±0.45l/min, P=0.006) and leg vascular conductance (Δ 5.38±5.67ml/min/mmHg, P=0.005) to intra-arterial ACh after efonidipine, whereas there was no change in the nifedipine group, and no differences between groups. We found no upregulation of endothelial nitric oxide synthase in vastus lateralis muscle biopsies within or between groups. Smooth muscle cell responsiveness was unaltered by efonidipine or nifedipine. Intravenous co-infusion of NAC did not affect endothelium-dependent vasodilatation in either of the CCB groups. These results suggest that 8weeks' inhibition of T- and L-type calcium channels augments endothelium-dependent vasodilatory function in healthy elderly males. Further studies are required to elucidate if T-type calcium channel inhibition can counteract endothelial dysfunction.

The evaluation of the effect of long-term antihypertensive drug usage on bone density with dental volumetric tomography.

HT is a systemic disease that presents with persistent high blood pressure, which has become an important health problem due to its cause of serious complications and high prevalence in the community. Aim: This study aims to examine the bone mineral density (BMD) of male patients using different groups of antihypertensive drugs for long terms with dental volumetric tomography. The study was carried out using the data of patients who applied to the Dicle University Faculty of Dentistry and underwent the Dental Volumetric Tomography (DVT) scan for any reason. The patients included in the study were divided into 4 groups according to their antihypertensive use; Group 1: 60 patients who never used hypertensive medication before, Group 2: 60 patients who received Calcium Channel Blocker treatment for over 5 years, Group 3: 60 patients who received Beta Blocker treatment for over 5 years, Group 4: 60 patients who received ACE inhibitor treatment for over 5 years. Radiomorphometric measurements were made on the DVT data and the DVT-Mandibular Index Inferior, DVT-Cortical Index, Hounsfield Unit-Cortical and Hounsfield Unit-Spongios values were calculated. The Kruskal-Wallis test, the Mann Whitney test with Bonferroni correction, the One-Way ANOVA and Post-Hoc Tukey test were used in the study. A significant increase in DVT-CI and a significant decrease in HU-CORTIKAL, HU-SPONGIOS and DVT-MII values were observed in the patients using Calcium Channel Blocker medication. These findings pointed to osteoporosis. In addition, no statistically significant difference in the use of antihypertensive drugs in the Beta Blocker and ACE Inhibitor groups compared to the Control Group were found. The long term use of Calcium Channel Blocker group antihypertensive drugs should be considered as a risk factor for osteoporosis in men. Key words:Antihypertensive drug, Osteoporosis, Radiomorphometric index, Mandible, Dental volumetric tomography, Bone mineral density.

Our Treatment Experience in Poisoning With Calcium Channel Blockers: A Series of Twelve Cases

Background: Intoxications with cardiovascular system drugs constitute a small percentage of all poisoning cases. Calcium Channel Blockers (CCBs) are the most common drug poisoning in this group. Objectives: We aimed to evaluate the effectiveness of treatments for CCB poisoning and add to the current body of literature by outlining the clinical treatments we employ for bradyarrhythmia, hypotension, and resistant vasodilation resulting from CCB poisoning, as well as sharing our clinical insights in this field. Methods: Twelve patients, ranging in age from 1 month to 18 years, were admitted to the Tertiary Paediatric Intensive Care Unit (PICU) for treatment of medication poisoning related to the CCB group. Patients who ingested several drugs that caused CCB were not allowed to participate in the trial. Results: Twelve patients were followed up in the PICU due to poisoning with CCB group drugs. Of the patients, 7 were male and 5 were female. Five of the patients had taken CCB medication with the purpose of committing suicide, and 7 of them accidentally. All of the patients who received CCB to commit suicide had taken verapamil. Five patients whose hypotension and bradycardia continued were administered inotropes. In addition to PI, calcium gluconate, intravenous lipid, glucagon, insulin, bicarbonate, and methylene blue were given as therapy to our symptomatic patients. Plasmapheresis was applied to a patient who was hospitalized in the PICU due to a sudden loss of consciousness. Conclusions: In the management of patients with CCB poisoning, the use of hyperinsulinemia euglycemia, intravenous lipid emulsion treatment, glucagon treatments, and treatments including methylene blue and extracorporeal life support should be considered in cases of resistant hypotension, bradycardia, and coma in the early period.

Mortality and Morbidity Among Individuals With Hypertension Receiving a Diuretic, ACE Inhibitor, or Calcium Channel Blocker

The long-term relative risk of antihypertensive treatments with regard to mortality and morbidity is not well understood. To determine the long-term posttrial risk of primary and secondary outcomes among trial participants who were randomized to either a thiazide-type diuretic, calcium channel blocker (CCB), or angiotensin-converting enzyme (ACE) inhibitor with up to 23 years of follow-up. This prespecified secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a multicenter randomized, double-blind, active-controlled clinical trial, followed up with participants aged 55 years or older with a diagnosis of hypertension and at least 1 other coronary heart disease risk factor for up to 23 years, from February 23, 1994, to December 31, 2017. Trial participants were linked with administrative databases for posttrial mortality (N = 32 804) and morbidity outcomes (n = 22 754). Statistical analysis was performed from January 2022 to October 2023. Participants were randomly assigned to receive a thiazide-type diuretic (n = 15 002), a CCB (n = 8898), or an ACE inhibitor (n = 8904) for planned in-trial follow-up of approximately 4 to 8 years and posttrial passive follow-up for up to 23 years. The primary end point was mortality due to cardiovascular disease (CVD). Secondary outcomes included all-cause mortality, combined fatal and nonfatal (morbidity) CVD, and both mortality and morbidity for coronary heart disease, stroke, heart failure, end-stage renal disease, and cancer. A total of 32 804 participants (mean [SD] age, 66.9 [7.7] years; 17 411 men [53.1%]; and 11 772 Black participants [35.9%]) were followed up for all-cause mortality and a subgroup of 22 754 participants (mean [SD] age, 68.7 [7.2] years; 12 772 women [56.1%]; and 8199 Black participants [36.0%]) were followed up for fatal or nonfatal CVD through 2017 (mean [SD] follow-up, 13.7 [6.7] years; maximum follow-up, 23.9 years). Cardiovascular disease mortality rates per 100 persons were 23.7, 21.6, and 23.8 in the diuretic, CCB, and ACE inhibitor groups, respectively, at 23 years after randomization (adjusted hazard ratio [AHR], 0.97 [95% CI, 0.89-1.05] for CCB vs diuretic; AHR, 1.06 [95% CI, 0.97-1.15] for ACE inhibitor vs diuretic). The long-term risks of most secondary outcomes were similar among the 3 groups. Compared with the diuretic group, the ACE inhibitor group had a 19% increased risk of stroke mortality (AHR, 1.19 [95% CI, 1.03-1.37]) and an 11% increased risk of combined fatal and nonfatal hospitalized stroke (AHR, 1.11 [95% CI, 1.03-1.20]). In this secondary analysis of a randomized clinical trial in an adult population with hypertension and coronary heart disease risk factors, CVD mortality was similar between all 3 groups. ACE inhibitors increased the risk of stroke outcomes by 11% compared with diuretics, and this effect persisted well beyond the trial period. ClinicalTrials.gov Identifier: NCT00000542.

An association between calcium channel blocker and breast cancer in patients with hypertension: A case-control study

Hypertension is a common disease in clinical practice. Calcium channel blocker (CCB) is an effective antihypertensive agent. There is inconsistent data of an association of CCB and breast cancer in literatures particularly in breast cancer cytology. This study aimed to evaluate this association by a case-control design. The inclusion criteria were adult patients with an age of 18 years or over, diagnosed as hypertension, with a result of mammogram. Those who were pregnant, had no pathological results, or had breast mass prior to diagnosis of hypertension were excluded. Cases defined if the pathological report of any types of breast cancer, while controls were those with benign breast mass. Factors associated with breast cancer were calculated by logistic regression analysis. There were 299 patients met the study criteria. Of those, 100 patients (33.4 %) were in the case group or breast cancer group. There were three factors independently associated with breast cancer. CCB treatment had adjusted odds ratio of 2.25 (95 % confidence interval of 1.36, 3.77), while age of 50 years old or over and hormonal therapy also independently associated with breast cancer with adjusted odds ratios of 3.41 and 2.91, respectively. The CCB group had significantly higher proportion of ductal breast cancer than those who did not take CCB (42.5 % vs 23.8 %, p < 0.001). CCB treatment may be associated with breast cancer especially ductal carcinoma in this study population.

Abstract 13555: Effect of Calcium Channel Blockers on Clinical Outcomes in Patients After Percutaneous Coronary Intervention With Left Ventricular Dysfunction

Although calcium channel blockers (CCBs) are effective in hypertension and IHD, short-acting CCBs are not recommended for heart failure due to have negative inotropic effects. On the other hand, long-acting CCBs have been reported to be safe for use in patients with cardiac dysfunction, but details are still unclear. In this study, we investigated the relationship between the effects of CCBs on CAD patients and left LV function. Methods: We enrolled 7173 consecutive CAD patients (Age; 69 [61-76] years and male; 78%) who underwent successful PCI for AP or ACS between April 2008 and March 2020 from prospective, multicenter registry (FUJISUN registry). Of the enrolled patients, 5307 analyzable patients were divided by LVEF &lt;40 or ≥40%. Patients were prospectively followed for a maximum of 8 years or until the occurrence of the cardiac events (CEs): cardiac death, nonfatal MI. Results: During the follow-up period (3.6 [1.4-6.7] years), 230 (4%) CEs occurred (109 Cardiac death, 121 MI). Both patients with LVEF &lt;40% and ≥40% had higher prevalence of HT and lower levels of BNP in CCB group than in non-CCB group. Propensity match analysis was performed to reduced selection bias for CCB use in each group. In patients with LVEF &lt;40%, Kaplan-Meier analysis showed that CCB group had significantly lower probability of CEs than non-CCB group, whereas in those with LVEF ≥40%, the probability of CE was similar in both groups. Multivariate Cox proportional hazards analysis showed that CCB group had significantly lower probabilities of CEs compared with non-CCB group in patients with LVEF&lt;40%, (HR 0.25; 95% CI 0.09-0.71, p &lt;0.01), but not in those with LVEF≥40% (HR 1.13; 95% CI 0.80-1.60, p = 0.50). Conclusions: Long-acting CCBs may improve clinical outcomes in post-PCI CAD patients with LV dysfunction.

Effects of olmesartan and amlodipine on blood pressure, endothelial function, and vascular inflammation

BackgroundAnti-hypertensive drugs can improve vascular endothelial function. However, the mechanism remains to be elucidated. ObjectivesThis study sought to investigate mechanisms of anti-hypertensive drugs on improvement of vascular endothelial function in patients with essential hypertension. MethodsForty-five patients (mean age 58.5 ± 11.2 years) with uncontrolled essential hypertension were randomly assigned to receive olmesartan, an angiotensin II type 1 receptor blocker (ARB) (N = 23), or amlodipine, a calcium channel blocker (CCB) (N = 22), for 6 months. Endothelial function was evaluated by flow-mediated dilatation (FMD) of the brachial artery. Vascular inflammation was measured by blood-normalized standardized uptake value, known as a target-to-background ratio (TBR) within the carotid arteries using 18F-fluorodeoxyglucose-positron emission tomography combined with computed tomography. ResultsThere were no significant differences of baseline clinical data between the ARB and CCB groups. Both anti-hypertensive drugs comparably lowered blood pressure and increased %FMD. TBR values were reduced by olmesartan (P < .001), while blood pressure variability was decreased by amlodipine (P = .004). Changes in %FMD from baseline (Δ%FMD) were inversely associated with ΔTBR in the olmesartan group (r = − .606, P = .003) and with Δsystolic blood pressure variability in the amlodipine group (r = − .434, P = .039). ConclusionOur study indicated that olmesartan and amlodipine could improve endothelial function in patients with essential hypertension in different manners, suppression of vascular inflammation, and decrease in blood pressure variability, respectively.

Effects of ACEI/ARB or CCB use on atrial fibrillation in hypertensive patients following permanent pacemaker implantation.

Permanent pacemaker implantation (PPI) combined with hypertension leads to a higher risk of new-onset atrial fibrillation (NOAF) for patients. Hence, it is essential to study how to reduce this risk. Currently, the effects of the two common anti-hypertensive drugs, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and calcium channel blockers (CCB), on the risk of NOAF for such patients remain unknown. This study aimed to investigate this association. This single-center retrospective study included hypertensive patients with PPI and without prior history of AF/atrial flutter, heart valve disease, hyperthyroidism, etc. Patients were classified into ACEI/ARB group and CCB group based on their exposure drug information. The primary outcome was NOAF events that occurred within 12 months after PPI. The secondary efficacy assessments were the changes from baseline to follow-up in blood pressure and transthoracic echocardiography (TTE) parameters. A multivariate logistic regression model was used to verify our aim. A total of 69 patients were finally included (51 on ACEI/ARB and 18 on CCB). Both univariate analysis [odds ratio (OR) 0.241, 95% confidence interval (CI) 0.078-0.745] and multivariate analysis (OR: 0.246, 95% CI: 0.077-0.792) demonstrated that ACEI/ARB were associated with a lower risk of NOAF compared to CCB. The mean reduction in left atrial diameter (LAD) from baseline was greater in ACEI/ARB group than in CCB group (P = 0.034). There was no statistical difference between groups in blood pressure and other TTE parameters after treatment. For patients with PPI combined with hypertension, ACEI/ARB may be superior to CCB in selecting anti-hypertensive drugs, as ACEI/ARB further reduces the risk of NOAF. One reason for this may be that ACEI/ARB improves left atrial remodelling such as LAD better.

Clinical Outcomes of Calcium-Channel Blocker vs Beta-Blocker: From the Korean Acute Myocardial Infarction Registry

BackgroundAlthough current guidelines recommend beta-blockers (BBs) after acute myocardial infarction (AMI), the role of calcium-channel blockers (CCBs) has not been well investigated, especially nondihydropyridine. ObjectivesThis study aimed to compare the effects of CCBs on cardiovascular outcomes compared with BBs in AMI because patients from East Asia have a higher incidence of a vasospastic angina component compared with Western countries. MethodsAmong 15,628 patients enrolled in the KAMIR-V (Korean Acute Myocardial Infarction Registry-V), we evaluated 10,650 in-hospital survivors who were treated with either CCBs or BBs. We applied a propensity score for 1:4 pair matching of baseline covariates and Cox regression to compare CCBs and BBs. The primary endpoint was all-cause death at 1 year. The secondary endpoints were 1-year major adverse cardiac and cerebrovascular events, which was the composite of cardiac death, myocardial infarction, revascularization, and readmission due to heart failure and stroke. ResultsThere was a significant interaction with the treatment arm with left ventricular ejection fraction (LVEF) (P for interaction = 0.011). CCB groups at discharge had higher 1-year cardiac death and major adverse cardiac and cerebrovascular events for patients with LVEF <50% (HR: 4.950; 95% CI: 1.329-18.435; P = 0.017; and HR: 1.810; 95% CI: 1.038-3.158; P = 0.037, respectively) but not for patients with LVEF ≥50% (HR: 0.699; 95% CI: 0.435-1.124; P = 0.140). ConclusionsCCB therapy did not increase adverse cardiovascular events for patients after AMI with preserved LVEF. CCBs can be considered as an alternative for BBs in East Asian patients after AMI with preserved LVEF.

Changes in Mean Arterial and Blood Pressure in Using Nicardipine in Hypertensive Crisis Patients at the Hajj General Hospital Surabaya from August to December 2021

Hypertension crisis is one of the most common disease problems; it will cause complications and death. Therapeutic management guidelines that the calcium channel blocker group, one of which is nicardipine, can increase the achievement of goals in mean arterial pressure (MAP) in preventing the progression of organ damage. This study aimed to evaluate the use of nicardipine therapy on the MAP and blood pressure (BP) in patients with hypertension crisis. The research design was cross-sectional with statistical analysis—retrospective data collection at Hajj General Hospital Surabaya for August to December 2021. The number of samples in this study matched the inclusion criteria; 20 patients were obtained, 16 with a diagnosis of hypertension emergency, and four with hypertension urgency who received single or combined intravenous nicardipine therapy &lt;0.005 with an average BP decrease of pre 20.375±31.492/103.50±10.400 mmHg and post 121.34±14.364/81.80±11.186 so that intravenous nicardipine therapy was significant in reducing systolic and diastolic BP. In the profile of the MAP value statistically using the paired T-test, it was found that the P-value was 0.000 &lt; 0.005 with a decrease in the MAP pre-value of 135.028±13.8857 mmHg and post 93.650±8.9499 mmHg, showing a reduction in MAP as expected. In conclusion, using nicardipine intravenously at a 5 mg/hour dose has shown an optimal decrease in BP and MAP in hypertensive emergency and urgency patients.

The regular use of calcium channel blockers before flexible URS appears to facilitate primary UAS insertion: a retrospective study in a single center.

To evaluate the effect of regular use of CCB before flexible URS for successful primary UAS insertion. We retrospectively analyzed 209 patients who underwent flexible ureteroscopy (URS) for upper urinary tract calculi between Jan 2021 and Dec 2021. Patients were divided into two groups based on whether calcium channel blockers (CCB) were used (n = 72) or not (n = 137). The following parameters were collected: age, sex, height and weight, BMI, stone location, stone burden, number of stones, operation time, hospital stay, hospital readmission, post-operative fever, post-operative SIRS rate, Clavien-Dindo grade, hospitalization costs, successful primary UAS insertion. We compared the two groups using Student's t test, Mann-Whitney U test and χ2 test for quantitative and categorical variables, respectively. A logistic regression model was used to identify predictive factors of UAS successful primary insertion. Compared with the non-CCB group, the CCB group had a higher successful primary UAS insertion rate (97.2% vs.85.4%, p = 0.008), and a lower hospital readmission rate (2.8% vs.12.4%, p = 0.021). In multivariate analyses, the regular use of CCB was the only predictive factor of successful primary UAS insertion rate (OR 6.32, 95% CI 1.41-28.29, p = 0.016). The regular use of calcium channel blockers (CCB) before flexible URS appears to facilitate ureteral access sheaths (UAS) primary insertion.

Myocardial bridge evaluation towards personalized medicine: study design and preliminary results of the RIALTO registry.

Myocardial bridge (MB) is the most frequent inborn coronary artery variant in which a portion of the myocardium overlies an epicardial coronary artery segment. Although MB has long been considered a benign entity, a growing body of evidence has suggested its association with angina and adverse cardiac events. However, to date, no data on long-term prognosis are available, nor on therapies improving cardiovascular outcomes. We are currently conducting an ambispective, observational, multicentre, study in which we enrol patients with a clinical indication to undergo coronary angiography (CA) and evidence of MB, aiming to describe the incidence of symptoms and cardiovascular events at baseline and at long-term follow-up (FUP). The role of invasive full-physiology assessment in modifying the discharge therapy and eventually the perceived quality of life and the incidence of major cardiovascular events will be analysed. Basal clinical-instrumental data of eligible and consenting patients have been acquired after CA; FUP was performed 6, 12, and 24 months after the angiographic diagnosis of MB. The primary endpoint of the study is the incidence of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, myocardial infarction, cardiac hospitalization, and target vessel revascularization; the secondary endpoints are the rate of patients with Seattle Angina Questionnaire (SAQ) summary score <70 and the incidence of MACE in patients undergoing invasive intracoronary assessment. Among patients undergone FUP visits, we recorded 31 MACE at 6 months (11.6%), 16 MACE at 12 months (6.5%), and 26 MACE at 24 months (13.5%). The rate of patients with SAQ <70 is 18.8% at 6 months, 20.6% at 12 months, and 21.8% at 24 months. To evaluate the prognostic role of invasive intracoronary assessment, we compared MB patients who underwent only angiographic evaluation (Angio group) to those who underwent acetylcholine (ACH) provocative test with indication to calcium-channel blockers (CCBs) at discharge (Angio + ACH + CCBs group) and those who underwent functional assessment with fractional flow reserve (FFR) with indication to beta-blockers (BBs) at discharge (Angio + FFR + BBs group). After 2 years of FUP, the rate of MACE was significantly reduced in both Angio + ACH + CCBs group (6 vs. 25%, P = 0.029) and Angio + FFR + BBs group (3 vs. 25%, P = 0.005) compared with Angio group. The preliminary results of our study showed that MB may be a cause of angina and adverse cardiac events in patients referred to CA for suspected coronary artery disease (CAD). Full-physiology assessment unmasking MB-related ischaemia mechanisms, allowed to guide the treatment, personalizing the clinical management, improving the quality of life, and cardiovascular outcomes in patients with MB.

Magnesium Sulphate and Nifedipine in Management of Preterm Premature Rupture of Membranes

Premature rupture of membranes (PROM) is defined as rupture before delivery that can occur at any gestational age. If it occurs before 37 weeks of gestation, it’s called Preterm Premature Rupture of Membrane (PPROM). PROM is a condition that still occurs in both developed and developing countries and cause a serious threat to the fetal and maternal well-being if not managed properly. Conservative management is chosen in PPROM until the fetus is viable, consist of hospitalization, assessment of sign of infection, well-being of the fetal and maternal. Spesific treatment includes the administration of corticosteroid, antibiotics, and tocolytics. Tocolytic agents that are widely used as first-line agents are magnesium sulphate (MgSO4) and nifedipine, one of the Calcium Channel Blocker (CCB) groups. MgSO4 and nifedipine both have an effect in reducing myometrial contractility. MgSo4 also has a neuroprotective effect in PPROM less than 31 weeks if there is a threat of delivery within 24 hours. Meta-analysis related to the use of these two agents in PPROM is still subject to differing result. Some studies have shown nifedipine is considered to have milder side effect than MgSO4, more easily tolerated by oral administration, and more affordable. However, some studies have shown that the two agents have the same efficacy. Other studies have shown no significant benefit in administering nifedipine to neonates or prolong pregnancy in women with PPROM without contractions.

Profile Of Antihypertensive Drug Use At Clinic M Surabaya

Hypertension is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg on two measurements with an interval of five minutes in a state of sufficient rest/quiet. The purpose of this study was to determine the profile of the use of antihypertensive drugs at Clinic M Surabaya for the period July-December 2021. This study was conducted by collecting data retrospectively from July-December 2021 by screening and classifying antihypertensive drug prescriptions based on age and gender, drug class , generic name of the drug, dosage of the drug, rules for taking the drug. The number of samples that met the inclusion criteria were 552 recipes. From the study results, it was known that the patients with the most age were in the 56-65 year age group by 29.9%. Female patients were 51.1% more than male patients, namely 48.9%. The group of drugs that are often prescribed is the Calcium Channel Blocker group of 73.2%. The generic name of the drug that is often prescribed is Amlodipine as much as 72.9%, with a dose of 5 mg (59.1%) and the rule of use is 1 time a day after meals (27.2%).

Renin-angiotensin system inhibitors may have an advantage over calcium channel blockers in reducing proteinuria in gastric cancer patients receiving ramucirumab.

This study aimed to investigate whether renin-angiotensin system inhibitors (RAS-I) have an advantage over calcium channel blockers (CCB) for suppression of proteinuria in hypertensive patients with gastric cancer receiving ramucirumab (RAM) treatment. Adult Japanese patients with gastric cancer who were outpatients at Asahikawa Medical University Hospital, National Hospital Organization Hokkaido Cancer Center, and Iwate Medical University Hospital between July 1, 2015, and March 31, 2021, were included in this study. Of these patients, those who had received first-time RAM treatment, and those treated with antihypertensive agents including RAS-I or a CCB at initial RAM administration were included. A total of 36 patients were analyzed in this study. Of these patients, 17 patients were classified into the RAS-I group and the remaining 19 into the CCB group. After 12 weeks of RAM administration, the prevalence of proteinuria in the RAS-I group was significantly lower than that in the CCB group. Additionally, Kaplan-Meier analysis showed that the cumulative occurrence of proteinuria in the RAS-I group over 12 weeks following RAM administration was significantly lower than that in the CCB group. Furthermore, simulation of the time course of RAM blood concentrations based on the O'Brien model showed that there may not be differences in the RAM blood concentration profiles over 12 weeks between the two groups. RAS-I may have an advantage over CCB for suppressing proteinuria in hypertensive patients with gastric cancer treated with blood pressure antihypertensive agents. Our results provide useful information to healthcare professionals involved in the administration of RAM treatment.

Calcium channel blockers improve the prognosis of patients with intrahepatic cholangiocarcinoma after resection.

Intrahepatic cholangiocarcinoma is the second most common primary cancer of the liver. It is highly malignant and its prognosis is very poor. Although there have been various reports on the effects of calcium channel blockers on cancer, the effects of calcium channel blockers on intrahepatic cholangiocarcinoma have not been reported so far. Seventy-nine patients diagnosed with intrahepatic cholangiocarcinoma by hepatectomy between January 2002 and May 2019 were retrospectively evaluated. We compared prognosis and time to recurrence between patients treated with calcium channel blockers (CCBs) (n = 29) and those not treated with CCBs (n = 50). Propensity score matching reduced confounding biases and yielded 25 matched patient pairs. Survival between groups was compared using Kaplan-Meier analyses, logrank tests, and Cox proportional hazard regression models. Overall survival and recurrence-free survival of the CCBs group were significantly longer than those of the non-CCBs group OS in the original cohort and matched cohort (98months vs 45months, p = 0.010; 96months vs 22months, p = 0.020, respectively). Multivariate analyses showed that CCBs treatment was independently associated with overall survival (HR, 0.37; 95% CI 0.16-0.85; p = 0.019) and recurrence-free survival (HR, 0.39; 95% CI 0.17-0.90; p = 0.020) in the original cohort and matched cohort, respectively. CCBs treatment might improve prognosis of patients with intrahepatic cholangiocarcinoma.

EVALUATION OF THE USE OF AMLODIPIN IN HYPERTENSION PATIENTS IN THE HOSPITAL OF RSUD Drs. H. AMRI TAMBUNAN

Hypertension is a chronic disease that often becomes a problem in health. One of the treatment patterns for hypertension patients that is often received by patients at the RSUD Drs. H. Amri Tambunan is Amlodipine from the CCB (Calcium Channel Blocker) group. The goal of hypertension treatment is to prevent morbidity and mortality due to high blood pressure by reducing pressure to as low as possible so as not to interfere with kidney function, brain function and quality of life. Hypertension is a disease that occurs due to an increase in systolic and diastolic blood pressure values ??of more than 130/80 mmHg on two measurements with an interval of five minutes in a calm state. Hypertension is a condition in which a person experiences an increase in blood pressure above normal, namely systolic blood pressure 140 mmHg or diastolic blood pressure 90 mmHg. Every 10 kg weight loss of obese patients can reduce 5-20 mmHg Systolic Blood Pressure (TDS). The purpose of this community service activity is so that people who seek treatment at Drs. H. Amri Tambunan can monitor his health condition. With the evaluation of the drug amlodipine, participants become more aware of matters related to hypertension and can take advantage of herbal plants that grow around their homes to prevent or treat hypertension.

Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum

BackgroundRhythm control and rate control are both employed commonly in patients with atrial fibrillation (AF) and heart failure (HF), but limited real-world data exist on them. We aimed to compare outcomes between these two strategies across the left ventricular ejection fraction (LVEF) spectrum. Materials and methodsThis retrospective cohort study used data from the randomized MISOAC-AF trial, including from patients with AF and coexistent HF who were hospitalized and followed up after discharge. At baseline, the patients were classified into pharmaceutical (or electrical cardioversion) rhythm control strategy or rate control treatment (b-blocker, digoxin, calcium channel blockers) groups. The primary outcome was all-cause mortality. Kaplan-Meier curves and multivariable-adjusted Cox regression were utilized to compare the two strategies. Spline curve models were used to demonstrate the results across the LVEF stratified spectrum. ResultsIn total, 199 AF patients with HF were studied (mean age, 77 years). At discharge, 73 (36.7%) patients received rhythm control and 126 (63.3%) rate control treatment. After a median follow-up period of 31 months, 26 (35.6%) patients in the rhythm-control group died, as compared to 43 (33.3%) in the rate-control group (aHR: 1.29; 95% CI: 0.78-2.14; p = 0.31). The spline curves also revealed no difference in all-cause mortality favoring either strategy in any HF subtype across the nominally classified LVEF. ConclusionThe use of a pharmacological rhythm-control strategy was not associated with a survival advantage compared to the rate control strategy in recently hospitalized patients with AF and comorbid HF. More randomized trials and large studies are needed in the future to explore these results in each subgroup of HF patients.