Oral Antihypertensives Research Articles

A Comparative Study on Effectiveness of Oral Labetalol Versus Oral Nifedipine Used in the Treatment of Gestational Hypertension in a Tertiary Care Teaching Hospital

Background Gestational hypertension is associated with increased risk of adverse maternal and fetal outcomes. Drug treatment is generally reserved for moderate or severe cases of gestational hypertension. Nifedipine and labetalol are the drugs which are exclusively used in oral anti-hypertensives to treat gestational hypertension where both belong to Category-C. Hence a prospective observational study was designed to compare the effectiveness of oral labetalol versus oral nifedipine used in the treatment of gestational hypertension.Aim To compare the efficacy safety availability cost minimization prescribing patterns of oral labetalol and oral nifedipine in the treatment of gestational hypertension.Methodology This is a prospective observational study conducted in Chigateri district hospital Davanagere Tertiary care teaching hospital for a period of six months where data of 150 subjects diagnosed with gestational hypertension were obtained from the department of Obstetrics and Gynecology OBG from the case sheets during ward rounds. Out of this 27 cases are excluded due to insufficient data.Results Among the studied subjects only 59 47.97 were prescribed oral antihypertensive drugs either labetalol or nifedipine. 88.89 subjects treated with nifedipine showed low birth weight LBW and 51.1 subjects had preterm deliveries. Both labetalol and nifedipine were found to have similar efficacy but nifedipine was associated with low birth weight in more cases when given prenatally. Cost of generic medicines was found to be very less when compared to highly prescribed brands.Conclusion Both labetalol and nifedipine retard exhibited similar efficacy but the cost of nifedipine was less when compared to labetalol in highly prescribed brands. In generic drugs the margin of difference between the costs of both the drugs was found to be less. Among the subjects who were prescribed nifedipine prenatally low birth weight neonates and other fetal adverse effects were observed. Therefore labetalol may be prescribed prenatally while nifedipine can be prescribed postnatally considering both efficacy and cost factor.

Burden of Neurological Diseases in the Philippines as Revealed by Web Searches: An Infodemiological Study.

Due to the real-time acquisition of big data from the Internet, analysis of Google queries is now recognized as a valuable tool to explore and predict human behavior and interests. It was suggested that online data can be correlated with actual health data. Although the data are not structured nor systematic, the huge data from search engines can easily identify trends concerning diseases and other health concepts from a population perspective. Moreover, Internet data with the use of web search advertising nowadays may not only reveal the interest of the general population but also of the healthcare industry as reflected by the bid prices in search terms for medications. We aimed to compare the interests of the general population using monthly search volumes from Google and the healthcare industry using bid prices in web searches. Data used in this study were obtained from the Google Ads Application Programming Interface (API). This study evaluated the population's interest in neurological disorders by using search volumes related to neurology, either disease diagnosis or medications. Bid values generated in API were used as a proxy for the interests of the healthcare industry. Spearman's rank-order correlation was performed between search volumes and bid prices to determine significance. Among the neurologic diseases listed, the most searched were attention deficit hyperactivity disorder, migraine, and Alzheimer's disease. The most commonly searched drugs were oral antihypertensives (amlodipine, losartan, carvedilol), lipid-lowering agents (atorvastatin, simvastatin, rosuvastatin), and antiplatelets (acetylsalicylic acid, clopidogrel). The other most searched drugs were analgesics such as acetaminophen, tramadol, diclofenac, and morphine. The correlational analysis did not reveal a statistically significant correlation between search volume and bid price for both neurologic diseases and medications. Web searches may reflect the interest of the general population and the healthcare industry. However, there was disagreement in the search interests of the general population and the scientific community, including the pharmaceutical industry. Further studies are necessary in order to align these interests for the common benefit of all stakeholders.

Initiation of oral antihypertensives in hospitalized patients with hypertensive urgency: A descriptive study.

In hypertensive urgency, guidelines recommend oral antihypertensives, but with limited guidance on implementation. The objective of this study was to determine whether time to initiation of oral antihypertensives impacts blood pressure (BP) reduction in patients with hypertensive urgency. A descriptive study was conducted of adult hospitalized patients with hypertensive urgency from November 2018 through November 2021. Patients with a systolic BP (SBP) of 180 mm Hg or higher or a diastolic BP (DBP) of 120 mm Hg or higher and receipt of oral antihypertensives within 48 hours of presentation were included. The primary outcome was the percentage change in SBP from baseline at 12 to 24 hours and 24 to 48 hours. Secondary outcomes included the change in DBP and mean arterial pressure (MAP), time to 3 consecutive goal SBP readings, continuation of home oral antihypertensives, administration of intravenous (IV) antihypertensives, and length of stay (LOS). Patients were stratified by quartile (Q1 through Q4) based on time to first oral antihypertensive. A total of 220 patients were included. A significant difference in SBP was observed among the quartiles, due to the greater sustained SBP reduction in Q1 at 12 to 24 hours and 24 to 48 hours (median [interquartile range, IQR], 22.9% [13.1%-30.5%] and 22.5% [IQR, 15.8%-32.9%] reduction, respectively). There were also reductions in DBP and MAP, with Q1 consistently having larger reductions than Q4. Patients in Q1 had 3 consecutive goal SBP readings earlier than those in the other quartiles (median [IQR], 13.1 [7.0-21.5] hours). Continuation of home medications, number of IV antihypertensives, and LOS did not differ among the quartiles. In this analysis, earlier administration of oral antihypertensives was associated with a larger sustained reduction in SBP.

Acute symptomatic epileptic seizures and epilepsy after stroke

Acute symptomatic epileptic seizures occur within 7 days after the stroke onset. Acute symptomatic epileptic seizures occur in 6.3% of stroke cases: ischemic stroke 4.2%, cerebral infarction with hemorrhagic transformation 12.5%, intracerebral hemorrhage 16.2%. Cumulative risk of subsequent unprovoked epileptic seizure after the first acute symptomatic seizure at follow-up for 10 years is 18.7 %. In acute symptomatic epileptic seizure secondary prevention with antiepileptic drugs usually is not indicated. If antiepileptic drug treatment is initiated after a single acute symptomatic seizure, it should be discontinued after the acute period of the disease. The 10-years risk of subsequent unprovoked epileptic seizures after the single unprovoked epileptic seizure in stroke patients is 71.5%. In this situation the epilepsy diagnosis is reasonable and antiepileptic drug treatment should be initiated. The incidence of epilepsy after acute ischemic or hemorrhagic stroke is identical 1012%. The choice of the group of antiepileptic drugs should be based on clinical guidelines for patients with focal forms of epilepsy. Pharmacokinetic interactions between antiepileptic drugs and oral anticoagulants, antiplatelet agents, antihypertensive drugs, and other xenobiotics should be minimized. Thus antiepileptic drugs that induce or inhibit microsomal liver enzymes should also be avoided.

Core-shell lipid-polymeric nanoparticles for enhanced oral bioavailability and antihypertensive efficacy of KY5 peptide

Hypertension is the leading risk factor for death and disability, and hypertensive patients always need long-term oral antihypertensive drugs. Some bioactive peptides that extracted from animals or plants have shown excellent advantages on antihypertension. However, the oral delivery of these peptides is always failure on account of instability and poor absorption in the gastrointestinal tract. Herein, we developed a core-shell lipid-polymeric nanoparticle for oral delivery of a highly efficient antihypertensive peptide KY5 (KY5-CSs). KY5-CSs had a particle size of 216.7 ± 2.5 nm, with a narrow PDI of 0.07 ± 0.01. The zeta potential was −4.1 ± 0.1 mV. It exhibited good stability in 4 °C and possessed a controlled release behavior in gastrointestinal tract. The cellular uptake study proved that the lipid shell imparted unique capability of permeation across the mucus layer and internalization by Caco-2/HT-29 cells. In addition, KY5-CSs enhanced in situ intestinal absorption in SD rats. The pharmacokinetic studies and antihypertensive efficacy showed a superior oral absorption and antihypertensive effect of KY5-CSs than KY5-NPs. In conclusion, the core-shell lipid-polymeric nanoparticles will provide attractive potential for oral delivery of antihypertensive peptides.

The role of low dose furesemide in reducing postpartum blood pressure among women with preeclampsia

A total of 264 women with preeclampsia have been chosen. They were randomly allocated either to the study group (N=132) or control group (N=132). Patients in either group had mild, severe or chronic hypertension with superimposed preeclkampsia. Patients in the study group were assigned to receive 20 mg furesemide plus potassium orally for 5 days only, while patient in the control group received none. Oral antihypertensive drugs were used only when diastolic blood pressure was eeither above 90 mmHg on 2 occasions, or 110 mmHg single reading. The total days for need of oral antihypertensive drugs as well as the total days spent inpatients were recorded. Patients with severe preeclampsia where categorized as those who have low platelets count as well as high serum liver enzymes in addition to the ordinary signs and symptoms of preeclampsia; hypertension, proteinurea and edema.

Assessment of Pediatric Hemolytic Uremic Syndrome Patients Hospitalized in Pediatric Intensive Care Unit

Aim: It is aimed to describe clinical properties and outcomes of pediatric hemolytic uremic syndrome hospitalized in pediatric intensive care.
 Material and Method: Our study was intended as observatory and retrospective. Symptoms before PICU admission, interventions before PICU admission, time period before PICU admission in days were defined as pre-PICU findings. Glasgow Coma Score (GCS) at admission, Pediatric Risk of Mortality Score (PRİSM-III), laboratory parameters, medical treatments, extracorporeal treatments data was collected as PICU interventions. Outcomes were examined as days in PICU, days in hospital and survival.
 Results: Twenty-three patients were included into study. Before PICU admission more than half of the patients were treated with antibiotics. Twenty-two were suffered from diarrhea. 3 patients had non-bloody diarrhea. 3 patients had central nervous system involvement presented as seizures. Intravenous diuretics (86.9%) and oral antihypertensives (73.9%) were the most common treatments in PICU. Eculizumab treatment was required for 6 patients. All patients got fresh frozen plasma. Nearly all of the patients required erythrocyte transfusions (95.6%). If we evaluated renal replacement therapies, 2 (8.6%) patients needed CRRT and 12 (52.7%) patients needed IHD. Extrarenal involvement was spotted in 5 patients (21.7%). Most of the patients were survived (95.3%).
 Conclusion: Hemolytic uremic syndrome is an important clinic entity. Most patients’ blood pressure could be controlled with oral antihypertensive treatments. Antibiotic prescriptions to diarrhetic patients should be more cautiously. There should be transfusion protocols of clinics about HUS patients to prevent over transfusion.

Trends in antihypertensive prescription for pregnant women with hypertension and their peripartum outcomes before and after label and guideline revisions in Japan.

We investigated the trends in the proportion of antihypertensive prescriptions listed in the guidelines for pregnant patients and their pregnancy outcomes before and after regulatory actions in Japan. This retrospective cohort study used the Japan Medical Data Center claims data from January 2005 to April 2020. We identified women who had delivered and had hypertensive disorders before childbirth. To evaluate the influence of regulatory actions (label revision in 2011 and guideline updates in 2014), we divided the study period into three terms based on the year of the last menstrual period. We assessed the time trend of the prescription proportion of antihypertensives and conducted multivariable logistic regression analyses to assess the impact of the investigation terms on pregnancy outcomes (preterm birth, cesarean section, emergency cesarean section, and Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome). Among the 13,797 eligible patients, 1739 (12.6%) were treated with oral antihypertensives during pregnancy. Before the policy revisions, the most frequently prescribed antihypertensive medication was methyldopa, but after the label and guideline revisions, nifedipine was the most frequently prescribed. The trend in the prescription proportion of nifedipine increased (P < 0.001) and that of hydralazine decreased (P < 0.001), while those of methyldopa and labetalol showed no significant trend. The adjusted odds ratios for all four pregnancy outcomes showed no significant differences according to the investigation terms. By investigating the three terms before and after the label and guideline revisions, significant changes were identified in the trend of the prescription proportion for pregnant women-an increase in nifedipine and a decrease in hydralazine-but not in pregnancy outcomes.

IN SILICO INVESTIGATION OF XANTHONE DERIVATIVE POTENCY IN INHIBITING CARBONIC ANHYDRASE II (CA II) USING MOLECULAR DOCKING AND MOLECULAR DYNAMICS (MD) SIMULATION

Objective: Hypertension is the leading contributor to all-cause death and disability worldwide. One of the most well-known first-line antihypertensive drugs is chlorthalidone which treats hypertension through carbonic anhydrase (CA) II inhibition. However, due to the high number of cases of hypertension, a more potent medication is still needed. Xanthone is a potential candidate for the compound group for its potency in inhibiting CA II. Therefore, this research aims to evaluate around 500 xanthones’ potency as a better oral antihypertensive drug than chlorthalidone. Methods: 507 xanthones were analyzed for their potency using in silico method. Xanthone’s structures were retrieved from the PubChem website or built using Avogadro software, while the CA II receptor was retrieved from The RCSB website. Then molecular docking, ADME evaluation, and toxicity test were evaluated from selected ligands. Finally, a molecular dynamics simulation was conducted to evaluate the stability of the potential ligand as the inhibitor of CA II protein. Results: This research found that globulixanthone c is considered to be a better CA II inhibitor compared to chlorthalidone. It is due to its lower binding affinity compared to chlorthalidone and its stable binding to CA II’s important inhibition sites with low fluctuation. It also has the potential to be consumed orally because it fulfills all of Lipinski's rule of five standards and its toxicity is on the moderate level. Conclusion: Globulixanthone c, a type of prenylated xanthones group, showed the best potential activity as the inhibitor of CA II protein to treat hypertension among other xanthones.

COST ANALYSIS OF ORAL ANTIHYPERTENSIVE DRUGS: ASSESSING THE EFFECT OF DRUG PRICE CONTROL ORDER IN INDIA

Objective: The study focuses on cost analysis of different available brands of oral antihypertensive drugs in India and assesses compliance with their ceiling prices fixed by drug price control order (DPCO). Methods: This is an observational study conducted in the Department of Pharmacology, GSVM Medical College Kanpur, from May to June 2022. The ceiling price of oral antihypertensive drugs was obtained from the DPCO price list 2021 and dosage and prices of the different brands of antihypertensive drugs available in India were obtained from medguideindia.com and Current Index of Medical Specialities-CIMS (Jan–April 2022 edition, India). Thereafter, data analysis of oral antihypertensive drugs was done on Microsoft Excel Office 2019 version. Results: Our study found a total 1575 brands of oral antihypertensive drugs available in market, 34% brands were having prices more than DPCO recommended ceiling price. Maximum price violation was noticed with capsule nifedipine 10 mg (83.33%) and tablet telmisartan 80 mg (60.98%). The maximum cost variation and cost ratio was seen with tablet propranolol 10 mg, that is, 3233.33% and 33.33, respectively, followed by tablet amlodipine 5 mg, that is, 2123.33% and 22.23. Conclusion: Stringent regulation and monitoring of the DPCO price list should be done to ensure that all drugs and especially oral antihypertensive drugs are not sold above the ceiling price set by the order so that the compliance for the drugs is optimized and India could achieve its objective of reducing the prevalence of hypertension to &lt;25% by 2025.

Clinical characteristics and prognosis of patients with very severe acute hypertension visiting the emergency department

BackgroundData regarding very severe acute hypertension, a serious problem in emergency departments (EDs), are scarce. We investigated the clinical characteristics, practice patterns, and long-term prognoses of patients presenting to the ED with very severe acute hypertension.MethodsCross-sectional study data were obtained from a single regional emergency medical center, including patients aged ≥ 18 years who were admitted to the ED between January 2016 and December 2019 for very severe acute hypertension, which was defined as systolic blood pressure of > 220 mmHg and/or diastolic blood pressure of > 120 mmHg. The patients were classified into two groups based on the presence or absence of hypertension-mediated organ damage (HMOD).ResultsAmong 1,391 patients with very severe acute hypertension in the ED, half of the them (50.2%) had a previous medical history of hypertension, and 547 (39.3%) had acute HMOD. The overall 3-month, 1-year, and 3-year mortality rates were 5.2%, 11.9%, and 17.3%, respectively. In particular, patients with HMOD had a significantly higher mortality rate at each time point than those without HMOD. Among patients with HMOD, acute ischemic stroke was the most common (28.7%). Moreover, intravenous antihypertensive drugs were significantly more prescribed in patients with HMOD than in those without HMOD (79.0% vs. 22.2%, P < 0.001), but there were no differences in oral antihypertensive drugs between the two groups.ConclusionsPatients with very severe acute hypertension had poor long-term clinical prognoses. Clinicians should be continuously monitoring and providing appropriate treatment and close follow-up for patients with very severe acute hypertension.

Secondary Hypertension due to Abdominal Coarctation; How do we identify and manage it?: A Case Report

Background Coarctation of the abdominal aorta (AoA) is a very uncommon condition, accounting for 0.5-2 percent of all aortic stenosis cases. We present an 11-year-old child who has been diagnosed with abdominal aorta coarctation. Case Illustration An 11-years old boy complained about dizziness since 1.5 years ago with hypertension. He underwent hypertension treatment for 1.5 years with a pediatrician but there is no improvement in his blood pressure. His current blood pressure was 150/95 mmHg in upper extremities and 120/80 mmHg in lower extremities with three antihypertensives drugs. We found bruit in the abdomen and decreases pulse in lower extremities. An echocardiogram shows no congenital defect. The first was on suspicion of renal stenosis and underwent ultrasonography of the abdomen but was not conclusive. Computed Tomography Angiographic (CTA) showed severe stenosis in the abdominal aorta on level thoracal 11-12. Aortogram shows significant stenosis in the abdominal aorta with a pressure gradient was 47 mmHg. He underwent percutaneous transluminal angioplasty with BMS self-stent implantation. At two months of follow up his blood pressure target was achieved with a minimal dose of oral antihypertensive drugs Discussion How to diagnose coarctation of the abdominal aorta is still challenging and often underdiagnosed. Patients with young age and persistent hypertension should be more careful in diagnosis. A bruit in the abdomen with a weak pulse in the lower extremity raises suspicion of Coarctation of the Abdominal Aorta. An angioplasty procedure, either with or without a stent or a surgery might be used as the primary therapy.

A study on cost analysis of oral antihypertensive drugs available in India

The major health care problem in developing world is shifting from communicable diseases to non-communicable disease which causes morbidities more than mortality affecting the personal efficiency. Hypertension is a major health care burden in developing countries like India causing both morbidity and mortality. Few studies shows that the hypertension prevalence has raised from 2% to 15% in rural population and 2% to 25% in urban population in last six decades in India. This research work aims to enumerate the price of commonly available oral antihypertensive drugs in India. It also aims to study the cost variation of oral antihypertensive drugs. The present study was carried out in the department of Pharmacology in a tertiary care medical college in south India. The cost analysis of individual drugs by different manufacturers were done. Percentage of cost variation was analysed. The variation in cost of most of the antihypertensive drugs is more than 100%. It’s found maximum in Amlodipine (5mg) with cost variation of 625%, Atenolol 100 mg with cost variation of 413%. In India there is a wide price variation among antihypertensive drugs. The major gap in the cost variation of antihypertensive drugs to be narrowed for the benefit of the patients. So the government and the prescribing doctors should think about the huge difference in cost and work in the direction of benefitting the patient.

Review of Long-Term Blood Pressure Control After Intracerebral Hemorrhage: Challenges and Opportunities.

Blood pressure (BP) is the most important modifiable risk factor for intracerebral hemorrhage (ICH). Elevated BP is associated with an increased risk of ICH, worse outcome after ICH, and in survivors, higher risks of recurrent ICH, ischemic stroke, myocardial infarction, and cognitive impairment/dementia. As intensive BP control probably improves the chances of recovery from acute ICH, the early use of intravenous or oral medications to achieve a systolic BP goal of <140 mm Hg within the first few hours of presentation is reasonable for being applied in most patients. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg and again in all ICH patients regardless of age, location, or presumed mechanism of ICH. The degree of sustained BP reduction, rather than the choice of BP-lowering agent(s), is the most important factor for optimizing risk reduction, with varying combinations of thiazide-type diuretics, long-acting calcium channel blockers, ACE (angiotensin-converting enzyme) inhibitors or angiotensin receptor blockers, being the mainstay of therapy. As most patients will require multiple BP-lowering agents, and physician inertia and poor adherence are major barriers to effective BP control, single-pill combination therapy should be considered as the choice of management where available. Increased population and clinician awareness, and innovations to solving patient, provider, and social factors, have much to offer for improving BP control after ICH and more broadly across high-risk groups. It is critical that all physicians, especially those managing ICH patients, emphasize the importance of BP control in their practice.

Acute bilateral ureteropelvic junction obstruction as a rare cause of hypertensive crisis: a case report

BackgroundBilateral ureteropelvic junction obstruction is a common cause of secondary hypertension in the pediatric population, often due to congenital malformation. On the other hand, it is less frequently encountered in the adult population and is usually due to an acquired condition, most commonly by a bilaterally obstructing nephrolithiasis causing hydronephrosis and subsequent hypertension. The aim of this study was to investigate and highlight the underlying mechanisms by which acute bilateral ureteropelvic junction obstruction causes hypertensive crisis and why early detection and prompt treatment are necessary to mitigate the effects of elevated blood pressure on target organs.Case presentationA 41-year-old African American man with hypertensive cardiomyopathy presented with anuria. He was found to have elevated blood pressure with evidence of target organ damage on laboratory examination, demonstrated by sudden elevation of his serum creatinine level. He was initially treated with oral and intravenous antihypertensives, with minimal improvement. The work-up was unremarkable apart from the imaging finding of acute bilateral ureteropelvic junction obstruction from obstructing nephrolithiasis causing hydronephrosis. Bilateral ureteral stents were placed for decompression, with resolution of the hypertensive crisis and improvement of renal function.ConclusionThis case highlights the importance of prompt diagnosis and treatment of underlying acute bilateral ureteropelvic junction obstruction to mitigate the deleterious effects of sudden blood pressure elevation on target organs.

Clinical and Imaging Data-Based Model for Predicting Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in Pregnant Women With Severe Preeclampsia or Eclampsia and Analysis of Perinatal Outcomes.

Objective This study aimed to investigate the risk factors of reversible posterior leukoencephalopathy syndrome (RPLS) in pregnant women with severe preeclampsia or eclampsia (SPE/E) based on a predicting model and to analyze the perinatal outcomes. Methods From January 2015 to March 2020, 78 pregnant women data diagnosed with severe preeclampsia or eclampsia with cranial magnetic resonance imaging (MRI) and transcranial Doppler (TCD) screening in Xiangyang No. 1 People's Hospital and Jiangsu Province Hospital of Chinese Medicine were analyzed retrospectively. They were divided into the RPLS group (n = 33) and non-RPLS group (n = 45) based on the MRI results. The general clinical data (blood pressure, BMI, symptoms, and so forth), laboratory examination, TCD results, and perinatal outcomes in the two groups were compared. The risk factors of severe preeclampsia or eclampsia complicated with RPLS were analyzed by multivariate logistic regression. The prediction model and decision curve (DCA) were established according to the clinical-imaging data. Results The univariate analysis showed that poor placental perfusion, hypertension emergency, use of two or more oral antihypertensive drugs, headache, white blood cell (WBC) count, platelet (PLT) count, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), uric acid (UA), serum albumin (ALB), average flow velocity, and resistance index of the posterior cerebral and basilar arteries were significantly different in the RPLS group compared with the non-RPLS group (all P < 0.05). The multivariate logistic regression analysis showed that hypertensive emergency, headache, WBC, PLT, ALT, and average flow velocity of the basilar artery (BAAFV) were the risk factors in the RPLS group. The aforementioned clinical-imaging data modeling (general data model, laboratory examination model, TCD model, and combined model) showed that the combined model predicted RPLS better. DCA also confirmed that the net benefit of the combined model was higher. In addition, the incidence of postpartum hemorrhage, stillbirth, and preterm infants was higher in the RPLS group than in the non-RPLS group (all P < 0.05). Conclusions More postpartum complications were detected in pregnant women with severe preeclampsia or eclampsia complicated with RPLS. Hypertensive emergency, headache, WBC, PLT, ALT, and BAAFV were the important risk factors for RPLS. The combined model had a better effect in predicting RPLS.

A Cost Comparison and Cost Variation Analysis of Anti Rheumatoid Drugs and Anti-Hypertensive Drugs in Ayurveda and Allopathy

Our study aimed to analyze and compare monthly costs along with cost variation between Ayurveda and Allopathy medicines used to treat 2 chronic disease conditions, viz. Rheumatoid Arthritis and Hypertension. The prices of Allopathic &amp; Ayurvedic drugs mentioned in the treatment guidelines for these 2 conditions were obtained from different sources. The minimum and the maximum cost of a particular drug of the same strength manufactured by various pharmaceutical companies were noted for both Ayurvedic and as Allopathic medicines. Cost Ratio and percent Cost Variation were also calculated. The results showed that the percent Cost Variation Difference (%CVD) for ayurvedic medicines for Anti-Rheumatoid arthritis ranged from 105% to 166.33%. In the case of Allopathic drugs, the %CVD ranged from 182% for DMARDs to 1184.39% for Corticosteroids. In the case of Anti-hypertensive medicines, too, the mean %CVD ranged from 84.21% for Rasaushadhi to 353.33% for Arishta, while %CVD ranged from 150.70% for ACE inhibitors to 269.85% for Calcium channel blockers for Ayurvedic and Allopathic medicines, respectively. A comparison of the monthly medicine cost for Rheumatoid Arthritis in Ayurveda and Allopathy showed that the cost for Ayurveda medicine ranged from ₹993.16 to ₹1994 while that for Allopathic medicines ranged from ₹735.53 to ₹2634.57. In the case of hypertension, the monthly medicine cost ranged from ₹255.64 to 2136.35 depending on the grade of Hypertension for Ayurvedic medicines and ₹312.65 to ₹631.15 for Allopathic medicines. Thus, we can conclude that there is a wide difference in the prices of the various brands of the same oral Antihypertensive and Anti-Rheumatoid arthritis drugs available in both Ayurveda and Allopathy in the Indian market.

ANTIHYPERTENSIVES IN ORAL SUB MUCOSAL FIBROSIS

Oral submucous brosis is a common pre-malignant condition affecting the oral mucosa with more prevalence among Indian population. Various treatment modalities have been elucidated in order to alleviate the symptoms associated with OSMF. Currently oral Anti hypertensive has been proved to have benecial result in treating OSMF because of its anti-inammatory, brinolytic, immunomodulatory and rheologic modifying property. Several categories of drugs have been used in the treatment of OSMF but their effectiveness leaves much to be desired and no treatment regimen has afforded denitive cure. While Oral administration limits the concentration of drugs in lesional tissue and increases the potential for side effects, the Intralesional injections are associated with signicant mechanical injury and non compliance on the patient’s part because of the accompanying discomfort and pain. The present study was done to evaluate the effectiveness of oral antihypertensives in the management of OSMF Very few studies across world have showed that anti hypertensive drugs showed signicant improvement in mouth opening, reduction in burning sensation. Hence anti hypertensive can be a good alternative in the management of OSMF for whom intralesional steroids or hyaluronidase are contraindicated, for those who cannot make frequent visit and to avoid pain due to injection. And most importantly anti hypertensive is cost effective and more compliant to the patient.

Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses.

We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future sample size estimates for definitive evidence. Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: https://www.crd.york.ac.uk/PROSPERO/; unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria/preeclampsia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. Of 1246 publications identified, 72 trials were included; 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria/preeclampsia (odds ratio, 0.73 [95% credible interval, 0.54-0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30-0.98]) compared with placebo/no therapy, and proteinuria/preeclampsia compared with methyldopa (odds ratio, 0.66 [0.44-0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41-0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to >15 000/arm (fetal/newborn death) would be required to provide definitive evidence. In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive sample sizes are required for definitive evidence. Real-world data are needed to individualize care.

Posterior Reversible Encephalopathy Syndrome in a Patient with Systemic Lupus Erythematosus: A Case Report

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by a combination of clinical and radiological features. PRES presents with the rapid onset of neurological symptoms, such as headache, convulsion, altered consciousness and visual disturbance. If PRES is recognized and treated early, it has a good prognosis. We present a patient with PRES due to systemic lupus erythematosus (SLE) and hypertension. This report aims to provide information for the early diagnosis and prompt management of SLE-related PRES to maximize patient outcomes. Case presentation: A 24-year-old woman came to the emergency department with an acute severe headache and visual disturbance. Two years earlier, she was diagnosed with SLE and hypertension. She was fully awake with normal orientation. Her initial blood pressure was 170/100 mmHg. Her visual acuity was 1/∞ (light perception only). Brain T2-weighted magnetic resonance imaging showed multiple hyperintensity patches at the occipital lobe and cerebellum; these findings suggested a diagnosis of PRES. Due to SLE-related PRES, she was treated with intravenous methylprednisolone, and her blood pressure was monitored. Her blood pressure was maintained using a combination of oral antihypertensive drugs. She was also treated with intravenous phenytoin for seizure prophylaxis. Her symptoms resolved completely, and her visual acuity returned to normal after 2 days. She was discharged without any neurological sequelae. Conclusion: PRES is a clinical syndrome with specific imaging findings. The diagnosis of PRES requires thorough clinical and neuroimaging examinations. Identifying the underlying cause and delivering prompt treatment is important for achieving a better outcome and minimizing neurological sequelae or mortality in patients with PRES.