scholarly journals Study of antihypertensive effect of ramipril alone and in combination with telmisartan

2017 ◽  
Vol 6 (4) ◽  
pp. 821
Author(s):  
Mustafa Raja ◽  
Ajay Kumar Shukla ◽  
Astha Agnihotri
Keyword(s):  
Hemorrhagic Stroke ◽  
Moderate Hypertension ◽  
Tertiary Care ◽  
General Medicine ◽  
Arterial Disease ◽  
Care Hospital ◽  
Increased Risk ◽  
One Year ◽  
Peripheral Arterial

Background: Hypertension is one of the leading causes of the global burden of disease. Hypertension has been associated with increased risk of cardiovascular diseases, including coronary heart disease (CHD), congestive heart failure (CHF), ischemic and hemorrhagic stroke, renal failure, and peripheral arterial disease. Majority of the hypertensive population are still either untreated or inadequately treated. Aims and objectives of the study were to compare ramipril alone and in combination with telmisartan as an antihypertensive in mild to moderate hypertension.Methods: This study was a hospital based prospective, comparative randomized, observational study conducted over a period of one year. The subjects of this study had mild to moderate hypertension selected from outpatient department of department of General Medicine of a tertiary care hospital. For the purpose of this study, equal numbers of subjects were randomly allocated equally between two groups: one group on ramipril alone and the other group on combination of ramipril and telmisartan. Patients were assessed for the blood pressure (BP) reduction during follow-up period of 6-months.Results: Ramipril alone and in combination with telmisartan, both were associated with significant reduction of systolic BP (SBP), diastolic BP (DBP), and mean BP (MBP) from beginning to the end of study. Combination of ramipril with telmisartan was more effective than ramipril in lowering SBP during 4 to 12 weeks but at the end of study both drug groups were found to be equally effective antihypertensive. Both ramipril alone and in combination with telmisartan were equally effective in lowering DBP and MBP from beginning to end of study.Conclusions: There was a significant reduction of SBP, DBP, and MBP from beginning to the end of study with both ramipril alone and in combination with telmisartan. Ramipril alone and in combination with telmisartan, both were equally effective antihypertensive for mild to moderate hypertension.

scholarly journals Amino-Terminal Pro–B-Type Natriuretic Peptide as Predictor of Mortality in Patients with Symptomatic Peripheral Arterial Disease: 5-Year Follow-Up Data from the Linz Peripheral Arterial Disease Study

2009 ◽  
Vol 55 (1) ◽  
pp. 68-77 ◽  
Author(s):  
Thomas Mueller ◽  
Benjamin Dieplinger ◽  
Werner Poelz ◽  
Georg Endler ◽  
Oswald F Wagner ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Natriuretic Peptide ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Rank Test ◽  
Care Hospital ◽  
Amino Terminal ◽  
All Cause Mortality ◽  
Peripheral Arterial

Abstract Background: Amino-terminal pro–B-type natriuretic peptide (NT-proBNP) has emerged as predictor of mortality endpoints in cardiac disease. In contrast, the prognostic value of NT-proBNP in patients with peripheral arterial disease (PAD) is unclear. Therefore, we aimed to evaluate the capability of NT-proBNP as a marker for long-term prognosis in atherosclerotic PAD. Methods: We obtained NT-proBNP serum concentrations in 487 consecutive patients with symptomatic PAD admitted to a tertiary-care hospital. The endpoint was defined as all-cause mortality, and the study participants were followed for 5 years. Results: Of the 487 patients enrolled, 114 died and 373 survived during follow-up. The median NT-proBNP concentration was higher among decedents than survivors (692 vs 143 ng/L; P < 0.001). Using the median NT-proBNP concentration of the entire cohort (213 ng/L) as threshold level, Kaplan–Meier curve analysis demonstrated that the survival probability was lower in patients with NT-proBNP above the median (log-rank test, P < 0.001). In the fully adjusted Cox proportional-hazards regression analysis, NT-proBNP >213 ng/L had a risk ratio of 2.27 (95% CI 1.27–4.03; P = 0.005) independent of age, sex, glomerular filtration rate, clinical stage of PAD, cardiovascular comorbidity, and other potential confounders. Further analyses showed that NT-proBNP added significantly to the value of established and emerging outcome predictors of PAD. Conclusions: In this study, a NT-proBNP serum concentration >213 ng/L was a robust and independent predictor of 5-year all-cause mortality in patients with symptomatic PAD. Thus, NT-proBNP measurements can be considered a valuable tool for risk stratification in these patients.

scholarly journals Assessment of the success rate of specialised female surgical clinic in tertiary care hospital

2019 ◽  
Vol 7 (1) ◽  
pp. 271
Author(s):  
Anand Gupta ◽  
Anshuman Sharma
Keyword(s):  
Success Rate ◽  
Multidisciplinary Approach ◽  
Tertiary Care ◽  
General Medicine ◽  
Care Hospital ◽  
Surgical Department ◽  
Female Patients ◽  
One Year ◽  
Surgical Clinic

Background: Specialized female surgical clinics are the basic requirement in surgical department which should be addressed routinely. The management of surgical problems in female patients requires multidisciplinary approach mainly general surgery, obstetrics and gynaecology, general medicine, paediatrics, dermatology and psychiatry. If proper care is provided then this will uplift the follow up of same patients in such clinics. The objective of the study was to assess the success rate of female surgical clinics and to determine the follow up visits done by female patients once visited the female surgical clinics.Methods: Prospective educational interventional study was conducted. A total of 952 patients visiting the clinic were studied. Statistical analysis was done.Results: Out of 952 cases 944 (99.2%) cases were willing to continue visit to the clinic, while 809 (84.9%) cases revisited for follow up treatment in female surgical clinics within one year duration.Conclusions: It can be concluded that there is a requirement and need of a fully functional specialized female surgical clinic in our hospital. As the success rate for follow up visit by patients in this clinic was high.

Relation between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease among Construction Workers

2021 ◽  
Vol 15 (10) ◽  
pp. 3473-3475
Author(s):  
U. Sivakumar ◽  
Rinku Garg ◽  
Sunita Nighute
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Peripheral Arterial Disease ◽  
Pulmonary Disease ◽  
Arterial Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
Peripheral Arterial

Introduction: PAD was asymptomatic in a large proportion of COPD patients and was associated with more severe lung disease than in COPD subjects without PAD. Materials and Methods: This was a Cross-sectional study conducted at Department of Physiology, Santosh Medical College diagnosed with COPD using Spirometry was recruited for the study with a Sample size of 130 patients. Results: The characteristics of the population for follow-up (n=130) are presented in table 1. The mean Mean±SD was 51.73±6.1 years. The prevalence of never smokers was 21.5%, former smokers were 51.5% and current smokers were 26.9%. In total, 41 out of 130 individuals (31.5%) had PAD based on an ABI of less than 0.6. A statistically significant association was found between COPD and newly diagnosed PAD during follow-up. The association between COPD and incident PAD was stronger (adjusted OR 1.91, 95% CI 1.14–3.21). Stratified analysis by smoking status revealed that the overall association between COPD and newly developed PAD was driven by the ever smoker group. Conclusion: Subjects with COPD have a higher risk of developing PAD. People with both COPD and PAD have a substantially increased risk of death. Consequently, early detection of PAD and preventive actions in people with COPD should receive more attention in clinical respiratory care. Keywords: Peripheral Arterial Disease, Chronic Obstructive Pulmonary Disease, Ankle-brachial index.

A minimalist electronic health record-based intervention to reduce standing lab utilisation

2020 ◽  
pp. postgradmedj-2019-136992
Author(s):  
Kuo-Kai Chin ◽  
Amrita Krishnamurthy ◽  
Talhah Zubair ◽  
Tara Ramaswamy ◽  
Jason Hom ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Complete Blood Count ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Medicine ◽  
Health Record ◽  
Care Hospital ◽  
Before And After ◽  
Electronic Health ◽  
One Year

BackgroundRepetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.ObjectiveTo evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.SettingOne year before and after intervention at a 600-bed tertiary care hospital. 18 000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).InterventionProviders were required to specify the number of times each test should occur instead of being able to order them indefinitely.MeasurementsFor eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.ResultsUtilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.ConclusionsRequiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.

scholarly journals Peripheral arterial disease diagnosis and management in primary care: a qualitative study

BJGP Open ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. bjgpopen19X101659 ◽  
Author(s):  
Jan Lecouturier ◽  
Jason Scott ◽  
Nikki Rousseau ◽  
Gerard Stansby ◽  
Andrew Sims ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Disease Diagnosis ◽  
Diagnosis And Management ◽  
Increased Risk ◽  
Peripheral Arterial ◽  
The Impact

BackgroundPatients diagnosed with peripheral arterial disease (PAD) are at an increased risk of coronary heart disease, stroke, heart attack, and PAD progression. If diagnosed early, cardiovascular risk factors can be treated and the risk of other cardiovascular diseases can be reduced. There are clear guidelines on PAD diagnosis and management, but little is known about the issues faced in primary care with regards adherence to these, and about the impact of these issues on patients.AimTo identify the issues for primary care health professionals (HPs) and patients in PAD diagnosis and management, and to explore the impact of these on HPs and PAD patients.Design & settingQualitative study conducted in a primary care setting in the North East of England. Data was collected between December 2014 and July 2017.MethodSemi-structured interviews and focus groups were conducted with PAD register patients (n = 17), practice nurses ([PNs], n = 17), district nurses (DNs], n = 20), tissue viability nurses (n = 21), and GPs (n = 21).ResultsHPs’ attitudes to PAD, difficulty accessing tests, and patient delays impacted upon diagnosis. Some HPs had a reactive approach to PAD identification. Patients lacked understanding about PAD and some reported a delay consulting their GP after the onset of PAD symptoms. After diagnosis, few were attending for regular GP follow-up.ConclusionPatient education about PAD symptoms and risks, and questioning about exercise tolerance, could address the problem of under-reporting. Annual reviews could provide an opportunity to probe for PAD symptoms and highlight those requiring further investigation. Improved information when PAD is diagnosed and, considering the propensity for patients to tolerate worsening symptoms, the introduction of annual follow-up (at minimum) is warranted.

P946Abnormal ankle brachial indices are associated with ischemic stroke: evidence from a large cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Bhatt ◽  
A S Tseng ◽  
M Girardo ◽  
C Firth ◽  
D Fortuin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
P Value ◽  
Care Hospital ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Artery Disease ◽  
Peripheral Arterial

Abstract Background Peripheral arterial disease is a marker of aggressive atherosclerosis. The ankle brachial index (ABI) is a simple and non-invasive tool to diagnose peripheral arterial disease (PAD). Patients with PAD are at increased risk for ischemic strokes and other cardiovascular diseases. Purpose To evaluate the association of abnormal ABI and poorly compressible vessels with ischemic stroke in a large patient cohort. Methods We analyzed lower extremity vascular studies of all patients with ABI measurements at a tertiary care hospital between January 1996 and August 2018. PAD is defined as ABI<1.0, and poorly or non-compressible (PC/NC) arteries as ABI>1.4 while ABI between 1.0–1.4 is normal. Association of these ABIs with new ischemic stroke events post ABI measurement were analyzed after adjusting for high risk confounders such as atrial fibrillation. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with 95% confidence intervals. Results In total, 38,016 unique patients (mean age 66.1±14.8 years, female 42.3%) were included. Abnormal ABI was found to be more prevalent among elderly male patients compared to patients with normal ABI. In contrast to non-PAD patients, both PAD and PC/NC patients as defined by ABI had a statistically significant risk of ischemic stroke, with PAD conferring the greatest risk compared to PC/NC vessels. The data is summarized in Table 1. Table 1 Unadjusted HR p-value Adjusted HR p-value PAD vs. No PAD 2.77 (2.62, 2.92) <0.001 2.10 (1.98, 2.22) <0.001 PC/NC vs. No PAD 2.11 (1.95, 2.28) <0.001 1.38 (1.26, 1.51) <0.001 PAD vs. PC/NC 1.37 (1.28, 1.46) <0.001 1.37 (1.28, 1.48) <0.001 Adjusted and unadjusted hazard ratios with p-values. HR adjusted for age, sex, atrial fibrillation, ischemic stroke, transient ischemic attack, chronic heart failure, diabetes mellitus, hyperlipidemia, hypertension, and coronary artery disease. PAD = Peripheral artery disease and PC/NC = poorly compressible/non-compressible. Conclusion This study adds to the growing body of evidence that PAD and poorly-compressible vessels are independently associated with an increased risk of ischemic stroke. Given the associated risk of cerebrovascular disease, clinicians should aggressively treat to minimize risk factors in those with abnormal ABIs.

scholarly journals Hypoglycaemia, Abnormal Lipids, and Cardiovascular Disease among Chinese with Type 2 Diabetes

2015 ◽  
Vol 2015 ◽  
pp. 1-8
Author(s):  
Yijun Li ◽  
Yiming Mu ◽  
Qiuhe Ji ◽  
Qin Huang ◽  
Hongyu Kuang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lipid Profile ◽  
Severe Hypoglycaemia ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Chinese Patients ◽  
Increased Risk ◽  
Mild Hypoglycaemia ◽  
Before And After ◽  
Peripheral Arterial

We recruited a group of 6713 consecutive Chinese patients with T2D but normal renal and liver function who were admitted to one of 81 top tertiary care hospitals in China. Mild hypoglycaemia was defined as having symptomatic hypoglycaemia in one month before hospitalization. Severe hypoglycaemia was defined as having hypoglycaemia that needed assistance from other people in three months before hospitalization. Prior cardiovascular disease (CVD) was defined as having coronary heart disease, stroke, or peripheral arterial disease. Of 6713 patients, 80 and 304 had severe and mild hypoglycaemia episodes, respectively, and 561 had CVD. Patients with severe and mild hypoglycaemia episodes were more likely to have prior CVD (32.5% versus 16.5% versus 7.7%,P<0.0001). Both mild and severe hypoglycaemia were associated with increased risk of CVD (adjusted odds ratios (ORs): 2.64, 95% CI: 1.85–3.76 for mild hypoglycaemia; 6.59, 95% CI: 3.79–11.45 for sever hypoglycaemia) than those patients free of hypoglycaemia. Further adjustment for lipid profile did not change these two ORs. In the same way, the ORs of lipid profile for CVD were similar before and after adjustment for hypoglycaemia. We concluded that hypoglycaemia and lipid profile were independently associated with increased risk of CVD.

Frequency of Myocardial Infarction in Type 2 Diabetic Patients with Peripheral Arterial Disease

2021 ◽  
Vol 17 (2) ◽  
pp. 120-124
Author(s):  
Malik Muhammad Arif ◽  
Muhammad Arif Mahmood ◽  
Mehboob Qadir ◽  
Muzammil Irshad ◽  
Humayun Riaz Khan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Peripheral Arterial Disease ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Research Centre ◽  
Diabetic Patients ◽  
Diabetes Research ◽  
Care Hospital ◽  
Type 2 Diabetic Patients ◽  
Peripheral Arterial

Objective:  This study aimed at determining the frequency of MI in diabetic Pakistani patients with PAD in a Pakistani tertiary care hospital. Methodology: A cross-sectional study carried out at Diabetes Research Centre, Nishtar Hospital Multan for six months from July 10, 2018 to January 09, 2019. The study was approved from the institutional ethics committee. As per study inclusion/exclusion criteria, the patients suffering from DM with PAD were enrolled, after signing the study informed consent. Each patient underwent electrocardiogram (ECG) recording under PI supervision. Patients having pathological Q waves (0.04 seconds wide and 2 mm deep) in two relevant leads were labeled as having myocardial infarction. Results: A total of 290 patients (men: 56.2% and women: 43.8%) were included in the study. Mean age of the patients was 51.29 ± 8.54 years with age range of 40-85 years. There were 71 (24%) smokers and 219 (76%) non-smoker patients. Fifty percent of the total patients were obese. Mean duration of diabetes was 7.39 ± 0.36 years whereas mean duration of peripheral arterial disease was 1.604 ± 0.005 years. The frequency of MI among diabetic patients with PAD was 14.8%. Conclusion: Prevalence of 14.8% MI in the present study alarms to diagnose and treat diabetes and PAD patients at earlier stage.

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