ROLE OF COMBINATION DRUG THERAPY FOR MANAGEMENT OF HYPERTENSION WITH INCREASING AGE

Objective: In South Asia, hypertension is the third highest factor contributing in public health burden of disease and major risk factor for coronary artery disease especially in women and old age people. The study was aimed to determine the role of gender and age (20–80 years) on severity of hypertension to design an effective schedule for management of hypertension. Methods: The levels of serum cholesterol, triglycerides (TG), high-density lipoprotein (HDL), low-density lipoproteins (LDL), and blood pressure (BP) of 240 hypertensive patients were monitored. Cholesterol, TG, and HDL levels were detected using ERBA Reagent kit of Transasia Bio-medicals LTD by CHOD-PAP, glycerol phosphate oxidase trinder End point, and polyvinyl sulfonic and polyethyleneglycol-methyl ether based methods, respectively. Results: The BP and levels of serum cholesterol, TG and LDL were increased in both the genders after 40 years of age. However, the rise in levels of these parameters was more in females in comparison to males. A hypertension management schedule involving (BP)/Cholesterol lowering drugs and lifestyle changes for period of 60 days showed that combination drug therapy was more effective than monotherapies of same drugs used at higher dosages. Conclusion: Hypertensive patients strictly followed the prescribed healthy food and exercise schedule showed improvement in their BP and lipid profile even with limited drug intervention.

The use of mono- and combination drug therapy in men and women with lower urinary tract symptoms (LUTS) in the UK: a retrospective observational study

Background Combination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines. Patterns of real-world LUTS drug use, especially combination drug therapy, have not been studied extensively. Moreover, further understanding of the recent landscape is required following the introduction of the beta-3-adrenoceptor agonist mirabegron in the UK in 2013 for overactive bladder (OAB). The objective was to describe mono- and combination drug therapy use for LUTS in patients in UK clinical practice. Methods This was a retrospective, descriptive, observational database study using UK Clinical Practice Research Datalink GOLD and linked databases. Men and women ≥ 18 years with a first prescription for any LUTS drug from 2014 to 2016 with ≥ 12 months continuous enrollment pre- and post-index date were included. Primary endpoints were mono- or combination drug therapy use for LUTS in male and female cohorts. Secondary endpoints were description of treatment prescribed, treatment persistence and patient demographics. Data were analyzed descriptively. Sub-cohorts were defined by drugs prescribed at index date. Results 79,472 patients (61.3% male) were included, based on index treatments. Of all men, 82.5% received any benign prostatic obstruction (BPO) drug, 25.4% any OAB drug, and 7.9% any BPO drug plus any OAB drug. As either mono- or combination drug therapy, 77.1% received an alpha-blocker, 18.9% a 5-alpha reductase inhibitor, 23.9% an antimuscarinic agent, and 2.1% mirabegron. Of all women, 94.5% received any OAB drug, 6.0% duloxetine, and 0.5% any OAB drug plus duloxetine. As either mono- or combination drug therapy, 87.7% received an antimuscarinic, and 9.7% mirabegron. In men or women receiving OAB treatment, approximately 2.5% received combination drug therapy with an antimuscarinic agent and mirabegron. For OAB drug monotherapies, mirabegron had the highest persistence in both male and female cohorts. Conclusions This study provides a better understanding of the recent landscape of LUTS drug use in UK clinical practice. It highlights potential undertreatment of storage symptoms in men with LUTS and the low use of combination OAB treatments.

Formulation and Optimization of Pulsatile Tablet for Circadian Rhythm of Blood Pressure

Circadian rhythm is a 24-hour cycle of human body, the body different aspect in the morning as compare to afternoon or night. The blood pressure rises in two time in a day, one is at early morning and second one is at evening.The aim of present project work was to design the pulsatile tablet for treatment of blood pressure with combination drug therapy. in most cases it is seen that the increasing in Plasma norepinephrine level and plasma renin activity in the morning; both hormones are potential to induce coronary vasoconstriction, therefore, there is a need to a such formulation who achieve peak plasma concentration of drug at morning and can control morning spate of B.P. The pulsatile release of nebivolol after the lag time with sustain release of curcumin which maintain the severity of blood Pressure. The Formulation of Core tablet of nebivolol was prepared by using superdisintegrate by direct compression with diluent. F10 batch was found to be optimized formulation as it shown potent drug release within short time. The lag time was prolonged with an increase of the coating level, whereas the drug release rate was almost constant, irrespective of the coating level the lag time of nebivolol was found to be 8 to 8.5hrsand drug release after 9hrs. drug release was above 95% after lag time with constant release of curcumin. Hence, this approach can provide a useful means and may be helpful for patients with morning spate of BP and development of PDDS of combination drug therapy is a promising approach to overcome the side effect of single drug i.e. nebivolol drug therapy and also oral drug delivery.