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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Beta-blocker and calcium-channel blocker therapy in patients with cardiovascular pathologies during post-COVID period

С начала 2020 г. в мире распространилась инфекция, вызванная вирусом SARS-CoV-2, что в дальнейшем привело к пандемии COVID-19. Долгое время вопросы ведения пациентов с новой коронавирусной инфекцией в остром периоде рассматривались как первоочередные. По мере накопления клинического опыта и данных о возбудителе новой коронавирусной инфекции стало очевидно, что проблема последствий перенесенного COVID-19 и ведения пациентов на постгоспитальном этапе является такой же важной. В силу прямой и опосредованной кардиотоксичности вируса SARS-CoV-2 особую группу риска на всех этапах составляют пациенты с сердечно-сосудистыми заболеваниями. Поэтому одной из важных задач мирового медицинского сообщества стала разработка способов улучшения качества и прогноза жизни пациентов с сердечно-сосудистыми заболеваниями в постковидном периоде. В статье сделан обзор наиболее крупных исследований, включая данные регистра «Анализ динамики коморбидных заболеваний пациентов, перенесших инфицирование SARS-CoV-2 (AКТИВ SARS-CoV-2)», по вопросу медикаментозной терапии пациентов с сердечно-сосудистыми заболеваниями с акцентом на бета-адреноблокаторы и блокаторы кальциевых каналов. В представленных работах терапия бета-адреноблокаторами продемонстрировала благоприятное влияние на тяжесть течения новой коронавирусной инфекции у пациентов с сердечно-сосудистыми заболеваниями, снижение смертности на госпитальном и в отдаленном постгоспитальном периодах. Данные по применению блокаторов кальциевых каналов изучены в меньшей степени, но можно отметить, что данная группа препаратов является одной из самых часто назначаемых в терапии пациентов с сохранением стойких жалоб на повышение артериального давления на постгоспитальном этапе. Требуется дальнейшее изучение влияния отдельных классов антигипертензивных препаратов на прогноз пациентов с сердечно-сосудистыми заболеваниями и COVID-19. Early in 2020, the infection caused by SARS-CoV-2 emerged and caused the COVID-19 pandemic. For a long time, management of patients with the acute novel coronavirus infection was of primary importance. With accumulation of clinical information and data on the causative agents of novel coronavirus infection it became obvious that the COVID-19 consequences and post-hospital follow-up of patients are important as well. Due to the direct and mediated cardiac toxicity of SARS-CoV-2 virus, cardiovascular patients are at high risk at any stage of the disease. Therefore, one of the priorities for healthcare professionals is development of the ways to improve the quality and prognosis of life for cardiovascular patients in the post-COVID period. The article discusses large-scale studies including the data from the International Register «Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients» (AСTIV-SARS-CoV-2), as regards drug therapy of cardiovascular patients with a focus on beta-blockers and calcium-channel blockers. In mentioned publications, beta-blocker therapy demonstrated favourable impact on the novel coronavirus infection severity in cardiovascular patients, reduction in mortality rates during the hospital and post-hospital periods. Data on the use of calcium-channel blockers have been studied to a lesser extent; however, calcium-channel blockers are thought to be one of the most commonly prescribed groups in the therapy of patients with persistent complaints of high blood pressure at the post-hospital period. A study of the impact of some categories of antihypertensives on the outcome for cardiovascular patients with COVID-19 is warranted.

DRUG UTILIZATION PATTERN OF ANTIHYPERTENSIVE MEDICATIONS IN A TERTIARY CARE HOSPITAL, SOUTH INDIA

Objective: The objective of the study is to assess drug use pattern of antihypertensive medications in hypertensive patients. Methods: It is a prospective cross-sectional study conducted in the outpatient dispensary, Government Medical College, Thiruvananthapuram for the period of 6 months from January 2019 to June 2019. About 500 prescriptions of patients visiting outpatient dispensary with an antihypertensive prescription were enrolled for the study. Drug use patterns of different classes of antihypertensive medications were analyzed from individual prescriptions. Results: A total of 500 patients were included in this study, among which 281 were male (56.2%) and 219 (43.8%) were female. In 500 patients, 133 patients were treated with monotherapy. In that 42.1% of patients were treated with amlodipine, 28.57% of patients were treated with losartan. In combination therapy most commonly used was double therapy (42.8%) followed by triple therapy (24.2%). Calcium Channel Blockers (56.2%) was most prescribed class of drug followed by Angiotensin Receptor Blockers. Conclusion: This study reveals that calcium channel blockers as most prescribed class of antihypertensive and Amlodipine was the most prescribed antihypertensive. In our study, most of the patients were treated with combination therapy in that double drug therapy was most common. There is a chance of various medication errors, development of adverse drug reaction as majority (290) of patients belong to age above 60 and chances of getting error also increases as combination therapy is most used. Therefore close monitoring is required for such patients.

Role of Polyphenols in Preventing Prostate Cancer Cell Growth by Calcium Channel Blockers: A Review

Prostate cancer (PCa) is the second most widely diagnosed cancer in men and the sixth leading cause of cancer death. Signal transductions are always linked with cancers, and phytochemicals play a predominantly striking role in chemo preventions. We specifically focused on the researches which have been done in last twenty year by using different search engines including Google Scholar, PubMed, Web of Sciences and Scopus. An increasing number of studies have looked into the role of polyphenols on prostate cancer cell growth, highlighting their ability to target various cellular mechanisms. In this review, we picked out and found the potential role of polyphenols in targeting prostate cancer through calcium channel blockers and concluded that polyphenols are the primary chemo-preventive agents for prostate cancer. Copyright(c) The Author