Browsing by Author "Saumitra Ray"

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Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease
(Journal of Association of Physicians of India, 2024) H.K. Chopra; Dinesh Khullar; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Navin C. Nanda; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin–angiotensin–aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective β1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities. ©The Author(s). 2024.
Corrigendum to “Cardiological Society of India position statement on management of heart failure in India” (Indian Heart Journal (2018) 70(S1) (S1–S72), (S0019483218303006) (10.1016/j.ihj.2018.05.003))
(Elsevier B.V., 2018) Santanu Guha; S. Harikrishnan; Saumitra Ray; Rishi Sethi; S. Ramakrishnan; Suvro Banerjee; V.K. Bahl; K.C. Goswami; Amal Kumar Banerjee; S. Shanmugasundaram; P.G. Kerkar; Sandeep Seth; Rakesh Yadav; Aditya Kapoor; Ajaykumar U. Mahajan; P.P. Mohanan; Sundeep Mishra; P.K. Deb; C. Narasimhan; A.K. Pancholia; Ajay Sinha; Akshyaya Pradhan; R. Alagesan; Ambuj Roy; Amit Vora; Anita Saxena; Arup Dasbiswas; B.C. Srinivas; B.P. Chattopadhyay; B.P. Singh; J. Balachandar; K.R. Balakrishnan; Brian Pinto; C.N. Manjunath; Charan P. Lanjewar; Dharmendra Jain; Dipak Sarma; G. Justin Paul; Geevar A. Zachariah; H.K. Chopra; I.B. Vijayalakshmi; J.A. Tharakan; J.J. Dalal; J.P.S. Sawhney; Jayanta Saha; Johann Christopher; K.K. Talwar; K. Sarat Chandra; K. Venugopal; Kajal Ganguly; M.S. Hiremath; Milind Hot; Mrinal Kanti Das; Neil Bardolui; Niteen V. Deshpande; O.P. Yadava; Prashant Bhardwaj; Pravesh Vishwakarma; Rajeeve Kumar Rajput; Rakesh Gupta; S. Somasundaram; S.N. Routray; S.S. Iyengar; G. Sanjay; Satyendra Tewari; G. Sengottuvelu; Soumitra Kumar; Soura Mookerjee; Tiny Nair; Trinath Mishra; U.C. Samal; U. Kaul; V.K. Chopra; V.S. Narain; Vimal Raj; Yash Lokhandwala
In the article titled ‘Cardiological Society of India Position Statement on Management of Heart Failure in India’ below is the list of corrections to be included. The authors would like to apologise for any inconvenience caused. Fig. 14 ECG of a patient with RVEMF and atrial fibrillation, qR in V1 and R/S ratio in lead V2 more than V1. Fig. 15 ECG of a patient with LVEMF showing LVH with strain pattern. Fig. 16. Fluoroscopy showing the presence of LV apical calcium. Fig. 17. LV angiogram in a patient with LVEMF showing the obliteration of the LV apex, transverse diameter more than the longitudinal diameter and no MR (primary diastolic HF). Fig. 18. RV angiogram in a patient with RVEMF showing obliteration of the RV apex and body, RVOF dilatation and significant TR. Fig. 19. Echocardiogram, apical 4-chamber view, showing the presence of calcium at the LV apex. Fig. 20. Perfusion MRI, 4-chamber view in diastole showing fibrosis and obliteration of RV apex (white arrow) [RV – right ventricle, RA – Right atrium, LA – left atrium]. In the text – Page S 48 Column 2 Section 3.10.3 Figs. 13 and 14 – Corrected as Figs. 14 and 15. Figs. 16–18 – Corrected as Figs. 16–19. Fig 19 – Corrected as Fig 20 References: The references are changed as given below (Page S 66). 240. K Balakrishnan, Ratnagiri R, S. Rao, M. Tungaturu Limiting the Number of Endomyocardial Biopsies does not impact one year survival after Heart Transplant. J heart Lung Transplant. Supplement. April 2016 Volume 35; Issue 4, Supplement: S210. 241. Stehlik J, Starling RC, Movsesian MA, et al. Utility of long-term surveillance endomyocardial biopsy: a multi-institutional analysis. J Heart Lung Transplant. 2006; 25:1402–1409. To be added at the end of references (Can be given as reference in the heading 2.8). Status of Cardiac Transplantation in India.(583) 583. Dr KR Balakrishnan, R Ravi Kumar; - “Status of Cardiac Transplantation in India” Pages 599–606 in Chapter 44 of CSI TEXT BOOK OF CARDIOLOGY. (Ed) PK Deb 2018 Jaypee Brothers, New Delhi. © 2018 Cardiological Society of India
CSI position statement on management of heart failure in India
(Elsevier B.V., 2018) Santanu Guha; S. Harikrishnan; Saumitra Ray; Rishi Sethi; S. Ramakrishnan; Suvro Banerjee; V.K. Bahl; K.C. Goswami; Amal Kumar Banerjee; S. Shanmugasundaram; P.G. Kerkar; Sandeep Seth; Rakesh Yadav; Aditya Kapoor; Ajaykumar U. Mahajan; P.P. Mohanan; Sundeep Mishra; P.K. Deb; C. Narasimhan; A.K. Pancholia; Ajay Sinha; Akshyaya Pradhan; R. Alagesan; Ambuj Roy; Amit Vora; Anita Saxena; Arup Dasbiswas; B.C. Srinivas; B.P. Chattopadhyay; B.P. Singh; J. Balachandar; K.R. Balakrishnan; Brian Pinto; C.N. Manjunath; Charan P. Lanjewar; Dharmendra Jain; Dipak Sarma; G. Justin Paul; Geevar A. Zachariah; H.K. Chopra; I.B. Vijayalakshmi; J.A. Tharakan; J.J. Dalal; J.P.S. Sawhney; Jayanta Saha; Johann Christopher; K.K. Talwar; K. Sarat Chandra; K. Venugopal; Kajal Ganguly; M.S. Hiremath; Milind Hot; Mrinal Kanti Das; Neil Bardolui; Niteen V. Deshpande; O.P. Yadava; Prashant Bhardwaj; Pravesh Vishwakarma; Rajeeve Kumar Rajput; Rakesh Gupta; S. Somasundaram; S.N. Routray; S.S. Iyengar; G. Sanjay; Satyendra Tewari; G. Sengottuvelu; Soumitra Kumar; Soura Mookerjee; Tiny Nair; Trinath Mishra; U.C. Samal; U. Kaul; V.K. Chopra; V.S. Narain; Vimal Raj; Yash Lokhandwala
[No abstract available]
Current Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India
(Journal of Association of Physicians of India, 2024) H.K. Chopra; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Jagat Narula; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Kiran Mehmood; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF. ©The Author(s). 2024.
Indian Consensus on the Role and Position of Angiotensin Receptor-neprilysin Inhibitors in the Management of Heart Failure
(Journal of Association of Physicians of India, 2024) Hriday Kumar Chopra; Chandrashekhar Ponde; Gurpreet Singh Wander; Tiny Nair; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Jagat Narula; Ravi R. Kasliwal; Devinder Singh Rana; Ashok Kirpalani; Jitendrapal Singh Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; Satyendra Tiwari; Arvind K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; Prasant Kumar Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; Jabir Abdullakutty; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; Shishu Shankar Mishra; Satya Narayan Routray; Ashok Kumar Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; Prabhakar Dorairaj; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Sanjay Jain; Priyank Shah; Mohan Bhargava; Ishwarappa Balekundri Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Kiran Mahmood; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; Rajnikant N. Shastry
The incidence of heart failure (HF) in India is estimated to be 0.5–1.7 cases per 1,000 people per year, and approximately 4,92,000–1.8 million new cases are detected every year. Despite the high rate of mortality associated with HF, most patients do not receive maximal guideline-directed medical therapy (GDMT). Current guidelines advocate early multidrug combination therapy with four classes of drugs, namely, beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose transport protein 2 inhibitors (SGLT-2is), particularly in patients with heart failure with reduced ejection fraction (HFrEF). ARNIs reduce cardiac morbidity and mortality in patients with HFrEF. However, recent data indicated that only 4.8% of patients with HFrEF receive ARNI in India. Hence, at a national consensus on HF meeting, cardiology experts from India formulated a national consensus on the use of ARNI in HF based on current evidence and guidelines. The consensus states that ARNI should be used early in HF, particularly in de novo patients with HFrEF, and those with acute decompensated heart failure (ADHF), irrespective of the presence of low systolic blood pressure (SBP) or diabetes. Moreover, those with HFrEF on renin–angiotensin–aldosterone system (RAAS) inhibitors should be switched to ARNI to reduce the risk of repeated hospitalization for HF, worsening HF, and cardiac death, and to improve the quality of life (QoL). Starting ARNI during the first hospitalization is preferable, and it is safe and effective across all doses. ARNIs can also be used for secondary benefits in patients with preserved ejection fraction [heart failure with preserved ejection fraction (HFpEF)] and HF with mildly reduced EF [heart failure with mildly reduced ejection fraction (HFmrEF)]. ©The Author(s). 2024Open Access.
National Consensus Statement on Role of Bisoprolol across Cardiovascular Continuum: Special Focus on Women
(Journal of Association of Physicians of India, 2025) Hriday Kumar Chopra; Kamal Kumar Sethi; Tiny Nair; Chandrashekhar Kashinath Ponde; Saumitra Ray; Sarita Rao; Shanmunga Sundaram; Dinesh K. Khullar; Navin C. Nanda; Jatinder Pal Singh Sawhney; Sarita M. Bajaj; Yatin Mehta; Arvind Kumar Pancholia; Pradeep Jain; Ashok Kumar Omar; Aditya K. Kapoor; Rishi Rishi Sethi; Atul Damodar Abhyankar; Vinod Kumar Sharma; Anil Dhall; Ajay Kumar Sinha; Shishu Shankar Mishra; Satya Narayan Rautray; Gyarsi Lal Sharma; Ashwani Mehta; Rajeev Agarwala; Rajeev Kumar Rajput; Ajay Umakant Mahajan; Sanjay C. Porwal; Ramesh K. Hotchandani; Vishal Rastogi; Rajeev Passey; Mohan Bhargava; Justin Paul Gnanaraj; Dorairaj Prabhakaran; Vivudh Pratap Singh; Vinod Mittal; Vitull Kumar Gupta; Anil Kumar Bhalla; Virender Kumar Katyal; Ishwarappa Balekundri Vijaylakshami; Asha Moorthy; Poonam Malhotra; Vanita Arora; Mona Bhatia; Prabhavathy Bhat; Shibba Takkar Chhabra; Sugandhi Gopal; Tripti Deb; Preeti Gupta; Hemlata Tewari; Anupam Goel; Rekha Mishra; Lovelina Singh; Zakia Khan; Geeta S. Sheth; Chandra Mukhi; Inder Pal Singh Kalra; Yogender Kumar Arora; Uttara Das; Kavita Tyagi; Satya Nand Pathak; Samir Kubba; Saurabh Bagga; Asha Mahilmaran; Ameet Sattur; Rohit Tandon; Dharmender Jain; Hetan C. Shah; Cecily Mary Majella; Ravi Prakash; Manish Aggarwal; Ruchi Verma; Sumit Sethi; Alka Gujral; Kanika Sood; Sonia Rawat; Varsha Kaul; Surinder S. Arora; Manjiti Arora; Veena Bhat; Anil Kumar Bali; Sanjay Sood; Shakuntala Dawesar; Bhushan K. Dawesar; Nilakshi Deka; Makarand Paithankar; Rajiv Handa; Nitish Parmar; Sheikh U. Nabi; Naveen K. Garg; Sandeep Sharma; Vivek Tandon; Manoj Pabrai; Samshad Alam; Manju Tyagi; Manisha Sahay; Manju Hotchandani; Anupama Kathpalia; Ish Kathpalia
Cardiovascular diseases (CVDs) represent a significant health concern worldwide, with women facing distinct challenges in the prevention, diagnosis, and management of these conditions. In India, hypertension is a prevalent cardiovascular (CV) risk factor, affecting nearly one-third of adults, and women experience a disproportionately high burden across all age-groups. The CV continuum, which spans from risk factors to CV events and ultimately to heart failure (HF), demonstrates how the progression of CVD impacts women at each stage differently due to gender-specific mechanisms like hormonal influences, pregnancy complications and the effects of menopause. This manuscript aims to present a set of consensus statements developed by an expert panel in India, focusing on the role of bisoprolol across the CV continuum with special attention to women. The consensus was formed based on a thorough review of clinical experiences, existing clinical data and alignment with both global and regional clinical guidelines. The manuscript highlights the gender-specific CV risks faced by women, their higher mortality rates following acute cardiac events, delayed diagnoses and less aggressive treatments. It also discusses bisoprolol as an effective therapy for managing hypertension, HF and other CV conditions in women. Bisoprolol's benefits include consistent blood pressure (BP) control, improved outcomes in HF and reduced CV risks, particularly in postmenopausal women and those with comorbidities. The manuscript underscores the need for gender-tailored approaches to the CV continuum, from prevention through to management, to address these challenges and improve outcomes for women. © The Author(s).
Role of Bisoprolol in Heart Failure Management: A Consensus Statement from India
(Journal of Association of Physicians of India, 2023) H.K. Chopra; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
In India, heart failure (HF) is an important health concern affecting younger age groups than the western population. A limited number of Indian patients receive guideline-directed medical therapy (GDMT). Selective β-1 blockers (BB) are one of the GDMTs in HF and play an important role by decreasing the sympathetic overdrive. The BB reduces heart rate (HR) reverse the adverse cardiac (both ventricular and atrial), vascular, and renovascular remodeling seen in HF. Bisoprolol, a β-1 blocker, has several advantages and can be used across a wide spectrum of HF presentations and in patients with HF and comorbid conditions such as coronary artery disease (CAD), atrial fibrillation (AF), post-myocardial infarction (MI), uncontrolled diabetes, uncontrolled hypertension, and renal impairment. Despite its advantages, bisoprolol is not optimally utilized for managing HF in India. This consensus builds on updated evidence on the efficacy and safety of bisoprolol in HF and recommends its place in therapy with a focus on Indian patients with HF. © The Author(s).
The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement
(Journal of Association of Physicians of India, 2023) H.K. Chopra; G.S. Wander; C.K. Ponde; Navin C. Nanda; Dinesh Khullar; K. Venugopal; Saumitra Ray; Tiny Nair; D.S. Rana; Vijay Kher; J.P.S. Sawhney; R.R. Kasliwa; A. Jabir; Rabin Chakraborty; Praveen Chandra; Sandeep Bansal; Viveka Kumar; A.K. Pancholia; Aditya Kapoor; Sunil Prakash; Anil Saxena; Vishal Rastogi; Vinod Sharma; Y.K. Arora; Arup Dasbiswas; Mohan Bhargava; Aparna Jaswal; K. Bhargava; Mona Bhatia; A.K. Omar; N.N. Khanna; Rajiv Passey; Dilip Bhalla; I.B. Vijayalakshmi; A.K. Bhalla; Asha Moorthy; H.S. Isser; S.S. Mishra; S.N. Routray; Vivek Tandon; Ajay Sinha; Manish Bansal; Praveen Jain; Ramesh Hotchandani; Dharmendra Jain; V.K. Katyal; Sanjiv Gulati; Rohit Tandon; Shalini Jaggi; Blessy Sehgal; Vitull Gupta; Rahul Mehrotra; N.C. Krishnamani; S.N. Pathak; M.S. Yadav; Rajeev Chawla; Jyotirmoy Pal; Nandini Chatterjee; Shambo S. Samajdar; N.R. Shastry
Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk. © 2023 Journal of Association of Physicians of India. All rights reserved.
The Promise of Cilnidipine in Hypertension with Comorbidities: National Consensus Statement
(Journal of Association of Physicians of India, 2024) Hirday Kumar Chopra; Gurpreet S. Wander; Chandrashekhar K. Ponde; Navin C. Nanda; Dinesh Khullar; K. Venugopal; Saumitra Ray; Tiny Nair; D.S. Rana; Vijay Kher; J.P.S. Sawhney; R.R. Kasliwal; Jabir Abdullakutty; Rabin Chakraborty; Praveen Chandra; Sandeep Bansal; Viveka Kumar; Arvind K. Pancholia; Aditya Kapoor; Sunil Prakash; Anil Saxena; Vishal Rastogi; Vinod Sharma; Y.K. Arora; Arup Dasbiswas; Mohan Bhargava; Aparna Jaswal; Kartikeya Bhargava; Mona Bhatia; Ashok K. Omar; Narendra Nath Khanna; Rajiv Passey; Dilip Bhalla; I.B. Vijayalakshmi; Anil Kumar Bhalla; Asha Moorthy; Harmohander S. Isser; S.S. Mishra; Satyanarayan Routray; Vivek Tandon; Ajay Sinha; Manish Bansal; Praveen Jain; Ramesh Hotchandani; Dharmendra Jain; V.K. Katyal; Sanjiv Gulati; Rohit Tandon; Shalini Jaggi; Blessy Sehgal; Vitull Gupta; Rahul Mehrotra; N.C. Krishnamani; S.N. Pathak; M.S. Yadav; Rajeev Chawla; N.R. Shastry; Nandini Chatterjee; Shambo Samrat Samajdar; Jyotirmoy Pal; Mangesh Tiwaskar
The rapidly increasing burden of hypertension is responsible for premature deaths from cardiovascular disease (CVD), renal disease, and stroke, with a tremendous public health and financial burden. Hypertension detection, treatment, and control vary worldwide; it is still low, particularly in low- and middle-income countries (LMICs). High blood pressure (BP) and CVD risk have a strong, linear, and independent association. They contribute to alarming numbers of all-cause and CVD deaths. A major culprit for increased hypertension is sympathetic activity, and further complications of hypertension are heart failure, ischemic heart disease (IHD), stroke, and renal failure. Now, antihypertensive interventions have emerged as a global public health priority to reduce BP-related morbidity and mortality. Calcium channel blockers (CCB) are highly effective vasodilators. and the most common drugs used for managing hypertension and CVD. Cilnidipine, with both L- and N-type calcium channel blocking activity, is a promising 4th generation CCB. It causes vasodilation via L-type calcium channel blockade and inhibits the sympathetic nervous system (SNS) via N-type calcium channel blockade. Cilnidipine, which acts as a dual L/N-type CCB, is linked to a reduced occurrence of pedal edema compared to amlodipine, which solely blocks L-type calcium channels. The antihypertensive properties of cilnidipine are very substantial, with low BP variability and long-acting properties. It is beneficial for hypertensive patients to deal with morning hypertension and for patients with abnormal nocturnal BP due to exaggerated sympathetic nerve activation. Besides its BP-lowering effect, it also exhibits organ protection via sympathetic nerve inhibition and renin–angiotensin–aldosterone system inhibition; it controls heart rate and proteinuria. Reno-protective, neuroprotective, and cardioprotective effects of cilnidipine have been well-documented and demonstrated. © 2024 Journal of Association of Physicians of India. All rights reserved.