Browsing by Author "Vijay Kher"

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Clinical perspectives towards improving risk stratification strategy for renal transplantation outcomes in Indian patients
(Wolters Kluwer Medknow Publications, 2022) Vijay Kher; Vivek B. Kute; Sarbeswar Sahariah; Deepak S. Ray; Dinesh Khullar; Sandeep Guleria; Shyam Bansal; Sishir Gang; Anil Kumar Bhalla; Jai Prakash; Abi Abraham; Sunil Shroff; Madan M. Bahadur; Pratik Das; Urmila Anandh; Arpita Ray Chaudhury; Manoj Singhal; Jatin Kothari; Sree Bhushan Raju; Dilip Kumar Pahari; G. Vishwanath Siddini; G. Sudhakar; Santosh Varughese; Tarun K. Saha
Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type - living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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.
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.
Epidemiology and risk factors of chronic kidney disease in India - Results from the SEEK (Screening and Early Evaluation of Kidney Disease) study
(2013) Ajay K. Singh; Youssef M.K. Farag; Bharati V. Mittal; Kuyilan Karai Subramanian; Sai Ram Keithi Reddy; Vidya N. Acharya; Alan F. Almeida; Anil Channakeshavamurthy; H Sudarshan Ballal; P. Gaccione; Rajan Issacs; Sanjiv Jasuja; Ashok L. Kirpalani; Vijay Kher; Gopesh K. Modi; Georgy Nainan; Jai Prakash; Devinder Singh Rana; Rajanna Sreedhara; Dilip Kumar Sinha; Shah Bharat V.; Sham Sunder; Raj K. Sharma; Sridevi Seetharam; Tatapudi Ravi Raju; Mohan M. Rajapurkar
Background: There is a rising incidence of chronic kidney disease that is likely to pose major problems for both healthcare and the economy in future years. In India, it has been recently estimated that the age-adjusted incidence rate of ESRD to be 229 per million population (pmp), and >100,000 new patients enter renal replacement programs annually. Methods. We cross-sectionally screened 6120 Indian subjects from 13 academic and private medical centers all over India. We obtained personal and medical history data through a specifically designed questionnaire. Blood and urine samples were collected. Results: The total cohort included in this analysis is 5588 subjects. The mean ± SD age of all participants was 45.22 ± 15.2 years (range 18-98 years) and 55.1% of them were males and 44.9% were females. The overall prevalence of CKD in the SEEK-India cohort was 17.2% with a mean eGFR of 84.27 ± 76.46 versus 116.94 ± 44.65 mL/min/1.73 m2 in non-CKD group while 79.5% in the CKD group had proteinuria. Prevalence of CKD stages 1, 2, 3, 4 and 5 was 7%, 4.3%, 4.3%, 0.8% and 0.8%, respectively. Conclusion: The prevalence of CKD was observed to be 17.2% with ∼6% have CKD stage 3 or worse. CKD risk factors were similar to those reported in earlier studies.It should be stressed to all primary care physicians taking care of hypertensive and diabetic patients to screen for early kidney damage. Early intervention may retard the progression of kidney disease. Planning for the preventive health policies and allocation of more resources for the treatment of CKD/ESRD patients are imperative in India. © 2013 Singh et al.; licensee BioMed Central Ltd.
INASL-ISN Joint Position Statements on Management of Patients with Simultaneous Liver and Kidney Disease
(Elsevier B.V., 2021) Anil Arora; Ashish Kumar; Narayan Prasad; Ajay Duseja; Subrat K. Acharya; Sanjay K. Agarwal; Rakesh Aggarwal; Anil C. Anand; Anil K. Bhalla; Narendra S. Choudhary; Yogesh K. Chawla; Radha K. Dhiman; Vinod K. Dixit; Natarajan Gopalakrishnan; Ashwani Gupta; Umapati N. Hegde; Sanjiv Jasuja; Vivek Jha; Vijay Kher; Ajay Kumar; Kaushal Madan; Rakhi Maiwall; Rajendra P. Mathur; Suman L. Nayak; Gaurav Pandey; Rajendra Pandey; Pankaj Puri; Ramesh R. Rai; Sree B. Raju; Devinder S. Rana; Padaki N. Rao; Manish Rathi; Vivek A. Saraswat; Sanjiv Saxena; Shalimar; Praveen Sharma; Shivaram P. Singh; Ashwani K. Singal; Arvinder S. Soin; Sunil Taneja; Santosh Varughese
Renal dysfunction is very common among patients with chronic liver disease, and concomitant liver disease can occur among patients with chronic kidney disease. The spectrum of clinical presentation and underlying etiology is wide when concomitant kidney and liver disease occur in the same patient. Management of these patients with dual onslaught is challenging and requires a team approach of hepatologists and nephrologists. No recent guidelines exist on algorithmic approach toward diagnosis and management of these challenging patients. The Indian National Association for Study of Liver (INASL) in association with Indian Society of Nephrology (ISN) endeavored to develop joint guidelines on diagnosis and management of patients who have simultaneous liver and kidney disease. For generating these guidelines, an INASL-ISN Taskforce was constituted, which had members from both the societies. The taskforce first identified contentious issues on various aspects of simultaneous liver and kidney diseases, which were allotted to individual members of the taskforce who reviewed them in detail. A round-table meeting of the Taskforce was held on 20–21 October 2018 at New Delhi to discuss, debate, and finalize the consensus statements. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system with minor modifications. The strength of recommendations (strong and weak) thus reflects the quality (grade) of underlying evidence (I, II, III). We present here the INASL-ISN Joint Position Statements on Management of Patients with Simultaneous Liver and Kidney Disease. © 2020 Indian National Association for Study of the Liver
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.
Multidisciplinary Consensus Document on the Management of Uncontrolled Hypertension in India
(Adis, 2020) R. Padmanabhan; Rana Gopal Singh; Govindan Unni; Bhupen Desai; Sanjeev Kumar Hiremath; Vidyut Jain; Saikat Bhawal; Sanjeev Gulati; Mukesh Shete; Ramesh Nair; Sunil Prakash; Vijay Kher; Bijan Bhattacharya
Cardiovascular disease is predicted to be the largest cause of death and disability in India by 2020. Hypertension (HT), one of the main contributing factors, presents a significant public health burden. Inability to achieve adequate blood pressure (BP) control results in uncontrolled hypertension (UHT). The prevalence of UHT is high in India, with only about 9–20% of patients achieving target BP goals. Presently, there are no guidelines specific to UHT, which if left uncontrolled can lead to resistant HT, chronic kidney disease and other complications of HT. A multidisciplinary panel, comprising of specialists in cardiology, nephrology and internal medicine, was convened to address the diagnosis and management of UHT in the Indian population. The panel identified key points concerning UHT and discussed management recommendations in the Indian clinical setting. © 2020, Italian Society of Hypertension.
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.