Browsing by Author "Nanda N.C."

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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) Chopra H.K.; Khullar D.; Nair T.; Wander G.S.; Ponde C.K.; Ray S.; Nanda N.C.; Kasliwal R.R.; Rana D.S.; Kirpalani A.; Sawhney J.P.S.; Chandra P.; Mehta Y.; Kumar V.; Tewari S.; Pancholia A.K.; Kher V.; Bansal S.; Mittal S.; Kerkar P.; Sahoo P.K.; Hotchandani R.; Prakash S.; Chauhan N.; Rastogi V.; Jabir A.; Shanmugasundaram S.; Tiwaskar M.; Sinha A.; Gupta V.; Mishra S.S.; Routray S.N.; Omar A.K.; Swami O.C.; Jaswal A.; Alam S.; Passey R.; Rajput R.; Paul J.; Kapoor A.; Prabhakar D.; Chandra S.; Malhotra P.; Singh V.P.; Bansal M.; Shah P.; Jain S.; Bhargava M.; Vijayalakshmi I.B.; Varghaese K.; Jain D.; Goel A.; Gaur N.; Tandon R.; Moorthy A.; George S.; Katyal V.K.; Mantri R.R.; Mehrotra R.; Bhalla D.; Mittal V.; Rao S.; Jagia M.; Singh H.; Awasthi S.; Sattur A.; Mishra R.; Pandey A.; Chawla R.; Jaggi S.; Sehgal B.; Sehgal A.; Goel N.; Gupta R.; Kubba S.; Chhabra A.; Bagga S.; Shastry N.R.
    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 ?1-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.
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    Current Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India
    (Journal of Association of Physicians of India, 2024) Chopra H.K.; Nair T.; Wander G.S.; Ponde C.K.; Ray S.; Khullar D.; Nanda N.C.; Narula J.; Kasliwal R.R.; Rana D.S.; Kirpalani A.; Sawhney J.P.S.; Chandra P.; Mehta Y.; Kumar V.; Tewari S.; Pancholia A.K.; Kher V.; Bansal S.; Mittal S.; Kerkar P.; Sahoo P.K.; Hotchandani R.; Prakash S.; Chauhan N.; Rastogi V.; Jabir A.; Shanmugasundaram S.; Tiwaskar M.; Sinha A.; Gupta V.; Mishra S.S.; Routray S.N.; Omar A.K.; Swami O.C.; Jaswal A.; Alam S.; Passey R.; Rajput R.; Paul J.; Kapoor A.; Prabhakar D.; Chandra S.; Malhotra P.; Singh V.P.; Bansal M.; Shah P.; Jain S.; Bhargava M.; Vijayalakshmi I.B.; Varghaese K.; Jain D.; Goel A.; Mehmood K.; Gaur N.; Tandon R.; Moorthy A.; George S.; Katyal V.K.; Mantri R.R.; Mehrotra R.; Bhalla D.; Mittal V.; Rao S.; Jagia M.; Singh H.; Awasthi S.; Sattur A.; Mishra R.; Pandey A.; Chawla R.; Jaggi S.; Sehgal B.; Sehgal A.; Goel N.; Gupta R.; Kubba S.; Chhabra A.; Bagga S.; Shastry N.R.
    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.
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    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) Chopra H.K.; Ponde C.; Wander G.S.; Nair T.; Ray S.; Khullar D.; Nanda N.C.; Narula J.; Kasliwal R.R.; Rana D.S.; Kirpalani A.; Sawhney J.S.; Chandra P.; Mehta Y.; Kumar V.; Tiwari S.; Pancholia A.K.; Kher V.; Bansal S.; Mittal S.; Kerkar P.; Sahoo P.K.; Hotchandani R.; Prakash S.; Chauhan N.; Rastogi V.; Abdullakutty J.; Shanmugasundaram S.; Tiwaskar M.; Sinha A.; Gupta V.; Mishra S.S.; Routray S.N.; Omar A.K.; Swami O.C.; Jaswal A.; Alam S.; Passey R.; Rajput R.; Paul J.; Kapoor A.; Dorairaj P.; Chandra S.; Malhotra P.; Singh V.P.; Bansal M.; Jain S.; Shah P.; Bhargava M.; Vijayalakshmi I.B.; Varghaese K.; Jain D.; Goel A.; Mahmood K.; Gaur N.; Tandon R.; Moorthy A.; George S.; Katyal V.K.; Mantri R.R.; Mehrotra R.; Bhalla D.; Mittal V.; Rao S.; Jagia M.; Singh H.; Awasthi S.; Sattur A.; Mishra R.; Pandey A.; Chawla R.; Jaggi S.; Sehgal B.; Sehgal A.; Goel N.; Gupta R.; Kubba S.; Chhabra A.; Bagga S.; Shastry R.N.
    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.
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    The Promise of Cilnidipine in Hypertension with Comorbidities: National Consensus Statement
    (Journal of Association of Physicians of India, 2024) Chopra H.K.; Wander G.S.; Ponde C.K.; Nanda N.C.; Khullar D.; Venugopal K.; Ray S.; Nair T.; Rana D.S.; Kher V.; Sawhney J.P.S.; Kasliwal R.R.; Abdullakutty J.; Chakraborty R.; Chandra P.; Bansal S.; Kumar V.; Pancholia A.K.; Kapoor A.; Prakash S.; Saxena A.; Rastogi V.; Sharma V.; Arora Y.K.; Dasbiswas A.; Bhargava M.; Jaswal A.; Bhargava K.; Bhatia M.; Omar A.K.; Khanna N.N.; Passey R.; Bhalla D.; Vijayalakshmi I.B.; Bhalla A.K.; Moorthy A.; Isser H.S.; Mishra S.S.; Routray S.; Tandon V.; Sinha A.; Bansal M.; Jain P.; Hotchandani R.; Jain D.; Katyal V.K.; Gulati S.; Tandon R.; Jaggi S.; Sehgal B.; Gupta V.; Mehrotra R.; Krishnamani N.C.; Pathak S.N.; Yadav M.S.; Chawla R.; Shastry N.R.; Chatterjee N.; Samajdar S.S.; Pal J.; Tiwaskar M.
    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.