Expert Opinion on the Treatment Options and Comorbidities of Indian Hypertensive Patients
Published: 2024-02-26
Page: 25-33
Issue: 2024 - Volume 7 [Issue 1]
Manjula S *
Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.
Krishna Kumar M
Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.
*Author to whom correspondence should be addressed.
Abstract
Objective: To investigate expert opinions regarding the preferred therapy options for hypertensive patients in an Indian clinical setting, with a specific focus on the prescription practice of cilnidipine.
Methodology: The cross-sectional study was conducted using a 25-question survey to gather insights from specialists regarding their perspectives on prescribing cilnidipine for hypertensive patients. The survey questions focused on the experts’ choice of prescribing an antihypertensive medication for hypertensive patients with comorbid conditions.
Results: The survey collected data from 612 respondents. Nearly half of the respondents (43.79% and 42.97%) reported that individuals with systolic blood pressure (SBP) ranging from 140-159 mm Hg and diastolic blood pressure (DBP) ranging from 90-99 mm Hg, as well as those with SBP ranging from 160-179 mm Hg and DBP ranging from 100-109 mm Hg, are newly diagnosed with hypertension. According to the experts, the most common comorbidities among hypertensive patients were chronic kidney disease, diabetes, and obesity. Calcium-channel blockers (CCBs) were recommended as the preferred antihypertensive drug. Among CCBs, cilnidipine was favoured by a majority of the respondents for patients with renal problems, as it not only provided continuous BP control but also demonstrated benefits in reducing cardiovascular risk, pedal edema, and ensuring renal safety. Telmisartan, chlorthalidone, olmesartan, and other drug combinations were frequently mentioned as preferred adjuncts to cilnidipine at a dosage of 10 mg.
Conclusion: The surveyed experts recommend CCBs as the preferred antihypertensive drugs. Cilnidipine, among the CCBs, is the preferred choice for patients with renal problems due to its ability to provide continuous BP control and its additional benefits in reducing cardiovascular risk, managing pedal edema, and ensuring renal safety.
Keywords: Hypertension, calcium-channel blockers, antihypertensive medication, cilnidipine, cardiovascular death
How to Cite
References
Hypertension [Internet].
[Cited 2023 Jul 18]. Available: https://www.who.int/news-room/fact-sheets/detail/hypertension
Hypertension [Internet].
[Cited 2023 Jul 18]. Available: https://www.who.int/india/health-topics/hypertension
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31(7):1281.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.
Chandra KS, Ramesh G. The fourth-generation calcium channel blocker: Cilnidipine. Indian Heart J. 2013;65(6):691–5.
Chakraborty RN, Langade D, More S, Revandkar V, Birla A, Langade DG, et al. Efficacy of cilnidipin (L/N-type calcium channel blocker) in treatment of hypertension: A meta-analysis of randomized and no randomized controlled trials. Cureus. 2021;13(11):e19822.
Kario K, Ando S ichi, Kido H, Nariyama J, Takiuchi S, Yagi T, et al. The effects of the L / N-Type calcium channel blocker (cilnidipine) on sympathetic hyperactive morning hypertension: Results From ACHIEV ONE*. J Clin Hypertens. 2013;15(2):133–42.
Adake P, Somashekar HS, Mohammed Rafeeq PK, Umar D, Basheer B, Baroudi K. Comparison of amlodipine with cilnidipine on antihypertensive efficacy and incidence of pedal edema in mild to moderate hypertensive individuals: A prospective study. J Adv Pharm Technol Res. 2015;6(2):81–5.
Xu G, Wu H, Du B, Qin L. The efficacy and safety of cilnidipine on mild to moderate essential hypertension: A systematic review and meta-analysis of randomized controlled trials in Chinese patients. Cardiovas Hematol Disord Drug Targets. 2012;12(1):56–62.
MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: A large cross-sectional study of prevalence in Scottish primary care. Br J Gen Pract. 2021;71(704):e243–9.
Kumela Goro K, Desalegn Wolide A, Kerga Dibaba F, Gashe Fufa F, Wakjira Garedow A, Edilu Tufa B, et al. Patient awareness, prevalence, and risk factors of chronic kidney disease among diabetes mellitus and hypertensive patients at Jimma University Medical Center, Ethiopia. Biomed Res Int. 2019;2019:e2383508.
Tripathy JP, Thakur JS, Jeet G, Jain S. Prevalence and determinants of comorbid diabetes and hypertension: Evidence from non communicable disease risk factor STEPS survey, India. Diabetes Metab Syndr: Clin Res Rev. 2017;11:S459–65.
Takahara A. Cilnidipine: A new generation Ca2+ channel blocker with inhibitory action on sympathetic neurotransmitter release. Cardiovas Ther. 2009;27(2):124–39.
Masuda T, Ogura MN, Moriya T, Takahira N, Matsumoto T, Kutsuna T, et al. Beneficial effects of L- and N-type calcium channel blocker on glucose and lipid metabolism and renal function in patients with hypertension and type II diabetes mellitus. Cardiovas Ther. 2011;29(1):46–53.
Rose GW, Kanno Y, Ikebukuro H, Kaneko M, Kaneko K, Kanno T, et al. Cilnidipine is as effective as benazepril for control of blood pressure and proteinuria in hypertensive patients with benig nephrosclerosis. Hypertens Res. 2001;24(4):377–83.
Kojima S, Shida M, Yokoyama H. Comparison between cilnidipine and amlodipine besilate with respect to proteinuria in hypertensive patients with renal diseases. Hypertens Res. 2004;27(6):379–85.
Tsuchihashi T, Ueno M, Tominaga M, Kajioka T, Onaka U, Eto K, et al. Antiproteinuric effect of an n-type calcium channel blocker, cilnidipine. Clin Exp Hypertens. 2005;27(8):583–91.
Iyer RP, Lindsey ML, Chilton RJ. A Two-for-one bargain: using cilnidipine to treat hypertension and its comorbidities. J Clin Hypertens. 2013;15(7):455–7.
Srivathsan M, Vardhan V, Naseem A, Patil S, Rai V, Langade DG, et al. Renal function in hypertensive patients receiving cilnidipine and L-type calcium channel blockers: a meta-analysis of randomized controlled and retrospective studies. Cureus. 2022;14(8):e27847.
Kawabata Y, Soeki T, Ito H, Matsuura T, Kusunose K, Ise T, et al. Effects of L-/N-type calcium channel blockers on angiotensin II–renin feedback in hypertensive patients. Int J Hypertens. 2020;2020:e6653851.
Jo JH, Lee DH, Han JH, Lee M, Jang KW, Myung CS. Effects of combination treatment with cilnidipine and telmisartan on hypertension, cardiovascular injury, and high blood glucose. J Pharm Investig. 2021;51: 337-46.
Sagarad SV, S HP. A prospective and open label study of use of cilnidipine and chlorthalidone fixed dose combination in Indian hypertensive patients, intolerant or uncontrolled on amlodipine and hydrochlorothiazide combination. Int J Adv Med. 2017;4(6): 1522–7.