Withdrawal of Blood Pressure Medicine - Possible - Weight Reduction and Salt Intake Reduction

 Withdrawal is possible.

Withdrawal of antihypertensive medication: a systematic review

J Hypertens. 2017 Sep; 35(9): 1742–1749. Published online 2017 May 9. doi: 10.1097/HJH.0000000000001405

PMCID: PMC5548513PMID: 28486271

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548513/

Stopping blood pressure medications in older people

Aim

This review aimed to find out if it is possible to stop blood pressure medications in older people. We also wanted to find out the effects of stopping these medications.

Antihypertensives can cause dangerous side effects, such as dizziness and fatigue which might lead to falls. Older people are at greater risk of medication side effects compared to younger people. It is unclear whether the benefits of antihypertensive medications outweigh the harms in older people.

Study characteristics

Our search to April 2019 found six studies, including 1,073 older adults in total. People in the studies had an average age of 58 to 82 years. In three of the studies, the dose of the antihypertensive was slowly lowered before stopping.

Key results

We found that stopping antihypertensive medications is possible in older adults. Most of the older people in the discontinuation groups did not need to restart their medication.

We found low certainty of evidence that stopping antihypertensive medication increased blood pressure by a small amount.

https://www.cochrane.org/CD012572/HTN_stopping-blood-pressure-medications-older-people

Can weight loss reduce the need for blood pressure medicine?

Answer From Francisco Lopez-Jimenez, M.D.

If you're overweight, losing even just 5 pounds (2.3 kilograms) can lower your blood pressure. The more weight lost, the more blood pressure can drop. As you lose weight, it may be possible to reduce your dose of blood pressure medicine. Or you might be able to stop taking blood pressure medicine completely.

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/blood-pressure-medication/faq-20058056

J Clin Hypertens (Greenwich). 2003 May-Jun; 5(3): 234. Published online 2007 May 21. doi: 10.1111/j.1524-6175.2003.02403.x

PMCID: PMC8099264PMID: 12826792

Can I Stop Taking This Blood Pressure Medicine?

Raymond R. Townsend, MD 1

In many patients hypertension is weight‐related. If someone has lost 15 pounds (or more), and had modest elevations in blood pressure before therapy, that patient may be a candidate for drug reduction. The same is true regarding salt intake, though my experience has been that weight loss is a more potent blood pressure reduction measure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) 2 also supports antihypertensive drug reduction particularly in conjunction with successful lifestyle modification.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099264/

Ud. 22.9.2024

pub. 26.9.2022

Varicose Veins - Issues

 

Causes

Weak or damaged valves can lead to varicose veins. Arteries carry blood from the heart to the rest of the body. Veins return blood from the rest of the body to the heart. To return blood to the heart, the veins in the legs must work against gravity.

Muscle contractions in the lower legs act as pumps, and elastic vein walls help blood return to the heart. Tiny valves in the veins open as blood flows toward the heart, then close to stop blood from flowing backward. If these valves are weak or damaged, blood can flow backward and pool in the veins, causing the veins to stretch or twist.

https://www.mayoclinic.org/diseases-conditions/varicose-veins/symptoms-causes/syc-20350643

Vain Diseases or Problems

case of iliac vein compression: a mid-40s woman who suffered from leg and buttock heaviness and achiness.

Authors: Back Kim MD &  Tae An Choi, ANP-BC

Heart Vein NYC, New York, New York

https://www.heartveinnyc.com/case-studies/case-of-iliac-vein-compression-a-mid-40s-woman-who-suffered-from-leg-and-buttock-heaviness-and-achiness/

https://www.jvsvenous.org/article/S2213-333X(18)30419-0/fulltext

Diet for Varicose Veins

https://www.blogaberry.com/health-and-fitness/how-a-therapeutic-diet-can-also-heal-painful-varicose-veins/

Exercises for Varicose Veins

https://heritagehospitals.com/blog/10-best-exercises-for-varicose-veins/

https://njvvc.com/how-exercise-promotes-healthy-veins/

ud. 6.2.2024

pub. 14.12.2022

Endothelial Health - Impairment to Endothelial Function

 

Endothelial Health

The Importance of Endothelial Health!

The 1998 Nobel Prize in Medicine was awarded to three American researchers who discovered how endothelium produces a gas that actually regulates your entire cardiovascular system.  The  gas is Nitric Oxide – the master signaling molecule of your entire cardiovascular system.  

This health information webinar will teach you how to effectively nourish your endothelium for proper nitric oxide production, which has the potential to significantly improve cardiovascular health. 

https://www.youtube.com/watch?v=2MQCDQgojLg                       

Watch the above YouTube video to learn how and why!

https://no-more-heart-disease.com/endothelial-health/

Endothelial Function and Cardiovascular Disease

Cardiology University of Washington

8 Oct 2021  University of Washington Cardiovascular Grand Rounds 2021-2022

Francis Kim, MD

Learning Objectives:

-State why endothelial function is important for cardiologists

-Describe how endothelial function is measured

-Describe mechanisms of endothelial dysfunction

https://www.youtube.com/watch?v=s6Geqf9YWe0

Nitric Oxide - Enabler of Cardio Vascular Health

https://oldageindia.blogspot.com/2016/11/nitric-oxide-enable-of-cardio-vascular.html

The American Journal of Clinical Nutrition

Volume 93, Issue 3, March 2011, Pages 500-505

The American Journal of Clinical Nutrition

Endothelial function is impaired after a high-salt meal in healthy subjects1,2,3

Author links open overlay panelDickinson Kacie M, Clifton Peter M, Keogh Jennifer B

https://www.sciencedirect.com/science/article/pii/S0002916523022219

Dietary Sodium Restriction Reverses Vascular Endothelial Dysfunction in Middle-Aged/Older Adults With Moderately Elevated Systolic Blood Pressure

FREE ACCESS

Hypertension

Kristen L. Jablonski, Matthew L. Racine, Candace J. Geolfos, Phillip E. Gates, Michel Chonchol, Matthew B. McQueen, and Douglas R. Seals

J Am Coll Cardiol. 2013 Jan, 61 (3) 335–343

Clinical significance

The concept that high sodium intake has adverse CV effects independent of BP has been advanced previously (9,12). High dietary sodium impairs EDD even in rodents that are salt-resistant and, thus, do not exhibit increases in BP in response to a high-salt diet (13,18,20). Acute impairment of EDD in normotensive adults after sodium loading also is BP independent (11), and adults with elevated SBP who report lower sodium intake have enhanced EDD independent of BP (16). The present results extend these findings to sodium restriction and lend support to the overall hypothesis that sodium intake not only elevates BP but also exerts other adverse influences (12). The effects of sodium restriction on endothelial function reported here also complement previous findings that reducing sodium intake can rapidly de-stiffen large elastic arteries (21), another independent vascular risk factor for CVD (40). The improvements in these 2 common forms of arterial dysfunction, both predictors of CV events (3,4,40), suggest that DSR has strong potential for reducing CVD risk via broad vasculoprotective effects.

https://www.jacc.org/doi/10.1016/j.jacc.2012.09.010

Recent Research - Deadly Arrhythmia Trifecta: Salt, Swelling, and Leaky Sodium Channels

 24 MAY 2022

Our new findings demonstrate that controlling blood sodium could help Long QT patients prevent dangerous arrhythmias,” -  Steven Poelzing, Associate professor at the Fralin Biomedical Research Institute.

Some Long QT syndrome patients are born with the disease, while others develop it as a result of natural aging, certain medications, tissue swelling, or heart disease. 

As humans naturally age, heart muscle cells grow and require more calcium to contract. To sustain elevated calcium levels, heart muscle cells also need more sodium. As a result, the aging human heart naturally adapts ‘leaky’ sodium channels, allowing more sodium to enter the cell.

Long QT is diagnosed when the length of time it takes for a heartbeat to drop from its peak to baseline, the QT interval, is extended on an electrocardiogram reading.

“Our data suggests that the combination of tissue edema, elevated blood sodium, and faulty sodium channels trigger deadly heart arrhythmias,”

 “Bringing the concept closer to the clinical setting will require teaching cardiologists on how parameters related to perinexal expansion and extracellular sodium levels may be monitored in a clinical environment.”

https://news.vt.edu/articles/2022/05/scientists-detect-deadly-arrhythmia-trifecta--salt--swelling--an.html

ORIGINAL RESEARCH article

Front. Nutr., 06 April 2023

Sec. Clinical Nutrition

Volume 10 - 2023 | https://doi.org/10.3389/fnut.2023.1073626

Evaluating the association between dietary salt intake and the risk of atrial fibrillation using Mendelian randomization

Sicen Wang1 Ye Cheng1,2 Qi Zheng3 Xin Su2* Yingjian Deng2*

https://www.frontiersin.org/articles/10.3389/fnut.2023.1073626/full

Nutrients. 2020 Dec; 12(12): 3714. Published online 2020 Nov 30. doi: 10.3390/nu12123714

PMCID: PMC7761364PMID: 33266329

Left Ventricular Mass Reduction by a Low-Sodium Diet in Treated Hypertensive Patients †

Natale Musso,* Federico Gatto, Federica Nista, Andrea Dotto, Zhongyi Shen, and Diego Ferone

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761364/

Abstract

Objective: To evaluate the left ventricular mass (LVM) reduction induced by dietary sodium restriction.

 Patients and Methods: 138 treated hypertensives were given a simple sodium-restricted diet was advised. They had to avoid common salt loads, such as cheese and salt-preserved meat, and were switched from regular to salt-free bread. 

Blood pressure (BP), 24-h urinary sodium (UNaV) and LVM were recorded at baseline, after 2 months. and after 2years. 

Results: 

In 76 patients UNaV decreased in the recommended range after 2 months and remained low at 2 years. In 62 patients UNaV levels decreased after 2 months and then increased back to baseline at 2 years.

The first group followed the diet advice for the long period. The second group did not follow the diet advice strictly.

Initially the two groups did not differ in terms of BP (134.3 ± 16.10/80.84 ± 12.23 vs. 134.2 ± 16.67/81.55 ± 11.18 mmHg, mean ± SD), body weight (72.64 ± 15.17 vs. 73.79 ± 12.69 kg), UNaV (161.0 ± 42.22 vs. 158.2 ± 48.66 mEq/24 h), and LVM index (LVMI; 97.09 ± 20.42 vs. 97.31 ± 18.91 g/m2). 

After 2years. they did not differ in terms of BP (125.3 ± 10.69/74.97 ± 7.67 vs. 124.5 ± 9.95/75.21 ± 7.64 mmHg) and body weight (71.14 ± 14.29 vs. 71.50 ± 11.87 kg). 

Significant differences were seen for UNaV (97.3 ± 23.01 vs. 152.6 ± 49.96 mEq/24 h) and LVMI (86.38 ± 18.17 vs. 103.1 ± 21.06 g/m2). 

Multiple regression analysis: UNaV directly and independently predicted LVMI variations, either as absolute values (R2 = 0.369; β = 0.611; p < 0.001), or changes from baseline to +2years. (R2 = 0.454; β = 0.677; p < 0.001). 

The prevalence of left ventricular hypertrophy decreased (29/76 to 15/76) in the first group while it increased in the less compliant patients (25/62 to 36/62; Chi2 p = 0.002). Conclusion: LVM seems linked to sodium consumption in patients already under proper BP control by medications.

The regression of the left ventricular mass, and the reversal of LVH, in severe hypertension under dietary sodium restriction is availabe in the existing research literature. In the papers by Walther Kempner, the rice-fruit diet, with its very low-sodium content, could normalize both the BP values and the cardiac mass. More recently, in hypertensive patients who actually restricted their sodium consumption, a reduction of the left ventricular mass was observed, even approaching the best pharmacological effect. Conversely, an increase in sodium/potassium ratio was associated with a higher LVMI in pre-hypertensive and hypertensive patients. The association between sodium intake and worsening of cardiac mass has been receiving widespread attention. The known linear relations between sodium intake and cardiovascular risk and between UNaV and LVH  have even shown a stepwise increase, irrespective of BP values.

Experimental data attribute the sodium-induced LVH to actions mediated by the renin-angiotensin system without an increased sympathetic tone. Furthermore, the restriction of alimentary sodium reduces central BP independently of changes in peripheral BP. It follows that a high central BP, a stronger and independent predictor of cardiovascular morbidity and mortality, can induce a cardiac damage unrelated with peripheral BP.

Published On 11 Dec 2018

Too Much Salt In Diet Can Cause Irregular Heartbeat 

Written By Medha Baranwal    

After accounting for several other risk factors -- including age, body fat, blood pressure, and smoking -- the researchers found that salt consumption was independently associated with the risk of atrial fibrillation.

https://speciality.medicaldialogues.in/too-much-salt-in-diet-can-cause-irregular-heartbeat

How Much Salt Should You Eat if there is a heart related problem?

If you’re living with congestive heart failure, it’s best if you limit the sodium in your diet to less than 1,500 milligrams a day. 

That’s far less than the amount recommended for normal people  -- 2,300 milligrams. But many Americans are taking 3,400 milligrams.

https://www.webmd.com/heart-disease/heart-failure/low-sodium-eating

Dietary Sodium Intake in Heart Failure

Originally published24 Jul 2012

Americans consume ≈3700 mg sodium daily,11 whereas the US Department of Agriculture and the Department of Health and Human Services recommend 2300 mg daily intake for the general population, with a stricter recommendation of 1500 mg/d for those >50 years of age, blacks, or individuals with hypertension, diabetes mellitus, or chronic kidney disease.

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.111.062430

Dietary Sodium Restriction Reverses Vascular Endothelial Dysfunction in Middle-Aged/Older Adults With Moderately Elevated Systolic Blood Pressure

FREE ACCESS

Hypertension

Kristen L. Jablonski, Matthew L. Racine, Candace J. Geolfos, Phillip E. Gates, Michel Chonchol, Matthew B. McQueen, and Douglas R. Seals

J Am Coll Cardiol. 2013 Jan, 61 (3) 335–343

Clinical significance

The concept that high sodium intake has adverse CV effects independent of BP has been advanced previously (9,12). High dietary sodium impairs EDD even in rodents that are salt-resistant and, thus, do not exhibit increases in BP in response to a high-salt diet (13,18,20). Acute impairment of EDD in normotensive adults after sodium loading also is BP independent (11), and adults with elevated SBP who report lower sodium intake have enhanced EDD independent of BP (16). The present results extend these findings to sodium restriction and lend support to the overall hypothesis that sodium intake not only elevates BP but also exerts other adverse influences (12). The effects of sodium restriction on endothelial function reported here also complement previous findings that reducing sodium intake can rapidly de-stiffen large elastic arteries (21), another independent vascular risk factor for CVD (40). The improvements in these 2 common forms of arterial dysfunction, both predictors of CV events (3,4,40), suggest that DSR has strong potential for reducing CVD risk via broad vasculoprotective effects.

https://www.jacc.org/doi/10.1016/j.jacc.2012.09.010

Ud. 12.6.2024

Pub. 31.5.2024

23 BMI - Risk Factor for Cardiovascular Problems for Indians and Asians - Don't Allow Your Weight to Increase and Cross 23 BMI

 

BMI above 23 is a risk factor for cardiovascular and metabolic disorders. Please note. Do not allow weight to increase and cross 23 BMI.

Diabetes is metabolic disorder. Triglycerides and Cholesterol are also metabolic disorders and have the foundation in food habits causing diabetes.

Increase in blood pressure indicates that a permanent problem in blood flow occurred in the blood pipes or vessels. When the problem occurs in main arteries, various pain symptoms appear. When the problem is in minor arteries, only blood pressure is the visible measurement.

Discussion Regarding 23 BMI

It is clear that increased body weight is a risk factor for type 2 diabetes. The relationship between body weight and type 2 diabetes is more properly attributable to the quantity and distribution of body fat . Abdominal circumference and waist and hip measurements are highly correlated with cardiometabolic risk.

The measurement of body weight with various corrections for height is frequently used to assess risk for obesity-related diseases because it is the most economical and practical approach in both clinical and epidemiologic settings. The most commonly used measure is Quetelet’s index or BMI, defined as weight ÷ height2, with weight in kilograms and height in meters. 

There is a propensity for Asians to develop visceral versus peripheral adiposity, which is more closely associated with insulin resistance and type 2 diabetes than overall adiposity.  Asians of both sexes have been shown to have a higher percentage of body fat at any given BMI level compared with non-Hispanic whites; this suggests differences in body composition that may contribute to variations in diabetes prevalence.

In 2004, data from the Behavioral Risk Factor Surveillance System (BRFSS) showed that the odds of prevalent diabetes were 60% higher for Asian Americans than non-Hispanic whites after adjusting for BMI, age, and sex (23). The National Health Interview Survey (NHIS; 1997–2008 data)  found that the odds of prevalent diabetes were 40% higher in Asian Americans relative to non-Hispanic whites after adjusting for differences in age and sex. In fully adjusted logistic regression models including an adjustment for BMI as a categorical variable (underweight/normal weight: BMI <23 kg/m2, overweight: 23 ≤ BMI < 27.5 kg/m2, and obese: BMI ≥27.5 kg/m2), Asian Americans remained 30–50% more likely to have diabetes than their non-Hispanic white counterparts.

Thus in the Diabetes Prevention Program (DPP), a BMI value of 22 kg/m2 was selected as the eligibility BMI for Asians. 

 The diagnostic cutoff for overweight BMI in India (48) is 23 kg/m2.

BMI cut points with a sensitivity of 80% fall consistently between 23–24 kg/m2 for nearly all Asian American subgroups (with levels slightly lower for Japanese). This makes a rounded cut point of 23 kg/m2 practical

ADA Recommendation

Testing for diabetes should be considered for all Asian American adults who present with a BMI of ≥23 kg/m2.

https://diabetesjournals.org/care/article/38/1/150/37769/BMI-Cut-Points-to-Identify-At-Risk-Asian-Americans

48.Misra A, Chowbey P, Makkar BM, et alConcensus Group. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163–170

[PDF] researchgate.net

[PDF] Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity …

A Misra, P Chowbey, BM Makkar, NK Vikram, JS Wasir… - Japi, 2009 - researchgate.net

Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity,

increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver,

muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type

2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries.

Based on percentage body fat and morbidity data, limits of normal BMI are narrower and

lower in Asian Indians than in white Caucasians. In this consensus statement, we present …

https://www.researchgate.net/profile/Janaki-Srinath-Puskuri/publication/325404564_Consensus_Statement_for_Diagnosis_of_Obesity_Abdominal_Obesity_and_the_Metabolic_Syndrome_for_Asian_Indians_and_Recommendations_for_Physical_Activity_Medical_and_Surgical_Management/links/5b0c416a0f7e9b1ed7fbabc2/Consensus-Statement-for-Diagnosis-of-Obesity-Abdominal-Obesity-and-the-Metabolic-Syndrome-for-Asian-Indians-and-Recommendations-for-Physical-Activity-Medical-and-Surgical-Management.pdf

 

48.Misra A, Chowbey P, Makkar BM, et alConcensus Group. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163–170

https://diabetesjournals.org/care/article/38/1/150/37769/BMI-Cut-Points-to-Identify-At-Risk-Asian-Americans

[PDF] researchgate.net

[PDF] Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity …

A Misra, P Chowbey, BM Makkar, NK Vikram, JS Wasir… - Japi, 2009 - researchgate.net

Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity,

increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver,

muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type

2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries.

Based on percentage body fat and morbidity data, limits of normal BMI are narrower and

lower in Asian Indians than in white Caucasians. In this consensus statement, we present …

https://www.researchgate.net/profile/Janaki-Srinath-Puskuri/publication/325404564_Consensus_Statement_for_Diagnosis_of_Obesity_Abdominal_Obesity_and_the_Metabolic_Syndrome_for_Asian_Indians_and_Recommendations_for_Physical_Activity_Medical_and_Surgical_Management/links/5b0c416a0f7e9b1ed7fbabc2/Consensus-Statement-for-Diagnosis-of-Obesity-Abdominal-Obesity-and-the-Metabolic-Syndrome-for-Asian-Indians-and-Recommendations-for-Physical-Activity-Medical-and-Surgical-Management.pdf

Nitric Oxide - Enabler of Cardio Vascular Health

New insights into nitric oxide in congestive heart failure make "the next step" possible
Shelley Wood
April 23, 2004
http://www.medscape.com/viewarticle/784684


What Are the Benefits of Nitric Oxide Supplements?
by KRISTEN UNGER  Last Updated: Aug 25, 2014
http://www.livestrong.com/article/518715-the-supplements-and-foods-that-increase-nitric-oxide-production/

Nitric oxide for heart health

WHAT is Nitric Oxide?  Discovery
http://www.all-fitness.info/2015/10/nitric-oxide-for-heart-health.html

Endothelial Health!
Posted on November 14, 2011
http://no-more-heart-disease.com/



A SIGNAL FOR A HEALTHY HEART
http://www.doctor-recommended.com/blog/a-signal-for-a-healthy-heart/

Foods That Contain L-Arginine, L-Citrulline, And Folic Acid

Daniel Hammer
http://www.danhammerhealth.com/
______________________

______________________

Ud. 12.6.2024

Pub. 5.11.2016

Use Heart - Know Heart - Life Style Change Will Improve Heart Health - World Heart Day 2023 Message

 

29 September - World Heart Day

Use Your Heart. Walk Daily. Heart Health Improves. 

On the Road on World Health Day

‣A promise to our families to cook and eat more healthily

‣A promise to our children to exercise more and help them to be more active, to say no to smoking and help our loved ones to stop

‣A promise as a healthcare professional to help patients give up smoking and lower their cholesterol

‣A promise as a policymaker to support policies that promote healthy hearts

‣A promise as an employee to invest in heart-healthy workplaces

A simple promise … for MY HEART, for YOUR HEART, for ALL OUR HEARTS.

Watch Video

https://www.youtube.com/watch?v=ifls343TgaU

https://world-heart-federation.org/world-heart-day/

https://world-heart-federation.org/world-heart-day/resource/whd-poster-lifestyle/

https://en.wikipedia.org/wiki/World_Heart_Federation

https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/world-heart-day-2023-theme-history-and-significance/articleshow/104017084.cms  

Watch Video

https://www.youtube.com/watch?v=F-JZTjXmTG0

Low Ejection Fraction - LVEF

 

How Can I Improve My Low Ejection Fraction?

https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/how-can-i-improve-my-low-ejection-fraction

Heart Failure Signs and Symptoms

https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure

Medications Used to Treat Heart Failure

https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure

Angiotensin-Converting Enzyme (ACE) Inhibitors

Commonly prescribed include:

Captopril (Capoten)

Enalapril (Vasotec)

Angiotensin II Receptor Blockers (or Inhibitors)

(Also known as ARBs or Angiotensin-2 Receptor Antagonists)

Commonly prescribed include:

Losartan (Cozaar)

Valsartan (Diovan)

Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)

ARNIs are a new drug combination of a neprilysin inhibitor and an ARB.

Sacubitril/valsartan

If Channel Blocker (or inhibitor)

This drug class reduces the heart rate, similar to another class of drugs called beta blockers.

Ivabradine (Corlanor)

Beta Blockers (Also known as Beta-Adrenergic Blocking Agents)

Commonly prescribed include:

Bisoprolol (Zebeta)

Metoprolol succinate (Toprol XL)

Aldosterone Antagonists

Commonly prescribed include:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Hydralazine and isosorbide dinitrate (specifically benefits African-Americans with heart failure)

Commonly prescribed:

Hydralazine and isosorbide dinitrate (combination drug) - (Bidil)

Diuretics (Also known as water pills)

Commonly prescribed include:

Furosemide (Lasix)

Torsemide (Demadex)

What this type of medication does:

Causes the body to rid itself of excess fluids and sodium through urination.

Helps to relieve the heart’s workload.

Decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.

Hypertension - Blood Pressure

GLOBAL BURDEN OF HYPERTENSION

Based on an analysis of data from 135 population-based studies that included 968,419 adults from 90 countries, we estimated that in 2010 the global age-standardized prevalence of hypertension (defined as systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, and/or current use of antihypertensive medication) was 31.1% (95% CI 30.0–32.2%).

Estimates suggest that in 2010, 31.1% of adults (1.39 billion) worldwide had hypertension. The prevalence of hypertension among adults was higher in LMICs (31.5%, 1.04 billion people) than in high-income countries (HICs; 28.5%, 349 million people). Variations in the levels of risk factors for hypertension, such as high sodium intake, low potassium intake, obesity, alcohol consumption, physical inactivity and unhealthy diet, may explain some of the regional heterogeneity in hypertension prevalence

In 2017, the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines redefined hypertension in adults as systolic BP ≥130 mmHg and/or diastolic BP ≥80 mmHg. This change was based on findings from a number of large-scale, prospective observational studies that reported significant increases in risk of CVD with increasing BP even from levels as low as systolic BP 115 mmHg, as well as the results of randomized clinical trials including the SPRINT trial (discussed further below) that showed that intensive BP lowering (target systolic BP <120 mmHg) reduces CVD and all-cause mortality to an even greater extent than does standard BP lowering (target systolic BP ≤140 mmHg). When the new definition was applied to the US general population, hypertension prevalence increased from 32.0% (based on the traditional criteria) to 45.4% (Table 2).19,20 In the Chinese general population, the increase was even greater from 23.2% to 46.4%.19,20 These findings suggest that if the new criteria were applied worldwide, the difference in hypertension prevalence between LMICs and HICs would be much greater than previously reported.3 Full implementation of the new guidelines would require a greater proportion of adults to be treated with antihypertensive medications but could prevent an estimated 610,000 CVD events and 334,000 deaths per year in the US alone.19

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998524/

WHO on Hypertension 

https://www.who.int/news-room/fact-sheets/detail/hypertension

Cilnidipine and Telmisartan Similarly Improves Vascular Damage in Hypertensive Patients

Yuki Kaneshiro, Atsuhiro Ichihara, M.D., Ph.D., FAHA, Mariyo Sakoda, ...

First Published January 1, 2007 Research Article

https://doi.org/10.4137/CMC.S353

https://journals.sagepub.com/doi/full/10.4137/CMC.S353

Ud. 30.5.2023

Pub. 12.6.2021

Collateral Arteries - Arteriogenesis

  

Stimulation of arteriogenesis; a new concept for the treatment of arterial occlusive disease 

Niels van Royen, Jan J. Piek, Ivo Buschmann, Imo Hoefer, Michiel Voskuil, Wolfgang Schaper Author Notes

Cardiovascular Research, Volume 49, Issue 3, February 2001, Pages 543–553, https://doi.org/10.1016/S0008-6363(00)00206-6

https://academic.oup.com/cardiovascres/article/49/3/543/308560

Pentoxifylline - Trental 400

Pentoxifylline for vascular health: a brief review of the literature.

McCarty MF1, O'Keefe JH2, DiNicolantonio JJ2

Author information

Open Heart, 08 Feb 2016, 3(1):e000365

DOI: 10.1136/openhrt-2015-000365 PMID: 26870389 PMCID: PMC4746528 

https://europepmc.org/article/pmc/4746528

Pentoxifylline: A Drug with Antiviral and Anti-Inflammatory Effects to Be Considered in the Treatment of Coronavirus Disease 2019

Ghasemnejad-Berenji M.a · Pashapour S.b · Sadeghpour S.c

Author affiliations

Corresponding Author

Keywords: Severe acute respiratory syndrome coronavirus-2Coronavirus disease 2019Pentoxifylline

Med Princ Pract 2021;30:98–100

https://doi.org/10.1159/000512234

https://www.karger.com/Article/FullText/512234

A Combined Treatment Effect of Cilostazol and Pentoxifylline in the Treatment of Peripheral Vascular Disease

Jalpa Suthar   Birju Shah  Ritu Ranjan

Asian Journal of Medicine and Health, Page 74-80

DOI: 10.9734/ajmah/2022/v20i1130528

Published: 3 September 2022

https://journalajmah.com/index.php/AJMAH/article/view/731

The rest pain: Out of 52 patients, 42 (80.7%)  showed improvement in six months.

For intermediate claudication 73% patients showed improvement in six months.

Zilast (Cilostazeol)

Trental, Kinetal (Pentoxifylline)

Ud 20.10.2022

pub 10.9.2022

Reduction of LDL Cholesterol

 Studies have found that if the LDL cholesterol is reduced to less than 70 mg/dL and preferably less than 55 mg/dL, the size of the plaques can get smaller.19-Jul-2021

https://www.uptodate.com/contents/high-cholesterol-and-lipid-treatment-options-beyond-the-basics

Safety and Efficacy of Extremely Low LDL-Cholesterol Levels and Its Prospects in Hyperlipidemia Management

Dhrubajyoti Bandyopadhyay,corresponding author 1 Arshna Qureshi, 2 Sudeshna Ghosh, 3 Kumar Ashish, 4 Lyndsey R. Heise, 5 Adrija Hajra, 6 and Raktim K. Ghosh 7

J Lipids. 2018; 2018: 8598054. Published online 2018 Apr 23. doi: 10.1155/2018/8598054

PMCID: PMC5937425PMID: 29850255

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937425/

PCSK9 Therapies

Inclisiran from Novartis

Inclisiran - It Was To Be The Cholesterol Drug For The Masses. Novartis Changed That.

John LaMattinaContributor

I cover news on drugs and R&D in the pharma industry

Jan 3, 2022,

https://www.forbes.com/sites/johnlamattina/2022/01/03/it-was-to-be-the-cholesterol-drug-for-the-masses-novartis-changed-that/ 

Two PCSK9 antibodies were approved by the FDA in 2015: Praluent (Sanofi/Regeneron) and Repatha (Amgen). Unfortunately, the list prices of these much anticipated drugs were initially set at a jaw dropping $14,000/year/patient.

in 2018 first Amgen, then Sanofi/Regeneron lowered the list prices to $5,850, hoping that higher sales would ensue. 

In India, Price on 26.9.2022

Repatha Sure Click Evolocumab 140mg Mg Solution For Injection in Prefilled Syringe

₹ 19,500/ PIECE

Usage/Application: Personal

size: 1 PREFILLED PEN DEVICE(s)

Treatment: Heart disorders

Manufacturer: DR REDDY'S LABORATORIES LTD

Strength: 140mg

Brand: EVOLOCUMAB

(Two injections per month are needed.)

Arterial Stiffness - Mechanism of Development and Its Reduction

 Mechanisms, Pathophysiology, and Therapy of Arterial Stiffness

Susan J. Zieman, Vojtech Melenovsky and David A. Kass

Originally published24 Feb 2005https://doi.org/10.1161/01.ATV.0000160548.78317.29Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:932–943

https://www.ahajournals.org/doi/10.1161/01.atv.0000160548.78317.29

Cilnidipine - Use and Benefits

 

Patent - New use of cilnidipine

https://patents.google.com/patent/CN102416013A/en

Congestive Heart Failure

 

Congestive Heart Failure (CHF)

https://www.healthline.com/health/congestive-heart-failure

Congestive Heart Failure Diet: How to Reduce Fluid

https://www.healthline.com/health/congestive-heart-failure-diet

PURE - Cardiovascular Diseases Studies - Publications

 

2017

https://www.thelancet.com/article/S0140-6736(17)32252-3/fulltext

2022

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01441-6/fulltext

https://www.thehindu.com/sci-tech/health/similar-strategies-required-to-handle-cardiovascular-disease-in-men-and-women-lancet-study/article65875126.ece

Pure Diet score

https://ipccs.org/2018/09/04/higher-healthy-diet-score-reduced-cv-disease-and-mortality-worldwide/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435701/

WHO guidelines on foods

https://www.who.int/news-room/fact-sheets/detail/healthy-diet

Practical advice on maintaining a healthy diet

Fruit and vegetables

Eating at least 400 g, or five portions, of fruit and vegetables per day reduces the risk of NCDs (2) and helps to ensure an adequate daily intake of dietary fibre.

Fruit and vegetable intake can be improved by:

always including vegetables in meals;

eating fresh fruit and raw vegetables as snacks;

eating fresh fruit and vegetables that are in season; and

eating a variety of fruit and vegetables.

Fats

Reducing the amount of total fat intake to less than 30% of total energy intake helps to prevent unhealthy weight gain in the adult population (1, 2, 3). Also, the risk of developing NCDs is lowered by:

reducing saturated fats to less than 10% of total energy intake;

reducing trans-fats to less than 1% of total energy intake; and

replacing both saturated fats and trans-fats with unsaturated fats (2, 3) – in particular, with polyunsaturated fats.

Fat intake, especially saturated fat and industrially-produced trans-fat intake, can be reduced by:

steaming or boiling instead of frying when cooking;

replacing butter, lard and ghee with oils rich in polyunsaturated fats, such as soybean, canola (rapeseed), corn, safflower and sunflower oils;

eating reduced-fat dairy foods and lean meats, or trimming visible fat from meat; and

limiting the consumption of baked and fried foods, and pre-packaged snacks and foods (e.g. doughnuts, cakes, pies, cookies, biscuits and wafers) that contain industrially-produced trans-fats.

Salt, sodium and potassium

Most people consume too much sodium through salt (corresponding to consuming an average of 9–12 g of salt per day) and not enough potassium (less than 3.5 g). High sodium intake and insufficient potassium intake contribute to high blood pressure, which in turn increases the risk of heart disease and stroke (8, 11).

Reducing salt intake to the recommended level of less than 5 g per day could prevent 1.7 million deaths each year (12).

People are often unaware of the amount of salt they consume. In many countries, most salt  comes from processed foods (e.g. ready meals; processed meats such as bacon, ham and salami; cheese; and salty snacks) or from foods consumed frequently in large amounts (e.g. bread). Salt is also added to foods during cooking (e.g. bouillon, stock cubes, soy sauce and fish sauce) or at the point of consumption (e.g. table salt).

Salt intake can be reduced by:

limiting the amount of salt and high-sodium condiments (e.g. soy sauce, fish sauce and bouillon) when cooking and preparing foods;

not having salt or high-sodium sauces on the table;

limiting the consumption of salty snacks; and

choosing products with lower sodium content.

Some food manufacturers are reformulating recipes to reduce the sodium content of their products, and people should be encouraged to check nutrition labels to see how much sodium is in a product before purchasing or consuming it.

Potassium can mitigate the negative effects of elevated sodium consumption on blood pressure. Intake of potassium can be increased by consuming fresh fruit and vegetables.

Sugars

In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake (2, 7).  A reduction to less than 5% of total energy intake would provide additional health benefits (7).

Consuming free sugars increases the risk of dental caries (tooth decay). Excess calories from foods and drinks high in free sugars also contribute to unhealthy weight gain, which can lead to overweight and obesity. Recent evidence also shows that free sugars influence blood pressure and serum lipids, and suggests that a reduction in free sugars intake reduces risk factors for cardiovascular diseases (13).

Sugars intake can be reduced by:

limiting the consumption of foods and drinks containing high amounts of sugars, such as sugary snacks, candies and sugar-sweetened beverages (i.e. all types of beverages containing free sugars – these include carbonated or non‐carbonated soft drinks, fruit or vegetable juices and drinks, liquid and powder concentrates, flavoured water, energy and sports drinks, ready‐to‐drink tea, ready‐to‐drink coffee and flavoured milk drinks); and

eating fresh fruit and raw vegetables as snacks instead of sugary snacks.

Concor & Inapure Comparison

 

Concor

Bisoprolol Fumarate 5 Mg Tablet Beta-Blockers (Systemic) - Uses, Side Effects, and More

COMMON BRAND(S): ZEBETA

GENERIC NAME(S): BISOPROLOL FUMARATE

Bisoprolol is used with or without other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.This medication belongs to a class of drugs known as beta blockers. It works by blocking the action of certain natural chemicals in your body such as epinephrine on the heart and blood vessels. This effect lowers the heart rate, blood pressure, and strain on the heart.

https://www.webmd.com/drugs/2/drug-14206/bisoprolol-fumarate-oral/details

https://www.axahealth.co.uk/health-information/conditions/heart/how-can-i-quit-taking-concor-5mg/

https://www.practo.com/medicine-info/concor-5-mg-tablet-23310

https://www.1mg.com/drugs/concor-5-tablet-117202

Ivabradine Tablet - Uses, Side Effects, and More

COMMON BRAND(S): CORLANOR

GENERIC NAME(S): IVABRADINE

Uses

This medication is used to treat heart failure. It is used by adults to help prevent the heart failure from getting worse and needing treatment in a hospital. It is also used by children who have heart failure due to an enlarged heart (dilated cardiomyopathy). Heart failure is a condition where your heart does not pump blood as well as it should. Ivabradine works by making your heart beat more slowly.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

https://www.webmd.com/drugs/2/drug-159226/ivabradine-oral/details

https://medlineplus.gov/druginfo/meds/a615027.html

https://www.practo.com/medicine-info/inapure-5-tablet-46591

https://www.1mg.com/drugs/inapure-5-tablet-33300

Stent versus Coronary Artery Bypass Surgery

Stent versus Coronary Artery Bypass Surgery in Multi-Vessel and Left Main Coronary Artery Disease: A Meta-Analysis of Randomized Trials with Subgroups Evaluation

Pedro José Negreiros de Andrade1  2

João Luiz de Alencar Araripe Falcão1  2

Breno de Alencar Araripe Falcão1  2

Hermano Alexandre Lima Rocha1  2

Arq. Bras. Cardiol. vol.112 no.5 São Paulo May 2019  Epub Feb 21, 2019
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2019000500511





Harvard Heart Letter
Bypass or angioplasty with stenting: How do you choose?
July, 2013
https://www.health.harvard.edu/heart-health/bypass-or-angioplasty-with-stenting-how-do-you-choose


Percutaneous Transluminal Coronary Angioplasty (PTCA)
Talia F. Malik; Vijai S. Tivakaran.
Last Update: December 15, 2018.
Andreas Gruentzig first developed PCTA in 1977, and the procedure was performed in Zurich, Switzerland that same year.
https://www.ncbi.nlm.nih.gov/books/NBK535417/

Heart and Heart Diseases Related Research & Development

Coronary artery dimensions in normal Indians.
Raut BK, Patil VN, Cherian G.
Indian Heart J. 2017 Jul - Aug;69(4):512-514

This study showed the diameter of vessels in males and females when taken together the left main was larger in size followed by proximal LAD, proximal RCA & proximal LCX respectively (4.08±0.44mm, 3.27±0.23mm, 3.20±0.37mm, 2.97±0.37mm).When the vessel diameter was indexed to body surface area there was no statistical difference between male and female (p value>0.05). The computed value of proximal coronary artery diameter unadjusted for individual body surface area, when compared to Caucasians showed that Caucasians have larger coronary artery dimensions than Indians. But when the proximal vessel diameter was indexed to body surface area there was no statistical significant difference between Indians and Caucasians (p value>0.05).

CONCLUSIONS:
We found that coronary artery size when indexed to body surface area is not statistically different in Indian males and females and compared to Caucasians. However with a smaller body habitus Indians have smaller coronary arteries.
https://www.ncbi.nlm.nih.gov/pubmed/28822520



Echocardiographic visualization of coronary artery anatomy in the adult
Pamela S. Douglas, John Fiolkoski, Barbara Berko and Nathaniel Reichek
Journal of the American College of Cardiology
Volume 11, Issue 3, March 1988

In the light of technologic advances and the development of new imaging planes, the feasibility of two-dimensional echocardiographic visualization of coronary artery anatomy was reevaluated in the adult. Thirty-five subjects were studied using an ultrasonograph equipped with a 3.5 and 5.0 MHz annular array transducer, digital processing and cine loop review.

The left main coronary artery was seen in 30 (86%) of the 35 subjects and its bifurcation was seen in 15. The left anterior descending coronary artery was seen in 30 subjects (mean length 3.9 ± 2.3 cm, maximal length 7.5), the left circumflex artery in 11 (1.1 ± 1.0, maximal 3.0) and the right coronary artery in 32 (5.6 ± 2.6, maximal 12). Proximal and mid portions of the left anterior descending artery were seen in 23 and 11 subjects, respectively. The average proximal length visualized was 4.2 cm, and the average luminal diameter visualized was 4.9 mm. The average length of the mid left anterior descending coronary artery seen was 1.9 cm and the average luminal diameter seen was 4.6 mm. The proximal right coronary artery was seen in 17 subjects (average visualized length 2.7 cm and average diameter 3.1 mm). Portions of the mid right coronary artery were seen in 24 subjects (average length 3.6 cm and average diameter 3.1 mm). An average of 2.9 cm of the distal right coronary artery was seen in 18 subjects (average diameter 2.7 mm). Septal or diagonal branches were seen in 11 (31%) of the 35 subjects, a marginal branch in 1, the coronary sinus in all and smaller veins in 3. Coronary artery lesions were correctly identified in four of five subjects (two in the left anterior descending, one in the left main and one in the right coronary artery), but these were obscured in one subject by a calcified aortic valve.

Improved instrumentation combined with new imaging techniques permits extensive visualization of the adult coronary vasculature. The clinical utility of this technique for the noninvasive evaluation of coronary artery disease remains to be determined.

http://www.onlinejacc.org/content/11/3/565

Particles in Blood and Their Sizes

When push comes to shove: Size matters for particles in our bloodstream
Research on the movement patterns of particles in the blood
by Colin Poitras, University of Connecticut - Anson Ma, an assistant professor of chemical and biomolecular engineering at UConn, used a microfluidic channel device to observe, track, and measure how individual particles behaved in a simulated blood vessel.
OCTOBER 5, 2016
https://phys.org/news/2016-10-shove-size-particles-bloodstream.html



Lipoproteins: When size really matters
J. Bruce German,a,b,* Jennifer T. Smilowitz,a and Angela M. Zivkovica
Curr Opin Colloid Interface Sci. 2006 Jun; 11(2-3): 171–183.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893739/


Introduction to Lipids and Lipoproteins
Kenneth R Feingold, MD and Carl Grunfeld, MD, PhD.
https://www.ncbi.nlm.nih.gov/books/NBK305896/

List of human blood components
https://en.wikipedia.org/wiki/List_of_human_blood_components