Cilnidipine for Amlodipine Induced Pedal Edema and its Anti-hypertensive Effect in a Tertiary Care Teaching Hospital of Western Nepal.

BACKGROUND: Hypertension is the most common cardiovascular disease. In Nepal, 27.3% populations are suffering from hypertension. Amlodipine is the most frequently prescribed anti-hypertensive drug. Up to 15% of patients develop pedal edema with amlodipine that may lead to discontinuation. Cilnidipine, a new calcium channel blocker, found equally effective and edema is uncommon in different studies from India. We aimed to study anti-hypertensive effect and to assess resolution of amlodipine induced Pedal edema with clinidipine. METHODS: This was a prospective, single centre observational study. Study was conducted in the department of cardiology, Manipal teaching hospital from 7th May to 6th November 2020. Hypertensive Patients who were on amlodipine for at least 6 months and presented with pedal edema were enrolled for the study. RESULTS: Total of 107 patients were enrolled for the study. The mean age of patients was 56.35 ± 12.84 years, ranged from 29 to 85 years and more than half(52.3 %) were male. Of the 107 patients, 90 (84.1%) patients received 10mg of clinidipine. On follow up, all patients except three (2.8%) had resolution of pedal edema. The blood pressure reduction with clinidipine was comparable with amlodipine (p: >0.05). Three patients who had persistent edema on follow up were on higher dose of clinidipine. CONCLUSIONS: The newer L and N type CCB, Clinidipine has comparable efficacy with amlodipine and well tolerated in our population. Though the incidence of pedal edema is low but can occur with clinidipine especially with higher doses.

Pattern of Cardiovascular Disease among Admitted Patients in Tertiary Care Teaching Hospital.

BACKGROUND: Cardiovascular diseases are the dominant cause of morbidity and mortality worldwide. In 2008, cardiovascular deaths represented 30% of all global deaths, with more than 80% of deaths in developing countries. There is increase in incidence of hypertension, atherosclerosis, stroke, chronic heart failure and atrial fibrillation. The objective of this study is to find the pattern of cardiovascular diseases among patients admitted in cardiac ward. METHODS: A retrospective analysis of records of admitted patients from 1st January 2016 - 30th December 2017 was conducted in Cardiology ward of Manipal Teaching Hospital, Pokhara, Nepal. A total of 2268 patients' data were taken from the ward register. The data was collected and analyzed with descriptive and inferential statistics using SPSS 18.0 version during the period from 1st June to 30th August 2018. RESULTS: The age ranged between 12 to 95 years with a mean (SD) is 61.23(16.34 years). More than half (51%) of the patients were female gender. Forty-six percentages of the patients were in the age group of 56 - 75 years. More than 1/3rd (35%) were diagnosed with Ischemic heart disease (IHD) followed by hypertension (22.8%) and arrhythmia(13.4%). There was a significant association between age and gender with the pattern of cardiovascular disease. CONCLUSIONS: Ischemic heart disease, hypertension and arrhythmia were the major causes of hospitalization. Preventive measures at community and personal level focusing on the risk factors management of ischemic heart disease will alleviate the burden of ischemic heart disease.

Prevalence of metabolic syndrome in Nepalese type 2 diabetic patients according to WHO, NCEP ATP III, IDF and Harmonized criteria.

BACKGROUND: Metabolic syndrome (MetS) present in type 2 diabetic patients greatly increases the risk of strokes and cardiovascular diseases. Timely detection and mapping of MetS facilitates appropriate preventive and therapeutic approaches to minimize these risks. Our study aimed to determine the prevalence of MetS among Nepalese type 2 diabetic patients using WHO (1999), NCEP ATP III (2001), IDF (2005) and Harmonized (2009) definitions and identify the diagnostic concordance and disparity resulting from these four definitions. METHODS: Clinical and biochemical data were collected for 1061 type 2 diabetic patients at Manipal Teaching Hospital, Pokhara, Nepal. The data was analyzed in order to identify prevalence of MetS in these patients. Statistical analysis included usage of Student's t- and Chi-square tests, kappa statistics and 95% confidence intervals. RESULTS: The total age adjusted prevalence rates of MetS were 80.3%, 73.9%, 69.9% and 66.8% according to Harmonized, NCEP ATP III, WHO and IDF definitions, respectively. Prevalence increased with the age and was higher in females (p <0.001) according to WHO, NCEP ATP III and Harmonized definitions. Patients of Dalit community had the highest prevalence (p<0.05) according to NCEP ATP III and Harmonized definitions while Mongoloid and Newar patients had the highest prevalence (p <0.05) according to WHO and IDF definitions, respectively. Prevalence was also highest among patient engaged in agriculture occupation. Central obesity and hypertension were respectively the most and the least prevalent components of MetS. The highest overall agreement was between Harmonized and NCEP ATP III definitions (κ =0.62, substantial) and the lowest between WHO & IDF definitions (κ=0.26, slight). The Harmonized definition had the highest sensitivity (99.9%) and negative predictive value (98.9%) while NCEP ATP III definition had the highest specificity (98.9%) and positive predictive values (99.9%) in identifying the cases of MetS. CONCLUSIONS: The prevalence of MetS among Nepalese type 2 diabetic patients was very high suggesting that these patients were at increased risk of strokes, cardiovascular diseases and premature death. The Harmonized definition was the most sensitive while NCEP ATP III and IDF definitions were the most specific in detecting the presence of MetS in Nepalese type 2 diabetic patients.