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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

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    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

6th October 2012, Saturday

New Type 2 Diabetes Guidelines


  • The first medical treatment is the use of metformin.
  • Metformin is a drug that has endlessly positive results and helps nearly every facet of the type 2 diabetes syndrome.
  • It lowers blood sugar levels, it helps reduce cardiovascular risk; it may even help reduce risk for cancer and Alzheimer's disease.
  • Many patients experience gastrointestinal side effects that limit its use.
  • 250-mg tablets are available
  • If a person cannot tolerate even 250 mg dose one should prepare an elixir of metformin with a teaspoonful having 50 mg. Start 50 mg for 2 weeks, 100 mg for the next 2 weeks. Aim at 1 gm twice daily or 500 mg twice daily.
  • If metformin is not enough and a target of A1c 7% is not achieved according to the algorithm, you have infinite choices. You can start a sulfonylurea, a dipeptidyl peptidase-4 (DPP-4) inhibitor, a glucagon-like peptide-1 (GLP-1) receptor agonist, insulin, or a thiazolidinedione.
  • In most cases one should add an agent that does not cause weight gain -- one that hopefully will cause weight loss -- and does not cause hypoglycemia. That is the ideal agent. For those benefits, we have a DPP-4 inhibitor or a GLP-1 receptor agonist.

DPP-4 inhibitors or GLP-1 receptor agonists

  • Choose GLP1 receptor agonist if the main aim is weight loss. It is the only agent that is associated with weight loss in most people.
  • Losing even a couple of pounds is beneficial and may motivate them to lose more weight.
  • When it comes to maintaining weight and avoiding hypoglycemia, either the DPP-4 inhibitor or the GLP-1 receptor agonist will be effective.
  • A DPP-4 inhibitor is a little easier because it is a pill rather than an injection, and it has very few side effects.
  • There is more robust A1c reduction with the GLP-1 receptor agonist than with a DPP-4 inhibitor.
  • If A1c is 8% and aim to reduce it to below 7%. Chose GLP-1 receptor agonist vs a DPP-4 inhibitor.
  • If A1c is 7.5% or 7.4% and aim is to lower it to below 7% add a DPP-4 inhibitor.
  • Both DPP-4 inhibitors and GLP-1 receptor agonists do not cause hypoglycemia and can cause either weight neutrality or weight loss.


  • In the United Kingdom Prospective Diabetes Study -- a very good, long-term diabetes study -- sulfonylurea agents were helpful.
  • They were part of the mix in the patients who were intensively treated.
  • They are associated with a reduction in both micro- and macrovascular events.
  • They reduce blood glucose levels with the caveats that they cause hypoglycemia and weight gain and are associated with progressive beta-cell failure.
  • So is metformin. The thiazolidinediones are the only class of drugs thus far that have not been shown to cause progressive beta-cell failure, which is part of the natural history of type 2 diabetes.
  • Use glimepiride and not glyburide -- it is less effective than glimepiride.
  • You can use short-acting glipizide as a premeal insulin secretagogue.


  • The only available agent is pioglitazone.
  • It helps preserve beta-cell function over time
  • Use a very low dose -- just 15 mg in most cases, and occasionally 30 mg.
  • One can use 15 mg on Monday, Wednesday, and Friday and see a marked improvement in blood glucose levels with very little weight gain or edema, which are 2 side effects of the thiazolidinediones.
  • They don't cause hypoglycemia, but this must be balanced with the risk for weight gain and fluid retention.
  • Use it after prescribing a DPP-4 inhibitor or a GLP-1 receptor agonist.
  • Add pioglitazone at a lower dose to help improve insulin sensitivity and get patients to target.
  • Higher doses (e.g., 45 mg) may be associated with osteoporosis or at least an increased risk for bone fracture, macular edema, and congestive heart failure.
  • One can add insulin at this point; that is certainly an option.
  • Add basal insulin to metformin, and even NPH insulin works.
  • Can add almost any overnight insulin to get the fasting blood sugar down and continue the metformin as an oral agent.
  • But do not prescribe insulin if you don’t have to, because it causes weight gain and hypoglycemia.

Insulin and Drug Combinations

  • The next step involves adding drugs that make sense with the drugs that the patient is already taking.
  • Use lower doses of pioglitazone and sulfonylurea agents, maximum doses of GLP-1 receptor agonists or DPP-4 inhibitors, and as the third-line add a thiazolidinedione or basal insulin, keeping the patient on the 2 drugs that they were started on initially.
  • In more complicated regimens keep patients on whatever agents they are on, including basal insulin. You may take away the sulfonylurea agent and add mealtime insulin. Add mealtime insulin for the biggest meal, or for the breakfast meal and the biggest meal later in the day, and try to get patients balanced.
  • Work on lifestyle, trying to get them to adhere or improve, and give patients the option of bariatric surgery. (Source Dr. Anne Peters for Medscape)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Levocarnitine Update

How is carnitine deficiency related to heart disease?

The energy required for the contraction of the myocardium mainly depends on fatty acid metabolism in the mitochondria, with glucose and lactate being less important sources. In carnitine deficiency states, energy production is decreased due to fewer amounts of long-chain fatty acids being available for beta-oxidation. This affects the cardiac muscle, which results in progressive cardiomyopathy and accumulation of intermediate organic acids. L-carnitine conjugates with these acids, removing them from the mitochondria and eliminating them in urine.1 Experimental and clinical studies have shown that in the ischemic, infarcted or failing myocardium, carnitine depletion occurs rapidly.2


  1. Azevedo VM, Albanesi FM, Santos MA, et al. The role of L-carnitine in nutritional status and echocardiographic parameters in idiopathic dilated cardiomyopathy in children. J Pediatr (Rio J) 2005;81(5):368-72.
  2. Gürlek A, Tutar E, Akçil E, et al. The effects of L-carnitine treatment on left ventricular function and erythrocyte superoxide dismutase activity in patients with ischemic cardiomyopathy. Eur J Heart Fail 2000;2(2):189-93.

For Comments and archives…

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Cigarettes Hurt womens Heart More than Men's

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th Perfect Health Mela in November (1st to 11th)

Addressing a press conference to announce the dates for 19th MTNL perfect Health Mela, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that focus of the Mela this year will be “Prevention of Non-Communicable Diseases”.

Dr K K Aggarwal
    National News

Meet to build healthy India

NEW DELHI: In a world of rat races, it is usually a person's health that faces the maximum brunt. Though medicines have improved, these have often failed to keep up with the life-style disorders caused by modern-age stress. To help build a healthy India, The Times of India, in association with Tetra Pak, is organizing the Times NIE Teachers' Knowledge Meet 2012. The idea is to train teachers who, in turn, will mentor young minds to lead a healthy life. Starting on October 8, this year's theme is 'Health & Nutrition in Schools'. The event is bringing together nutritionists, paediatricians and industry experts who will provide teachers a perspective on how to lead a healthy life, build stamina and let go the stress. So be ready to stretch your limbs in a 'healthy body, healthy mind' session along with activities like quiz. The meet will be held at India Habitat Center. (Source: TOI, Oct 5, 2012)

For comments and archives

My Profession My Concern

Ayurveda doctors want to do ultrasounds

The Maharashtra state had advised Ayurvedic doctors to approach the Union government to amend the existing Pre-conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act so that they are allowed to conduct sonography tests. At present, ayurvedic doctors are not allowed to conduct USG test as they are not registered with the Medical Council of India (MCI), reports Times of India.

Ayurvedic doctors want permission to conduct sonography tests. According to the PCPNDT Act, only doctors registered with the MCI can perform a sonography test. If these doctors want the permission, then one has to make changes in the PCPNDT Act," Suresh Shetty, public health minister said. As the PCPNDT Act is a central government Act, the state cannot make any changes in it. Hence, the public health department has advised these doctors to approach union government. The advice was given to a delegation of the ayurvedic doctors at a meeting in Mantralaya.

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

Bicuspid aortic valve

  • Valve re-replacement with a homograft is reasonable in patients with active prosthetic valve endocarditis.
  • The evidence was considered less well established for a bioprosthesis in women of childbearing age.
  • Mechanical valve may be recommended for patients with small aortic roots in whom annular enlargement is high risk or contraindicated.

(Experts: Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Beta-blockers not always life savers

Contrary to long held belief beta-blockers may not reduce the risk of a second heart attack and in some patients the drugs appear to increase the risk of events, according to a large observational study. (Source: Medpage Today)

For comments and archives

Vitamin D ineffective for respiratory tract infections

Adding vitamin D supplements to your diet with will not prevent upper respiratory tract infections (URTIs) or hasten your recovery from them, according to the results of a randomized, placebo-controlled trial published online October 3 in the Journal of the American Medical Association. (Source: Medscape)

For comments and archives

Rare muscle disorders eased by heart drug

A well known anti-arrhythmic medication improved muscle stiffness in a set of rare disorders called nondystrophic myotonias, a phase II trial showed. (Source: Medpage Today)

For comments and archives

Preop geriatric evaluation guidelines issued by ACS/AGS

The American College of Surgeons (ACS) and the American Geriatrics Society (AGS) have issued a best practices guideline for preoperative evaluation of patients at least 65 years of age who are undergoing surgery. The new recommendations, which resulted from the first collaboration of ACS with AGS on this topic, appear in the October issue of the Journal of the American College of Surgeons. (Source: Medscape)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Diabetes is a progressive disease Diabetes is a progressive disease, said Padma Shri and Dr B C Roy National... http://fb.me/1HYxZx93V

@DeepakChopra: Is there a balance between self-care & self-centeredness? Watch the latest episode of #SpiritualSolutions http://tinyurl.com/8fp33mp

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Instruments for obtaining a spiritual history – Part 2

Examples of content
FICA: spiritual history• F: Faith F: What is your faith?
I: Importance/influence I: How important is it?

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How can the ectopic pregnancy be treated?

Methotrexate is a drug that stops the ectopic pregnancy from continuing to develop. Your doctor will give you this medicine by injection. To determine if methotrexate has worked, the doctor will do a series of blood tests for hCG. Your doctor will follow the hCG levels until they are negative, which will indicate that the pregnancy has ended. If you receive a methotrexate injection, you should avoid alcohol, vitamins, drugs like ibuprofen, and food containing folate and folic acid to make sure the medicine works correctly.

Laparoscopy: It is called a minimally invasive surgery because the doctor makes very small incisions in your lower belly. A small telescope attached to a camera is placed into one incision, and the doctor can look for the ectopic pregnancy. The doctor will insert small instruments through the incisions and remove the ectopic pregnancy. If the fallopian tube is damaged, the doctor may have to remove the tube.

Laparotomy: It is a surgery during which an abdominal incision is made. Laparotomy to treat ectopic pregnancy is often performed in emergency situations when a woman has excessive internal bleeding from an ectopic pregnancy.

For comments and archives

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Blood Donation - Gift of Liquid Love

Developments over the last three decades in the field of renal dialysis, cancer therapy, cardio-vascular surgery, transplantation surgery, treatment of hemophilia and related disorders have put enormous burden on the blood transfusion services, not just for whole blood, but for products not available earlier, namely blood components or blood selectively depleted of specific cellular components.

As a consequence three major changes have taken place in the blood transfusion services throughout the globe.

For comments and archives

    Liver Abscess Update

(Dr. Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

What is the empirical therapy for liver abscess?

A combination of anti-staphylococcal drug like cloxacillin, an anti-anaerobic and antiamebic drug like metronidazole and an aminoglycoside or cephalosporin for gram-negative bacilli is a good initial choice.

For comments and archives

    An Inspirational Story

This is good

An old story is told of a king in Africa who had a close friend with whom he grew up. The friend had a habit of looking at every situation that ever occurred in his life (positive or negative) and remarking, “This is good!”

One day the king and his friend were out on a hunting expedition. The friend would load and prepare the guns for the king. The friend had apparently done something wrong in preparing one of the guns, for after taking the gun from his friend, the king fired it and his thumb was blown off. Examining the situation the friend remarked as usual, “This is good!” To which the king replied, “No, this is NOT good!” and proceeded to send his friend to jail.

About a year later, the king was hunting in an area that he should have known to stay clear of. Cannibals captured him and took him to their village. They tied his hands, stacked some wood, set up a stake and bound him to the stake. As they came near to set fire to the wood, they noticed that the king was missing a thumb. Being superstitious, they never ate anyone that was less than whole. So untying the king, they sent him on his way.

As he returned home, he was reminded of the event that had taken his thumb and felt remorse for his treatment of his friend. He went immediately to the jail to speak with his friend. “You were right,” he said, “it was good that my thumb was blown off.” And he proceeded to tell the friend all that had just happened. “And so I am very sorry for sending you to jail for so long. It was bad for me to do this.”

“No,” his friend replied, “This is good!”

“What do you mean? This is good? How could it be good that I sent my friend to jail for a year?”

“If I had NOT been in jail, I would have been with you.”

- Author Unknown

(Source: http://www.motivationalwellbeing.com/motivational-stories-4.html)

For comments and archives

  Cardiology eMedinewS

Upping physical activity slashes CV events, deaths in type 2 diabetics
Read More

Rethinking routine testing of chest-pain patients Read More

  Pediatric eMedinewS

Anemia pre-cardiac surgery predicts bad outcome Read More

Probiotic for babies may not fight allergies later Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with uncontrolled diabetes came with hearing loss.
Dr Bad: Go for a hearing aid.
Dr Good: Get your sugar controlled first.
Lesson: Lack of glycemic control shows a positive correlation with extent of hearing loss when compared to those diabetics with good glycemic control (Source: Int J Diab Dev Ctries 2008;28:114–20).

For comments and archives

Make Sure

Situation: A hypertensive patient on atenolol developed erectile dysfunction (ED). Atenolol was stopped.
Reaction: Oh my God! Why did you stop the beta-blocker? You should have just switched over to nebivolol.
Lesson: Make Sure that nebivolol is used as the beta–blocker of choice in a hypertensive patient with ED (Source: Asian J Androl 2006;8(2):177–82).

For comments and archives

    Legal Question of the Day (Dr M C Gupta)

Q. What is the concept of PharmaD?


  • The concept of PharmaD, a postgraduate degree in pharmacy, with emphasis on clinical environment, is based upon the following realisations:
    • That health and medicine is a team work and not the sole domain of a physician.
    • That nursing, pharmacy, physiotherapy etc. are too special areas to be mastered by a physician.
    • That a physician needs time and energy to concentrate upon matters like proper diagnosis, treatment, procedures etc., and needs expert help from others so that his time and energies are not frittered away in mundane tasks.
    • That the number and types and variety of drugs and their modes of action and interactions and side effects etc. are too complicated to be adequately remembered or managed by a physician.
  • The situation in USA is that when a doctor examines a patient in his clinic, he sends an e prescription, by email, to a pharmacy near the patient’s house and he collects it on the way back from the clinic or in the evening. If the pharmacist has a doubt, he crosschecks with the physician. When there is an obvious mistake, he does not dispense the prescription and gives a feedback to the physician about the mistake. The physicians respect the pharmacist for this and do not feel offended.
  • The mutual respect between the physician and the pharmacist in USA is the result of development of a new course titled as Pharma D, on the lines of MD. In 1990, the American Association of Colleges of Pharmacy (AACP) mandated that a doctor of pharmacy degree would be the new first-professional degree. Currently all accredited schools and colleges of pharmacy in the US offer the Pharm D degree. Many also offer post-Pharm D graduate programs in specialized areas of the profession. Moreover, it is possible to further obtain a PhD degree (such as PhD. in Pharmacology or Pharmaceutics). In the USA, legal requirements to becoming a pharmacist include graduating with a Doctor of Pharmacy (Pharm D) degree from an accredited college of pharmacy, serving an internship under a licensed pharmacist, and passing a national exam(NAPLEX - North American Pharmacist Licensure Exam) and a pharmacy law exam (MPJE - Multistate Pharmacy Jurisprudence Exam).
  • It is obvious that such a situation may take a long time to develop in India where, in practice, the qualification of diploma or degree in pharmacy serves merely as a licence to open a chemist shop selling almost any medicine to anybody on demand, with or without prescription. It may be mentioned, however, that the Pharm D course has been started in India also. It is a 6-year course that was introduced by the Pharmacy Council of India in 2008. The first batch passed out in August 2011 The course includes five years of classroom-based academic study followed by a year of internship. According to the Pharmacy Council of India, persons holding a Pharma D degree can pre-fix the initials "Dr" before their name.
  • While the replacement of the bachelor’s degree in pharmacy by Pharma D occurred in the USA in the sixties, the medical profession is still against Pharma D in India where it is seen as an encroachment on their territory.
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    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

BNP and NT–proBNP

BNP or NT–proBNP may be used to help diagnose heart failure and to grade the severity of that heart failure. BNP and NT–proBNP levels decrease in most patients who have been taking drug therapies for heart failure, such as ACE inhibitors, beta blockers, and diuretics. Levels of both BNP and NT–proBNP tend to increase with age. Levels of NT–proBNP and BNP are increased in persons with kidney disease.

While both BNP and NT–proBNP will rise with left ventricle dysfunction and either can be measured, they are not interchangeable and the results cannot be directly compared.

  Quote of the Day (Dr GM Singh)

Strength does not come from physical capacity. It comes from an indomitable will. Mahatma Gandhi

    Mind Teaser

Read this…………………

Which of the following signs and symptoms would Nurse Maureen include in teaching plan as an early manifestation of laryngeal cancer?

a. Stomatitis
b. Airway obstruction
c. Hoarseness
d. Dysphagia

Yesterday’s Mind Teaser: Which is considered as the earliest sign of increased ICP that the nurse should closely observed for?

A. Abnormal respiratory pattern
B. Rising systolic and widening pulse pressure
C. Contralateral hemiparesis and ipsilateral dilation of the pupils
D. Progression from restlessness to confusion and disorientation to lethargy

Answer for Yesterday’s Mind Teaser: D. Progression from restlessness to confusion and disorientation to lethargy

Correct answers received from: Dr PC Das, Dr Kanta Jain, Dr Pankaj Agarwal, Dr Pankaj Agarwal,
Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr K Raju, Dr U Gaur, Dr Avtar Krishan, Suresh Bohra, Chandra Pal Singh.

Answer for 4th October Mind Teaser: D. frequently elevating the arm of the affected side above the level of the heart.
Correct answers received from: Dr Thakor Hitendrsinh G, Dr K Raju, Dr U Gaur, Dr Avtar Krishan, Suresh Bohra, Chandra Pal Singh.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

At a history examination

Examiner: "Mention an important event in 1564."
Examinee (after thinking for a long time): "Shakespeare was born."

Examiner: "Very well, and in 1574?"
Examinee: "Let me think...ah, yes. I know. Shakespeare's 10th birthday!"

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What is the Continuing Treatment Rule?

In medical practice, when a physician retires or moves and sells his or her practice to a succeeding health care provider, patients records are often sold as part of the transaction. However, physicians should be warned that many states have medical record retention acts, and these acts usually do not provide an exception for record-keeping requirements even in such a transfer.

  • When the patient treatment continues for a period of time, during which it is difficult to ascertain when the negligence occurred. Some jurisdictions have adopted a "continuing treatment" rule to determine the time of injury for purposes of the statute of limitations.
  • The continuing treatment rule provides another exception to the statute of limitations by extending the time allowed for the filing of a complaint.
  • The malpractice action would only accrue, thus activating the statute of limitations, when treatment of the medical condition ceases.

(Ref: American College Of Legal Medicine, the Medical Malpractice Survival Handbook 2007)

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Give BP drugs at night

Blood pressure drugs should be taken at night said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse, blood pressure and thickening of platelets are all higher in the early morning hours.

Controlling early morning blood pressure can reduce cardiovascular mortality.

According to a study published in the Journal of the American Society of Nephrology, among patients with chronic kidney disease and high blood pressure taking at least one antihypertensive drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events.

The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least 1 BP-lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening.

A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping.

For each 5 mmHg decrease in mean sleep-time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow-up.

Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

    Readers Response
  1. Dear Sir, emedinews is really very informative. Regards: Dr Rachna
    Forthcoming Events
Dr K K Aggarwal

19th MTNL Perfect Health Mela

Heart Care Foundation of India and Depts. of Health & Family Welfare, Govt. of Delhi in association with World Fellowship of Religions, NDMC, MCD are organizing 19th MTNL Perfect Health Mela at Constitution Club of India Rafi Marg, New Delhi from 7th-11th November 2012 (8am-8pm). The focus this year will be Prevention of Non Communicable Diseases.

    eMedinewS Special

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta