Assessment of Secondary Recurrence of Stroke in Aspirin-Clopidogrel Combination Therapy and Aspirin Monotherapy in Transient Ischemic Attack Patients in South India: A Comparative Study

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PCV4 The Impact of Dementia on the Outcomes of Treatments For Acute Coronary Syndrome Choo DW, Wang J, Chien K, Wu FL, Lin Z National Taiwan University, Taipei, Taiwan

Objectives: The aim of this study was to assess the treatment and rehospitalization for acute coronary syndrome (ACS) patients with dementia.  Methods: This is a nationwide population-based retrospective cohort study using administrative claims data National Health Insurance Research Database in Taiwan. A total of 212,110 patients who have been hospitalized for ACS between 2006 and 2010 were enrolled. Patients were categorized into five groups based on the number of guideline recommended medications (aspirin, beta-blockers, ACEI/ARB, statins, clopidogrel) used in comparison to using aspirin alone group. Cox proportional hazards regressions were performed to estimate the risk of rehospitalization for ACS associated with the number of medications used among all patients and patients with dementia.  Results: The study identified 212,110 patients with ACS; the mean age was 66.0 ± 12.9 and 34.6% were female. A higher number of guideline recommended medications was found to be associated with lower risk of rehospitalization for ACS. However, a non-significant increasing risk of rehospitalization for ACS was observed among 6486 ACS patients with dementia when a higher number of medications was prescribed. From 2-medications used group to 5-medications used group among ACS patients with dementia, the adjusted hazard ratios are 0.85 (95% CI 0.66-1.10), 0.99 (95% CI 0.71-1.37), 1.26 (95% CI 0.86-1.87) and 1.62 (95% CI 0.96-2.72) respectively.  Conclusions: Among all ACS patients, the risk of rehospitalization for ACS decreased with increasing number of guideline recommended medications. However, this finding was not observed among ACS patients with dementia. The outcomes of treatment among ACS patients with dementia are different from other ACS patients. PCV5 Accelerated/Malignant Hypertension with a Diagnostic Ambugity: A Retrospective Cohort Study Srujitha M Manipal university, manipal, India

Objectives: To investigate the incidence, TOD of patients presenting with A/ MH, and its management.  Methods: A retrospective cohort analysis was carried out at our 2500 bedded tertiary care teaching hospital on patients admitted with essential HTN or hypertensive retinopathy during 2010 with ICD – 10 ( I.10 /H 35 ) coding with no comorbidities, were considered for the study. A 4 – year follow-up to evaluate their clinical outcomes of those diagnosed with A/MH was carried.  Results: Of the 480 in-patients diagnosed with essential HTN or hypertensive retinopathy, 52 (10.8%) were found to have Grade III HTN (ESH/ESC 2013) which were documented as A/MH. Male predominance was found to be higher with 63.5% with a mean age of 49.58 years (±13.6 SD) and mean BMI of 25.0 (±5.6 SD).The Mean Arterial Pressure on admission was found to be 166.3(±16.6) mmHg and on discharge found to be 122.5(±10.9)mmHg. TOD was identified in 42 patients among them 22(42.3%) patients had retinal damage, 15(28.8%) had left ventricular failure, 2(3.8%) patients had renal damage and 3(5.7%) reported to have cerebral damage.  Conclusions: Our experience suggests that malignant hypertension is still common, with a small proportion of hypertensive’s presenting each year. We consider ours is the first study to report the incidence of A/MH in patients previously diagnosed with essential HTN from an Indian sub-population. We observe through our study that diagnosis of A/MH is not fulfilling the standard criteria. Thus we strongly believe that patients presenting with BP >  180/110 mm Hg should undergo ophthalmic evaluation, before being diagnosed as A/MH.

PCV6 Assessment of Secondary Recurrence of Stroke in AspirinClopidogrel Combination Therapy and Aspirin Monotherapy in Transient Ischemic Attack Patients in South India: A Comparative Study Pal M1, Prasad O2, Fatima A1, Bakki C3, Ahmed M4 Institute of Pharmaceutical Sciences, Warangal,Telangana, India, 2Rohini Super speciality Hospitals, Warangal, India, 3St peter’s Institute of Pharmaceutical sciences, Warangal, India, 4St.Peter’s Institute of Pharmaceutical Sciences, Warangal, India

1St.Peter’s

Objectives: TIA is a prognostic indicator of stroke. Stroke is the prime cause of mortality within the nation, the circumstances has touched a borderline from where improvisation of the enduring therapy have become vital. The prime objective is to establish the safety and efficacy outcome of dual therapy of Aspirin and Clopidogrel within 12 hours of index event of TIA, as they are considered safe and effective when administered alone in stroke.  Methods: A randomized, double-blind, placebo-controlled study, conducted on patients diagnosed with TIA, and those accomplishing the study criteria are enrolled into study. We randomly enrolled 150 patients to combination therapy of clopidogrel and aspirin and on aspirin monotherapy. The study cohort was followed for 3 months and based on clinician’s evaluation, ABCD2 scoring and CT or MRI scanning, secondary recurrence of stroke was determined.  Results: Occurrence of stroke was seen in 7.5% patients in the aspirin-clopidogrel group,as compared with 24.24% of those in the aspirin group. Out of 132 patients, 64(48.48%) and 68 (51.52%) patients were on dual and monotherapy respectively.Patients on dualtherapy, 6.06% experienced severe GI bleeding, 15.91% experienced mild GI bleeding and 26.52% had no bleeding. Similarly, patients on monotherapy, 0% patients experienced severe GI bleeding, 3.03% experienced mild GI bleeding and 48.48% patients had no bleeding. The recurrence of major stroke is significantly lower (P< 0.0001) in patients who were randomized within 12 hours of the index event when compared with patients randomized in 24hrs.  Conclusions: Our study demonstrates that, clopidogrel plus aspirin therapy is superior to aspirin in reducing the subsequent recurrence of secondary event of TIA within 12 hours of

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index event.The execution of the study with a multicenter approach will provide the health policy and decision makers with an applicable document to promote dual therapy over monotherapy in Indian population. PCV7 A Prospective Study of Antihypertensive Drugs Utilization Pattern in Outpatients of a Tertiary Care Teaching Hospital Chakka G1, Thattakudian Sheikuduman MS1, B N1, K PL1, K P1, R VA1, M SR2 College of Pharmacy, YSR Kadapa, India, 2Rajiv Gandhi Institute of Medical Sciences, AP, India

1Annamacharya

Objectives: The present study was designed to evaluate the drug utilization pattern of anti-hypertensive drugs and its possible efficacy on high blood pressure in patients admitted in the outpatient ward.  Methods: A prospective observational research conducted during September 2014 and F2015 February. Medical records of 206 patients aged 40-91 (mean: 59.89±10.25) years, with male to female ratio of 1.51 : 1 were randomly selected. Information on anti-hypertensive prescriptions was recorded and analyzed by using Student’s t- test  Results: Out of 206 patients studied, 51% (105) were on monotheraphy and 49 % ( 101) on combination therapy. Of the patients on combination therapy, 46.60% (96), 1.94 %( 4) and 0.485 % (1) were on 2, 3, and 4 drugs, respectively. Calcium channel blockers were the most frequently prescribed drug either as a single agent (29.12%) or as combination therapy (76.23%). There is no significant difference of mean reduction in both systolic and diastolic blood pressures in patients on Angiotensin II receptor blockers, Calcium channel blockers, selective Beta blockers in monotherapy (F Value = 3; P Value = 0.33 for both systolic and diastolic BP, respectively). Mean reductions in both Systolic and Diastolic blood pressures were more in patients enrolled on combination therapy than those on monotherapy (t= 4 and P value = 0.0234 for both systolic and diastolic blood pressures). Blood pressure control rate was 64.56%.  Conclusions: Patients on combination therapy had significantly higher reduction in blood pressures than those on monotherapy and the study demonstrated that there is no significant difference in efficacy with monotherapy of Angiotensin II receptors blockers, Calcium channel blockers, Beta blockers in blood pressure lowering effect in the study population. The prescribing pattern of physicians is in compliance with the Joint National Committee (JNC-VIII) guidelines. Major limitation of this work is the inability to determine the actual patients’ adherence to drug therapy. PCV8 Correlation Between Tea Consumption and Prevalence of Hypertension Among Singaporean Chinese Residents Over 40 Li W1, Yang J2, Li SC3, Ho CL4 University, Piscataway, NJ, USA, 2National University Hospital System, Singapore, Singapore, 3University of Newcastle, Callaghan, NSW, Australia, 4National University of Singapore, Singapore, Singapore

1Rutgers

Objectives: In Singapore, the prevalence of hypertension increased markedly from age 40 years onwards. Tea has been approved to possess many beneficial pharmacological effects including antihypertension. However, no clinical studies on drinking tea and hypertension among Singaporeans have been conducted. We are the first to investigate the correlation of hypertension and consumption of tea, health supplements, living habits and socio-demographic factors among Singaporean Chinese residents.  Methods: By a cross-sectional epidemiology study, Singaporean Chinese residents aged ⩾40 years were randomly selected and interviewed by research assistants. Hypertension was defined as measured systolic blood pressure at least 140 mm Hg and/or diastolic blood pressure at least 90 mmHg or self-reported history/treatment for hypertension.  Results: The prevalence of hypertension among the whole investigated population (N= 1184, 58.27% females) was 49.73% and the prevalence increased to 66.47% in the sub-population aged ⩾ 60 years. High risk of hypertension was associated with age ⩾ 60 years (OR: 4.15–4.19, p< 0.01), obesity (body mass index > 25 kg·m−2, OR: 2.10–2.11, p< 0.01), family history of hypertension (OR: 2.69–2.76, p< 0.01), diabetes history (OR: 2.29–2.33, P< 0.01), hyperlipidemia history (OR: 1.79–1.80, P< 0.01), male (OR: 1.56–1.59, p< 0.01) and coffee intake (OR: 1.44–1.46, p< 0.05). In contrast, drinking green tea at least 150 ml per week was associated with lower hypertension risk (OR: 0.63, 95% CI: 0.43–0.91, p< 0.05). Drinking combination of green tea and British tea was associated with higher reduction in the risk of hypertension (OR: 0.58, 95% CI: 0.39–0.85, p< 0.05).  Conclusions: This cross-sectional study suggests that consumption of tea, especially green tea and British tea, was associated with lowering the risk of hypertension. On the other hand, consumption of coffee could be a risk factor of hypertension. These findings may provide useful information for health promotion to reduce risk of hypertension and warrant further study to confirm and elucidate such association. PCV9 Improvement of Long Term Risks of Cardiovascular Events Associated with Community Based Disease Management in Chinese Patients of the Xin Jiang Autonomous Region of China Yang L1, Cai M1, Ma M2, Huang X2, Liu L3, Wang B4, Zhu M5, Zhu W2, Zhe W3, Guan Y3, Kongnakorn T6, Peng S7, Hach T8 University, Beijing, China, 2Health and Family Planning Commission of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China, 3Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, Xinjiang Uygur Autonomous Region, China, 4Novartis Pharmaceuticals (China), Shanghai, China, 5Novartis Group China, Beijing, China, 6Evidera, Bangkok, Thailand, 7Evidera, Bethesda, MD, USA, 8Novartis International AG, Basel, Switzerland 1Peking

Objectives: A recent community-based disease management (CBDM) pilot study reported a 20.45% prevalence of hypertension and a 0.5% and 3.6% prevalence of stroke and coronary heart disease (CHD), respectively, in an elderly population (mean age 65 years) in the Xin Jiang autonomous region of China. The CBDM was initiated in 2013 as an essential public health service; however, the potential long-term impact of CBDM on cardiovascular (CV) events is unknown.  Methods: A discrete event simulation