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    Herbesser Stroke

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    Princess Mira
    Diltiazem can reduce various risk factors for stroke in 3 or fewer sentences: Diltiazem reduced hypertension according to the NORDIL study, lowered the occurrence of atrial fibrillation and diabetes in hypertension patients per the same study, and increased HDL while decreasing LDL/HDL ratio according to another study, demonstrating its ability to impact multiple stroke risk factors.

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    Herbesser Stroke

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    Princess Mira
    75 views15 pages
    Diltiazem can reduce various risk factors for stroke in 3 or fewer sentences: Diltiazem reduced hypertension according to the NORDIL study, lowered the occurrence of atrial fibrillation and diabetes in hypertension patients per the same study, and increased HDL while decreasing LDL/HDL ratio according to another study, demonstrating its ability to impact multiple stroke risk factors.

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    Diltiazem can reduce various risk factors for stroke in 3 or fewer sentences: Diltiazem reduced hypertension according to the NORDIL study, lowered the occurrence of atrial fibrillation and diabetes in hypertension patients per the same study, and increased HDL while decreasing LDL/HDL ratio according to another study, demonstrating its ability to impact multiple stroke risk factors.

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    75 views15 pages

    Herbesser Stroke

    Uploaded by

    Princess Mira
    Diltiazem can reduce various risk factors for stroke in 3 or fewer sentences: Diltiazem reduced hypertension according to the NORDIL study, lowered the occurrence of atrial fibrillation and diabetes in hypertension patients per the same study, and increased HDL while decreasing LDL/HDL ratio according to another study, demonstrating its ability to impact multiple stroke risk factors.

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    of 15

    Herbesser: Prevention of stroke!

    Stroke & myocardial infarction in 6 countries (areas)


    No. of events /1000patients-years
    16 15 12.9 10 5.2 4.4 10.3 8.1 7.9 5.5 4 2 0 2.5

    Stroke 16 Myocardial Infarction

    SHEP MRC Syst-EurSTONE Syst- NICS-EH China 1) JAMA,1991 2) Br USA England Europe China Med J, 1985 China Japan

    3) 4) 5) 6)

    Lancet, 1997 J Hypertens, 1996 J Hypertens, 1998 Hypertens Res, 2000

    Stroke Prevention with CCB (vs. Conventional therapy)


    STOP-2 1) INSIGHT 2) NORDIL 3) RR (95% CI) 0.88 (0.73-1.06) 0.94 (0.74-1.28) 0.80 (0.65-0.99) P value 0.16 NA 0.04

    Herbesser is a sole antihypertensive agent to reduce Stroke significantly vs. conventional therapies. 1) Lancet,1999
    2) Lancet, 2000 3) Lancet, 2000

    Ref. Stroke reduction


    Reduction in Odds

    1999 WHO/ISH Hypertension 0 Guideline


    -10 -20 -30 -40

    NORDIL
    39% reduction
    0 -10 -20

    (-blocker or Diuretics vs placebo) -50

    20% -30
    -40 -50

    further reduction With Diltiazem

    Stroke Primary Prevention:


    Modifiable risk factors
    New ischemic stroke guideline issued by AHA! Relative Risk (vs. without) Hypertension Atrial fibrillation Diabetes Hypercholesterolemia Asymptomatic Carotid Stenosis Cigarette smoking 1.0 ~ 4.0 2.6 ~ 4.5 1.8 ~ 6 1.8 ~ 2.6 2.0 1.8
    Stroke. 2001;32:280-299

    Stroke prevention:
    Diltiazem in NORDIL study
    Diltiazem reduced stroke 20% more than Diuretics and -blocker.

    Lancet 2000; 356: 359-65

    Risk Factor 1: Hypertension


    Mean BP reduction in NORDIL : Diltiazem: Diuretic and -blocker: 20.3/18.7 mmHg 23.3/18.7 mmHg

    Lancet 2000; 356: 359-65

    Risk Factor 2: Atrial fibrillation


    Diltiazem: Reduction in atrial fibrillation in hypertension! NORDIL results: Occurrence of Atrial fibrillation
    6 Event rate per 1000 patient- years

    18% reduction
    5

    Diuretics and - blocker

    Di Diltiazem

    Relative risk (95% CI) = 0.82 (0.64-1.07) P = 0.14

    Diltiazem reduced new atrial fibrillation by 18% compared with Diuretics and -blocker
    Lancet 2000; 356: 359-65

    Ref: Diltiazem for Atrial fibrillation


    Diltiazem improved in symptom in patients with atrial fibrillation.
    Subject: Method: Drug: 252 patients with atrial fibrillation (7-360 days) Randomized trial Diltiazem po (n=125) mean dose 226, 234, 234 at 3, 6, 12th month Amiodarone (n=127) mean dose 255, 204, 211 at 3, 6, 12th month

    Results: Symptomatic improvement (palpitation, dyspnoea, and dizziness) was similar in both groups at any point during the course of the trial. Exercise tolerance was better in amiodarone group. Hospital admissions was significantly few in Diltiazem group. Diltiazem*1 vs. Amiodarone*2 = 30/125 (24%) vs. 87/127 (69%), p=0.001 *1 : mainly due to drug related side effect (68%, kind of side effect not mentioned) *2 : mainly due to electrical cardioversion (67%) or drug related side effect (27%, kind of side effect not mentioned)
    Lancet 2000; 356: 1789-94

    Ref: Atrial fibrillation How to induce stroke?


    If you have atrial fibrillation, the upper left chamber (Atrium) of your heart beats rapidly and unpredictably, making it hard for all the blood in the chamber to empty. The remaining blood tends to form clots that can travel to any part of your body. If they travel to the brain, these clots can cause a stroke. Blood circulation: .. L. Atrium L. Ventricle Aorta Peripheral artery
    clots

    Risk Factor 3: Diabetes


    Diltiazem: Reduction in Diabetes mellitus in hypertension! NORDIL Occurrence of Diabetes mellitus results:
    Event rate per 1000 patient-years 11 10.5 10 9.5 9 8.5

    13% reduction

    Diuretics and -blocker

    Diltiazem

    Relative risk (95% CI) = 0.87 (0.73-1.04) P = 0.14

    Diltiazem reduced new diabetes mellitus by 13% compared with Diuretics and -blocker
    Lancet 2000; 356: 359-65

    Ref: Diltiazem for Diabetes


    Diltiazem reduced proteinuria in hypertension with type 2 diabetes.
    m g/ day 1000 Nifedipine Effect on Urinary protein excretion

    600 Di

    Diltiazem
    * P <0.05

    200 Baseline 21 Months

    Subject: 21 type-2 DM with hypertension and proteinuria Drug: Diltiazem OD (mean dose 43643 mg) vs. Nifedipine OD (mean dose 7812 mg) Results: Both group reduced blood pressure significantly at similar level. Only diltiazem reduced proteinuria significantly without change in GFR and PRF
    Kidney International. 1998; 54: 889-896

    Ref: Diabetes How to induce stroke?


    Diabetes Hyperinsulinemia or insulin resistance (Syndrome X) Hyperglycemia, High LDL, Low HDL and Hypertension Stroke

    Risk Factor 4: Hypercholesterolemia


    Diltiazem: Increase in HDL and reduction in LDL/HDL ratio

    LDL/HDL
    HDL
    1.1 Diltiazem ** P < 0.001

    4.4 4.2

    ** P < 0.001 Atenolol **


    Randomization 1 year

    mmol/L

    1.0 Atenolol 0.9 Randomization 1 year

    4.0 3.8

    Diltiazem

    T. Thulin et al, Int. J. Clin. Pharmacol. Ther. 1999;37:28-33

    Summary
    Diltiazem can reduce various risk factors for stroke!
    Hypertension Atrial fibrillation Diabetes Hypercholesterolemia BP reduction Occurrence reduced in HT (NORDIL) AF related symptom improved. Occurrence reduced in HT (NORDIL) Proteinuria reduced in HT with DM HDL increased and LDL/HDL ratio decreased.

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