Background: Hypertension is a leading risk factor affecting mortality and disability-adjusted life years worldwide. The objective of the study was to determine the prevalence of insomnia, co-morbid medical conditions, lifestyle attributes, related sleep habits and sleep quality among Indian hypertensive patients.Methods: Adults (≥18 years) with newly diagnosed or known history of hypertension, willing to participate were enrolled in this cross-sectional, epidemiological study. Several variables including lifestyle attributes, sleep habits, quality, medications, demographics, medical/surgical history and other details pertaining to hypertension were analyzed. Insomnia was assessed by Athens Insomnia Scale (AIS) in patients not identified in the past one month.Results: All the 657 enrolled patients completed the study (mean age: 55.4±11.61 years; men: 53.7%; women: 46.3%). Prevalence of insomnia among hypertensive population was approximately 47.2% (n=310; 95% CI: 43.4, 51.0). Number of patients newly diagnosed with insomnia by AIS scale was higher compared with patients already diagnosed with insomnia (34.9% [95% CI: 31.2, 38.5] vs. 12.3% [95% CI: 9.81, 14.8]). Common medical conditions associated with hypertension were diabetes mellitus (61.1%) and dyslipidemia (28.3%). More than half of the hypertensive patients with insomnia had sleep-related problems once or twice a week. Further, the daytime impact of insufficient sleep on wellbeing and functioning was markedly decreased in insomniac patients.Conclusions: Prevalence of insomnia among patients suffering from hypertension was higher than that reported in general Indian population in various studies. Present study shows that about 75% insomniac cases were undiagnosed, indicating that insomnia diagnosis may have been missed in a large proportion of hypertensive patients.

The current recommendations by Indian experts who are focused on the challenges in the management of patients with acute coronary syndrome (ACS) in rural areas, due to limited catheterization (CATH) lab facilities and interventional cardiologist coverage across the country, are described. 120 cardiologist experts drafted recommendations during ten advisory board meetings conducted from April to May 2022. Experts framed statements based on experience, collective clinical judgment from practical experience, and available scientific evidence regarding ACS. The consensus positioned fondaparinux as highly useful in non-CATH-lab-based hospitals for patients diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS) and ST elevation acute coronary syndrome (STE-ACS) patients who cannot be shifted to percutaneous coronary intervention (PCI)-capable centres, or for patients who are thrombolysed at peripheral centres.

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Lipid-lowering is a central theme in the management of patients with atherosclerotic cardiovascular disease (ASCVD) and heterozygous familial hypercholesterolemia (HeFH), with statins being currently used as the first-line lipid-lowering agent (LLAs). Bempedoic acid (BA) has been recently approved for lipid management in ASCVD/HeFH patients. This expert opinion paper brings out the essential concept to assess the current place of BA in the Indian population. Here we highlight that the majority of the patients with clinical ASCVD may not be receiving the optimal dose of statin, thereby failing to achieve their lipid targets. The addition of BA to statin results in a significant reduction in low-density lipoprotein cholesterol (LDL-C) along with substantial reductions in non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein (hsCRP) levels. For patients who do not achieve LDL-C targets, BA can be an effective add-on alternative to choose among non-statin LLAs. BA is a good choice for statin-intolerant cases, especially in combination with ezetimibe. Given the lack of effect of worsening hyperglycemia or any increase in the occurrence of new-onset diabetes, BA can be used without hesitation in patients with diabetes. The small risk of hyperuricemia could be mitigated with appropriate patient selection and monitoring of serum uric acid levels in patients at high risk of hyperuricemia. We believe BA is an excellent non-statin therapy that is efficacious, well-tolerated, and cost-effective for lipid management in ASCVD, HeFH, and statin-intolerant patients in India.

Atrial fibrillation (AF) is considered as one of the most common cardiac arrhythmias worldwide and is always associated with a significantly increased risk of stroke and thromboembolism. VKAs (Warfarin & Acenocoumarol) are highly effective in reducing the risk of stroke in patients with AF, but bleeding issues & disutility sparked the development of direct oral anticoagulants (DOACs) or NOACs (Novel oral anticoagulants). These drugs, offer the convenience of once or twice daily dosing without the need for laboratory monitoring of coagulation activity (PT/ INR) or routine dose adjustment. Various clinical trials proved their non-inferiority to warfarin (VKA) in reducing the risk of stroke or systemic embolism, and each was associated with markedly lower rates of ICH than well-adjusted warfarin. Yet there are no direct head-to-head comparative trials for the efficacy & safety of NOACs. In this review we try to provide patient centric approach to assist Indian physicians in selecting right OAC therapy for SPAF with respect to best possible evidence and recommendations available worldwide.

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