Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Rationale for a new low-dose triple single pill combination for the treatment of hypertension(Elsevier, 2024) Rodgers, A.; Salam, A.; Cushman, W.; de Silva, A.; Tanna, G.L.D.; Gnanenthiran, S.R.; Grobbee, D.; Narkiewicz, K.; Ojji, D.; Oparil, S.; Poulter, N.; Schlaich, M.P.; Schutte, A.E.; Spiering, W.; Williams, B.; Wright, J.T.Jr.; Whelton, P.Two recent large trials showed the potential of single pill combinations (SPCs) with ≥3 low-dose components among people with hypertension who were untreated or receiving monotherapy. In both trials, these 'hypertension polypills' were superior to usual care, achieving >80% BP control without increasing withdrawal due to side effects. However, there are no such products available for prescribers. To address this unmet need, George Medicines developed GMRx2 with telmisartan/amlodipine/indapamide in three strengths (mg): 10/1.25/0.625, 20/2.5/1.25; 40/5/2.5. Two pivotal trials are ongoing to support FDA submission for the treatment of hypertension, including initial treatment. These assess efficacy and safety of GMRx2 compared to: placebo, and each of the three possible dual combinations. Regulatory submissions are planned for 2024, with the aim of providing access to GMRx2 in developed and developing regions. Wider implementation of GMRx2-based treatment strategies will be guided by further research to inform access and appropriate scale up.Item Patient perspectives on hypertension management in health system of Sri Lanka: a qualitative study.(BMJ Publishing Group Ltd, 2019) Perera, M.; de Silva, C.K.; Tavajoh, S.; Kasturiratne, A.; Luke, N. V.; Ediriweera, D.S.; Ranasinha, C.D.; Legido-Quigley, H.; de Silva, H.A.; Jafar, T.H.INTRODUCTION:Uncontrolled hypertension is the leading risk factor for mortality globally, including low-income and middle-income countries (LMICs). However, pathways for seeking hypertension care and patients' experience with the utilisation of health services for hypertension in LMICs are not well understood.OBJECTIVES:This study aimed to explore patients' perspectives on different dimensions of accessibility and availability of healthcare for the management of uncontrolled hypertension in Sri Lanka.SETTING:Primary care in rural areas in Sri Lanka.PARTICIPANTS:20 patients with hypertension were purposively sampled from an ongoing study of Control of Blood Pressure and Risk Attenuation in rural Bangladesh, Pakistan, Sri Lanka.METHOD:We conducted in-depth interviews with patients. Interviews were audio-recorded and transcribed into local language (Sinhala) and translated to English. Thematic analysis was used and patient pathways on their experiences accessing care from government and private clinics are mapped out.RESULTS:Overall, most patients alluded to the fact that their hypertension was diagnosed accidentally in an unrelated visit to a healthcare provider and revealed lack of adherence and consuming alternatives as barriers to control hypertension. Referring to the theme 'Accessibility and availability of hypertension care', patients complained of distance to the hospitals, long waiting time and shortage of medicine supplies at government clinics as the main barriers to accessing health services. They often resorted to private physicians and paid out of pocket when they experienced acute symptoms attributable to hypertension. Considering the theme 'Approachability and ability to perceive', the majority of patients mentioned increasing public awareness, training healthcare professionals for effective communication as areas of improvement. Under the theme 'Appropriateness and ability to engage', few patients were aware of the names or purpose of their medications and reportedly missed doses frequently. Reminders from family members were considered a major facilitator to adherence to antihypertensive medications. Patients welcomed the idea of outreach services for hypertension and health education closer to home in the theme 'Things the patients reported to improve the system'.CONCLUSION:Patients identified several barriers to accessing hypertension care in Sri Lanka. Measures recommended improving hypertension management in Sri Lanka including public education on hypertension, better communication between healthcare professionals and patients, and efforts to improve access and understanding of antihypertensive medications.TRIAL REGISTRATION NUMBER:NCT02657746.Item Knowledge on hypertension and consequences of its poor control among hypertensive patients at medical clinics, Teaching Hospital, Batticaloa(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kisokanth, G.; Ilankoon, I.M.P.S.; Arulanandem, K.; Goonewardena, C.S.E.; Sundaresan, K.T.; Joseph, J.Background: Hypertension is one of the major non communicable diseases worldwide and isa major risk factor for stroke, coronary heart disease and chronic kidney failure/ disease. Lack of knowledge on the benefits of controlling and seriousness of untreated hypertension is the barrier for hypertensive care. Objective: To assess knowledge on hypertension and the consequences of poor control. Methods: A cross-sectional descriptive study was carried out among 424 patients diagnosed with ‘Essential hypertension’ attending medical clinics at Teaching Hospital, Batticaloa. Systematic sampling technique was used with pre-tested interviewer administered questionnaire for data collection and descriptive, inferential statistics were used for analysis. Results: The study consisted of 174 (41%) males and 250 (59%) females. The mean age was 60.4 (SD± 9.6) years. Knowledge score was inadequate (<50%) among 92% (n=391) with mean of 30.8% (SD ± 15.5) ranging from 4.4 – 89.1%. Nearly half of the participants believed that the heart is affected by poor controlled hypertension and about 26% mentioned that kidney, nervous system and eyes could be affected too. A statistical significant relationship was observed between knowledge score and marital status (p = 0.03), family history of chronic disease (P< 0.001), educational level (P<0.001) and monthly income (P<0.001). Conclusions: This study revealed inadequate patient knowledge on hypertension and consequences of poor control. Targeted health education strategies are needed urgently to improve patients’ knowledge level in order to prevent consequences of poorly controlled hypertension.Item Impact of hypertension on mortality: Findings from the Ragama Health Study(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kasturiratne, A.The relationship of hypertension on mortality is well known. In Sri Lanka this relationship has not been quantified in a comprehensive analysis. The objective of the presentation will be to describe the relationship of incident and prevalent hypertension on the 7-year cardio-vascular and all-cause mortality in the Ragama Health Study (RHS) cohort. RHS is a prospective cohort study that recruited nearly 3000 adults between 35-64 years of age resident in the Ragama Medical Officer of Health area in 2007. The participants were sampled using an age-stratified random sampling technique to represent the three 10-year age groups. Baseline assessment of the cohort included socio-demographic, lifestyle, anthropometric and clinical assessments. The cohort was followed up in 2010 and 2014 to determine incidence of important clinical outcomes. 7-year mortality of the cohort was determined through comprehensive community surveys conducted in 2012 and 2014/15. The RHS cohort comprises 2986 individuals who participated in the baseline survey. By the end of 2014, 107 participants had died. The all-cause mortality was significantly associated with a higher systolic hypertension at baseline after controlling for age and sex. One Hg mm increase in systolic blood pressure was associated with 1.02 times increase in all-cause mortality. This presentation will discuss the anthropometric, lifestyle, bio-chemical and clinical characteristics associated with the prevalence and the incidence of hypertension, and cardio-vascular and all-cause mortality over the seven year follow up period.Item Incidence of hypertension in an urban population - can we modify the risk?(Sri Lanka Medical Association, 2012) Kasturiratne, A.; Medagoda, K.; Kurukulasuriya, S.A.P.; Wickremasinghe, A.R.INTRODUCTION AND AIMS: To determine the incidence and risk factors of incident hypertension in an urban population in Sri Lanka. METHODS: This study was conducted in the Ragama Health Study Cohort which consists of 2986 individuals between 35-64 years of age living in the Ragama Medical Officer of Health area in the district of Gampaha. Participants were selected using age-stratified random sampling from the electoral lists in 2007 arid investigated using clinical, bio-chemical and anthropometric examinations and liver ultrasound for assessment of fatty liver. A complete follow-up assessment of the cohort was conducted in 2010. Baseline age-adjusted prevalence and three year incidence of hypertension was estimated. Independent predictors of incident hypertension were identified by Cox's Proportional Hazards modelling. Results: Baseline age-adjusted prevalence of hypertension was 33% in males and 37% in females. Out of 1644 normotensive subjects at baseline, 407 [24.8) developed hypertension by 2010. Incidence was 80.2 per 1000 person-years of follow up. Overall incidence was higher in females. Highest incidence (111 per 1000 person-years of follow up] was seen in males in the oldest age group (55-64 years). Independent predictors of incident hypertension were low level of physical activity, presence of diabetes mellitus, a BMI over 25 kg/m2, presence of non-alcoholic fatty liver disease and older age. CONCLUSIONS: Risk of incident hypertension is largely modifiable as evident from the findings from this population with a high incidence of hypertension highlighting the need for lifestyle modifications targeting physical activity and diet at both population and individual level for prevention of hypertension.