Efficacy, Safety and Tolerability of Valsartan and Hydrochlorothiazide Compared to Valsartan and Amlodipine in Stage 2 Hypertension

Background: Hypertension is a growing medical and public health issue. The United States and European treatment guidelines have been issued to attain smooth control of hypertension in various categories of patients. It is a need of time to unveil safe combination therapies in various populations. Objectives: (i) To determine the efficacy of valsartan and hydrochlorothiazide versus valsartan and amlodipine (ii) To determine the safety and tolerability of both combinations. Materials & Methods: This experimental study was conducted at Shalamar Hospital Lahore. 126 patients with stage 2 hypertension were recruited from the medical outdoor of Shalamar Hospital Lahore after getting informed consent. In group A, 63 patients were given valsartan and hydrochlorothiazide. In group B, 63 patients were given valsartan and amlodipine. Blood pressure (BP) of both study groups was recorded on day zero, 2nd, 4th, and 8th weeks and the readings were entered on a Proforma. The efficacy of drug combinations was accessed in both groups by recording the change in mean systolic blood pressure (MSBP) and mean diastolic blood pressure (MDBP). The safety and tolerability of the drug combinations were assessed in terms of side effects and laboratory findings. Results: In group A, there was a 39±7mmzHg and 18±1mmHg decrease in MSBP and MDBP, respectively, from baseline BP. In group B, there was a 26.7±4mmHg and 14±2 mmHg decrease in MSBP and MDBP, respectively, from baseline BP. Both combinations were safe, and no significant difference in the efficacy of both combinations was observed after 8-week of treatment. Conclusion: Both combinations are effective for control of BP, but the valsartan and hydrochlorothiazide combination (group A) appears to have better tolerability and greater effect in decreasing BP as compared to the combination of valsartan and amlodipine (group B), although this difference is not statistically significant.  

رسول اللہ اور خلفائے راشدین کے اجتہادی فیصلے: عصر حاضر کے تناظر میں تحقیقی جائزہ

Ijtihad has played a vital role to bring compatibility between society and Islamic law, its expansion, development, and changing needs of society.This Principle has provided solution to various political, social, economical and other problems during the times of The Holy Prophet Muhammad (SAW) and his Pious Caliphs. Significance of ljtihad cannot be denied. Change and evolution are the basic to human life and problems and solutions all come with it. The existence of nations lies in their response to the emerging problems while stagnancy brings an end to them. Islam doesn't keep narrow view regarding human life, rather removes obstacles in its way to development. The Quran says, this day, I have perfected your religion for you, completed My Favour upon you and have chosen for you Islama as your religion.(5:3) ljtihad is the alternate method in case if no clear instructions and guidance are mentioned in basic sources of Shariah, Quran, and Sunnah, to find solutions to the problems. It keeps the stream of life flowing, repels stagnancy and provides other ways to maintain evolution i.e. Qiyaas, Istedlal and lstihsan etc. All these are the indirect offshoots of ljtihad. The Holy Prophet Muhammad (SAW) himself, many times practiced ljtihad regarding matters rising in newly establiShed Islamic State & the Ummah. Many of his decisions were ratified and corrected by revelation to him as well. This research - work has been focused on the decisions and Judgments delivered by the Holy Prophet (SAW) and his Pious Caliphs on the basis of ljtihad. Moreover, I have tried to deduce and infer the principles for an Up-dated ljthad which is need of the hour for the Muslim Ummah in Particular. The practice of ljtihad continued since time of Mohammad (SAW) till date. In contemporary times the shape is different but the spirit is same either by an individual or by institutions in 20th century. It proves the flexibility and compatibility of Islamic laws with ever-changing world. It is the sphere which proves Islam as a religion for every caste, creed, and nation and for all the times.