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.  

Water Scarcity and Conflict: A Case Study of India-Pakistan Water Dispute

This study presents the explanation of a natural phenomenon of water scarcity and its correlation with an inevitable reality called conflict. Today, the distribution of water is constantly changing with globalization, change in environment and factors such as global warming and population growth. This change and unequal distribution of water, its limited accessibility to different nations and its ever increasing demand has introduced a natural and relatively dormant crisis. Different regions of the world are facing the problem of water shortage resulting in inter and intrastate conflict. The study argues that conflicts are essentially due to scarcity of resources. It is due to water shortage that many countries are unable to meet the increasing water demands of consistently growing population. The problem has severely affected agricultural production and respective economies of those countries which extensively rely upon agriculture. The gradual depletion of water resources has become a matter of serious apprehension especially for water stressed regions. With the passage of time the utilization of water has increased and resulted in competitive environment where states are striving to secure and enhance control over the depleting water resources. The situation is worsening and giving birth to disputes over water sharing. The region of South Asia is also facing severe water stress. The water resources of the region have been consistently depleting. South Asia is an agricultural region; the states of this region largely rely upon rivers for irrigation of lands. Considering this fact that many rivers are transboundary, the sharing of rivers has lead to several disputes among states. At the same time hydro politics and exploitation of water has become a prevalent reality. India is determining to gradually enhance control over the water resources of the region to maintain its hydro hegemony. The country has been involved in prolonged water disputes with its neighboring countries. However, this study specifically highlights India's prolonged water conflict with Pakistan which remains unresolved and significantly explains the likely chances of an interstate conflict between the two neighboring countries which are nuclear powers posing threat to regional stability. This study is essentially an attempt to employ the theory of environmental scarcity and conflict to understand India-Pakistan conflict.