Acute coronary syndrome (ACS) is a significant cause of morbidity and mortality worldwide. Patients can be stratified by symptoms, risk factors and electrocardiogram results but cardiac biomarkers also have a prime role both diagnostically and prognostically. The proper diagnosis of ACS requires reliable and accurate biomarker assays to detect evidence of myocardial necrosis. Currently, troponin is the gold standard biomarker for myocardial injury and is used commonly in conjunction with creatine kinase-MB (CK-MB) and myoglobin to enable a more rapid diagnosis of ACS. Other markers of myocardial necrosis, inflammation and neurohormonal activity have also been shown to have either diagnostic or prognostic utility, but none have been shown to be superior to troponin. The measurement of multiple biomarkers and the use of point of care markers may accelerate current diagnostic protocols for the assessment of such patients.

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Sixty-six self-identified African-American subjects with stage 1 and 2 hypertension and characteristics of the cardiometabolic syndrome were treated with amlodipine/olmesartan (A/O) versus losartan/hydrochlorothiazide (L/H) for 20 weeks in an open-label, active comparator fashion. Subjects not meeting a blood pressure (BP) value of <125/75 mm Hg on either regimen at week 14 were placed on additional or alternative therapy. After 20 weeks of therapy, systolic BP was reduced by 34.6 ± 4.2 mm Hg in the A/O group and by 27.0 ± 4.1 mm Hg in the L/H group (p = 0.012 A/O vs. L/H). Diastolic BP was reduced by 16.9 ± 2.0 mm Hg in the A/O group and by 12.3 ± 2.0 mm Hg in the L/H group (p = 0.022 A/O vs. L/H). There was a substantial increase in endothelial function of 44 and 103% in the L/H and A/O groups, respectively (p < 0.005 A/O vs. L/H). Central aorta augmentation pressure was significantly reduced by 42% with the A/O treatment, and a smaller, significant reduction of 28% was observed with the L/H treatment (p = 0.034 A/O vs. L/H). There was a reduction in sIL-6 levels of 20 and 33%, a reduction in serum leptin levels of 22 and 40%, and an increase in serum adiponectin of 19 and 46% in the L/H and A/O groups, respectively (p < 0.005 A/O vs. L/H for each biomarker). Treatment with A/O after 14 weeks reduced pulse wave velocity by 22% (p = 0.011 time comparison), whereas L/H treatment had no significant effect. Our findings suggest that, in addition to effective BP reduction, A/O differentially regulates markers of inflammation and obesity, thereby potentially providing greater vascular protection.

Hypertension also called a silent killer is a serious problem. The numbers of hypertensive patients are increasing day by day. The present study aim to assess the primary causes of hypertension in Khyber Pakhtunkhwa. Data for the study were collected from 298 hypertensive patients who were admitted or visited to Hayatabad Medical Complex Peshawar as patients. Simple random sampling method was used for selection of the sampled respondents. The results indicate a significant association between hypertension and the level of education (P=.000). Educated people were found not only having more information about hypertension but also found more conscious about the disease (P=.000), while no or low level of educated patients were reported not only caring (P.000) the hypertension but also were not consulting doctors (P=.000). Sampled hypertensive patients were also agreed that regular use of antihypertensive medicines (P=.000), easy supply of medicines (P=.001), regular exercise (P=.000) and regular check-up of blood pressure (P.000) can help maintain blood pressure in normal range while irregularity in taking of medicines (P=.000) and sedentary life style (P=.000) contributed to high blood pressure. Dietary habits (P=.005) such as junk food (P=.000) and spicy diet (P.000) reported affected the blood pressure. Regarding precautions significant association was found with life style modification (P=.000), regular check-up of blood pressure (P=.000), regular exercise (P=.036), weight reduction (P=.001), avoid alcohol consumption (P=.000), stopped smoking (P=.000) and avoid stress (P=.002) along with more use of vegetables and fruits (P=.001). On the other hand hypertension was also associated significantly with the people who have obesity (P=.004), lake of exercise P=.000), old people (P=.034), low socio-economic status (P=.000), kidney diseases (P=.000), endocrine diseases (P=.000), excessive salt intake (P=.008), low potassium intake (P=.010) and family history (P=.001). Individually and psychologically the hypertension can also be due to alcohol intake (P=.000), cigarette smoking (P=.000), sedentary life style (P=.000), lake of exercise (P=.000), lake of knowledge about the signs, symptoms of hypertension (P=.000), its causes (P=.000), and precautions (P=.000). Study recommends that in order to control hypertension, a special attention is needed to follow the precautions about hypertension, diet plan, regular check-up of blood pressure, awareness about the disease and avoid stress.