As there is a strong, positive, and continuous correlation between blood pressure and risk of cardiovascular diseases; improved control of blood pressure is necessary to produce maximum reduction in clinical cardiovascular endpoints. The primary objective was to demonstrate that atenolol/amlodipine combination therapy is superior to atenolol monotherapy with respect to mean fall in systolic blood pressure and diastolic blood pressure. The secondary objective was to compare the response rate and to evaluate the tolerability of study medications. This randomized, comparative, multicentric, 12-week study consisted of screening visit followed by baseline visit 48-hours postscreening. All enrolled patients received 7-day placebo washout. Eligible patients were randomized to receive either atenolol 25 mg/amlodipine 2.5 mg or atenolol 25 mg alone. Nonresponders after 4 weeks of therapy were escalated to atenolol 50 mg/amlodipine 5 mg or atenolol 50 mg, respectively. Out of 190 enrolled patients (94: combination group; 96: monotherapy group), 174 patients (84: combination therapy, 90: monotherapy) completed the study. After 4 weeks of therapy, low-dose combination group was superior to low-dose monotherapy with respect to mean fall in SBP (P = 0.008) and DBP (P = 0.021) and response rate (P = 0.012). Also high-dose combination therapy was superior to high-dose monotherapy with respect to mean SBP (P = 0.001), DBP (P = 0.011), and response rate (P = 0.035) at the end of 12 weeks of therapy. At the end of therapy, significantly more number of patients from combination group achieved normalization of BP (SBP < 120 mmHg and DBP < 80 mmHg) (P = 0.009). Thus, once daily treatment with atenolol/amlodipine fixed-dose combination offers superior antihypertensive efficacy over atenolol monotherapy in patients with mild-to-moderate essential hypertension.

Postpartum haemorrhage (PPH) is a fatal complication of the third stage of labour. PPH accounts for 25% maternal mortality worldwide. Fortunately most PPH cases are preventable and thus can significantly reduce maternal mortality and morbidity. Misoprostol, a PGE1 analogue, an uterotonic, is inexpensive, easily available with simple route of administration. The study group was given 600mcg of misoprostol within 5 min of clamping of cord and blood loss was measured with help of BRASS-V delivery drape. The parameters ascertained were total blood loss in third stage of labour, length of third stage, time taken for retraction of uterus, need of any additional uterotonic drug or surgical intervention, need for blood transfusion, adverse effect of 600mcg of oral misoprostol. Oral administration of 600mcg misoprostol is an effective method of preventing PPH, though it may not be as effective as potent uterotonics like ergometrine or PGF2alpha. Nevertheless, it scores over them in low resource settings due to its cost effectiveness, and ease of availability, transport, storage and administration to the patient.