The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

Chlorthalidone 6.25 mg in combination with atenolol 25 mg is effective and safe in stage I (JNC 7) essential hypertensive patients. This low dose of chlorthalidone could reduce dose-related concerns over metabolic adverse effects and may lead to wider usage of this proven antihypertensive agent in combination therapy.

ObjectiveHigh blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.MethodsTotal 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.ResultsThe study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na+, K+, Cl-)and fasting blood sugar, evident across the treatment groups.ConclusionChlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option.

Background: Type 2 Diabetes Mellitus (DM) is a non-communicable disease. DM produces damage in small blood vessels characterized by morphologic and biochemical alterations of the capillary basal lamina. These abnormalities have been observed in several organs including the lung. As the prevalence of diabetes is rapidly increasing, it would be important to study pulmonary functions in this sub group. Methods: The present observational study carried out at medicine department. It includes previously diagnosed type 2 DM patients between 31 to 50 years of age, non-smoker, non-pregnant with no major respiratory illness. Ventilatory Pulmonary Function Test (VPFT) which includes FVC, FEV1 and FEV1% were studied in all selected participants. VPFT categorized as per American Thoracic Society (ATS). All collected data analysed using Microsoft Excel 2010. Results: The total of 55 previously diagnosed Type 2 DM cases was recruited. 26 (47.2 %) & 29 (52.7 %) were male & female respectively. 21 (38.2 %) has duration of DM more than 5. 11 (20 %) & 5 (9 %) had neuropathy and retinopathy respectively. 29 (52.7 %) had abnormal pulmonary function test. The Mean FVC (84.11 ± 14.94), Mean FEV1 (84 ± 13.72) & Mean FEV1% was (100.05 ± 7.32) among the study participants. 29 (100.0 %) were restrictive type of abnormality. Conclusion: The reduced lung function is likely being a complication of diabetes mellitus. Lung functions needs to be checked periodically.