BACKGROUND:Management of essential hypertension (HTN) remains challenging, with contemporary control being achieved in <1/10 of the cases, especially when aligned with the recently updated guidelines of American College of Cardiology (ACC) or International Society of Hypertension (ISH). The place and positioning of beta-blockers have been evolving, with recent focused updates, such as the European Society of Hypertension (ESH) 2023 guidelines, that may hold relevance for the Indian phenotypic traits of premature cardiovascular disease (CVD), fragile coronary architecture, and/or high resting heart rate. To further develop consensus on the clinical role and relevance of beta-blockers, including nebivolol, an Indian consensus was evolved with graded recommendations on their clinical role in HTN, HTN with additional cardiovascular (CV) risk, or type 2 diabetes mellitus (T2DM). METHODOLOGY:An expert review panel was constituted, comprising interventional and clinical cardiologists as experts, to synthesize the literature for the development of a validated knowledge, attitude, and practice (KAP) survey questionnaire. Research databases, including Cochrane Systematic Reviews, PubMed, and Google Scholar, were accessed for contemporary information and guidelines on beta-blockers updated until Dec 2023. Delphi rounds were conducted to develop graded recommendations based on the strength, quality of evidence, and the agreement among the panelists (n = 9). Consensus was achieved on the graded recommendations, with ≥70% of national panelists in agreement. RESULTS:Ninety-six percent of respondents opined that the new ESH HTN guidelines (2023) help gain confidence in using beta-blockers, which are considered first-line drugs for the treatment of HTN. Beta-blockers, including nebivolol, can be recommended in patients with HTN with high resting heart rates, including young hypertensive patients under 40 years of age. For people under 60 years old with HTN, regardless of whether they have comorbid diseases, beta-blockers are the recommended drug choice. Ninety-five percent of respondents opined that nebivolol is the preferred beta-blocker in hypertensive patients with T2DM, followed by bisoprolol and metoprolol. More than 90% of respondents opined that the three most commonly preferred beta-blockers by experts in patients with angina were nebivolol, metoprolol, and bisoprolol. CONCLUSION:Beta-blockers, including nebivolol, can be considered initial-line therapy for HTN management in real-life settings in India and nebivolol is preferred because of its two important properties: highest beta-1 selectivity and endothelial-dependent vasodilation.

Cardiovascular diseases (CVDs) are responsible for 17.5 million deaths globally, and India is more susceptible to coronary artery disease (CAD) than its western counterparts because of certain challenges such as suboptimal management, increased healthcare costs, and physicians undermining the extent of limitation in angina patients. All of these could be resolved by employing strategies starting with accurate diagnosis to timely implementation of aggressive management techniques to contain morbidity and mortality. Pan India, experts from the field of cardiology came together in order to discuss risk stratification and aggressive management of chronic coronary syndromes (CCS). The expert consensus laid down a path of recommendations considering the prevailing healthcare service infrastructure, local evidence-based studies and key international guidelines. With the wide diversity in terms of geographical distribution in India and the risk factors presented across various divisions of the population, risk stratification is necessary for prompt identification and subsequent management of CCS. In this consensus, various risk stratification techniques such as risk stratification based on ventricular function, electrocardiogram (ECG), stress echocardiography (ECHO), the Duke treadmill score (DTS), and myocardial perfusion imaging (MPI) were discussed. After risk stratification, the consensus focused on aggressive management of CVDs with therapeutic optimization for various types of patient profiles such as revascularization for stable angina and angina with comorbidities (diabetes and renal failure), apart from emphasis on various medications and their roles in ameliorating disease symptoms.

Uncontrolled hypertension is an important cardiovascular risk factor and therefore requires effective approaches to patient management. This study assessed approaches to the management of patients with Stage 2 hypertension by cardiologists in India. This was a retrospective, multicenter, observational, case-based questionnaire study. Data on demographic characteristics, risk factors associated with Stage 2 hypertension, use of antihypertensive medications, side effects, and approaches to education for 2,540 patients were extracted from questionnaire responses provided by 508 cardiologists. The study population of patients with Stage 2 hypertension had a mean age of 55.0 years. Most of the patients (62.6%) were aged 30 to 60 years and diabetes mellitus was the most prevalent comorbidity (48.9%). Triple antihypertensive therapy was being used by 760 patients, and 634 and 1,146 patients were receiving 4 and 5 different antihypertensive medications, respectively. Telmisartan, amlodipine, chlorthalidone, hydrochlorothiazide, spironolactone, metoprolol, and prazosin were the commonly prescribed drugs. Ankle edema (27.7%) was the most frequent side effect of therapy. Pharmacotherapy was supported by patient education and lifestyle modifications for better blood pressure control. The standardized approach to the collection and assessment of these contemporary data provides useful insights into the characteristics and treatment of patients with Stage 2 hypertension in India.

Worldwide, coronary heart disease (CHD), have assumed epidemic proportions. Increasing use of interventional therapy and a higher adherence to medical therapy have led to a 33% reduction in cardiac deaths at 5 years after hospital discharge. Angina pectoris is a common symptom of ischemic heart disease. The goals of anti-ischemia therapy in patients with stable coronary artery disease (CAD) include relieving angina symptoms, improving duration of exercise and quality of life, improving prognosis and preventing cardiovascular (CV) events. The consensus statement was devised with the help of multiple meetings held across India. Ten regional advisory board e-meetings were held in Mumbai, Delhi, Chennai, Kolkata, Ahmedabad, Cochin, Trivandrum, Lucknow, Bhopal and Varanasi. These meetings were attended by ten eminent experts from the field of cardiology from each region. Extensive literature review, intense discussions, and feedback from the cardiologists led to the development of the following consensus statements on definition, diagnosis, and management of angina, which have been reported in this article.

Blood pressure (BP), even in healthy normotensive individuals, is dynamic, varies with a circadian periodicity, and is influenced by physiological and environmental factors. Abnormal 24-h BP patterns have been observed in many patients with hypertension (HTN), which may be overlooked if evaluations are based only on office BP measurements. Out of office BP measurements, such as Ambulatory Blood Pressure Monitoring and Home Blood Pressure Monitoring (ABPM and HBPM) is important for optimal BP management and are better predictors of adverse outcomes. However, HTN diagnosis and management are often based on relatively few clinic BP measurements, and there are no recommendations to guide clinicians managing patients with abnormal 24-h BP patterns in India. Thus, the present consensus statement aims to provide uniform evidence-based recommendations for the diagnosis and management of abnormal 24-h BP patterns. Strategies for screening for HTN based on the current prevalence trends in India have been suggested. Further, recommendations on the appropriate use of ABPM and HBPM in diagnosis and management of HTN are provided.

Chronic stable angina (CSA) is an incapacitating disorder. The pain can hinder the routine chores of an individual and significantly impact one’s quality of life (QoL). However, the good news is that this can be treated and the QoL can be improved. The key to apt management lies in the accurate early diagnosis of this condition, followed by a detailed evaluation and accordingly planned management, which should be regularly revised and be backed by an adequate follow-up. OPTA-OPtimal Treatment for chronic stable Angina-is an educational initiative to assist the clinicians in India with screening and diagnostic tools, strengthened by updated guideline-directed management to ensure satisfactory patient outcomes. OPTA aims to improve clinical outcomes by providing optimized pharmacotherapy for patients with stable angina. This expert consensus document intends to provide information for better understanding of the condition by clinicians and to ensure an early, accurate diagnosis, followed by optimal management of angina. For better clinical and practical understanding of Indian clinical scenario, the most commonly encountered patient profiles are briefly described here. These inputs and an extensive literature review were blended to develop the recommendations for clinicians across the country. An attempt is made to include clinical recommendations that meet the needs of the majority of patients in most circumstances in the Indian scenario. However, the ultimate judgment regarding individual case management should be based on clinician’s discretion. This expert consensus document is not a substitute for textbooks and/or a clinical judgment.