Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.

INTRODUCTION:Cardiovascular Disease (CVD) continuum often begins with uncontrolled hypertension, progressing through structural/functional impairment of the cardiovascular system and atherosclerosis toward myocardial infarction, stroke, and cardiovascular death. Hypertension affects over one billion people globally, yet less than half have been diagnosed and received treatment. Suboptimal management of elevated Blood Pressure (BP) remains a challenge across low- and middle-income countries, including India. This review outlined the CVD continuum associated with hypertension, along with guideline-recommended new paradigm and emerging/ novel approaches for managing hypertension and CVD risk. METHODS:Data from PubMed and Google Scholar have been extracted using the following search terms: cardiovascular disease continuum, hypertension management, cardiovascular risk reduction, anti-hypertensive drugs, non-pharmacological approach, guideline recommendations, evolving strategies, and herbal medicine. RESULTS:A total of 101 articles, published between 2004 and 2025, were included, comprising 20 systematic reviews and meta-analyses, 27 trials, 24 research articles, 10 guidelines, 18 review articles, and 2 editorials. The evidence and guideline recommendations on clinical and therapeutic considerations for effective management of hypertension have been discussed. DISCUSSION:Several guidelines preferred initial treatment (BP threshold: 130-140/80-90 mmHg) with monotherapy (angiotensin-converting enzyme inhibitor/ angiotensin-receptor blocker/ calcium channel blocker/ diuretic/ beta-blocker) or combination therapy of two or more medications with complementary mechanisms (in a single-pill) for managing cardiovascular complications and improving treatment adherence. Beta-blockers are thought to be recommended for people with cardiovascular complications, but their effect in reducing stroke, infarction, and mortality is inferior to other drug classes. The addition of an anti-aldosterone drug to the first-line therapy is recommended for managing resistant hypertension. Recent pharmacological advancements, including anti- aldosterone agents, non-steroidal mineralocorticoid receptor antagonists, endothelin receptor antagonists, etc., have demonstrated remarkable efficacy in BP reduction with tolerable safety profiles. CONCLUSION:A holistic management strategy integrating standard medical care along with lifestyle modifications, herbal medicines, and digital health platforms could enhance treatment adherence and interrupt the CVD continuum.

The global prevalence of diabetes mellitus (DM) and heart failure (HF) is rapidly increasing. Hyperglycemia, insulin resistance and hyperglycemia-induced oxidative stress in people with DM are the key etiological factors of HF. The factors disrupt systemic, myocardial and cellular mechanisms, leading to lipotoxicity, mitochondrial dysfunction, altered calcium signaling and inflammation, ultimately resulting in HF. Heart failure on the other hand induces new-onset diabetes by modulating insulin signaling. Despite the availability of novel treatment approaches, these comorbid conditions continue to increase hospitalization, treatment expenditure and mortality. Therefore, a thorough understanding of the complex bidirectional relationship between DM and HF might be helpful in managing the associated complications of both conditions. This review aims to provide an overview of cellular and pathophysiological interplay of the glucovascular continuum from DM to HF, and vice versa. Additionally, updated estimates on prevalence and outcomes of incident HF in people with DM and new-onset DM after HF are discussed. Guidelines from the United States, Europe and Korea recommended sodium glucose cotransporter-2 inhibitors (SGLT-2is) for primary prevention of DM and HF, and for reduction of HF hospitalization. Evidences from large-scale clinical trials and meta-analyses have shown that SGLT2i (empagliflozin, canagliflozin and dapagliflozin), semaglutide (glucagon-like peptide-1 receptor agonist) and finerenone (mineralcorticoid receptor antagonist) act as effective anti-diabetic agents and provide cardiovascular protection. Future research should prioritize diabetic control to manage and prevent lipotoxicity, oxidative stress, inflammation and advanced glycation end-product formation in order to diminish the disease burden.

Type 2 diabetes (T2D), along with other co-morbidities (hypertension, hyperlipidemia, etc.), causes vascular complications and atherosclerosis, leading to heart or kidney damage. The timely detection of cardiovascular disease (CVD) and chronic kidney disease (CKD) risk helps in targeted treatment, thereby reducing hospitalization/death in people with T2D. The vascular complications of T2D, including the onset of CVD or CKD, have been widely studied. However, a clear understanding of the concurrent inter-relatability of diabetes-kidney-heart or diabetes-heart-kidney continuum would further assist the clinicians in preventing morbidity and mortality. The narrative review sought to outline the stages ("prevent," "regress," and "retard"), pathophysiological mechanism, and management of the continuum with defined patient profiles and associated risk factors. Pharmacotherapies with a focus on managing both cardiac and renal vascular changes (e.g., sodium-glucose transporter-2 inhibitors {SGLT-2is}, glucagon-like peptide-1 receptor agonists {GLP-1RA}, dipeptidyl peptidase-4 inhibitors {DPP-4is}, lipid-lowering therapy, and renin-angiotensin-aldosterone system {RAAS} blockers) have been discussed. In addition, new diagnostic approaches such as levels of B-type natriuretic peptide (BNP), N-terminal prohormone, cardiac troponin, cystatin C, and single-cell transcriptome sequencing, with proven accuracy for detecting vascular complications in the heart and kidney, have been summarized. The review underscores the importance of the early detection of the vascular complications in T2D with individual risk stratification for the initiation/continuation/switching of therapies, to enhance treatment adherence and outcomes.

Objective: To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. Methods: This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. Results: 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) Conclusions: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher. (c) 2023 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective: To formulate a consensus statement for the utilization of bisoprolol in combination with telmisartan based on the contemporary evidence and the real-world experiences of the Indian cardiologists Design and method: A virtual collaborative educational initiative was convened from November 2022, to December 2022, through a series of 8 nationwide virtual interactive meetings by leading cardiologists (n = 90) at the forefront of cardiovascular care (CERTAIN Study Group). The cumulative clinical experience was approximately 2,500-man-years, who rated their level of agreement for 14 questions with each item on a 5-point Likert scale. This was preceded by a contemporary evidence-based discussion on the contemporary updates for hypertension and for the combination of bisoprolol (beta blocker) and telmisartan (ARB). Weighted mean for the Likert scale was calculated and consensus was pre-defined as a score > 100. GraphPad 9.4.0 and ANOVA were used for statistical analysis. Results: The highest agreement score was for the concurrence for the diabetes have consistently higher risks over the whole BP range (127), bisoprolol is a suitable choice for management of Left Ventricular Dysfunction post MI (124), bisoprolol has impactful clinical implications for modulation of resting heart rate in patients with CAD (123), telmisartan has a distinctive pharmacological properties that translate into a clinically relevant approach for management of hypertension (122), bisoprolol is beneficial in patients with hemodialysis (120), bisoprolol in combination with telmisartan is useful in patients with co-morbidities (115), bisoprolol has modulatory properties for the impact of remodelling in patients with heart failure (111), bisoprolol in combination with telmisartan is a useful tool to manage hypertension. (Figure). The highest mean response scores (±SD, 95% CI) for consensus were for agree (25±10, 95% CI 19 to 31) followed by strongly agree (14±11, 95% CI 7.6 to 20) Conclusions: We observed a high preference for the combination of bisoprolol with telmisartan for use in patients with hypertension with comorbidities. We attribute this to a high level of perceived effectiveness, based on the recent clinical trials.

Objectives: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. Methods: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. Results: Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (+/- 13.7) years, and 59.97 (+/- 14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. Conclusion: The outcomes of ADHF patients admitted during the Covid pandemic did not differ signif-icantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years. (c) 2023 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND:Patients with diabetes mellitus (DM) represents a challenging subset of population as they experience worse outcomes after percutaneous coronary intervention than patients without diabetes. We evaluated the 2-year efficacy and safety profile of the Abluminus DES+ in patients with diabetes within the population enrolled in the large multicenter en-ABL e-registry.METHODS:Multicenter, prospective, all-comers registry performed in 31 centers in India. We analyze patients according to the diagnosis of DM and insulin dependency (ID or Non-ID): non-DM (1641 patients), NIDDM (721 patients), IDDM (138 patients). The primary endpoint was a composite of device-oriented major adverse cardiac events (MACE): cardiac death, target vessel-related myocardial infarction (MI), and ischemia-driven target lesion revascularization (TLR)/ target vessel revascularization (TVR) at 2-year. Stent thrombosis (ST) at any time point was also recorded.RESULTS:The MACE rate at 2-year follow-up was 3.0% in the overall population with DM patients showing a higher rate of primary endpoint compared to non-DM (4.4% vs. 2.4%, P=0.025). Rate of cardiac death was actually low and consistent between the 2 groups (1.7% vs. 0.9%, P=0.100). At 2-year follow-up, the rate of ST was 0.9% in DM patients versus 0.5% in non-DM, P=0.213.CONCLUSIONS:At 2-year follow-up, the Abluminus DES+ technology that merges the features of a sirolimus coated balloon with those of a bioresorbable polymer drug eluting stent appears to be safe and effective. This safety/efficacy profile was consistent in patients with or without DM.

Background: The current gold standard for blood pressure (BP) measurements is based on office BP measurements (OBPMs) by a sphygmomanometer or a digital device. Ambulatory BP measurement (ABPM) is a noninvasive method for continuous monitoring of BP over a period during routine activities of the patient. Thus, ABPM offers multiple BP readings during the patients' daily routine as compared to the single reading by OBPM at rest. A good correlation exists between mean 24-hour BP readings and the prediction of cardiovascular events. The present multicenter observational study was aimed to assess the correlation between ABPM and OBPM in patients with newly diagnosed, controlled, or uncontrolled hypertension in the community setting. Our hypothesis was to test if ABPM provides any further value in those hypertensive patients in whom the office blood pressure levels are controlled. A supplementary hypothesis was whether obtaining ABPM in patients with newly diagnosed or uncontrolled hypertension yields any value over and beyond OBPM. Another objective was to find out the applicability of ABPM in the community setting where the medical care is provided by primary care family physicians and not by specialists. Materials and Methods: Materials and Methods A total of 1000 patients were analysed for this study. Those with controlled hypertension were assigned to Group A, and those with newly diagnosed/untreated hypertension comprised Group B. Group A was followed up during Visit 2 and Group B was followed up during Visit 2 and either Visit 3 or Visit 4 to assess the BP measurements by ABPM and OBPM. Results: The correlation between ABPM and OBPM showed minimal variation in the BP readings of Group A subjects at Visit 2. A variation in BP readings was observed in Group B at Visit 2. Furthermore, the correlation was established between ABPM and OBPM noted for Group B subjects during Visit 3, and minimal variation was noted during Visit 4. Conclusions: Conclusions A good correlation was observed between ABPM and OBPM during both visits in patients in Groups A and B. However, a notable variation was noted in the diastolic BP readings. Thus, large-scale clinical studies are required to detect the prevalence of hypertension, masked hypertension, and dipping patterns associated with hypertension and other related medical co-morbidities.

We investigated the performance of MagicTouch sirolimus-coated balloon (SCB) (Concept Medical), on the immediate performance and the long-term clinical outcome, including target lesion revascularization (TLR) and major adverse cardiac event (MACE), in patients with a broad spectrum of coronary

Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05). Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST.

Objective: India Heart Study (IHS) is aimed at investigating the agreement between office blood pressure measurement (OBPM) and self (S)BPM in a hypertension-naive population. Methods: A total of 18 918 individuals (aged 42.6 ± 11.7 years, 62.7% men), visiting 1237 primary care physicians across India, underwent OBPM. They performed SBPM for a period of 1 week using a validated oscillometric BP monitor that was preprogrammed to adhere to a guideline-based SBPM-schedule and blinded to the results. Thereafter, individuals underwent a second OBPM. Available laboratory results were obtained. Thresholds for elevated OBPM and SBPM were 140/90 and 135/85 mmHg, respectively. Results: On the basis of first-visit OBPM and SBPM, there were 5787 (30.6%) individuals with normotension; 5208 (27.5%) with hypertension; 4485 (23.7%) with white-coat hypertension (WCH) and 3438 (18.2%) with masked hypertension. Thus, a diagnosis contradiction between SBPM and first-visit OBPM was seen in 9870 (41.9%) individuals. On the basis of second-visit OBPM, the normotension, hypertension, WCH and masked hypertension prevalence values were 7875 (41.6%); 4857 (25.7%); 2397 (12.7%) and 3789 (20.0%). There was poor agreement (kappa value 0.37) between OBPM of visit 1 and 2 with a diagnosis difference in 6027 (31.8%) individuals. The majority of masked hypertension and WCH individuals had BP values close to thresholds. Conclusion: There was a poor agreement between OBPM of visit1 and visit 2. Likewise, the agreement between OBPM at both visits and SBPM was poor. SBPM being considered to have a better correlation with patient prognosis should be the preferred method for diagnosing hypertension.

Type 2 diabetes mellitus (T2DM) is a known predisposing factor for heart failure (HF). The growing burden of these two conditions and their impact on health of the individual and on society in general needs urgent attention from the health care professionals. Availability of multiple treatment choices for managing T2DM and HF may make therapeutic decisions more complex for clinicians. Recent cardiovascular outcome trials of antidiabetic drugs have added very robust evidence to effectively manage subjects with this dual condition. This consensus statement provides the prevalence trends and the impact of this dual burden on patients. In addition, it concisely narrates the types of HF, the different treatment algorithms, and recommendations for physicians to comprehensively manage such patients.