INTRODUCTION

Clindor  10 Tablet is a medicine used to treat high blood pressure (hypertension). It belongs to a class of medicines known as a calcium channel blocker which helps to lower blood pressure. This helps prevent heart attacks and strokes. It may also be prescribed to prevent angina (heart-related chest pain).

Clindor 10 Tablet may be prescribed alone or along with other medicines. The dose depends on the severity of your condition. You can take it at any time of day, with or without food, but it is best to take it at the same time each day.  Keep taking it for as long as advised by your doctor. Do not stop this medicine on your own, even if you feel well because high blood pressure often has no symptoms. This makes it hard to identify any sudden spike and if you stop taking it, your condition may get worse.

Keeping active with regular exercise, reducing your weight, and eating a healthy diet will also help control your blood pressure. Follow your doctor’s advice while taking this medicine.

The most common side effects include fatigue, edema (swelling in the feet), sleepiness, dizziness, flushing, the unusual beating of the heart (palpitations), and headache. Consult your doctor if any of these bother you, or do not go away. Side effects like swelling in the feet or ankles and palpitations are lesser in severity than other similar medicines of the group. Studies have shown that it also has a protective effect on the kidneys.

Before taking it, let your doctor know if you have any liver, kidney or heart problems. Pregnant or breastfeeding women should also consult their doctor for advice before taking this medicine. You also need to tell your doctor what other medicines you are taking, especially those used to treat high blood pressure or heart conditions. You should have your blood pressure checked regularly to make sure that this medicine is working properly.

USES OF CLINDOR TABLET

• Treatment of Hypertension (high blood pressure)
• Prevention of Angina (heart-related chest pain)
• Prevention of Heart attack
• Prevention of Stroke

• Hypertension (high blood pressure)

• Description of Hypertension (high blood pressure)

Introduction 

• Hypertension is a condition in which the blood vessels have persistently raised pressure. 

• Blood pressure is one of the vital signs of life. It is the pressure exerted by the blood against the walls of your blood vessels. In hypertension, the blood exerts increased pressure on the walls of the vessels. Therefore, it is also called high blood pressure. It is measured in millimeters of mercury (mmHg) and expressed as systolic/diastolic blood pressure. ‘Systolic’ is the maximum pressure exerted when your heart contracts to pump blood. ‘Diastolic’ is the minimum pressure exerted when your heart is at rest between contractions. 

• Some people may have high blood pressure readings when measured at the doctor’s clinic but normal blood pressure readings when measured at home or while performing their routine activities (ambulatory blood pressure). This condition is termed white coat hypertension. In contrast, some people may have normal blood pressure readings when measured at the doctor’s clinic but consistently above normal blood pressure readings when measured at home or while performing their routine activities. This condition is termed masked hypertension.

• According to A Global Brief on Hypertension published by the World Health Organization, “Hypertension is defined as a systolic blood pressure equal to or above 140 mmHg and/or diastolic blood pressure equal to or above 90 mmHg.”

• According to the American Heart Association (AHA) 2017 guidelines, hypertension is defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg.

• Types:

• There are two main types of hypertension:

• 1. Essential hypertension – It is the type of high blood pressure which has no obvious underlying medical condition. It has three subtypes:
  
  
• Systolic hypertension in teenagers and young adults – It occurs mainly in people aged between 17-25 yrs of age. Its prevalence varies and may reach up to 25% in young men. There is an underlying sympathetic system overactivity.
  
  
• Diastolic hypertension in middle age – It is a condition in which both the systolic and the diastolic blood pressures are elevated. It mostly occurs in patients between 30-50 yrs of age and is associated with weight gain.
  
  
• Isolated systolic hypertension in older adults – It is a condition in which the systolic blood pressure is increased and the diastolic blood pressure is normal or lower. Therefore, the difference between the systolic BP and diastolic BP is increased. It is often seen in older people with hypertension.

• 2. Secondary hypertension – This type of high blood pressure is caused as a result of some underlying medical conditions of the kidneys, heart, blood vessels, or endocrine (hormonal) system. Some of the common causes are renal parenchymal disease, acute/chronic renal diseases, renovascular hypertension, endocrinal causes like pheochromocytoma, acromegaly, hypothyroidism, hyperparathyroidism, etc. and coarctation of aorta, especially in young people with high blood pressure.

• Further, based on fluctuations in blood pressure within your arteries, you may also be classified as one among the following types:

• 1. Labile hypertension: Some elderly patients undergo frequent changes in blood pressure over a short-term duration. Conventional medication is unable to stabilize the blood pressure in such patients.
  
  
• 2. Malignant hypertension: This is the most severe form of hypertension in which a very high blood pressure develops suddenly and quickly. This is a medical emergency. The diastolic blood pressure often rises above 130 mmHg and is accompanied by bleeding in the retina. Also, there is leaking of lipid residues from damaged retinal capillaries (called as exudates) with a swelling of optic disc (called as papilledema). Optic disc is the place where the nerve that goes to your brain is connected inside your eyes. 
  
  
• 3. Accelerated hypertension: This type is identified by the presence of high blood pressure accompanied by retinal bleeding and/or exudates but without optic disc swelling.
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• Severe rise in BP (>180/120 mmHg), accompanied with organ damage like hypertensive encephalopathy, acute ischemic stroke, acute MI, etc. is termed as hypertensive emergency. If the severe elevations in BP are not associated with progressive organ dysfunction then the situation is termed as hypertensive urgency. Majority of such situations arise due to inadequate treatment of hypertension or if the person fails or refuses to take medications as prescribed (non-compliance).

Angina (heart-related chest pain)

Description of Angina (heart-related chest pain)

Definition

Angina is a medical term for pain or discomfort in the chest when there is decreased blood supply to the heart muscles. Angina is a symptom of an underlying blockage in the coronary arteries that supply blood to the heart.

Causes and Risk Factors

Common causes and risk factors are:

1. The commonest cause of poor blood supply to the heart muscles is accumulation of fat inside the coronaries called atherosclerosis.

2. Diseases of coronaries like embolus (an unattached blood clot causing blockage), inflammation of arteries, a spasm in the arteries, Kawasaki disease and congenital abnormalities can also cause angina pain.

3. Other heart diseases like hypertrophic cardiomyopathy (thickening and loosening of heart muscles), severe aortic valve disease, etc. are some of the rare causes.

4. Factors like emotional stress, cold weather, and obesity can act as a triggering factor.

5. Men have a higher risk than women.

6. Men older than 45 and women older than 55 years of age are at a high risk.

7. Modifiable risk factors include high blood pressure, high cholesterol levels in blood, type 2 diabetes, cigarette smoking, sedentary lifestyle, and stress.

Signs and Symptoms

There are many variants of angina.

1. Stable angina/angina pectoris: It is the most commonly occurring left sided or central chest pain. It is caused due to strenuous physical activity or stress and usually pain reduces when patient rests.

2. Unstable angina: It is an acute condition. It can occur even when you are resting or eating. The pain is more severe and often recurring.

3. Prinzmetal’s angina: It is also referred as variant angina, angina inversa or Prinzmetal’s variant angina. It is rare type of angina pain, which almost always occurs when a patient is at rest. It may be more painful and lasts longer than other types of angina. It usually occurs at night or early morning.

4. Microvascular angina: This type of angina is a symptom of coronary microvascular disease.

Patients describe angina pain as feeling of tightness or crushing weight in the central chest region radiating to arms, neck, jaw, back, or stomach region. Pain can also be accompanied by breathlessness, confusion, anxiety, profuse perspiration, and nausea. This pain usually lasts a few minutes, arises suddenly, and stops when you rest.
Chest pain that lasts only a few seconds is usually not angina, but you should visit the doctor as soon as possible as it may be a warning of heart attack.

Investigations

1. Doctor will be able to diagnose angina depending on the symptoms described by the patients.

2. They may carry out some basic investigations like resting electrocardiogram (ECG), chest x-ray, and blood test like troponin I or creatine phosphokinase-MB (CPK-MB). Further testing like echocardiography, coronary angiogram, stress ECG, CT-scan, or MRI of chest, CT angiography, etc. may also be advised as per patient’s condition.

Treatment

If the patient is diagnosed with angina, the doctor will start with initial drug therapy to stabilize the symptoms. Common line of treatment includes aspirin, beta blockers, nitroglycerin and morphine sulfate orally while maintaining oxygen saturation.

If the patient is not stabilized with medical therapy, surgical procedures like angioplasty or bypass operation [coronary artery bypass graft (CABG)] will be advised.
Lifestyle modifications like stop smoking, healthy diet and exercise will be advised by your doctor 

Did You Know?

Cardiovascular disease is the leading cause of death and is responsible for one of every three deaths in the world.

Heart attack

Description of Heart attack

Definition

A heart attack or a myocardial infarction means death of heart tissue due to lack of blood supply to the heart muscles. This can happen when there is an accumulation of fat or cholesterol narrowing the coronary arteries or when other substances like a blood clot are blocking the blood flow. This can damage or destroy a part of the heart muscle permanently.

Causes and Risk Factors

Causes include:

1. Coronary heart disease: Most heart attacks arise when your coronary arteries narrow with deposition of fatty materials within their walls, i.e., atherosclerosis. If a piece of this fatty material comes off its place it may cause a blood clot. This clot blocks the artery and cuts the blood supply to the heart.

2. Spasm of coronary arteries: If a coronary artery goes into spasm, it cuts off blood supply to the heart. Use of cocaine drug is one such known cause of spasm of coronary arteries.

Risk factors include:

1. Age: Men above the age of 45 and women above the age of 55 are at a higher risk of suffering a heart attack.

2. Tobacco: Chronic smoking can tremendously increase the risk.

3. Hypertension: High blood pressure damages the arteries that can cause heart attack.

4. High cholesterol

5. Diabetes

6. Obesity

7. Family history of heart attack

8. Stress

Signs and Symptoms

Signs and symptoms include:

1. Severe pressure or squeezing sensation in your chest or arms that can spread to the neck, jaw or back.

2. Indigestion, acidity, and abdominal pain

3. Shortness of breath or difficulty in breathing

4. Rapid or irregular heartbeat

5. Excessive cold sweat breaking out

6. Exhaustion

7. Lightheadedness or dizziness

Diabetics typically do not experience pain to a large extent and theirs is often a ‘Silent attack’ which is fatal because prompt action is often not taken. 

Investigations

This is usually a medical emergency where immediately your heart rate and blood pressure will be monitored. Electrocardiogram will be done immediately to confirm the diagnosis. Assessment of symptom history and past medical history will be done.

Blood tests will be conducted to check for certain enzymes which show heart damage, e.g., Troponin I and creatine phosphokinase-MB (CPK-MB). Other additional tests include chest x-ray, echocardiogram, angiogram or cardiac catheterization, and cardiac CT scan.

Treatment

Treatment starts immediately as heart attack is a medical emergency.

A. Medical treatment: Drugs should be given immediately to decrease the amount of damage to the heart. Drugs used include:

1. Thrombolytic therapy to dissolve any blood clots

2. Aspirin and other blood thinners to prevent blood clotting that can aggravate another heart attack.

Other drugs include:

1. Antiplatelet agents — to prevent formation of new clots.

2. Pain relievers

3. Nitroglycerin — this medication helps the heart muscle to relax and improve blood flow to the heart.

B. Surgical procedures:

1. Coronary angioplasty and stenting where a metal mesh is placed inside the artery to keep it open.

2. Coronary artery bypass graft surgery (CABG) where a vein is used to create a new route for blood to flow to the affected region of the heart.

Complications and When Should You See a Doctor

Damage to your heart can occur if not treated in time frame of 2 to 3 hours, and may lead to.:

1. Abnormal heart rhythm which can also be fatal.

2. Heart failure — an attack can cause serious damage to the heart tissue that it fails to pump blood efficiently out of the heart.

3. Rupture of the heart — parts of the heart muscle can rupture causing damage.

4. Heart valve problems — they can get damaged and can also leak causing severe problems.

Stroke

Description of Stroke

Definition

A stroke is a life-threatening medical emergency. It occurs when there is a sudden deprivation of oxygen and nutrients to the brain cells when the blood supply to the brain is interrupted or greatly reduced. Since the brain cells are starved of oxygen-rich blood there is damage to the surrounding nerves which causes the death of brain cells within minutes. The body parts controlled by the damaged brain cells lose their ability to function.

Signs and Symptoms

Following signs and symptoms are important to watch out for if you suspect someone may be having a stroke:

1. Difficulty in speaking and comprehending — slurred speech

2. Paralysis or numbness on one side of the face, arm, or leg

3. Blurred vision or difficulty in seeing with both eyes

4. Severe headache

5. Difficulty in walking straight

Investigations

The doctor needs to assess and evaluate which type of stroke you are having and which areas of your brain are affected. Elimination of other possible causes is also important, e.g., brain tumor, or adverse drug reaction. A complete physical examination will be performed with evaluation of personal and family history, review of current medications, and neurological examination.

Diagnostic tests include:

1. Blood tests — check your blood sugar, clotting factors, and also check whether vital blood salts are out of balance

2. CT scan — assess whether it is a tumor, blood leak, or cut off blood supply

3. MRI — assess the blood flow to the brain

4. Carotid ultrasound — assess carotid arteries in your neck

5. ECG — check functioning of your heart

Treatment

Treatment differs depending upon the type of stroke:

1. Ischemic stroke: Drugs which break down clots are used, e.g., aspirin. TPA which is tissue plasminogen activator can also be injected as it dissolves clots very fast. This can be given in an emergency via a catheter directly into the artery.

2. Hemorrhagic stroke: Drugs to reduce pressure in the brain and to prevent sudden seizures and constrictions of blood vessels are given.

Content Details

BENEFITS OF CLINDOR TABLET

In Treatment of Hypertension (high blood pressure)

Clindor 10 Tablet is a calcium  channel blocker. It works by relaxing the blood vessels so that blood can flow more easily around your body. This lowers your blood pressure and reduces your risk of having a stroke, a heart attack, or kidney problems in the future. You do not usually feel any direct benefit from taking this medicine, but it works in the long term to keep you well. Take regularly, as prescribed for this medicine to be most effective, even if you feel better.

In Prevention of Angina (heart-related chest pain)

Clindor 10 Tablet belongs to a class of medicines known as a calcium channel blockers. It works by relaxing blood vessels so that blood can flow more easily around your body. This means that more oxygen gets to your heart and reduces the risk of getting chest pain (angina). This medicine should not be used to treat chest pain which is already happening. It is used to prevent or reduce the frequency of angina attacks. This medicine needs to be taken regularly as prescribed for it to work effectively. So, it is important to keep taking it even if you feel well and have no symptoms.

In Prevention of Heart attack                           

Clindor 10 Tablet helps lower your blood pressure and make it easier for your heart to pump blood around your body. This reduces the chances of you having a heart attack. It can also reduce the risk of dying if it is given immediately after a heart attack. This medicine needs to be taken regularly to be effective, so keep taking it even if you feel well. Do not stop without talking to your doctor.

In Prevention of Stroke              

Clindor 10 Tablet reduces the risk of future strokes. It helps lower your blood pressure and make it easier for your heart to pump blood around your body. This reduces the chances of you having a stroke. Take it as advised by the doctor to get the maximum benefit.

SIDE EFFECTS OF CLINDOR TABLET

Most side effects do not require any medical attention and disappear as your body adjusts to the medicine. Consult your doctor if they persist or if you’re worried about them

Common side effects of Clindor

• Fatigue
• Sleepiness
• Flushing (sense of warmth in the face, ears, neck and trunk)
• Headache
• Nausea
• Dizziness
• Palpitations
• Edema (swelling)
• Abdominal pain

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HOW TO USE CLINDOR  TABLET

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Clindor 10 Tablet may be taken with or without food, but it is better to take it at a fixed time.

HOW CLINDOR  TABLET WORKS

Clindor 10 Tablet is a calcium channel blocker. It lowers blood pressure by relaxing blood vessels, which makes the heart more efficient at pumping blood throughout the body.