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Comparison of 3 Dual Single-Pill Combinations for Blood Pressure Lowering: A Secondary Analysis of an International Randomized Trial

2026-01-01T00:00:00Z

Title: Comparison of 3 Dual Single-Pill Combinations for Blood Pressure Lowering: A Secondary Analysis of an International Randomized Trial Authors: Schutte, A.E.; Salam, A.; Cushman, W.C.; De Silva, H.A.; Di Tanna, G.L.; Grobbee, D.E.; Narkiewicz, K.; Ojji, D.P.; Poulter, N.R.; Schlaich, M.P.; Spiering, W.; Williams, B.; Wright Jr, J.T.; Kumanan, T.; Hay, P.; Galappatthy, G.; Pereira, T.; Rahuman, F.; De Silva, A.P.; Constantine, G.; Gianacas, C.; Vander Hoorn, S.; Shanthakumar, M.; Liu, X.; Wang, N.; Gnanenthiran, S.R.; Whelton, P.K.; Rodgers, A.; GMRx2 Abstract: Recent clinical practice guidelines recommend dual low-dose single-pill combination therapy for initial treatment of hypertension, given the improvements in efficacy, adherence, and reduction in therapeutic inertia that they impart without compromising tolerability.1 However, randomized comparisons between different dual single-pill combinations are limited. We therefore report the comparative efficacy of 3 dual combinations, each containing 2 of the major antihypertensive drug classes: an angiotensin receptor blocker (telmisartan), a dihydropyridine calcium channel blocker (amlodipine), and a thiazide-like diuretic (indapamide). This analysis was embedded in a previously reported trial in 7 countries.2 Ethics approval was obtained in each country; all participants provided informed consent. After a 4-week single-blind run-in with low-dose triple therapy (20 mg of telmisartan, 2.5 mg of amlodipine, and 1.25 mg of indapamide), participants were randomized to triple therapy or one of its 3 dual combinations at the same doses as the triple therapy: telmisartan-indapamide (TI), telmisartan-amlodipine (TA), or amlodipine-indapamide (AI). After 6 weeks, doses were doubled unless contraindicated. The primary efficacy outcome was change in mean home systolic blood pressure (BP) from randomization to week 12, analyzed using hierarchical linear modeling with final systolic BP (SBP) as the model outcome and controlling for baseline SBP, treatment arm, and visit. Huber-White sandwich estimation and covariance matrices accounted for clustering within patient and site. The primary safety outcome was treatment withdrawal attributable to adverse events. Because the parent trial was designed to compare triple therapy with each dual therapy, dual-versus-dual comparisons should be interpreted as exploratory (Trial registration: NCT04518293). Documentation around the analyses presented here will be made available to qualified scientific and medical researchers, upon researcher’s request, as necessary for conducting legitimate research. Patient data will be deidentified and will be shared via a secure means. Requests for data will only be reviewed after approval of the product in the United States and the European Union, and after approval by George Medicines of its data access request and receipt of its executed data sharing agreement. A request form can be obtained by email to the corresponding author or to info@georgemedicines. com. After the 4-week run, 834 participants with an SBP 110 to 154 mm Hg were randomized to dual therapy, with similar baseline characteristics across groups

Predictive Performance of Cardiometabolic Indices for Metabolic Syndrome among Adults in Northern Sri Lanka

2026-01-01T00:00:00Z

Title: Predictive Performance of Cardiometabolic Indices for Metabolic Syndrome among Adults in Northern Sri Lanka Authors: Madhurahini, R.; Viveka, M.; Arasaratnam, V.; Kumanan, T. Abstract: Introduction and Objectives: Metabolic syndrome (MetS) raises cardiovascular and Type 2 diabetes risk in South Asia. Simple indices enhance early detection and risk stratification. This study assessed the predictive performance of Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI) and Cardiometabolic Index (CMI) in identifying MetS. Methods: A community-based cross-sectional study was conducted among 753 adults from rural and urban Northern Sri Lanka. Anthropometric and biochemical measurements were made using standardised procedures and cardiometabolic indices were calculated using established formulas. MetS was defined by IDF criteria. Associations were assessed using logistic regression, and predictive performance was evaluated using Receiver Operating Characteristic (ROC) curves. Results: All the cardiometabolic indices were significantly associated with MetS (p<0.001). In age- and gender-adjusted models, AIP showed the strongest association (OR = 72.58), followed by CMI (OR = 14.63), VAI (OR = 2.05), and LAP (OR = 1.08). ROC analysis demonstrated that LAP had the highest diagnostic performance (AUC = 0.904), followed by CMI (AUC = 0.833), VAI (AUC = 0.818), and AIP (AUC = 0.777). The optimal cut-off values were 32.84 cm.mmol/L for LAP (sensitivity 88.9%, specificity 78.5%), 0.615 for CMI (sensitivity 79.3%, specificity 75.2%), 1.985 for VAI (sensitivity 78.8%, specificity 74.1%), and 0.055 for AIP (sensitivity 76.4%, specificity 70.5%). Conclusion: All indices were significantly associated with MetS, though predictive performance varied. LAP showed the best performance and may be preferred for screening, while other indices can support risk assessment in a low middle income country like Sri Lanka.

Fatal foreign body aspiration in a toddler due to peanut lodgement in the right main bronchus: A case report

2026-01-01T00:00:00Z

Title: Fatal foreign body aspiration in a toddler due to peanut lodgement in the right main bronchus: A case report Authors: Sayanthan, B.; Pranavan, S. Abstract: Foreign body aspiration is a leading cause of accidental morbidity and mortality in children under 3 years of age. Organic foreign bodies such as peanuts pose a particularly high risk due to their hygroscopic nature and tendency to cause airway inflammation. We report a fatal case of delayed airway obstruction in an 18-month-old female child following peanut aspiration, initially presenting with transient choking that appeared to resolve. The child subsequently developed acute respiratory distress several hours later and died despite hospital admission. Autopsy revealed a peanut lodged in the right main bronchus with hyperinflation of the right lung. This case highlights the deceptive clinical course of foreign body aspiration, the dangers of delayed presentation and the need for heightened clinical suspicion even when initial symptoms subside.

A prospective study on ablative therapy for small renal masses (SRM) at a tertiary care centre in Sri Lanka

2026-01-01T00:00:00Z

Title: A prospective study on ablative therapy for small renal masses (SRM) at a tertiary care centre in Sri Lanka Authors: Kiritharan, K.; Sangavi, S.; Nivetha, M.; Thishanthini, V.; Neeranjali, P.; Sripandurangana, R.; Priyatharsan, K.; Varothyan, S.; Jeyanthan, B.A.D.; Mayuran, M.; Brammah, R.T.; Gowribahan, T.; Theepan, J.M.M.; Vinothika, S.; Jenil, A.A.; Balagobi, B. Abstract: Introduction: Renal cell carcinoma (RCC) is the fourteenth most common malignancy. Improved cross-sectional imaging has increasedthe identification of small renal masses (SRMs), resulting in a change in care to nephron sparing techniques such as microwave ablation (MWA). This study evaluated the patient characteristics, tumor features, and early outcomes of imageguided MWA for SRMs in a tertiary care environment in Sri Lanka Methodology: This prospective observational study was carried out in a tertiary care hospital between April 2023 and May 2024. Consecutive patients with biopsy—proven T1a SRMs (≤4 cm) who underwent curative percutaneous MWA following multidisciplinary team (MDT) evaluation, were included. Clinical, radiological, histological, and renal function data were obtained. The outcomes included technical success, complications, recurrence, and changes in renal function. Results: Twelve patients (mean age 52.1 ±13.19 years; 83.33% male) underwent MWA with a mean follow-up of 28.63 months until April 2026. Hypertension was the most common comorbidity, and 75% of lesions were incidentally detected. Clear cell RCC was the most common histological subtype (66.67%), followed by oncocytoma (16.67%). Technical success was achieved in all cases, with 83.33% required a single ablation session. Only two minor complications (16.67%) (Clavien-Dindo grades I and II) were recorded. Renal function was preserved, with no evidence of local recurrence or distant metastasis during follow-up. Conclusion: Image-guided MWA revealed great technical success, acceptable safety, and effective short-term oncological management while maintaining renal function, indicating that it is a potential nephron-sparing alternative for selected SRMs in resource-limited settings.