Superior treatment for all hypertensive patients

Hypertensive diabetic patient

Newly diagnosed patient

CAD patient

Patient with h/o stroke / TIA

• Coversyl means powerful efficacy

• Coversyl means excellent acceptability

• Coversyl means more patients achieve target BP

• Coversyl means guaranteed CV protection

• Coversyl means sustained benefits in long-term

• Coversyl means ease of up-titration

• Coversyl means guideline recommended Rx

• Coversyl means a global brand

• Coversyl means … MY BRAND (Innopharm/SBE)

Reference book update, Jan 2016

Coversyl is a superior antihypertensive

Evidence (Meta-analysis)

Establishing that Coversyl is

superior vs. …

ConfirmingCoversyl is

superior in …

Expert Review from Prof. Ferrari

Coversyl vs. ARBsHypertensive

patients

Cheng Meta-analysis

Coversyl vs. ARBsDiabeticpatients

Bangalore Meta-analysis

Coversyl vs.other ACEIs

Hypertensive patients

Meta-analysis of ACEIs vs. ARBs Expert review from Prof. Ferrari

Hypertensive patients

- Ferrari R. et.al. Expert Review Cardiovascular Therapy,2013;11(6):705-17.

• Expert review by Prof. Ferrari on the basis of the Van-Vark meta-analysis

• Meta-analysis in 1,58,998 hypertensive patients, treated with ACEIs and ARBs

• Results:

• ACEIs reduce all-cause mortality

• ACEIs reduce cardiovascular mortality

• ARBs have no effect on mortality

Only ACEIs protect hypertensive patients

ACEIs reduce all-cause mortality significantly by -10 % (p = 0.004)

ARBs have no effect on all-cause mortality

- 1% (p = NS)

ACEIs reduce CV mortality significantly by -12 % (p = 0.051)

ARBs have no effect on CV mortality

- 4% (p = NS)

- Ferrari R. et.al. Expert Review Cardiovascular Therapy,2013;11(6):705-17.

Coversyl is a superior ACEI

- Ferrari R. et.al. Expert Review Cardiovascular Therapy,2013;11(6):705-17.

Among the ACEIs, 3 “perindopril based”trials contributed significantly to give the results in favour of ACEIs

Perindopril showed a significant – 13% reduction in mortality (p < 0.001)

Perindopril showed a significant - 22% reduction in CV mortality (p < 0.001)

- Ferrari R. et.al. Expert Review Cardiovascular Therapy,2013;11(6):705-17.

Cardio Visual Aid – page 2

Coversyl provides superior cardioprotection

- Ferrari R. et.al. Expert Review Cardiovascular Therapy,2013;11(6):705-17.

Meta-analysis of ACEIs vs. ARBs in diabetic patients - Cheng Meta-analysis

• Meta-analysis in 56,444 diabetic patients (from 35 trials)

• Included trials conducted in diabetic patients, with effects of ACEIs & ARBs on all-cause mortality, cardiovascular death, major cardiovascular events and with a follow-up of at least 12 months

• Studies like ADVANCE, PERSUADE, HOPE-substudy, ROADMAP, ORIENT andPRoFESS were part of this meta-analysis

Diabetic patients

- Cheng J. et.al. JAMA Internal Medicine,2014;174(5):773-85.

- Cheng J. et.al. JAMA Internal Medicine,2014;174(5):773-85.

Only ACEIs protect diabetic patients

ACEIs reduce all-cause mortality significantly

by -13 % (p = 0.02)

ARBs have no effect on all-cause mortality,

-6% (p = NS)

ACEIs reduce major CV events significantly by

-14 % (p = 0.003)

ACEIs reduce major CV mortality significantly by

-17 % (p = 0.04)

ARBs have no effect on major CV events,

-6% (p = NS)

ARBs INCREASE THE RISK OF CV

mortality, + 21 % (p = NS)

Coversyl offers dual benefit

Increases bradykinin

Decreases angiotensin II

Coversyl offers dual benefit

- DiNicolantonio J D et al. Postgraduate Medicine, July 2013, Volume 125, Issue 4: 1941-9260 - Ferrari R. et.al. Expert Review Cardiovascular Therapy, 2013;11(6):705-17

Vasoconstriction

Adhesion of monocytes

SMC growth, proliferation & migration

PAI -1 and thrombogenesis

Free radical formation

Vasodilation

Anti-remodelling effect

eNOS expression

t – PA and fibrinolysis

Antioxidant effect

Decreases angiotensin II Increases bradykinin

“The decrease in angiotensin II levels prevents a no. of deleterious cardiovascular effects, while

the increase in bradykinin has cardioprotective consequences.”

eNOS = endothelial nitric oxide synthase, PAI- 1 = plasminogen activator inhibitor -1, SMC= smooth muscle cell, t-PA = tissue plasminogen activator

All Doctors Visual Aid – page 3

Meta-analysis on ACEIs associated cough - Bangalore Meta-analysis

• Meta-analysis in 1,98,130 patients (from 125 studies). Mainly hypertensive patients without Heart failure( 83%).

• Included trials, with at least 100 patients in the ACEI arm, 3 months follow-up & reporting incidence of cough.

• Studies like ADVANCE, EUROPA, PROGRESS for perindopril and HOPE and AIRE for ramipril were part of this meta-analysis.

Hypertensive patients

- Bangalore S. et.al. The American Journal of Medicine, 2010;123:1016-30.

Coversyl has less incidence of cough

15.5%

12.5%

11.2% 11%10.2% 10%

2.5%

0

2

4

6

8

10

12

14

16

Trandolapril Quinapril Enalapril Ramipril Captopril Lisinopril Perindopril

Incidence of cough reported in %

- Bangalore S. et.al. The American Journal of Medicine,2010;123:1016-30.

Coversyl has the least risk of cough due to less affinity for pulmonary ACE. Cough with Coversyl is not dose dependent i.e. any patient who does not cough with Coversyl 4 mg will not cough with Coversyl 8 mg.

Let’s Review

Diabetic patients

Meta-analysis of ACEIs vs. ARBs in diabetic patients

Cheng Meta-analysis

For dual benefit of blood pressure control and cardioprotection, choose Coversyl

based treatment right from the beginning

Hypertensive diabetic patient

Newly diagnosed patient

CAD patient

Patient with h/o stroke / TIA