Trichlormethiazide

It is currently unknown whether baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, a marker of pressure-related cardiac stress, affect the efficacy and safety of esaxerenone vs trichlormethiazide. This exploratory subanalysis of the EXCITE-HT study aimed to compare the antihypertensive efficacy and safety of esaxerenone vs trichlormethiazide in Japanese patients with uncontrolled essential hypertension stratified by baseline NT-proBNP. EXCITE-HT was a randomized, open-label, parallel-group study. In this subanalysis, patients were divided into low and high NT-proBNP subgroups based on their baseline levels (<125 pg/mL and ≥125 pg/mL, respectively). The low NT-proBNP subgroup included 188 and 212 patients and the high NT-proBNP subgroup included 49 and 41 patients in the esaxerenone and trichlormethiazide groups, respectively. A significant decrease in morning home systolic/diastolic blood pressure (SBP/DBP; the primary endpoint) was observed from baseline to the end of treatment in both NT-proBNP subgroups. In the low NT-proBNP subgroup, esaxerenone was superior to trichlormethiazide in lowering SBP and non-inferior in lowering DBP. Non-inferiority could not be confirmed in the high NT-proBNP subgroup. The geometric mean urinary albumin-to-creatinine ratio significantly decreased from baseline to Week 12 in all subgroups (all P  < 0.001 vs baseline). No cases of serum potassium level ≥6.0 mEq/L were reported. These findings suggest that esaxerenone is efficacious across a wide range of baseline NT-proBNP levels, while also supporting its favorable safety profile.

All anti‐doping programmes face financial constraints and monitoring trends in medication use or abuse in a population of racehorses can be difficult and expensive. Obtaining biological samples is the primary method of anti‐doping control in individual horses or stables of horses but can be invasive and expensive. Another important practice of anti‐doping control has been the confiscation of used and filled syringes by regulators for individual forensic analysis. Pooled samples testing involves the testing of multiple individual samples together as one composite sample. This pooled sample approach has been employed to gather information concerning populations' exposure to substances and infectious agents including the analysis of samples of wastewater (a large, pooled sample) that have been used during the pandemic to monitor the presence of new COVID variants. Moreover, pooled samples of urine and wastewater have been used to monitor for recreational drug use and for the presence of new psychoactive substances in cities and large events. This approach has been credited with providing timely insight in the trends of illicit drugs use. To be effective, an anti‐doping programme should not be predictable to avoid being defeated by countermeasures; therefore, the implementation of new methods is considered essential. A new pooled sampling technique using confiscated groups of used syringes and needles including biomedical sharps containers obtained from veterinarians and other horse racing industry participants has been employed over several years in Ontario, Canada. These containers held needles used to administer substances to racehorses along with syringes and other debris. The analysis of the wash provided a timely insight of medications being administered in horses, and substances present at racetracks and training centres including substances predominantly of human use and abuse. Sharp containers confiscated from veterinarians and trainers provided insight into injectable medications administered at numerous stables and to hundreds of horses.