User talk:Patelurology2


 * User Page under construction.

Hello there, welcome to the 'pedia! I hope you like the place and decide to stay. If you need pointers on how we title pages visit Naming conventions or how to format them visit our manual of style. If you have any other questions about the project then check out Help or add a question to the Village pump.


 * Requests for feedback
 * Task force/Recommendations
 * Task force/Recommendations
 * User:Patelurology2/Article Preparation page for Alumni of Rajkumar College, Rajkot
 * User:Patelurology2/The Alumni In Memoriam of The Rajkumar College, Rajkot
 * User:Patelurology2/RKC Rajkot Alumni
 * User:Patelurology2/RKCAlumni NYC-NJ 2010
 * User:Patelurology2/Expeditions of The Students and Alumni of The Rajkumar College, Rajkot
 * User:Patelurology2/College Campus Co-ordinator of The Alumni of The Rajkumar College, Rajkot
 * User:Patelurology2/Overseas Alumni Ambassadors of The Rajkumar College, Rajkot

March 27, 2009 Patelurology2 (talk) 12:42, 30 July 2009 (UTC)

Welcome
Welcome!

Hello,, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are some pages that you might find helpful: I hope you enjoy editing here and being a Wikipedian! Please sign your messages on discussion pages using four tildes ( ~ ); this will automatically insert your username and the date. If you need help, check out Questions, ask me on, or ask your question on this page and then place  before the question. Again, welcome! —C.Fred (talk) 22:09, 27 March 2009 (UTC)
 * The five pillars of Wikipedia
 * Tutorial
 * How to edit a page
 * How to write a great article
 * Manual of Style

Ext link
Hi! Yeah, after seeing more of the site I decided to post it. English external links are preferred, but in some cases non-English external links work as well. WhisperToMe (talk) 16:58, 10 June 2009 (UTC)

User:Patelurology2/Maritime history Kathiawar

 * User:Patelurology2/Maritime history Kathiawar
 * YALE UNIVERSITY "The history of Kathiawad from the earliest times [microform"]

Pronunciation
<!--- wikipedia english pronounciation of names - Search (bing.com)

ALLIMAGESVIDEOSMAPSNEWSSHOPPINGMORE16,500,000 ResultsAny timeShow filtersIncluding results for wikipedia english pronunciation of names.Do you want results only for wikipedia english pronunciation of names?Specific places CountryPlacePronunciationPronunciationRespellingIPACanadaAgassizAG-ə-see/ ˈæɡəsi /IrelandAghabulloguea-HAB-ul-ug/æˈhæbʌlʌɡ/AustraliaAlbanyAL-bə-nee/ ˈælbəni / 36 more rows ...Feb 24 2022List of irregularly spelled English names - Wikipediaen.wikipedia.org/wiki/List_of_irregularly_spelled_English_namesWas this helpful?People also askWhat is pronunciation?How do you transcribe wikipedia pronunciations?How important is pronunciation of Your Name?Is it possible to find different pronunciation of the same name?FeedbackWikipedia:Manual of Style/Pronunciation - Wikipediahttps://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/PronunciationNormally, pronunciation is given only for the subject of the article in its lead section. For foreign words and names, use the pronunciation key for the appropriate language. If a common English rendering of the foreign name exists (Venice, Nikita Khrushchev), its pronunciation, if necessary, should be indicated before the foreign …IPA StyleOther Transcription SystemsPlacementIPA Templates on WikipediaEntering IPA CharactersRelated TemplatesSee AlsoWhenever the IPA appears in an article, it should be contained within the template. This allows registered users to assign a different font to display the IPA symbols. The [brackets] should be inside the template for uniformity of the font. When using the IPA, provide an e…See more on en.wikipedia.orgList of irregularly spelled English names - Wikipediahttps://en.wikipedia.org/wiki/List_of_irregularly_spelled_English_names103 rows · This is a set of lists of English personal and place names having spellings that are ...Estimated Reading Time: 4 minsCOUNTRYPLACEPRONUNCIATION(RESPELLING)PRONUNCIATION(IPA)CanadaAgassizAG-ə-see/ ˈæɡəsi /IrelandAghabulloguea-HAB-ul-ug/æˈhæbʌlʌɡ/AustraliaAlbanyAL-bə-nee/ ˈælbəni /IrelandAthyath-EYE/æˈθaɪ/See all 103 rows on en.wikipedia.orgHow to pronounce Wikipedia in Englishhttps://dictionary.cambridge.org/us/pronunciation/english/wikipediaHow to pronounce Wikipedia. How to say Wikipedia. Listen to the audio pronunciation in the Cambridge English Dictionary. Learn more.English phonology - Wikipediahttps://en.wikipedia.org/wiki/English_phonologyOverviewLinguistic terminologySee alsoExternal linksPronunciation (Latin: prōnūntiātiō) is the way in which a word or a language is spoken. This may refer to generally agreed-upon sequences of sounds used in speaking a given word or language in a specific dialect ("correct pronunciation") or simply the way a particular individual speaks a word or language. Contested or widely mispronounced words are typically verified by the sources from which they …Wikipedia · Text under CC-BY-SA licensePronunciation - Wikipediahttps://en.wikipedia.org/wiki/PronunciationRelated searches for wikipedia english pronunciation of namespronunciation of proper names dictionaryaudio pronunciation of proper namesaudio name pronunciation dictionaryfrench name pronunciation dictionaryname pronunciation toolhear pronunciation of wordspronunciation audiopronounce words audioIncluding results for wikipedia english pronunciation of names.Do you want results only for wikipedia english pronounciation of names?12345

-->

MH370
<!--- * Special circumstances and situations may give a clue to certain parameters along the way but no assumptions be needed to use those as a given or basis to base other calculations. e.g. Examining the Tangent Path of MH370 : Brian Anderson's spherical geometric derivation of Airspeed shortly after arc2 - 370Location.org & & https://www.duncansteel.com/archives/1874 BOTH DUNCANSTEEL Deducing the Mid-Flight Speed of MH370 by Brian Anderson 2015 March 20 (Document prepared 26 December 2014) see in edit mode

The wind speed and direction for a potential southern track over this segment is about 21 knots from 65 degrees True [2]. Using this wind information, and the above ground speed of 494 knots on a track azimuth of 186 degrees, one can calculate the KTAS (True Air Speed, Knots) for the aircraft as being approximately 484 knots. ->] -http://www.mh370-caption.net/wp-content/uploads/How_Many_Straight_line_trajectories_for_MH370-v1c.pdf How many straight-line trajectories for MH370 ? CAPTIO V1.0c, 20-Apr-2021 Executive Summary This study provides positive answers to the question: from Arc2 crossing locations within the range of latitudes [15°N; 3.4°S], is it possible to determine linear trajectories taking advantage of the 3D characteristics of the so-called Inmarsat arcs modulo some small adjustments of the flight parameters? Millions of numerical estimations of such trajectories have been computed based on Arc2 latitude, track direction and speed limits using discrete sets of crossing locations at each arc. Numerous such trajectories were found within latitudes within [5.8°N; 3.4°S] fitting all of the Inmarsat constraints i.e. timing, BTOs and BFOs, as well as operational and meteorological constraints and fuel autonomy. They are statistically equivalent to each other and equally
 * Satellite BTO processing output by ground station computer with errors of <1 km-8.85 km (<0.6 mi-5.5 mi) each ping return cycle reading.
 * FLIGHT LEVEL 34000 ARC2-ARC6 DIST 2067 KNOT MILES SPEED 450 KNOTS - no need to assume Airspeed or final Path; it is to be considered autopilot set & ground speed varies with wind component which depends to the final Path set in the Autopilot-- Dear Henry, Dear Henry....-
 * FLIGHT LEVEL 40000 ARC2-ARC6 DIST 2146 KNOTMILES SPEED 485 KNOTS
 * SIN CALC LINK
 * BTO/BFO CALCULATOR
 * sighted may be linked to Flight MH370 - The Washington Post
 * FIND THE BEST SATELLITE TO PLANE PING ARC UP IN THE AIR AT FLIGHT LEVEL- no assumption of FL NEEDED
 * FIND THE BEST ESTIMATE OF RELIABLE WIND SPEED AND DIRECTION AND CALCULATE THE HEAD WIND OR TAIL WIND COMPONENT TO BE ADDED OR SUBTRACTED FROM AUTPILOT SET CONSTANT AIRSPEED THROU THE STRAIGHT SOUTHERN TRACK WITH INTERAC DISTANCES COVERED IN AN HOUR OR WHATEVER THE VALUE NEEDS TO ISED TO AGAINST THE WIND EFFECT FOR THE SAME TIME PERIOD USUALLY OR MOSTLY HOURLY. THE STRAIGHT TRACT BETWEEN THE ARCS 2 TO 6 NEEDS TO BE FRACTIONATED FOR EACH OF THE FIVE PERIOS INTO MORE OR LESS THAN 20% DISTANCE COVERED. A TRANSPERENT RULER WITH THESE FRACTIONS MARKED FROM NORTH TO SOUTH PLACED OVER THE SAME SCALED MEASURED DISTANCED IMAGE OF PROPORTIONAL ARCS.... THE MARKING ON THE RULER WITH FIT THE ARCS UNDERNEATH ONLY IN ONE DIRECTION WHICH OTHER HAVE CALCULATED AT 197 DEGREES SHOWN IN THE TABLE-- OK TO USE A87 DECREE TO GET THE WIND COMPONENT CALC USING TRIG, BUT DON'T NEED TO ASSUME 187 AT ALL AND THAT CAN BE DERIVED INTO THE WHOLE DERIVATION OF CONSTANT AIRSPEED AS WELL.

<!--- Aircraft || 1st handshake || A 'log-on request' message. Flight 370 now registered as an active terminal on Inmarsat network.
 * 02:39:52 || 18:39:52 || Ground station || – || Ground to aircraft telephone call, acknowledged by SDU, unanswered
 * 03:41:00 || 19:41:00 || Ground station || 2nd handshake || Normal handshake
 * 04:41:02 || 20:41:02 || Ground station || 3rd handshake || Normal handshake
 * 05:41:24 || 21:41:24 || Ground station || 4th handshake || Normal handshake
 * 06:41:19 || 22:41:19 || Ground station || 5th handshake || Normal handshake
 * 07:13:58 || 23:13:58 || Ground station || – || Ground to aircraft telephone call, acknowledged by SDU, unanswered
 * 08:10:58 || 00:10:58 || Ground station || 6th handshake || Normal handshake
 * 08:19:29 || 00:19:29 || Aircraft || 7th handshake|| A 'log-on request' from the aircraft, followed by an acknowledgement and four other transmissions from the ground station.
 * 08:19:37 || 00:19:37 || Aircraft || 7th handshake || 'Log-on acknowledge' message transmitted by aircraft. This is the final transmission received from Flight 370.
 * 09:15 || 01:15 || Ground station || Unsuccessful ping/handshake || Three handshake requests from the ground station, without a response from the aircraft.
 * }
 * 07:13:58 || 23:13:58 || Ground station || – || Ground to aircraft telephone call, acknowledged by SDU, unanswered
 * 08:10:58 || 00:10:58 || Ground station || 6th handshake || Normal handshake
 * 08:19:29 || 00:19:29 || Aircraft || 7th handshake|| A 'log-on request' from the aircraft, followed by an acknowledgement and four other transmissions from the ground station.
 * 08:19:37 || 00:19:37 || Aircraft || 7th handshake || 'Log-on acknowledge' message transmitted by aircraft. This is the final transmission received from Flight 370.
 * 09:15 || 01:15 || Ground station || Unsuccessful ping/handshake || Three handshake requests from the ground station, without a response from the aircraft.
 * }
 * 08:19:37 || 00:19:37 || Aircraft || 7th handshake || 'Log-on acknowledge' message transmitted by aircraft. This is the final transmission received from Flight 370.
 * 09:15 || 01:15 || Ground station || Unsuccessful ping/handshake || Three handshake requests from the ground station, without a response from the aircraft.
 * }
 * }

AF447
Thank you for posting to my talk page concerning the current discussions on the AF447 talk page. Firstly, thank you for pointing out the remark about nationalities, which indeed has no place here on Wikipedia. An apology has been presented and accepted.

Secondly concerning original research and speculation we should indeed limit ourselves to what comes from reliable sources. If I understand you correctly, we are agree that information from the BEA is our most reliable source. Thank you by the way for posting the full document in English - if you have the French version available I would be very keen to read it as it is the reference document.

I haven't had time to do much more than a cursory read of the article and the talk page, but as of 15:00 UTC the article seems to be sufficiently NPOV and factual to me. I suspect that some of the contested information has been resolved. However, if there are any points which you think may be missing, please do not hesitate to contact me on my talk page. Regards AlexandrDmitri (talk) 15:41, 4 July 2009 (UTC) Patelurology2 (talk) 18:54, 20 July 2009 (UTC) Patelurology2 (talk) 19:02, 20 July 2009 (UTC) Patelurology2 (talk) 19:15, 20 July 2009 (UTC) ms.wikipedia.org/wiki/Fail:Air_france.jpg route diagramPatelurology2 (talk) 00:33, 21 July 2009 (UTC) Patelurology2 (talk) 00:55, 21 July 2009 (UTC)
 * Different language Wikipedia pages for AF447 and respective talk pages need further study by active contributors of their respective language pages as an example of divergence and similarities in evolution of study of any subject at hand. e.g., a link for French page is noted here....French wikipedia page for AF447 ... Language is no barrier. Patelurology2 (talk) 00:53, 7 July 2009 (UTC)




 * }

VIT E



 * Interactions between tocopherols, tocotrienols and carotenoids during autoxidation of mixed palm olein and fish oil.... nutritionally interesting mixtures of palm oil and fish oils can be stabilised satisfactorily, thereby allowing simple distribution of fish oils. The more refined yellow palm olein stabilised fish oil better than did red palm

Different language Wikipedia pages for the same topic- Translation: Machine Vs Human of All Pages in All Languages

 * With respect to above in AF447 section of my talk page, the following may help understand the extent of problems and opportunities to learn from Wikipedias in other languages; Language barrier can be overcome.Topic title listed in Language barrier :

Same Topic in Different Language Wikipedia- Divergence & Similarities in Study of any Subject ..include also opportunities to learn and cross feed.


 * Different language Wikipedia pages for the same topic for e.g. the English page AF447 and the French page and respective talk pages are likely to have divergence and similarities in evolution of study of any subject at hand; ability to cross contribute the content save Language barrier needs further study by active contributors of their respective language pages.  ...Language is no barrier. Auto-translation programs can be used e.g. Bing Translator as possibly preferred for a such study for Side by Side feature of ability to view two languages, the original and machine translation to understand the gist; auto-translation is no substitute for a professional human translator.
 * Any page in any Wikipedia should have a machine auto-translation feature to help understand  atleast the gist of the article; existing links on all pages in languages are for the the original pages in those respective languages. Importance of translation of all the articles that Wikipedia has in different languages is emphasised; machine auto-translation feature on any page and talk pages in any langnguage Wikipedia would suffice and for intensive study human translators available in Wikipedias would help. Meta.Wikipedia Translation Requests. Machine auto-translation is no substitute for human translation; meaning and context are often inaccurate or lost in the former.Patelurology2 (talk) 18:27, 8 July 2009 (UTC)







TRANSLATION TEMPLATE PROGRAM FOR ANY PAGE ANY LANGUAGE--possibilties
الخطوط الجوية الفرنسية رحلة 447 Vol 447 d'Air France Let Air France 447 Air France Flight 447 Air-France-Flug 447 Air France'i lend 447 Πτήση Air France 447 Vuelo 447 de Air France Flugo Air France 447 Air Francen 447 hegaldiaren istripua fa:پرواز شماره ۴۴۷ هواپیمایی فرانسه Vol 447 Air France Voo 447 de Air France 에어프랑스 447편 Air France Penerbangan 447 Volo Air France 447 טיסה 447 של אייר פראנס Az Air France 447-es járatának katasztrófája Penerbangan 447 Air France Air France-vlucht 447 エールフランス447便墜落事故 Air France Flight 447 Katastrofa lotu Air France 447 Voo Air France 447 Zborul 447 al Air France Авиакатастрофа над Атлантическим океаном 1 июня 2009 Пад авиона Ер Франса на линији 447 (2009. године) Air France let 447 Air Francen lento 447 Air France Flight 447 แอร์ฟรานซ์ เที่ยวบินที่ 447 Air France Uçuş 447 Chuyến bay 447 của Air France wuu:法国航空447号班机 法國航空447號班機空難 Patelurology2 (talk) 03:53, 31 July 2009 (UTC) Patelurology2 (talk) 18:37, 31 July 2009 (UTC)

Taal Sprache لغة Luengache Lengua Idioma Ñe'ẽ Aru Dil Kan ভাষা Gí-giân Basa Тел (фән) Мова Мова Sprache Jezik Yezh Език (лингвистика) Llenguatge Чĕлхе Pinulongan Jazyk (lingvistika) Iaith Sprog Schprooch Sprache ބަސް Saad Keel (keeleteadus) Γλώσσα eml:Langua Lenguaje Lingvo Hizkuntza fa:زبان hif:Bhasa Mál Langage Taal Lengaç Teanga (cumarsáid) Çhengey (çhaghteraght) Cànan Linguaxe 語言 ભાષા 언어 Լեզու भाषा Jezik Linguo Pagsasao Bahasa Linguage Æвзаг Ulwimi Tungumál Linguaggio שפה Basa Oqaatsit ಭಾಷೆ ენა (მეტყველება) Yeth Тил Lugha Кыв Ndinga Lang Ziman Linguaje ພາສາ Lingua Valoda Sprooch Kalba Taol Lokótá bangu Nyelv Јазик Fiteny ഭാഷ भाषा arz:لغة mzn:Zivan Bahasa Ngṳ̄-ngiòng Taal Taol 言語 Lengua Мотт Laenghwij Språk Språk Laungue Lenga pnb:بولی Idioma ژبه Język (mowa) Linguagem Sprooch Limbă (comunicare) Chhib Lingua Rimay Язык sah:Тыл Giella Limbas Leid stq:Sproake Lingua (parràta) Language Jazyk (lingvistika) Ѩꙁꙑ́къ Jezik (sredstvo sporazumevanja) Језик Kieli Språk Wika மொழி Tel భాష ภาษา Забон (суxан) ᎦᏬᏂᎯᏍᏗ Dil (lisan) Dil Мова لسان Ngôn ngữ Pük Keeleq Lingaedje Yinaknan wuu:言话 שפראך Èdè 語言 Zıwan (lisan) zea:Taele Kalba 语言
 * List of languages from Language page

Patelurology2 (talk) 17:18, 9 October 2009 (UTC)


 * Select languages for RKC page
 * List of languages from Language page
 * Langage French
 * ભાષા Gujarati
 * भाषा Hindi
 * भाषा Marathi
 * لغة Arabic

Patelurology2 (talk) 17:38, 9 October 2009 (UTC)

Gujarat State
Patelurology2 (talk) 19:14, 4 August 2009 (UTC)
 * List of people from Gujarat

NRI-PIO : Indians Abroad
Patelurology2 (talk) 23:17, 5 August 2009 (UTC)

An exciting opportunity to get involved!
As a member of the Aviation WikiProject or one of its subprojects, you may be interested in testing your skills in the Aviation Contest! I created this contest, not to pit editor against editor, but to promote article improvement and project participation and camraderie. Hopefully you will agree with its usefulness. Sign up here, read up on the rules here, and discuss the contest here. The first round of the contest may not start until September 1st-unless a large number of editors signup and are ready to compete immediately! Since this contest is just beginning, please give feedback here, or let me know what you think on my talkpage. -  Trevor  MacInnis   contribs  03:41, 23 August 2009 (UTC)

Rajkot Schools and Colleges

 * University/Colleges


 * AV Parekh Technical Institute
 * BK Mody Government Pharmacy College
 * Government Medical College
 * Government Polytechnic
 * H and HB Kotak Institute of Science
 * Kundaliya College
 * Lukhdhirji Engeering College
 * M and N Virani Science College
 * Matushree Virbaima Mahila College
 * PD Malaviya College
 * Saurastra University
 * VVP Engineering College


 * High Schools


 * AS Chowdry High School
 * Akshar Pursotam Swaminarayan High School
 * Central School
 * GT High School
 * Kadvibai Virani Kanya Vidyalaya
 * Kendriya Vidyalaya
 * Matru Mandir
 * Mohandas Karamchand Gandhi High School
 * Rajkumar College
 * Saurastra High School
 * SN Kansagara School
 * Saint Mary's High School
 * Samji Velji Virani High School
 * Shri Lal Bahadur Shastri Vidyalaya
 * Sun Shine School
 * Swaminarayan Gurukul

Major CBSE Schools in India and abroad
Major CBSE Schools in India and abroad

RKC

 * see in edit mode

http://1.bp.blogspot.com/_SxkQ-eXyVkQ/R-EnnizzePI/AAAAAAAAAFg/DmR6xxTS2TE/s1600-h/P05.jpg current colours ? only four? Current divisions: Halar, Gohilwad, Sorath, Zalawad colours in link above might be approximate and any revision thoughts encouraged.

Current colors at Girls' school also to be described if different. Likewise Prefectorial colours and stripe system if changed needs to described; past blue Prefectorial badge system for the Principal's house ceased circa 1963-64; prefectorial badges were bright red with golden stripes.

Past Divisions Mac and Mayne: the badge colours were different in different houses with


 * MAC:  Senior bright red,  Junior darker red,  Prep dark blue
 * Mayne: Senior yellow   , Junior green,       Prep light blue

The pairs are:
 * http://en.wikipedia.org/wiki/List_of_colors:_A-M
 * http://en.wikipedia.org/wiki/List_of_colors:_N-Z


 * Macpherson – Nevett
 * Manifold – Smith
 * Woodbridge – Dart
 * Hayhoe – Wigan
 * Cuthbert – Robin
 * Krome – Butler
 * Larritt

For house table with badge colours e.g Bom Sco
 * houses           =  Blue,  Green,  Red,  Yellow

another e.g. a school

Current and Former House and Badge System:


 * For house table with badge colours

<!--- 1941

Charles R. Giles Christopher A. Windle Philipdela Farge Magande Farge Pravinsinhji Keshrisinhji (K. S. Of Miyagam) Sultan Ahmed Cassimally Manji 1942

Alimohamed Hussein Kasim Dada Asif Chandrajitsinhji Vijaysinhji (K. S. Of Bhavnagar) Hemantkumar Manilal Shah Kazimali Husseinuddin Mohamedali S. Abdul Prakramsinhji Narsinhsinhji Jhala Razali Husseinuddin Ramzanali Surendrasinhji Indrabhanusinhji Jhala (K. S. Of Dhrangadhra) Surendrasinhji Naharsinhji Rathore (K. S. Of Auwa) Vanrajsinhji Narsinhsinhji Jhala (K. S. Of Dhrangadhra) 1943

Bharatkumar Ghanshyamsinhji Gohel (K. S. Of Bhavnagar) Christopher B. Taylor Gaisford Julian Lt. Col. P. Harikrishna Chhotalal Dudhia Hasan Alibhai Zaved Hemantkumar Motibhai Patel Hussain Alibhai Zaveri Ibrahim Umar Sonawala Mohamed Khanji Saheb Khanji (K. S. Of Vajnia) Mohamedhussain Abubakar Sonawala Perviz Palanji Wadia Prithviraisinhji Ajitsinhji Gohel (K. S. Of Agiari) Robbin Charles Clarke Sajjansinhji Takhatsinhji (K. S. Of Katosan) Surendrasinhji Gajendrasinhji Chaunan (K. S. Of Chhota Udepur) Virendrasinhji Joravarsinhji Jhala (K. S. Of Wadhwan) Yusufali Alibhal Zaveri 1944

Ashifalikhan Mir Intezamalikhan (M. Of Dharana) Babi Gulam Mohmuddinkhanji Sherkhanji Dineshkumar Jaswantlal Gaisford Godfrey Lt. Co. P. Hemant Chimanlal Broker Jagdevsinhji Shivsinhji Jethwa (K. S. Of Shrinagar) James John James Laxmansinhji Bhavanisinhji Jadeja (T. S. Of Gavridad) Mahavirsinhji Keshrisinhji Jadeja (K. S. Of Jamnagar) Mazhruddin Nuruddin N. Narendrasinhji Vijaysinhji (K. S. Of Vakhatpur) Nimbekar Bon Bihari V. Paghuvirsinhji Ajitsinhji Gohel (K. S. Of Bhavnagar) Rajendrasinh Gajendrasinh Chauhan Rameshchandra Roshanlal Bajaj Rustom Nariman Green Shivralsinhji Bhojrajji Jadeja (K. S. Of Gondal) Sinclair Ian Major M. C. Surendrasinhji Naharsinhji Rathore (K. S. Of Auwa) Syed Gulammohinudit Syed Mohmed Pirzada Vakhatsinhji Ajitsinhji Gohel Vijaysinhji Ramchandrarao Chavan

1945

Adam Usman Allu Balbahadursinh Bhawanisinh Rana (K. S. Of Barwaha) Balwantsinhji Arjumsinhji Jadeja (K. S. Of Mengani) Derek James D"Eath Donald J. Spence Dushyantrao Jagdeorao Pandhare (K. S. Of Baroda) Harshadrai P. Dave Jaywatsinhji Rajsinhji Jadeja (K. S. Of Jamnagar) Mohabatsinhji Kishoresinhji Jadeja Mulrajsinhji Prakramsinhji Jadeja (K. S. Of Khirasara) Sukhdevsinhji Rajendrasinhji Jadeja Vasantkumar Dahyabhai Chudasama 1946

Bhagwansinhji Balsinhji Jadeja (K. S. Of Gondal) Girjashanker Narottamdas Ojha Harishctiandrasinhji 121haratsinhji Jadeja (K. S. Of Pal) Kiritsinhji Prithvirajsinhji Solanki (T. S. Of Mehlol) Nanawalla Ebhalwalla Wala (K. S. Of Dangavadar) Pragraisinhji Gambhirsinhji Gohei (K. S. Of Varal) Punjawala Najawala Wala (K. S. Of Manpur) Sahdevsinhji Narhardevji (M. S. Of Dharampur) Sarvani Mahommed Aminkhan Bahadurkhan (K. S. Of Junagadh) Shivrajkumar Ala Khachar (T. S. Of Jasdan) Shushikumar Prataprao Harpale Soon Siew Tan Soon Hock Tan Soon Lock Tan Suryaveerbhupati Pratapsinghji (K. S. Of Banswara) Vjkrannsinhji Jorawarsinhji Jhala (K. S. Of Wadhwan) 1947

Babi Maqbool Ahmedkhan Faizmahomedkhan Babi Mohamed Aminullahkhan Karimkhanji Babi Mohamed Bashirkhan Zabardastkhanji (K. S. Of Sultanabad) Babi Mohamed Hussainkhanji Nizam Ahmedkhanji Babi Munir Ahmedkhan Faizmahomedkhan Balwantsinhji Sahebsinhji Vaghela (T. S. Of Gangad) Barnard Daniel A. W. S. Bhartendrasinhji Chandrabhanusinhji Jhala (K. S. Of Wankaner) Dilipkumar Himatlal Chalishazar Dilipsinhji Godji Jadeja (K. S. Of Kutch) Fatehddinkhan Amiruddinkhan Malek (K. S. Of Vanod) Gambhirsinhji Takhatsinhji (K. S. Of Katosan) Harianawala Fakhruddin Abdul Husain Himmatsinhji Vijayrajji Jadeja (K. S. Of Kutch) Jorawarsinhji Jagatsinhji Jadeja (K. S. Of Sajjanpur) Kali M. Bokdawalla Kiratsinhji Prakramsinhji Jadeja (K. S. Of Khirasara) Lagdhirsinh Gumensinhji Jadeja Laxmansinhji Ratansinhji Solanki (T. S. Of Sathamba) lndravijaysinhji Shivsinhji Jadeja (K. S. Of Kotharia) Mahipatsinhji Jalamsinhji Vadher (K. S. Of Aramba) Minoo Temasp Patel Mohamed Gulamhussain Dossa Mulsinhji Ratansinhji (K. S. Of Sathamba) Narendrasingh Vishwanathsingh (K. S. Of Semlia) Parekh Mohammed Safi Ahmed Pesi M. Bokdawalla Phiroze E. Bapooji Ranjitsinh Gumensinhji Jadeja Sajjad Hussain M. Taherally Sami Framroze Wadia Sarvani Mohamed Yusuf khan Bahadurkhan Shaikh Mohamed Saeedsaheb Abdulkhaliq (K. & Of Mangrol) Shameem S. Qureshi Vijaysinhji Mansinhji Rana

--->



Articles need to be completed or added to
see all in edit mode also


 * User:Patelurology2/AIIAT2
 * User:Patelurology2/Archives1
 * User:Patelurology2/Bandstand culture (Mumbai)
 * User:Patelurology2/Digvijaysinhji Jadeja's and India's Polish Refugee Initiative
 * User:Patelurology2/DrugIP
 * User:Patelurology2/Educational excellence
 * User:Patelurology2/Excess nutrition
 * User:Patelurology2/Exercise Activity Energetic Equivalency
 * User:Patelurology2/Fatty acid composition of cooking oils
 * User:Patelurology2/Flying By The Seat--of-the-pants
 * User:Patelurology2/GLW&P
 * User:Patelurology2/HDLComplex
 * User:Patelurology2/Hormonal flux in pregnancy and post-partum
 * User:Patelurology2/IFS Sujan Chinoy
 * User:Patelurology2/Interactions and Temporal Relationships of Nutrition, Exercise, Mind, Pollution, Fitness, Health and Longevity
 * User:Patelurology2/Interactions of diet, exercise, pollution and mind on fitness,health, procreation and longevity
 * User:Patelurology2/Kolki, Rajkot district, India
 * User:Patelurology2/Malloss
 * User:Patelurology2/Medical Controversies, Conundra & Paradoxes
 * User:Patelurology2/Nocturnal paradoxical polyuria & Nocturia
 * User:Patelurology2/Nutritive values of peel and pulp of fruits and vegetables
 * User:Patelurology2/Pprbt
 * User:Patelurology2/Qxmgp
 * User:Patelurology2/Searchlight tattoo at Rajkumar College, Rajkot
 * User:Patelurology2/Toiip

Editing for beginner

 * how to of reference tag -- see in edit mode



How To use this function

Welcome to the Wikipedia Article Wizard! This wizard will help you through the process of submitting a new article to Wikipedia. There are 6 sections to step through, then you'll be taken to the editing page. As each section is completed, the next will become available. If you have questions at any point, you can go to the New Contributors' Help Page.

Hospital Box

 * Image     = University-Hospital-Cleveland.JPG
 * Caption   = Front view of Lerner Tower
 * Logo      =
 * Location  =
 * Region    = Cleveland
 * State     = Ohio
 * Country   = United States
 * HealthCare = Private
 * Type      = Academic
 * Speciality = Multispecialty
 * Affiliation= Case Western Reserve University
 * Beds      = 1032
 * Founded   = 1866
 * CEO       = Thomas F. Zenty, III
 * Employees = 25,000
 * Closed    =
 * Website   = http://www.uhhospitals.org/ University Hospitals Case Medical Center
 * Wiki-Links = List of hospitals in the United States|}}--->

Clickable E-mail Link
 mailto:shushrushahospital@yahoo.com Email links Are a good way of getting feedback from your site. To add a email link just add a 'mailto:' to the  tag, like so

Email me Which looks like this: Email me (Note email address is a made up one)

Email

LINKS AND INFO ON ACTIVE PROJECTS

 * Rahul Gajjar Digital Printmaker and Graphic Designer
 * RKCalumni
 * 1996 Felicitation by the renowned "Rajkumar College" (Rajkot) for the Publication of "Bhagavadgomandal." Gopalbhai Mohanbhai Makadia: Chairman - Pravin Prakashan Pvt. Ltd., Rajkot

🇫🇷 🇩🇪 🇬🇧
 * 3 Digit country code list for flag generation
 * WhatLinksHere/Gallery_of_sovereign-state_flags
 * List_of_sovereign_states
 * Gallery_of_sovereign-state_flags
 * Sovereign-state_flags
 * Can you name the flags of the World?
 * DIVYABHANUSINH :

http://74.6.239.67/search/cache?ei=UTF-8&p=rajkumar+college+rajkot&xa=uprzABm7eZq7LJ0KyEUzAQ--%2C1254601646&fr=yfp-t-156&SpellState=n-2419620232_q-kSXjQDvizFg4isiIUh20%2FAAAAA%40%40&u=www.utexas.edu/cola/insts/southasia/events/6190&w=rajkumar+college+rajkot&d=XhR10N29TdJA&icp=1&.intl=us&sig=Qoa7PYpwuAepBd_Qq3cDzQ--

Submitted by editor on October 1, 2009 - 12:07 http://www.webnewswire.com/node/467291 The writer, Hanif Haji Majid Salat was born on 24th January 1953 in Saurashtra ... and very strict atmosphere of a public school, Rajkumar College of Rajkot. ... www.explore-quran.com/intro_hanif salat.htm http://www.explore-quran.com/intro_hanif%20salat.htm*
 * RKC Taking Gandhi's message to France on 2nd October
 * INTRODUCTION OF THE WRITER Dr. U. M. Farooqui
 * HNCEP organization lead by Mr. Lavkumar Khachar http://himalayanhikes.com/aboutus.html
 * XSEED is a complete education solution designed to transform classroom teaching.

--->
 * text here use for blue large quote marks
 * text here use for blue large quote marks

Hospital
Shushrusha Citizens' Co-operative Hospitalis located in Shivaji Park, Mumbai. Shushrusha stands tall to be the first in Asia for Hospital Co-operative initiative; Doctors' Co-operatives are long standing. The contribution of Mission, Voluntary, Government and Private Hospitals, is well recognised.


 * The term Shushrusha (lit. "desire to hear") covers a range of meanings from:


 * The devotee's homage to god, or the obsequious service of a being.
 * Attentive in an ingratiating or servile manner.
 * Characterized by or showing servile complaisance or deference.
 * Servilely compliant or deferential: obsequious in service.
 * Obedient; dutiful.
 * Showing too great a willingness to serve

Vision of Shushrusha
Shushrusha was founded in 1966 by the late Dr. V.S. Ranadive with the objective of providing excellent healthcare facilities at an affordable price. The late Prime Minister Mrs. Indira Gandhi inaugurated the hospital in 1969. From a humble beginning, the hospital grew into a full-fledged Medical Institute.

In 1971, shortly after, Dr Ranadive passed away, hospital entered a phase of slackening of patient flow; Dr Nandu S Laud, MS (Ortho), the current Chairman, gradually rejuvenated; fund raising and expansion of member base was exemplary. Since then, the hospital had not looked back.

The vision statement of this hospital is eloquently resonating in the following Sanskrit shloka:

rugnaanaam vyaadhinashaaya, kshipranchaarogya hethave, shushrusha shushruta bhuyath, swaya nishkaama sevayaa

This vision translated into English becomes:

“To free all patients of all the ailments”

The mission statement of the hospital is:

“Carry On the work initiated by the great surgeon Shushruta”

Service Above, Beyond, Before Self

Check everything in every patient in the hope of finding nothing wrong

Shushrusha's Doctors, Learn the Whole, so that they Can Detect the Defective "Part"

Foundation and Progress : Co-operative Initiative
Health care today is beyond the reach of citizenry, especially lower income group. Family income of 10% is spent on emergency health care and old age problems. The emergency and specialty care is well beyond the reach of an average citizen. The awareness to create financial capability is shockingly lacking.

Shushrusha Citizens’ Co-operative Hospital is a unique experiment offering total health care, including super-specialty care at affordable cost based on the principle of health care as a right without exploitation with self participation; health care governed by four A's fulfilling the objective of the National Human Rights Commission Recommendation is principleCentral.

.......... Accessible, Available on Demand, Affordable and Accountable.

The members of the Co-operative society, run the hospital for the people. Management involves participation of competent medical administrative experts and emplyees. This is the essence of co-operative movement in its true sense in providing medical care.

The hospital has grown progressively form 80 bed to 130 with an ICU with 17 beds and modern state-of-the-art technology throughout the facility.

Latest diagnostic facilities such as imaging equipments e.g. Ultrasound with Doppler, Ventilators for critical care, Operating Microscopes, Dialysis Unit, Blood Gas Analysers, Cardiac Monitoring equipments, EEG/EMG and ancillary aids complement the facility.

Specialized operations for spinal injuries and brain tumours, lungs, intestine, breast, speciality surgical treatment for Cancer, Trauma, Sport injuries, Joint replacement, Micro-surgeries of limb Reimplants and Reconstruction, are all available at reasonable cost. Coronary Angiography, Interventional Cardiology and Cardiac surgery amongst other facilities are on the horizon.

The hospital provides the community service by conducting free camps in the field of Ophthalmology, Cardiology, Skin, Paediatric, Cancer Detection etc. and specialised camp for the deaf, mute and the mentally challenged.

The hospital caters to the health and medical care of all citizens. Care is concessional for members upto 50% in all the services, free medical check-up for senior citizens, subsidy is also available to spouse and children upto two and members enjoy fixed rates for operations of all specialities.

Encouraged by this successful experiment at Shivaji Park, Dadar, Mumbai, the Management has decided to extend this experiment to one of the busy suburbs of Mumbai, Vikhroli, with replication of the model.

Medical tourism is being investigated. Shushrusha Citizens’ Co-operative Hospital is registered with all existing TPAs and Insurance Companies. ISO Certification is in the works. The hospital proposes to attract people from abroad, who would find it much less expensive to have the medical care, combined with tourism, and return fully cured healthy as true Ambassadors. Shushrusha prpoposes to extend in-patient and domiciliary cover and treatment to elderly parents of Indians diaspora abroad.

Co-Operative Concept and Organization
About the Membership: The unique aspect of this hospital is that this is the only hospital in Mumbai, and probably the first in India, which falls under the cooperative sector. This experiment was necessitated by the fact that private medical facilities charge exorbitantly for services rendered and the public hospitals lack hygiene and they are badly managed. In such a situation, this hospital envisages providing “The Third Force” – institutions where the health of the patient is more important than financial resources.

To avail of the services of this hospital, citizens have to first become members of the cooperative society which runs this hospital. Membership is open to citizens of Greater Mumbai and Thane Districts. A person who is legally competent to contract can become a member by paying a non-refundable amount of Rs 1000 towards the Shareholders’ fund (one time) plus an entrance fee of Rs 5. No dividend or bonus is payable on the amount paid. This membership is transferable to another person, voluntarily, after a period of two years or, automatically and irrespective of minimum holding period, to an heir/nominee of the member upon the death of member.

The cooperative society is governed by a Board of Directors comprising of 25 members elected by the members of the society every 5 years. Even an institution, firm, or body may become a member (as an institutional member) of this hospital by paying Rs 200,000.

Medical Facilities

 * Imaging Centre
 * CT Scan Centre
 * Ultrasound Sonography, 2-D Echo and Cardiology Department
 * Ophthalmology
 * Operation Theatre
 * Pathology Department and Blood Bank (24hrs.)
 * Artificial Kidney Dialysis
 * Intensive Care Unit
 * General Ward
 * OPD Schedule & List of Specialists

Medical Services
1. Operation Theatre Complex - With Laminar Air Flow System; three Operation Theaters.

2. Intensive Care Unit - Equipped with 16 Philips Monitors, 13 Ventilators, 21 Pulse-Oximeters, 2 Defibrillators, 1 Bi- pap, and 12 Syringe Pumps. 17 Beds. E.C.G. / Cardio Pulmonary Function Laboratory / Stress Test

3. Neonatal Intensive Care Unit - With Ventilators, Warmer & Photo Therapy Units

4. Artificial Kidney Dialysis - With 6 dialysis machines

5. Emergency Medical Service Department - With Transport Ventilators Defibrillators & other Life Support Systems

6. Out Patient Department - With 15 well equipped consulting rooms for various disciplines

7. Blood Bank - 24 hours open. Blood Component Therapy also available.

8. Optometry Department

9. Audiometry & Speech Therapy

10. Physiotherapy Department - With al electrical and exercise modality

11. Diet Department - With 2 full time dieticians.

12. Pathology - 24 hours Open

13. Radiology Department - Digital X- Ray Machine, Multislice CT Scan, Ultra Sonography

14. Neurology - EEG/ EMG/ ENG

15. Pediatric Ward

16. General Ward

17. Deluxe Ward - A/C & Non A/C categories, Three-in-One, Two-in-One & Single Rooms. - All rooms equipped with Intercom, Telephone, Color TV, and attached Toilet, Round-the-clock hot water.

18. Online computerization

19. Patient friendly services

Additional Services for the Community: Shushrusha Hospital regularly conducts workshops, day care centres and camps for the public, such as eye camps, disaster management workships, camps for diabetics, etc.

Community Services

 * Traditionally, regular camps under Community Services to render medical aid to the poor and needy patients are held. Following Camps were organized and have received overwhelming response from the citizens.


 * Community Welfare Camps held in various fields with free care.


 * Cataract Detection and surgery Camp.
 * Diabetic Camp.
 * Healthy Baby Competition.
 * Day Care Centre for senior citizens at Damnodar hall, Parel.
 * Disaster Management at Kirti College.
 * Cuts and Burns in the Kitchen at Kohinoor College of Catering.
 * Dr. V. S. Ranadive Memorial Eye, Skin and Paediatric Check-up Camp at Hopital.


 * Smile Train Project, in association with New York Chapter. Cleft Lip, Cleft Palate and related deformities conducted free of cost to all the patients admitted. During the year 161 operations free of cost in all respects have been performed.  Patient’s relatives coming from tribal areas have also been served free food during their stay at the hospital.  Opinion of the hospital is a jewel in the crown.  The outlook of the children was transformed; Institution will be remembered forever.


 * Blood Donation Camps are conducted to meet demand. Shushrusha Blood Bank Registry, a voluntary donor endeavor is being developed as per new FDA rules. This registration would help the family to procure blood at a short notice, as a right, without hassles. It would also help the community by affording blood and blood substitutes during disaster and natural calamities.


 * Socially Responsibility Activities: Efforts to reach out to street children to provide subsidized care by Social Service department. Likewise, other groups needing help are being identified.


 * Neuro Rehabilitation Clinic for the patients with Parkinsons Disease and other Movement Disorders is able to reach the needs of the community.


 * Free consultation and information on Cancer are provided in association with V Care and Intas Bio-pharmaceutical Limited.


 * Meetings to offer guidance and help to senior citizens have been regularly held at our hospital in association with the Shivaji Park Police Station and Health Department of Municipal Corporation.


 * Swaasthya, the monthly health magazine, has gained popularity. The magazine is as much a product of the members' feedback as the topics written by medical staff. Here, the dictum of education is a two way street applies; health professionals learn also from the patients. Continuing Education of health Professionals follows matra of Knowing the Whole, so that defective 'part' can be detected; the core competency is emphasized for health professional education.
 * Participated in “Wealth of Health” Exhibition held under the auspices of Loksatta and Vama Events at Ravindra Natya Mandir.

Medical and health Education and Research
Participation in Medical and Health Education and Research :


 * Poster: "Role of omega-3 fat in Women's Health"
 * Co-chair, Rekha Bhatkhande, the head of the MSSI pilot project “ MS Society of India on UK team visit
 * Rare presentation of leucocytosis, Bhave AA, Rao RG, Patil GT, J Assoc Physicians India. 2006 Nov;54:881-2.
 * Ketogenic Diet in Indian Children with Uncontrolled Epilepsy
 * The Hip Masters Course 24-30 Dec’06: Shushrusha's Faculty N. S. Laud and S. Gawhale
 * Pituitary metastases in carcinoma breast
 * Breast-Feeding and Risk for Childhood Obesity
 * ICU registrar,Vivek Desai, Shushrusha Hospital, Mumbai to Hospmac Hospital Consultancy
 * Prevalence of Nonalcoholic Fatty Liver Disease and Its Association With Cardiovascular Disease Among Type 2 Diabetic Patients, Targher et al. and Hu et al. Ctritc: M Talim, Shushrusha Hospital
 * Balance between n-3 and n-6 fatty acids in foods: M Talim
 * Proper eating habits, Rekha Bhatkhande, GI
 * Women for Good Governance Conference Presentation: Women's Health Topics: Rekha Bhatkhande
 * Probing issues: Awkward pause: Constipation, Rekha Bhatkhande, GI
 * Gastric mucormycosis: AG Shahapure, RV Patankar, Rekha Bhatkhande, Indian J gastroenterology :2002

Hospital Day is celebrated on 20th of May.

CW
|- | style="padding: 0; border: none;" | |}  -->

Metabolic syndrome, hypertension, dementia, drug therapy, interactions, side effects, pathophysiology
User:Patelurology2/Metabolic syndrome, hypertension, dementia, drug therapy, interactions, side effects, pathophysiology
 * |The Medications That Change Who We Are (msn.com)

Formation of Beta Amyloid
Aβ is formed after sequential cleavage of the amyloid precursor protein, a transmembrane glycoprotein of undetermined function. APP can be processed by α-, β- and γ-secretases; Aβ protein is generated by successive action of the β and γ secretases. The γ secretase, which produces the C-terminal end of the Aβ peptide, cleaves within the transmembrane region of APP and can generate a number of isoforms of 39-43 amino acid residues in length. The most common isoforms are Aβ40 and Aβ42; the shorter form is typically produced by cleavage that occurs in the endoplasmic reticulum, while the longer form is produced by cleavage in the trans-Golgi network. The Aβ40 form is the more common of the two, but Aβ42 is the more fibrillogenic and is thus associated with disease states. Mutations in APP associated with early-onset Alzheimer's have been noted to increase the relative production of Aβ42, and thus one suggested avenue of Alzheimer's therapy involves modulating the activity of β and γ secretases to produce mainly Aβ40.

disease: progress, problems and perspectives
 * Clearance of amyloid-beta in Alzheimer’s
 * study also raises some concerns about therapeutic efforts to block or reverse the formation of Aβ fibrils. The risk/benefit ratio of this approach might critically depend on the extent to which it also diminishes the pool of pathogenic Aβ oligomers. Within the obvious constraints of mouse-to-human extrapolations, our data caution against any strategies that decrease Aβ fibrils at the cost of augmenting pathogenic Aβ oligomers. They also raise the possibility that promoting fibril formation in ways that bypass oligomer formation or rapidly sequester oligomers into more inert fibrils might be of therapeutic benefit. Additional studies are needed to further test these hypotheses.


 * Brain tissue has ACE enzyme, which takes part in local RAS and converts Aβ42 (which aggregates into plaques) to Aβ40 (which is thought to be less toxic) forms of beta amyloid. The latter is predominantly a function of N domain portion on the ACE enzyme. ACE inhibitors that cross the blood–brain barrier and have preferentially selected N-terminal activity may therefore cause accumulation of Aβ42 and progression of dementia.

Metabolism & Transport of β Amyloid fragments
Potential Role of Endogenous and Exogenous Ab Binding Molecules in Ab Clearance and Metabolism
 * Study indicates that intrasynaptic (o = Oligomeric ) oAβ42, but not oAβ40, acutely inhibits transmission at the squid giant synapse. This inhibition is molecularly tied to a cascade of events involving CK2 activation and the rapid clathrin-independent endocytosis pathway. The reduction of FAT induced by oAβ42 showed in the accompanying article, in combination with our results showing a dramatic acute inhibition of synaptic transmission after intrasynaptic injection of oAβ42, represent novel findings concerning AD synaptic failure now clearly associated with a reduction of synaptic vesicle pools and transmitter release.
 * Synaptic transmission block by presynaptic injection of oligomeric amyloid beta - oAβ42, but not oAβ40 or extracellular oAβ42
 * Effective therapeutic intervention in progressive neurological disorders depends on a clear understanding of the molecular mechanisms associated with the disease in question. In this manuscript we have shown that dysregulation of CK2 by oAβ is capable of inhibiting the vital neuronal process of FAT. Therefore, we propose that pharmacological regulation of CK2 activity represents a promising target for therapeutic intervention in AD, particularly when combined with treatments that help manage GSK3 activity as well.Disruption of fast axonal transport is a pathogenic mechanism for intraneuronal amyloid beta
 * Amyloid plaque is dynamic reservoir of toxicity reverting to toxic species: amyloid plaques, although apparently biologically inert, should not be considered as inert remnants of the aggregation process, as the amyloid fibrils they contain can, under certain conditions, be rapidly reverted to toxic species. In that sense, the amyloid plaques should rather be considered as reservoirs of toxicity.


 * Clearance of amyloid-beta in Alzheimer’s disease: progress, problems and perspectives

ACE Inhibitors

 * Angiotensin-converting Enzyme Degrades Alzheimer Amyloid β-Peptide (Aβ); Retards Aβ Aggregation, Deposition, Fibril Formation; and Inhibits Cytotoxicity

Examples=

ACE inhibitors can be divided into three groups based on their molecular structure:

Sulfhydryl-containing agents

 * Captopril (trade name Capoten), the first ACE inhibitor
 * Zofenopril

Dicarboxylate-containing agents
This is the largest group, including:


 * Enalapril (Vasotec/Renitec)
 * Ramipril (Altace/Tritace/Ramace/Ramiwin)
 * Quinapril (Accupril)
 * Perindopril (Coversyl/Aceon)
 * Lisinopril (Lisodur/Lopril/Novatec/Prinivil/Zestril)
 * Benazepril (Lotensin)

Phosphonate-containing agents

 * Fosinopril (Monopril) is the only member of this group

LIPOPHILIC vs hydrophilic

 * Inhibition of brain angiotensin-converting enzyme by peripheral administration of trandolapril ( lipophillic ) versus lisinopril ( hydrophilic ) in Wistar rats


 * captopril, fosinopril, lisinopril, perindopril, ramipril, and trandolapril were classified as crossing the blood-brain barrier (centrally active), while benazepril, enalapril, moexipril, and quinapril were classified as not (noncentrally active).


 * need to consider lipophilicity, BBB crossing and lipophilicity driven widespread effects in brain vs limited say in Amyloid, C & N domain ratio in relation to Amyloid degradation

Naturally occurring
Casokinins and lactokinins are breakdown products of casein and whey that occur naturally after ingestion of milk products, especially cultured milk. Their role in blood pressure control is uncertain. The tripeptides Val-Pro-Pro and Ile-Pro-Pro produced by the probiotic Lactobacillus helveticus have been shown to have ACE-inhibiting and antihypertensive functions.
 * Hypotensive Peptides from Milk Proteins
 * Hypotensive Peptides from Milk Proteins

Blood Brain Barrier, ACE & ACE Inhibitors, Dementia
Further, functionally can be grouped according to ability to cross Blood Brain Barrier- implication currently being studied for ability to affect dementia. List:

BBB Crossing ACE
 * Lisinopril
 * Perindropril
 * Ramipril
 * Trandolapril
 * Captopril
 * Fosinopril

BBB Non Crossing ACE
 * Benzapril
 * Enalapril
 * Moexipril
 * Imidapril

Other Antihypertensives, and even all ACE Inhibitors, possibly indirectly via RAAS feedback some of the effects on dementia and related complex - Construct: deemntia and BP dynamics and possibly incorporating known circadian rythm affecting Beta amyloid.

Centrally Active ACE Inhibitors Trandolapril Zofenopril Non-Centrally Active ACE Inhibitors
 * Captopril
 * Fosinopril
 * Lisinopril
 * Perindopril


 * Benazepril
 * Enalapril
 * Moexepril
 * Quinapril
 * Ramipril

Note: Finer meaning of difference in above two categories... coming.

Choosing an ACE Inhibitor
2019: Now the factor needing to be addressed for choice to prevent decrease dementia-- mainly addressing Amyloid construct and again mainly concentrating effort on the clearance of amyloid; the formation and all and other non ACE factors will be dealt with separately: a question is posed a priori ... Is ACE inducible or affectable by non-Ace inhibitors?
 * C and N domain differentials of all clinically used ACE- Lisinopril may be better than Captopril as detailed a decade ago below in this page


 * The slot at the site of action.. how the ACE inhibitor fits in the slot matters


 * BBB Crossing ACE Inhibitors are the subjects under this construct-- Lipophillic vs hydrophillic... is a continuum. Question a Priori now secundum... Lowering the BP by any means activates RAAS putting it on high including ACE at least at renal level...? Does that ACE or the brain ACE gets affected -- a la is that like induction of even central ACE? -- NEEDS THINKING CAP! At least ARB inhibitors are effective at decreasing bad effects of amyloid complex.

ACE inhibitors can be divided into three groups based on their molecular structure:
 * sulfhydryl containing converting enzyme inhibitor captopril increased vasodilator prostaglandin production (PGE2-metabolite) both acutely and chronically. This increase in PGE2-metabolite was not seen with the non-sulfhydryl converting enzyme inhibitor, enalapr

Sulfhydryl-containing agents

 * Captopril (trade name Capoten), the first ACE inhibitor
 * Zofenopril

Dicarboxylate-containing agents
This is the largest group, including:
 * Enalapril (Vasotec/Renitec)
 * Ramipril (Altace/Prilace/Ramace/Ramiwin/Triatec/Tritace)
 * Quinapril (Accupril)
 * Perindopril (Coversyl/Aceon)
 * Lisinopril (Listril/Lopril/Novatec/Prinivil/Zestril)
 * Benazepril (Lotensin)
 * Imidapril (Tanatril)
 * Zofenopril (Zofecard)
 * Trandolapril (Mavik/Odrik/Gopten)

Phosphonate-containing agents

 * Fosinopril (Fositen/Monopril) is the only member of this group

Naturally occurring
Several ACE inhibitors are on the market. Here is a list of some by generic name followed by brand name(s).
 * Perindopril improved learning and memory in AD rats, which correlated with decreased ACE activity and delayed AD
 * Conclusions ACE activity increased in the brains of AD rats. Perindopril improved learning and memory in AD rats, which correlated with decreased ACE activity and delayed AD pathogenesis
 * benazepril (Lotensin)
 * captopril (Capoten)
 * enalapril (Lexxel, Vaseretic, Vasotec)
 * fosinopril (Monopril)
 * lisinopril (Prinivil, Prinzide, Zestoretic, Zestril)
 * moexipril (Univasc)
 * quinapril (Accupril)
 * ramipril (Altace)
 * trandolapril (Mavik, Tarka)


 * .Even hydrophilic ACE inhibitors can result in marked inhibition of brain ACE inside the BBB but that different brain structures show variable inhibition
 * Perindopril improved learning and memory in AD rats, which correlated with decreased ACE activity and delayed AD
 * Conclusions ACE activity increased in the brains of AD rats. Perindopril improved learning and memory in AD rats, which correlated with decreased ACE activity and delayed AD pathogenesis


 * BBB crossing ACE inhibitors/Centrally active ACE inhibitors include
 * captopril (Capoten, Bristol-Myers Squibb)
 * fosinopril (Monopril, Bristol-Myers Squibb)
 * ramipril (Altace, King Pharmaceuticals)
 * trandolapril (Mavik, Abbott Laboratories, Tarka)
 * lisinopril (Prinivil, Prinzide, Zestoretic, Zestril)
 * Perindropril


 * BBB Non Crossing/ Non–centrally active ACE inhibitors include
 * benazepril (Lotensin, Novartis Pharmaceuticals)
 * enalapril (Vasotec, Merck ,Lexxel )
 * moexipril (Univasc, Schwarz Pharma)
 * quinapril (Accupril, Pfizer)
 * Imidapril

Beneficial Role of Centrally Acting ACE Inhibitors in Congestive Heart Failure

 * Benefical Role of Centrally Acting ACE Inhibitors in Congestive Heart Failure
 * Critically important contribution of the brain renin-angiotensin system to the pathophysiology of congestive heart failure.


 * ALDO of adrenal origin enters the hypothalamus in direct proportion to plasma levels and suggest that ALDO contributes to the upregulation of hypothalamic RAS activity and sympathetic drive in heart failure.
 * Sympathetic neuronal regulation of the heart in aging and heart failure Sympathetic nervous system in the failing heart and the healthy, aging heart, and consider whether the sympathetic activation accompanying aging may, perhaps, underlie and contribute to the neural pathophysiology of heart failure.... conclusion, on balance, that this proposition is not supported by the available evidence.

Dynamics & Flux Between Amyloid β fragments Beta amyloid & Blood Pressure & Autonomous System-  Dementia as a Case Study

 * Brain tissue has ACE enzyme, which takes part in local RAS and converts Aβ42 (which aggregates into plaques) to Aβ40 (which is thought to be less toxic) forms of beta amyloid. The latter is predominantly a function of N domain portion on the ACE enzyme. ACE inhibitors that cross the blood–brain barrier and have preferentially selected N-terminal activity may therefore cause accumulation of Aβ42 and progression of dementia.


 * study also raises some concerns about therapeutic efforts to block or reverse the formation of Aβ fibrils. The risk/benefit ratio of this approach might critically depend on the extent to which it also diminishes the pool of pathogenic Aβ oligomers. Within the obvious constraints of mouse-to-human extrapolations, our data caution against any strategies that decrease Aβ fibrils at the cost of augmenting pathogenic Aβ oligomers. They also raise the possibility that promoting fibril formation in ways that bypass oligomer formation or rapidly sequester oligomers into more inert fibrils might be of therapeutic benefit. Additional studies are needed to further test these hypotheses

<!--- 	  Unifying hypothesis Top Abstract Do diuretics have a... Diuretics in combination therapy Beta-blockers Calcium antagonists Angiotensin II receptor blockers... Angiotensin-converting enzyme... Unifying hypothesis Experimental evidence Conclusions References Our brief review seems to indicate that even though they lower BP to a similar extent, not all antihypertensive drug classes are equal in their cerebroprotective effect. This seems to hold true in hypertensive patients with a low incidence of coronary artery disease, such as in CAPPP, PATS, and PROGRESS. Specifically, diuretics, calcium antagonists, and ARBs, which increase angiotensin II formation (by stimulating renin secretion through sodium depletion [32], sympathetic activation [33,34], or blunting of the negative feedback [32], respectively) seem to have an edge over ACE inhibitors and beta-blockers, which decrease angiotensin II formation. The contrast between these drug classes that have an opposite effect on angiotensin II formation seems to be particularly important in low-renin populations, such as in hypertensive African Americans (32), in whom in ALLHAT (11,13) the stroke risk with lisinopril was 40% higher than that with chlorthalidone, which is unlikely to be related to the 4-mm Hg difference in SBP. In their hypothesis, Brown and Brown (1) suggested that the vasoconstrictive effect of angiotensin II in the proximal cerebral arteries could prevent Charcot-Bouchard aneurysms from rupturing. However, this AT1 receptor-mediated vasoconstrictive effect could only explain prevention of hemorrhagic but not ischemic strokes. To explain the reduction in ischemic strokes, which are far more prevalent, we further postulate that activation of the AT2 receptors by drugs that generate elevated levels of angiotensin II facilitates the recruitment of collateral vessels and increases neuronal resistance to anoxia. Conclusions Top Abstract Do diuretics have a... Diuretics in combination therapy Beta-blockers Calcium antagonists Angiotensin II receptor blockers... Angiotensin-converting enzyme... Unifying hypothesis Experimental evidence Conclusions References Recent trials have documented better stroke protection with diuretics, calcium antagonists, and ARBs compared with ACE inhibitors and beta-blockers. Clinical and experimental observations support the concept that this reduction of strokes may be mediated by AT2 receptors in small cerebral arteries. For any given fall in arterial pressure, drugs that activate these receptors have been shown to be more beneficial than drugs that are devoid of such activation (at least in patients with a low incidence of cardiac complications). As with all hypotheses, the Emmenthal cheese principle applies—it looks good, it smells good, it tastes good, but it has large holes! However, stroke is the most devastating consequence of hypertensive cardiovascular disease, and its prevention is the foremost goal of antihypertensive therapy. Our hypothesis of cerebroprotection by AT2 receptor activation should be thoroughly tested by a head-to-head comparison of an ARB and an ACE inhibitor in a patient population at high risk of cerebrovascular disease.

--->

<!--- Angiotensin II Receptor Blocker (ARB)

Click here for why I feel that Micardis® (telmisartan) should be the first line treatment for hypertension.

Related Topics:

Hypertension / pulse pressure / hardening of the arteries / angiotensin II receptor blockers (ARBs) / ace inhibitors / alpha blockers / calcium channel blockers / diuretics / beta blockers / Renin Inhibitors / Vanlev (omapatrilat) / aldosterone blockers / dihydropyridine (DHP) calcium antagonist / first line treatment for hypertension

Popular ARBs:

Cozaar® (losartan) / Diovan® (valsartan) Avapro® (irbesartan) / Atacand® (candesartan) / Micardis® (telmisartan) / Benicar (olmesartan)

News & Research:

Angiotensin-II Receptor Antagonists: Their Place in Therapy - American Academy of Family Physicians Neuroendocrine characterization and anorexigenic effects of telmisartan in diet- and glitazone-induced weight gain - Metabolism. 2009 Sep 28 - "Telmisartan prevents weight gain and decreases food intake in models of obesity and in glitazone-treated rodents" - Note: That might be another reason for using telmisartan as a first line treatment for hypertension. Valsartan Reduces Morbidity And Mortality In Japanese Patients With High Risk Hypertension: Results From The KYOTO HEART Study - Science Daily, 9/1/09 Cognitive Deficit in Amyloid-{beta}-Injected Mice Was Improved by Pretreatment With a Low Dose of Telmisartan Partly Because of Peroxisome Proliferator-Activated Receptor-{gamma} Activation - Hypertension. 2009 Jul 27 - "Taken together, our findings suggest that even a low dose of telmisartan had a preventive effect on cognitive decline in an Alzheimer disease mouse model, partly because of PPAR-gamma activation" Achieving blood pressure goals: should angiotensin II receptor blockers become first-line treatment in hypertension? - J Hypertens. 2009 Jul;27 Suppl 5:S9-14 - "Recently, the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study established that telmisartan reduces morbidity and mortality in a broad cross-section of patients at high risk for heart and vascular events, to an extent similar to that of the angiotensin-converting enzyme inhibitor ramipril. In addition, ONTARGET demonstrated that telmisartan is somewhat better tolerated than ramipril. Attributes such as effective blood pressure lowering, tolerability and convincing outcomes data mean that ARBs satisfy the requirements for first-line antihypertensive agents" Effects of angiotensin II receptor blockers on diabetic nephropathy - J Hypertens. 2009 Jul;27 Suppl 5:S15-21 - "Key beneficial effects of ARBs and ACE inhibitors throughout the kidney disease continuum are primarily explained by blood pressure lowering effects and partially by their direct blockade of angiotensin II. Recent studies have shown that telmisartan, an ARB with high lipophilicity and the longest half-life compared with other ARBs, provides benefits on markers of cardiovascular risk, that is, microalbuminuria and slowing of early-stage nephropathy" Clinical evidence from ONTARGET: the value of an angiotensin II receptor blocker and an angiotensin-converting enzyme inhibitor - J Hypertens. 2009 Jul;27 Suppl 5:S23-9 - "Telmisartan was better tolerated than ramipril in this high-risk population: notably, the incidence of cough and angioedema was significantly lower with telmisartan alone. Thus, telmisartan provides comparable efficacy to ramipril with less adverse events, which may encourage patient compliance" Liver Disease 'Shrunk' By Blood-pressure Drug - Science Daily, 6/2/09 - "analysed a small clinical trial of losartan, a drug normally prescribed for hypertension, on 14 patients in Spain, who had Hepatitis C ... Half of the patients in the trial saw the scars in their liver shrink allowing the organ to repair itself ... Researchers believe that the drug blocks the signalling pathway so that the liver myofibroblasts die, removing the source of scar tissue. As the scar tissue breaks up, the damaged area of the liver is repaired by the body" Breast Cancer Gene Can Be Blocked By Blood Pressure Drug - Science Daily, 6/1/09 - "The gene, called AGTR1, caused normal breast cells to behave like cancer cells. This behavior was reversed by treatment with the blood pressure drug losartan. Tumors in mice that expressed AGTR1 shrunk by 30 percent eight weeks after treatment with losartan" Telmisartan Increases the Permeability of Endothelial Cells through Zonula Occludens-1 - Biol Pharm Bull. 2009 Mar;32(3):416-20 - "telmisartan but not valsartan downregulated ZO-1 mRNA and protein levels, disrupted the distribution of ZO-1 in cultured endothelial cells, and increased the permeability of endothelial cells in a dose-dependent manner ... telmisartan disrupts the continuous pericellular distribution of ZO-1, downregulates the expression of ZO-1 in endothelial cells, and increases the permeability of endothelial cells at least partly through PI3K and the peroxisome proliferator-activated receptor gamma-dependent pathway" Antihypertensive efficacy of telmisartan vs ramipril over the 24-h dosing period, including the critical early morning hours: a pooled analysis of the PRISMA I and II randomized trials - J Hum Hypertens. 2009 Feb 19 - "The adjusted mean treatment differences in the last 6-h mean ambulatory SBP/DBP were -5.8/-4.2 mm Hg after 8 weeks and -4.1/-3.0 mm Hg after 14 weeks, in favour of telmisartan (P<0.0001 for all four comparisons). Secondary end point results, including the mean 24-h ambulatory BP monitoring, day- and night-time BP and 24-h BP load, also significantly favoured telmisartan (P<0.0001). Both treatments were well tolerated; adverse events, including cough, were less common with telmisartan. These findings suggest that telmisartan is more effective than ramipril throughout the 24-h period and during the EMBPS; this may be attributable to telmisartan's long duration of effect, which is sustained throughout the 24-h dosing period" - Click here for why I feel telmisartan should be a first line treatment for hypertension. See telmisartan at OffshoreRX.com. Telmisartan induces proliferation of human endothelial progenitor cells via PPARgamma-dependent PI3K/Akt pathway - Atherosclerosis. 2008 Dec 31 - "since endothelial progenitor cells (EPCs) are thought to play a critical role in ischemic diseases, we investigated effects of telmisartan on proliferation of EPCs ... These findings suggest that telmisartan might contribute to endothelial integrity and vasculogenesis in ischemic regions by increasing numbers of EPCs" Hypertension Drug Dramatically Reduces Proteinuria In Kidney Disease Patients - Science Daily, 2/22/09 - "patients taking 128 mg of candesartan experienced more than a 33% reduction in proteinuria compared with those receiving 16 mg candesartan by the end of the study. This reduction was in addition to the reduction in proteinuria that the patients would have had when they first started taking candesartan at 16 mg daily" Telmisartan improves insulin resistance in high renin nonmodulating salt-sensitive hypertensives - J Hypertens. 2008 Dec;26(12):2393-8 - "Nonmodulating (NMHT) is a high-renin subtype of salt sensitive hypertension, which additionally develops insulin resistance and oxidative stress. Conversely, modulating hypertensives (MHT) normally regulates renal hemodynamics after high sodium intake without metabolic impairment ... In NMHT, telmisartan, after 3 months treatment, significantly reduced fasting and 120 min insulinemia (fasting: 8.4 +/- 2, 120 min: 25 +/- 10 muU%; P < 0.01) compared either to basal values or ramipril treatment. Similarly, only in NMHT, compared with basal values and ramipril treatment, telmisartan improved the HOMA-IR index in both MHT (2.76 +/- 0.16 to 2.24 +/- 0.18, P < 0.05) and NMHT (from: 4.4 +/- 1 to 2.3 +/- 0.7) and triglyceride plasma levels (MHT: from 139 +/- 1.85 to 122 +/- 2.4 mg%, P < 0.05; NMHT: from: 223 +/- 12 to 146 +/- 10 mg%, P < 0.01). Finally, highly sensitive C-protein-reactive protein values were higher in NMHT (0.33 +/- 0.07 mg.dl) than in MHT (0.14 +/- 0.06 mg.dl; P < 0.01). Both treatments reduced highly sensitive C-protein-reactive protein in NMHT. (ramipril from 0.32 +/- 0.05 mg.dl to 0.26 +/- 0.06 m.dl (P < 0.05) and telmisartan from 0.34 +/- 0.05+/- to 0.20 +/- 0.05 mg.dl (P < 0.01). CONCLUSION: Our data suggest that the improvement of the insulin sensitivity by telmisartan, instead of a similar effect on blood pressure shown by both drugs, could be ascribed to the PPAR agonistic action of telmisartan. This opens an interesting therapeutic approach for patients with hypertension and altered glycemic metabolism" Telmisartan prevents aneurysm progression in the rat by inhibiting proteolysis, apoptosis and inflammation - J Hypertens. 2008 Dec;26(12):2361-73 - "The angiotensin II type 1 receptor antagonist, telmisartan, prevents abdominal aortic aneurysm progression independently of blood pressure reduction by inhibiting proteolysis, apoptosis and inflammation in aortic tissue" Angiotensin II type 2 receptor blockade increases bone mass - J Biol Chem. 2008 Nov 11 - "Treatment with AT2 receptor blocker significantly enhanced the levels of bone mass and this effect was based on the enhancement of osteoblastic activity as well as the suppression of osteoclastic activity in vivo" Effects of Telmisartan and Ramipril on Adiponectin and Blood Pressure in Patients with Type 2 Diabetes - Am J Hypertens. 2008 Oct 30 - "There was a significant increase in adiponectin levels in the telmisartan (0.68 (95% confidence interval (CI), 0.27 to 1.10) microg/ml, P < 0.01) but not in the ramipril group" - See my adiponectin page. An increase in adiponectin is a good thing. Telmisartan versus angiotension-converting enzyme inhibitors in the treatment of hypertension: a meta-analysis of randomized controlled trials - J Hum Hypertens. 2008 Nov 6 - "Telmisartan had fewer drug-related adverse events than enalapril (RR 0.57, 95% CI 0.44-0.74), ramipril (RR 0.44, 95% CI 0.26-0.75), lisinopril (RR 0.70, 95% CI 0.56-0.89) and perindopril (RR 0.52, 95% CI 0.28-0.98). The meta-analysis indicates that telmisartan provides a superior BP control to ACEIs (enalapril, ramipril and perindopril) and has fewer drug-related adverse events and better tolerability in hypertensive patients" - Click here for reasons telmisartan might be a first line treatment. Beneficial Effects of Combination Therapy with Angiotensin II Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor on Vascular Endothelial Function - Hypertens Res. 2008 Aug;31(8):1603-10 - "these results suggest that the angiotensin I-converting enzyme inhibitor perindopril is superior to the calcium channel blocker amlodipine for reducing vascular endothelial dysfunction when co-administered with angiotensin receptor blockers in patients with essential hypertension" Angiotensin receptor blockers in the treatment of NASH/NAFLD: Could they be a first-class option? - Adv Ther. 2008 Oct 29 - "Nonalcoholic fatty liver disease (NAFLD) ... nonalcoholic steatohepatitis (NASH) ... In our opinion there are two major advantages of ARBs that make them a possible therapeutic option for treating NASH and MS: their specific antihypertensive effect, and their impact on liver fibrosis. In light of this, and based on the current evidence (including existent human studies), we can speculate that some ARBs like telmisartan, candesartan, and losartan can be beneficial in treating NASH/NAFLD and its consequences, and further larger controlled clinical trials will bring consistent data into this field" Association of ACE Inhibitors and Angiotensin Receptor Blockers With Keratinocyte Cancer Prevention in the Randomized VATTC Trial - oncologystat.com, 9/3/08 - "squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs) ... Time to new BCC was 2.5 years for ACE inhibitor or ARB users and 2.2 years for nonusers. The absolute incidence rate of BCCs per 1000 patient-years was lower among ACE inhibitor/ARB users than nonusers (154 vs 233; unadjusted incidence rate ratio [IRR] = 0.66 ... Time to new SCC was 2.9 years for ACE inhibitor or ARB users and 2.6 years for nonusers. The absolute incidence rate of BCCs per 1000 patient-years was lower among ACE inhibitor/ARB users than nonusers (83 vs 141; unadjusted IRR = 0.58" Effects of telmisartan on adiponectin levels and body weight in hypertensive patients with glucose intolerance - Metabolism. 2008 Oct;57(10):1473-8 - "Telmisartan decreased body weight while increasing serum adiponectin levels in hypertensive patients with glucose intolerance. Candesartan did not achieve similar improvements in these patients. Among ARBs, telmisartan may have a larger impact on obesity-related diseases that can lead to cardiovascular disorders" Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial - Lancet. 2008 Aug 29 - "Telmisartan was well tolerated in patients unable to tolerate ACE inhibitors. Although the drug had no significant effect on the primary outcome of this study, which included hospitalisations for heart failure, it modestly reduced the risk of the composite outcome of cardiovascular death, myocardial infarction, or stroke" Medication To Lower Blood Pressure Reduces Outcome Of Cardiovascular Death, Heart Attack Or Stroke, Study Suggests - Science Daily, 8/31/08 - "Telmisartan reduced the outcome of cardiovascular death, heart attack, stroke or hospitalization for heart failure by a relative eight per cent ... However, when the outcome included cardiovascular death, heart attack or stroke (and not hospitalization for heart failure), telmisartan reduced that outcome by a significant 13 per cent" Angiotensin Inhibitors And Receptor Blockers Linked To Lower Risk Of Nonmelanoma Skin Cancer - Science Daily, 8/28/08 - "The group taking either an ACE inhibitor or ARBs had a 39 percent relative reduction in incidence of basal cell cancer and a 33 percent relative reduction in squamous cell cancers compared with nonusers" Comparison of the effects of telmisartan and olmesartan on home blood pressure, glucose, and lipid profiles in patients with hypertension, chronic heart failure, and metabolic syndrome - Hypertens Res. 2008 May;31(5):921-9 - "telmisartan had more beneficial effects on glucose and lipid profiles in patients with relatively high HbA1c, serum total and low-density lipoprotein cholesterol, and triglyceride levels. Therefore, we concluded that telmisartan was more beneficial than olmesartan for controlling blood pressure in the early morning, as well as for improving glucose and lipid profiles in patients with hypertension, chronic heart failure, and metabolic syndrome" - Click here for why I feel that telmisartan should be the first line treatment for hypertension. Telmisartan prevented cognitive decline partly due to PPAR-gamma activation - Biochem Biophys Res Commun. 2008 Aug 17 - "Pretreatment with a non-hypotensive dose of telmisartan significantly inhibited such cognitive decline. Interestingly, co-treatment with GW9662, a PPAR-gamma antagonist, partially inhibited this improvement of cognitive decline. Another ARB, losartan, which has less PPAR-gamma agonistic effect, also inhibited Abeta-injection-induced cognitive decline; however the effect was smaller than that of telmisartan and was not affected by GW9662. Immunohistochemical staining for Abeta showed the reduced Abeta deposition in telmisartan-treated mice. However, this reduction was not observed in mice co-administered GW9662. These findings suggest that ARB has a preventive effect on cognitive impairment in Alzheimer disease, and telmisartan, with PPAR-gamma activation, could exert a stronger effect" The angiotensin II receptor blocker telmisartan improves insulin resistance and has beneficial effects in hypertensive patients with type 2 diabetes and poor glycemic control - Diabetes Res Clin Pract. 2008 Aug 8 - "The telmisartan significantly improved HOMA-IR in hypertensive patients and also significantly decreased HbA1c in type 2 diabetic patients especially in the patients with poor glycemic control (HbA1c>==8.0%). These results indicate that telmisartan improves insulin resistance and gives beneficial effects in hypertensive patients with type 2 diabetes and a poor glycemic control" The angiotensin II receptor blocker telmisartan improves insulin resistance and has beneficial effects in hypertensive patients with type 2 diabetes and poor glycemic control - Diabetes Res Clin Pract. 2008 Aug 8 - "The telmisartan significantly improved HOMA-IR in hypertensive patients and also significantly decreased HbA1c in type 2 diabetic patients especially in the patients with poor glycemic control (HbA1c>==8.0%). These results indicate that telmisartan improves insulin resistance and gives beneficial effects in hypertensive patients with type 2 diabetes and a poor glycemic control" - Just another reason I feel that telmisartan should be the first line treatment for hypertension. Click here for other reasons. See telmisartan at OffshoreRX.com. Angiotensin Receptor Blockers Are Lower Incidence, Progression Of Alzheimer's Disease - Science Daily, 7/27/08 - "Researchers at Boston University School of Medicine (BUSM) have, for the first time, found that angiotensin receptor blockers (ARBs)—a particular class of anti-hypertensive medicines—are associated with a striking decrease in the occurrence and progression of dementia" Telmisartan but not candesartan affects adiponectin expression in vivo and in vitro - Hypertens Res. 2008 Apr;31(4):601-6 - "the changes in serum adiponectin and plasma glucose over 3 months were significantly greater in the telmisartan group than in the candesartan group. In vitro, although the protein level of adiponectin was not significantly elevated, the mRNA expression of adiponectin was elevated 1.5-fold by telmisartan in 3T3-L1 adipocytes. Our findings suggest that telmisartan may have beneficial effects in type 2 diabetes beyond its antihypertensive effect" - I've been saying that telmisartan should be the first line treatment for hypertension for some time now if natural methods such as coenzyme Q10 don't work. Telmisartan, an Angiotensin II Type 1 Receptor Blocker, Improves Coronary Microcirculation and Insulin Resistance among Essential Hypertensive Patients without Left Ventricular Hypertrophy - Hypertens Res. 2008 Apr;31(4):615-22 - "Coronary flow velocity reserve (CFVR) ... CFVR was improved in the telmisartan group (2.4+/-0.4 to 2.9+/-0.4; p<0.01), but there was no difference in the nifedipine group (2.5+/-0.3 to 2.5+/-0.3; n.s.). HOMA-IR was improved in the telmisartan group (3.1+/-1.1 to 1.6+/-0.7; p<0.01), but there was no difference in the nifedipine group (2.8+/-1.1 to 2.4+/-0.7; n.s.). In conclusion, this study demonstrates that antihypertensive therapy with telmisartan, but not nifedipine, has a beneficial effect on coronary microcirculation and insulin resistance among essential hypertensive patients" Microalbuminuria Reduction with Telmisartan in Normotensive and Hypertensive Japanese Patients with Type 2 Diabetes: A Post-Hoc Analysis of the Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) Study - Hypertens Res. 2008 Apr;31(4):657-64 - "The patients treated with either dose of telmisartan showed lower transition rates from microalbuminuria to overt nephropathy compared to the placebo group. In addition, more patients on telmisartan reverted to normoalbuminuria (UACR<30 mg/g creatinine): 15.5% of the 40 mg group, 19.6% of the 80 mg group, and 1.9% of the placebo group ... Side effects did not differ among the groups. The present study demonstrates that telmisartan prevents the progression of microalbuminuria (in some cases induces remission of albuminuria) in normotensive Japanese patients with type 2 diabetes. Telmisartan is shown to be safe and well tolerated in these patients" Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome - Int J Impot Res. 2008 Jul 3 - "Erectile function increased significantly (P<0.0001) after 6 months of treatment with irbesartan, irrespective of dosage and independent of additional treatment with hydrochlorothiazide. Prevalence of ED declined to 63.7% from 78.5% at baseline, along with a significant increase in orgasmic function (P<0.001) and intercourse satisfaction (P<0.001). Treatment with irbesartan alone, as well as in combination with hydrochlorothiazide is associated with an improvement of sexual desire, frequency of sexual contacts and erectile function in hypertensive patients with the metabolic syndrome. These results suggest a beneficial role of angiotensin receptor antagonists in the treatment of metabolic syndrome, and ED" - Note: I've been suggesting telmisartan (an ARB) for some time as the first line treatment for hypertension. See telmisartan at OffshoreRX. Hypertension Treatment Effective In Reversing Vascular Damage, Study Suggests - Science Daily, 6/17/08 - "A hypertension medication called olmesartan medoxomil is effective in reversing the narrowing of the arteries that occurs in patients with high blood pressure ... After one year of treatment, olmesartan medoxomil improved the artery abnormalities in high blood pressure patients and returned arterial architecture to normal levels. This was not seen with the atenolol" Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy - Kidney Int. 2008 May 21 - "telmisartan is superior to losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy, despite a similar reduction in blood pressure" - Just one more reason I feel telmisartan should be the first line treatment for hypertension if natural methods such as coenzyme Q10 don't work. See telmisartan at OffshoreRX.com. Effects of Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Antagonist Combination on Nitric Oxide Bioavailability and Atherosclerotic Change in Watanabe Heritable Hyperlipidemic Rabbits - Hypertens Res. 2008 Mar;31(3):575-84 - "1) vehicle (control), 2) the ACEI enalapril (E: 3 mg/kg/day), 3) the ARB losartan (L: 30 mg/kg/day) and 4) enalapril (1.5 mg/kg/day) + losartan (15 mg/kg/day) (E+L). Intra-aortic infusion of ACh produced an increase in plasma NO concentration, which was significantly greater with all the drug treatments than with the control. E increased ACh-induced NO significantly more than L (by 6.9 nmol/L, and 4.7 nmol/L, respectively). E+L increased ACh-induced NO by 9.5 nmol/L, significantly more than either E or L ... the combined treatment with an ACEI and an ARB may have additive protective effects on endothelial function as well as atherosclerotic change" Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, or Both for Patients With Proteinuria? A Best Evidence Review - Medscape, 5/20/08 - "Most significantly, the addition of ACEIs to ARBs reduced proteinuria to a greater degree than ARBs alone (ratio of means 0.76 at 1 to 4 months and 0.75 at 5 to 12 months). Combination therapy was also superior to treatment with ACEIs alone ... The 2 important conclusions that can be drawn from this meta-analysis are that ARBs are not superior to ACEIs in improving proteinuria, and that the combination of these 2 treatments appears superior in this outcome compared with either treatment alone ... Two of the biggest safety concerns regarding the combination therapy include the risks for hyperkalemia and acute worsening of renal function. A review of the literature, however, suggests that these risks may not be significantly worse with combination treatment vs monotherapy" Telmisartan increases fatty acid oxidation in skeletal muscle through a peroxisome proliferator-activated receptor-gamma dependent pathway - J Hypertens. 2008 Jun;26(6):1209-1215 - "telmisartan may increase energy expenditure and protect against dietary induced obesity and features of the metabolic syndrome at least in part by increasing muscle fatty acid oxidation through activation of peroxisome proliferator-activated receptor-gamma" Meta-analysis of Randomized Controlled Trials Comparing Telmisartan With Losartan in the Treatment of Patients With Hypertension - Am J Hypertens. 2008 May;21(5):546-52. Epub 2008 Mar 20 - "In comparison with losartan, telmisartan provides superior control of BP and has no association with increased risk of adverse events" Valsartan Improves Arterial Stiffness in Type 2 Diabetes Independently of Blood Pressure Lowering - Hypertension. 2008 Apr 21 - "Increased arterial stiffness, as estimated from aortic pulse wave velocity (Ao-PWV), and albuminuria are independent predictors for cardiovascular disease in type 2 diabetes mellitus (T2DM) ... Ao-PWV showed a significantly greater reduction, mean (95% CI), -0.9 m/s (-1.4 to -0.3) for valsartan/HCTZ compared to amlodipine (P=0.002). AER fell significantly only with Val/HCTZ from 30.8(20.4, 46.5) to 18.2(12.5, 26.3) mcg/min, (P=0.01) with between treatment difference in favor of Val/HCTZ of -15.3mcg/min" - Telmisartan, another ARB and my first line plug, will decrease arterial stiffness also. See: Angiotensin II Antagonist Telmisartan Fights Stiffening Arteries In Hypertensive Diabetics - Doctor's Guide, 4/6/01 - "not only effectively lowered blood pressure compared with placebo, but also significantly decreased arterial stiffness" - See telmisartan at OffshoreRX. Blood Pressure Drugs Halt Pancreatic Cancer Cell Growth, Researchers Find - Science Daily, 4/14/08 - "one type of pressure-lowering drug called an angiotensin receptor blocker inhibits pancreatic cancer cell growth and causes cell death" Effects of telmisartan, a unique angiotensin receptor blocker with selective peroxisome proliferator-activated receptor-gamma-modulating activity, on nitric oxide bioavailability and atherosclerotic change - J Hypertens. 2008 May;26(5):964-972 - "In addition to a class effect of ARBs, telmisartan may have additional effects on nitric oxide bioavailability and atherosclerotic change through its PPARgamma-mediated effects in genetically hyperlipidemic rabbits" - Just one more reason to consider telmisartan as a first line treatment for hypertension. See telmisartan at OffshoreRX.com. Telmisartan, an Angiotensin II Type 1 Receptor Blocker, Inhibits Advanced Glycation End-product (AGE)-elicited Hepatic Insulin Resistance via Peroxisome Proliferator-activated Receptor-gamma Activation - J Int Med Res. 2008 Mar-Apr;36(2):237-43 - "Candesartan, another ARB, did not affect AGEs-induced serine phosphorylation of IRS-1 at serine-307 residues in Hep3B cells. Our study suggests that telmisartan could improve AGE-elicited insulin resistance in Hep3B cells by inhibiting serine phosphorylation of IRS-1, at least in part, via activation of PPAR-gamma" - Note: That might be another reason for considering telmisartan as a first line treatment for hypertension. See telmisartan at OffshoreRX.com. Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events - N Engl J Med. 2008 Mar 31 - "Telmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. The combination of the two drugs was associated with more adverse events without an increase in benefit" - Yeah but if you have to go with two drugs it sure seems like it's the least of all the evils regarding side effects. See telmisartan at OffshoreRX.com. ONTARGET: ARB Similar to ACE - Medscape, 3/31/08 - "The angiotensin receptor blocker (ARB) telmisartan (Micardis, Boehringer Ingelheim) was "noninferior" to the ACE inhibitor ramipril in patients with vascular disease or high-risk diabetes in the landmark ONTARGET trial" New Blood Pressure Medication Has Fewer Side Effects, Global Study Suggests - Science Daily, 3/31/08 - "The study found a new drug telmisartan is as effective as the popular drug ramipril in reducing cardiovascular death in high risk patients and it has fewer side effects" - I've been plugging telmisartan for some time now. Click here. See telmisartan at OffshoreRX.com. Telmisartan treatment decreases visceral fat accumulation and improves serum levels of adiponectin and vascular inflammation markers in Japanese hypertensive patients - Hypertens Res. 2007 Dec;30(12):1205-10 - "telmisartan treatment was associated with an improvement of vascular inflammation, reductions in visceral fat and increases in serum adiponectin" Angiotensin II receptor blocker inhibits tumour necrosis factor-alpha-induced cell damage in human renal proximal tubular epithelial cells - Nephrology (Carlton). 2008 Mar 5 - "The present study demonstrates that TNF-alpha induces renal tubular cell damage in RPTEC and AT1/AT2 receptor blockers showed cytoprotective effects probably via at least partly different mechanism" Treatment of hypertension in individuals with the cardiometabolic syndrome: role of an angiotensin II receptor blocker, telmisartan - Expert Rev Cardiovasc Ther. 2008 Mar;6(3):289-303 - "Concerning drug treatment of hypertension associated with other cardiometabolic risk factors, many results of head-to-head studies have demonstrated a reduction in new-onset Type 2 diabetes in hypertensive patients treated with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, when compared with conventional antihypertensive therapy. The explanations of the different actions of both these drugs include several mechanisms related to pancreatic insulin release and insulin sensitivity improvement. Another mechanism by which the inhibition of the renin-angiotensin system may improve insulin sensitivity is through the partial peroxisome proliferator-activated receptor-gamma agonism of telmisartan. For that reason, telmisartan has been considered by some experts to be an antihypertensive agent that is particularly useful in the treatment of hypertension associated with cardiometabolic risk factors" Reduced incidence of new-onset atrial fibrillation with angiotensin II receptor blockade: the VALUE trial - J Hypertens. 2008 Mar;26(3):403-411 - "These findings suggest that angiotensin II receptor blockers may result in greater benefits than calcium antagonists in hypertensive patients at risk of new-onset AF" Effects of angiotensin II type 1-receptor blockade on retinal endothelial function - J Hypertens. 2008 Mar;26(3):516-22 - "AT1-receptor blockade with irbesartan improves endothelial function of the retinal vasculature, taken as a model of cerebral circulation" Effect of Telmisartan on Nitric Oxide-Asymmetrical Dimethylarginine System. Role of Angiotensin II Type 1 Receptor and Peroxisome Proliferator Activated Receptor {gamma} Signaling During Endothelial Aging - Hypertension. 2008 Feb 4 - "Telmisartan, in addition to blocking angiotensin (Ang) II type 1 receptor (AT1R), activates peroxisome proliferator activated receptor gamma (PPARgamma) signaling that interferes with nitric oxide (NO) system. Because aging of endothelial cells (ECs) is hallmarked by a reduction in NO synthesis, we hypothesized that telmisartan increases NO formation by regulated asymmetrical dimethylarginine (ADMA)-dimethylarginine dimethylaminohydrolase (DDAH)-system through blocking AT1R and activating PPARgamma signaling ... During the process of aging, PPARgamma protein expression decreased significantly, whereas the expression of AT1R increased. Telmisartan reversed these effects and dose-dependently decreased reactive oxygen species and 8-iso-prostaglandin (PG) F2alpha formation ... telmisartan mainly by activating PPARgamma signaling can alter the catabolism and release of ADMA as an important cardiovascular risk factor. We therefore propose that telmisartan translationally and posttranslationally upregulated DDAH expression via activation of PPARgamma signaling, causing ADMA to diminish and increase NO synthesis sufficient to delay senescence" Establishing A New Option for Target-organ Protection: Rationale for ARB Plus ACE Inhibitor Combination Therapy - Am J Hypertens. 2008 Jan 24 - "Combination therapy targeting RAS activation may reduce target-organ damage and provide superior blood pressure (BP) control; combining angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) represents one possible approach" ACE Inhibitors or ARBs in Hypertension? In Chronic Kidney Disease? - Medscape, 1/17/07 - "ARBs and ACE inhibitors were similarly effective at lowering proteinuria, ARBs were more effective than calcium-channel blockers, and a combination of ARBs and ACE inhibitors was more effective than either agent alone" The effect of losartan on hemoglobin concentration and renal outcome in diabetic nephropathy of type 2 diabetes - Kidney Int. 2007 Dec 19 - "Compared with placebo, losartan treatment was associated with a significant decrease of hemoglobin, with the largest between-group difference at 1 year. After adjustment, there were significant relative risk reductions for losartan compared with placebo for ESRD and for ESRD or death regardless of the baseline hemoglobin even in those patients with a baseline hemoglobin below 120 g l(-1). Hence, the renoprotective properties of losartan were maintained despite a significant lowering of the hemoglobin concentration" Sustained Tubulo-interstitial Protection in SHRs by Transient Losartan Treatment: An Effect of Decelerated Aging? - Am J Hypertens. 2008 Jan 10 - "Transient losartan treatment reduces cell-turnover not only acutely but also for a prolonged period after drug withdrawal. This results in the long-term in reduced aging and attenuated tubulo-interstitial damage, suggesting there exists a modulating effect of angiotensin II (ANGII)-antagonism on long-term cell turnover" - Note: Losartan is an ARB. I would think that telmisartan (also and ARB and my recommendation for hypertension) would give the same effect. ACE Inhibitors vs ARBs in HTN and in CKD - Medscape, 1/4/08 - "In the setting of chronic kidney disease (CKD), concludes the other study, which is a meta-analysis, ACE inhibitor and ARB monotherapy are similarly effective at reducing proteinuria, but a combination of the two angiotensin-2-suppressing drugs works better than either agent individually [2]. But a blanket recommendation to combine them would be premature, according to the authors, because there is little evidence that the combination would improve clinical outcomes over monotherapy, and the safety of such combination therapy is largely undefined" Anti-atherosclerotic properties of telmisartan in advanced atherosclerotic lesions in apolipoprotein E deficient mice - Atherosclerosis. 2007 Dec 17 - "These data suggest that chronic inhibition of the RAS by telmisartan prevails in reducing advanced atherosclerosis and promoting plaque stability over ramipril, possibly through the reduced activity of the pro-inflammatory transcription factors NFkappaB and Egr-1 and through the activation of PPARgamma" Blood Pressure Drug Telmisartan Shows Powerful Activity Against Stroke, Study Suggests - Science Daily, 12/17/07 - "83 percent of rats given no medication showed signs of stroke, as did 56 percent of rats given ramipril alone. However, no strokes were noted in the telmisartan-only or the telmisartan/ramipril combo groups ... Telmisartan's ability to easily pass through the blood-brain barrier (something ramipril cannot do) is likely behind the neuroprotective effect noted in the study" Effect of the Angiotensin Receptor Blocker Irbesartan on Metabolic Parameters in Clinical Practice: the DO-IT Prospective Observational Study - Cardiovasc Diabetol. 2007 Nov 27;6(1):36 - "Six months of irbesartan therapy decreased systolic blood pressure by 14% (157.4+/-14.7 vs. 135.0+/-10.7 mmHg) and diastolic blood pressure by 13% (92.9+/-9.2 vs. 80.8+/-6.8 mmHg). This was associated with a decrease in body weight (-2.3%), fasting glucose (-9.5%), HbA1c (-4.6%), LDL-cholesterol (-11%), triglycerides (-16%) and gamma-GT (-12%) and an increase in HDL-cholesterol (+5%)" Renoprotective effect of the addition of losartan to ongoing treatment with an Angiotensin converting enzyme inhibitor in type-2 diabetic patients with nephropathy - Hypertens Res. 2007 Oct;30(10):929-35 - "During the 12-month treatment, addition of losartan or addition of an ACE-I to the treatment protocol reduced systolic blood pressure (SBP) by 10% and 12%, diastolic blood pressure (DBP) by 7% and 4%, and urinary albumin excretion by 38% and 20% of the baseline value, respectively. However, the effects on both BP and urinary albumin were not significantly different between the two therapies. In conclusion, addition of losartan or an ACE-I to an ongoing treatment with an ACE-I, or addition of an ACE-I to ongoing treatment with a conventional antihypertensive were equally effective at reducing the urinary albumin excretion and BP, and provided renal protection in patients with type-2 diabetic nephropathy" Systematic Review: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers for Treating Essential Hypertension - Ann Intern Med. 2007 Nov 5 - "Available evidence shows that ACE inhibitors and ARBs have similar effects on blood pressure control, and that ACE inhibitors have higher rates of cough than ARBs. Data regarding other outcomes are limited" High-Dose Candesartan Reduces Persistent Proteinuria - Doctor's Guide, 11/6/07 Candesartan Improves Outcomes in Diabetes, Kidney Patients - Doctor's Guide, 11/8/07 - "new onset diabetes occurred in just 1.1% of the 1,024 patents on candesartan compared with 2.9% of the patients treated with other blood pressure lowering medications that did not include angiotensin receptor blockers ... "We observed that treatment with candesartan reduced that risk by 63% (P =.027)," he said during a press briefing. He also noted that patients on candesartan had fewer adverse events than the 1,025 patients who received standard therapy" - I would have liked to see telmisartan (also an ARB) in this study. Common Medications Provide Equal Blood Pressure Control - Doctor's Guide, 11/2/07 - "Two common classes of blood pressure medications – angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) – are equally effective at controlling high blood pressure ... ACEIs are slightly more likely than ARBs to cause a harmless but persistent dry cough ... If left untreated, high blood pressure can cause catastrophic health problems: the heart may enlarge, which can lead to heart failure; small bulges --aneurysms -- may form in blood vessels, including the aorta (the main artery to the heart) and others in the brain, legs, and intestines; blood vessels in the kidney may narrow, causing kidney failure; blood vessels in the eyes may burst or bleed, possibly leading to blindness; and arteries throughout the body may "harden" faster, potentially leading to heart attack or stroke" Renoprotection provided by losartan in combination with pioglitazone is superior to renoprotection provided by losartan alone in patients with type 2 diabetic nephropathy - Kidney Blood Press Res. 2007;30(4):203-11 - "Renoprotection conferred by losartan combined with pioglitazone is superior to that conferred by losartan alone in subjects with type 2 diabetic nephropathy. The combination is generally well tolerated" Drugs For Hypertension May Help Prevent And Treat Alzheimer's Disease - Science Daily, 10/26/07 - "mice genetically determined to develop Alzheimer's disease beta-amyloid production and subsequent cognitive deterioration, significantly benefit from the treatment with the anti-hypertensive agent Valsartan, found to pharmacologically prevent beta-amyloid production in the brain even when delivered to Alzheimer's disease mice at doses 3-4 fold lower than the minimal equivalent dose prescribed for the treatment of hypertension in humans. Other anti-hypertension drugs with beneficial results included Propranolol HCI, Carvedilol, Losartan, Nicardipine HCI, Amiloride HCI and Hydralazine HCI" - Note: I'm big on Micardis (telmisartan). Valsartan and losartan (generic names so they shouldn't have been capitalized) are also ARBs. I'm wondering if telmisartan was in the study. Do ACE inhibitors and ARBs mix well? Analysis urges caution - theheart.org, 10/10/07 - "patients receiving both an ACE inhibitor and an ARB were more likely not to comply with therapy due to side effects, which included hypotension, cough, angioedema, worsening renal function as defined by a change in serum creatinine >0.5 mg/dL, hyperkalemia as defined by serum potassium level changes >5.5 mEq/L, and symptomatic hypotension" Adverse Effects of Combination Angiotensin II Receptor Blockers Plus Angiotensin-Converting Enzyme Inhibitors for Left Ventricular Dysfunction: A Quantitative Review of Data From Randomized Clinical Trials - Arch Intern Med. 2007 Oct 8;167(18):1930-6 - "there were significant increases in worsening renal function (RR, 2.17 [95% CI, 1.59-2.97] and RR, 1.61 [95% CI, 1.31-1.98], respectively), hyperkalemia (RR, 4.87 [95% CI, 2.39-9.94] and RR, 1.33 [95% CI, 0.90-1.98], respectively" Prevention of stroke in patients with hypertension - Am J Cardiol. 2007 Aug 6;100(3A):17J-24J - "In contrast to angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ARBs) provide consistent benefits in stroke protection beyond blood pressure lowering. The ARB telmisartan has a particularly interesting profile for stroke management. Selective angiotensin II type 1 receptor blockade and 24-hour blood pressure control with telmisartan provide the potential for improved stroke prevention" Rationale for double renin-angiotensin-aldosterone system blockade - Am J Cardiol. 2007 Aug 6;100(3A):25J-31J - "The clinical benefits of both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) extend beyond blood pressure reduction to encompass tissue-protective effects in target organs, such as the heart, vasculature, and kidneys, that underlie the reductions in cardiovascular mortality and morbidity seen in large outcome trials. However, these effects are achieved by different mechanisms. ACE inhibitors reduce circulating and tissue angiotensin II levels and potentiate the beneficial effects of bradykinin, including generation of nitric oxide (NO). By contrast, the protective effects of ARBs are owing to the blockade of the angiotensin II type 1 (AT(1)) receptors and possibly also to the stimulation of angiotensin II type 2 (AT(2)) receptors, again resulting in NO release. In addition, some ARBs, such as telmisartan, are selective activators of peroxisome proliferator-activated receptor-gamma (PPAR-gamma), thereby increasing insulin sensitivity. In contrast to other PPAR-gamma ligands, such as the thiazolidinediones, activation of this receptor by telmisartan does not result in weight gain. The complementary mechanisms of action of ACE inhibitors and ARBs create a rationale for combination therapy in high-risk patients" Angiotensin receptor blockers versus angiotensin-converting enzyme inhibitors: where do we stand now? - Am J Cardiol. 2007 Aug 6;100(3A):38J-44J - "Both classes of agent can prevent or reverse endothelial dysfunction and atherosclerosis, thereby potentially reducing the risk of cardiovascular events. Such a reduction has been shown with ACE inhibitors in patients with coronary artery disease, but no such data are currently available for ARBs. Both ACE inhibitors and ARBs have been shown to reduce damage in target organs, such as the heart and kidney, and to decrease cardiovascular mortality and morbidity in patients with congestive heart failure" New opportunities in cardiovascular patient management: a survey of clinical data on the combination of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers - Am J Cardiol. 2007 Aug 6;100(3A):45J-52J - "Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) differ in their actions on the renin-angiotensin-aldosterone system (RAAS). ACE inhibitors prevent the formation of angiotensin II, although angiotensin II may still be generated by alternative pathways. However, ACE inhibitors interrupt bradykinin breakdown, which in turn potentially enhances nitric oxide and prostacyclin mechanisms. In contrast, ARBs selectively prevent the binding of angiotensin II to the angiotensin type 1 (AT(1)) receptor while leaving the potentially beneficial effects of the AT(2) receptor unaffected. The supposition is that dual blockade of the RAAS effectively overcomes the harmful effects of angiotensin II mediated by the AT(1) receptor while offering the additional effects of the ACE inhibitor" Telmisartan Improves Endothelial Function and Nitrate Tolerance in Patients With Coronary Artery Disease and the Metabolic Syndrome - Doctor's Guide, 9/11/07 - "Telmisartan is mainly an angiotensin II receptor blocker, but recently it has [shown] antioxidant effects and insulin resistance improvement effects ... After 4 weeks of treatment, the endothelium-dependant measure of flow-mediated dilatation was significantly increased in the telmisartan group (P <.01, vs control group), indicating improvements in endothelial dysfunction with telmisartan" ACE-I/ARB treatment in type 1 diabetes patients with albuminuria is associated with lower odds of progression of coronary artery calcification - J Diabetes Complications. 2007 Sep-Oct;21(5):273-9 - "coronary artery calcification (CAC) ... In backward logistic regression, presence of albuminuria at baseline predicted progression of CAC among subjects not treated with ACE-I/ARB [odds ratio=4.06 ... Among the subjects with albuminuria, the odds of progression was 62% lower (95% CI=88% decrease to 23% increase; P=.106) in those treated with ACE-I/ARB ... Albuminuria is a significant independent risk factor for CAC progression in young type 1 diabetes patients asymptomatic for CAD, and ACE-I/ARB treatment is associated with substantially lower odds of CAC progression" Heart Damage Can Be Reversed with Early Treatment - Science Daily, 8/27/07 - "During the first six months of the study, 38 subjects received a placebo, and the other 38 subjects took 160mg of Valsartan, a drug that blocks a hormone that is detrimental to the blood vessels and the heart. During the next six months, both groups took Valsartan ... Those who took the drug for the first six months significantly reduced their Rasmussen Disease Score compared with those who took the placebo. At the 12-month mark -- after both groups were taking the drug -- every patient showed better Rasmussen Disease Scores, effectively demonstrating that Valsartan can slow progression and even reverse early cardiovascular disease in asymptomatic high-risk patients" Telmisartan, an Angiotensin II Type 1 Receptor Blocker, Inhibits Advanced Glycation End-product (AGE)-induced Monocyte Chemoattractant Protein-1 Expression in Mesangial Cells Through Downregulation of Receptor for AGEs via Peroxisome Proliferator-activated Receptor-gamma Activation - J Int Med Res. 2007 Jul-Aug;35(4):482-9 - "Candesartan, an Ang II type 1 receptor blocker, did not suppress AGEs-induced superoxide generation. Telmisartan and the antioxidant, N-acetylcysteine, completely inhibited AGEs-induced MCP-1 overproduction by mesangial cells" Vitamin C 'benefits diabetics' - BBC News, 6/28/07 - "Vitamin C neutralises free radicals, while Telmisarten stimulates the natural removal of the molecules by cells" Telmisartan Staves Off Overt Diabetic Nephropathy - Medscape, 6/27/07 - "During a mean follow-up of 1.3 years, transition rates to overt nephropathy were significantly lower with telmisartan 40 mg (22.6%) and telmisartan 80 mg (16.7%) than with placebo (49.9%)" Angiotensin Receptor Blockers: Benefits Beyond Blood Pressure Lowering? - Medscape, 6/26/07 - "I would say that at this time, both ACE inhibitors and ARBs can be said to be useful in preventing or delaying progression of nondiabetic patients into type 2 diabetes" Baseline Glycaemic Control Has No Effect on Telmisartan-Related Improvements in Diabetics With Nephropathy - Doctor's Guide, 6/25/07 - "Chronic telmisartan treatment may slow the progression of renal disease in patients with type 2 diabetes and diabetic nephropathy, irrespective of baseline glycaemic control" Telmisartan May Help Preserve Renal Function in Patients With Hypertension, Diabetes - Medscape, 6/1/07 - "In patients with hypertension and type 2 diabetes, telmisartan and ramipril both may help preserve cardiovascular and renal function by increasing nitric oxide (NO) activity of the renal endothelium" The Differential Effects of Angiotensin II Type 1 Receptor Blockers on Microalbuminuria in Relation to Low-Grade Inflammation in Metabolic Hypertensive Patients - Am J Hypertens. 2007 May;20(5):565-72 - "There was a significant increase in high molecular weight adiponectin in the telmisartan group ... The reductions of microalbuminuria and high-sensitivity C-reactive protein (hs-CRP) were significant in the telmisartan group" Telmisartan-Hydrochlorothiazide Outperforms Valsartan-Hydrochlorothiazide for Blood Pressure Reduction - Doctor's Guide, 5/29/07 - "The change in diastolic blood pressure was -18.2 mmHg for the telmisartan-hydrochlorothiazide group and -17.0 mmHg for the valsartan-hydrochlorothiazide group. The change in systolic blood pressure was -24.6 mmHg and -22.5 for the two groups, respectively" Telmisartan Reduces Proteinuria More Than Losartan - Doctor's Guide, 5/28/07 - "Our findings suggest that at similar levels of blood pressure control, telmisartan may confer greater protection against progression to end-stage renal disease" Metabolic effects of telmisartan and irbesartan in type 2 diabetic patients with metabolic syndrome treated with rosiglitazone - J Clin Pharm Ther. 2007 Jun;32(3):261-8 - "Telmisartan seemed to improve glycaemic and lipid control and metabolic parameters of the metabolic syndrome better than irbesartan" Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta-analysis - Diabet Med. 2007 May;24(5):486-93 - "This meta-analysis suggests that ACEI + ARB reduces 24-h proteinuria to a greater extent than ACEI alone. This benefit is associated with small effects on GFR, serum creatinine, potassium and blood pressure" The effect of telmisartan and ramipril on early morning blood pressure surge: a pooled analysis of two randomized clinical trials - Blood Press Monit. 2007 Jun;12(3):141-147 - "Telmisartan significantly reduced the early morning systolic blood pressure surge compared with ramipril" Angiotensin II receptor blockers downsize adipocytes in spontaneously type 2 diabetic rats with visceral fat obesity - Am J Hypertens. 2007 Apr;20(4):431-6 - "adipocyte downsizing was significantly greater with telmisartan compared to valsartan. The likely mechanism for this difference was thought to be the PPAR-gamma-mediated action of telmisartan" Combination ACE inhibitor and angiotensin receptor blocker therapy - future considerations - J Clin Hypertens (Greenwich). 2007 Jan;9(1):78-86. - "The individual gains seen with each of these drug classes have led to speculation that their combination might offer additive if not synergistic outcome benefits. The foundation of this hypothesis, although biologically possible, has thus far not been sufficiently well proven to support the everyday use of these 2 drug classes in combination. Additional outcomes trials, which are currently proceeding to their conclusion, may provide the necessary proof to support an expanded use of these 2 drug classes in combination" Treating the metabolic syndrome - Expert Rev Cardiovasc Ther. 2007 May;5(3):491-506 - "appropriate treatment of MS components often requires pharmacologic intervention with insulin-sensitizing agents, such as metformin and thiazolidinediones, while statins and fibrates, or angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are the first-line lipid-modifying or antihypertensive drugs" Novel ARB Provides Greater Reductions in Proteinuria in Diabetics With Overt Nephropathy - Medscape, 5/22/07 - "One year of treatment with the novel angiotensin receptor blocker (ARB) telmisartan provided greater reductions in proteinuria when compared with losartan, a drug approved for the treatment of diabetic nephropathy to prevent renal-disease progression" Valsartan Cuts C-Reactive Protein Levels in Prediabetics - Doctor's Guide, 5/22/07 - "In diabetic patients with abdominal obesity, after 16 weeks of hydrochlorothiazide therapy, median hsCRP values were increased 16% (4.9 vs 3.7 mg/L at baseline, P <.05) but decreased 9% in patients on valsartan (3.7 vs 4.1 mg/L at baseline, P <.05) and 5% in patients on combination therapy" Valsartan Is a Prudent Choice in Young Hypertensives - Doctor's Guide, 5/21/07 ARBs for the Treatment of Heart Failure: A Class Effect? - Medscape, 5/15/07 - "Our results suggest that all ARBs are not equivalent. Valsartan, irbesartan, and candesartan were all associated with better survival rates when compared with losartan. The comparison for telmisartan was not statistically significant, possibly because this group included the smallest number of patients. In addition, there are no data from randomized trials on the effect of telmisartan on mortality in patients with heart failure" Angiotensin II receptor blockers for the treatment of heart failure: a class effect? - Pharmacotherapy. 2007 Apr;27(4):526-34 - "Elderly patients with heart failure who were prescribed losartan had worse survival rates compared with those prescribed other commonly used ARBs" Metabolic effects of telmisartan and irbesartan in type 2 diabetic patients with metabolic syndrome treated with rosiglitazone - J Clin Pharm Ther. 2007 Jun;32(3):261-8 - "Telmisartan seemed to improve glycaemic and lipid control and metabolic parameters of the metabolic syndrome better than irbesartan. These differences could be relevant in the choice of therapy for this condition and diabetes" Effect of antihypertensive agents on plasma adiponectin levels in hypertensive patients with metabolic syndrome - Nephrology (Carlton). 2007 Apr;12(2):147-53 - "Ramipril and valsartan increased the plasma adiponectin levels significantly higher than the other regimens" Effects of telmisartan on fat distribution in individuals with the metabolic syndrome - J Hypertens. 2007 Apr;25(4):841-8 - "The visceral fat area, determined by abdominal computed tomography scan, was reduced in the telmisartan group after 24 weeks' treatment" Telmisartan shows an equivalent effect of vitamin C in further improving endothelial dysfunction after glycemia normalization in type 1 diabetes - Diabetes Care. 2007 Apr 24 - "Combining insulin and vitamin C normalized endothelial dysfunction and decreased oxidative stress to normal level. Telmisartan significantly improved basal endothelial function and decreased nitrotyrosine plasma levels. In patients treated with Telmisartan a near normalization of both flow mediated vasodilation and oxidative stress was achieved when glycemia was normalized, while adding vitamin C infusion did not show further effect on endothelial function or nitrotyrosine plasma levels" The effects of telmisartan and amlodipine on metabolic parameters and blood pressure in type 2 diabetic, hypertensive patients - J Renin Angiotensin Aldosterone Syst. 2006 Dec;7(4):243-6 - "Group A: rosiglitazone (RSG) 4 mg + Telm 80 mg; Group B: RSG 4 mg + Aml 10 mg ... Lower values of glucose, HbA1C, HOMA index and higher adiponectin levels were observed in Group A compared to Group B ... insulin sensitivity may confer make Telm particularly suitable in the treatment of the metabolic syndrome" ACE Inhibitors Provide Greater Heart Protection - Science Daily, 4/22/07 - "Our research evaluated the effects of both drugs, and found that they both provided comparable blood pressure reduction. However, ACE inhibitors reduced the risk of coronary heart disease in patients by a further 9%. This so-called blood pressure-independent effect was not seen for ARBs" FDA Panel Favors First-Line Use of Irbesartan/HCTZ Combo - Medscape, 4/19/07 - "The US FDA Cardiovascular and Renal Drugs Advisory Committee recommended extended use of the combination product irbesartan plus hydrochlorothiazide (Avalide, Bristol-Myers Squibb) for the first-line treatment of hypertension" - Yeah, if you can get by the side effects of hydrochlorothiazide plus the increased chance of diabetes. Irbesartan is a ARB and hydrochlorothiazide is a diuretic. I'm not a doctor and here I am criticizing those who are but I still feel that telmisartan (a ARB)/ramipril (a ACE inhibitor) should be the first time treatment. Click here for the research. Some doctors claim you can't mix a ARB with an ACE inhibitor but I couldn't find any evidence of that. Treating hypertension in the patient with overt diabetic nephropathy - Semin Nephrol. 2007 Mar;27(2):182-94 - "The renoprotective and proteinuria-decreasing effects of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers recommend these agents as the standard of care in type 2 diabetic nephropathy" The effects of irbesartan and telmisartan on metabolic parameters and blood pressure in obese, insulin resistant, hypertensive patients - J Endocrinol Invest. 2006 Dec;29(11):957-61 - "The greater impact on the improvement of the metabolic profile showed by telmisartan and the inverse correlation between adiponectin levels and blood pressure may be partly due to the action as partial PPARgamma agonist displayed by telmisartan" Effect of inhibition of the Renin-Angiotensin system on development of type 2 diabetes mellitus (meta-analysis of randomized trials) - Am J Cardiol. 2007 Apr 1;99(7):1006-12. Epub 2007 Feb 16 - "In ACE inhibitor trials, the odds of developing DM were reduced by 28% (OR 0.72, 95% CI 0.63 to 0.84, p <0.001), and in the 5 ARB studies, there was a 27% reduction (OR 0.73, 95% CI 0.64 to 0.84, p <0.001) in the odds. In conclusion, evidence accumulated to date indicates that inhibition of the renin-angiotensin system may contribute to the prevention of DM" Effect of losartan, compared with atenolol, on endothelial function and oxidative stress in patients with type 2 diabetes and hypertension - J Hypertens. 2007 Apr;25(4):785-791 - "losartan significantly improved endothelial function in type 2 diabetes patients with hypertension compared with atenolol. This must be independent of the blood pressure-lowering effect of losartan and is probably caused by an antioxidative effect of the angiotensin receptor blocker" Telmisartan and irbesartan therapy in type 2 diabetic patients treated with rosiglitazone: effects on insulin-resistance, leptin and tumor necrosis factor-alpha - Hypertens Res. 2006 Nov;29(11):849-56 - "The decrease in HbA1c and FPG at 12 months was statistically significant only in the telmisartan group" Angiotensin receptor blockade in diabetic renal disease-Focus on candesartan - Diabetes Res Clin Pract. 2007 Mar 3 - "In patients with type 2 diabetes and varying degrees of albuminuria, treatment with candesartan 8-32mg daily was shown to reduce urinary albumin excretion (UAE) by up to 60%. When given in addition to an ACE inhibitor (dual blockade), reductions in UAE of 25-35% relative to ACE inhibitor monotherapy have been found" Impact of Telmisartan Versus Ramipril on Renal Endothelial Function in Patients with Hypertension and Type 2 Diabetes - Diabetes Care. 2007 Mar 2 - "In patients with type 2 diabetes telmisartan and ramipril both increased NO activity of the renal endothelium significantly that in turn may support the preservation of cardiovascular and renal function" Angiotensin type-1 receptor blockade with losartan increases insulin sensitivity and improves glucose homeostasis in subjects with type 2 diabetes and nephropathy - Nephrol Dial Transplant. 2007 Feb 17 - "Fasting blood glucose, HbA1c, AUC glucose, and urinary protein values were significantly decreased in the losartan group as compared with the amlodipine group (P < 0.05). Furthermore, C-peptide concentrations, the insulin sensitivity index, and the insulin-to-glucose ratio were significantly increased after 3 months of therapy with losartan as compared to amlodipine" The effects of irbesartan and telmisartan on metabolic parameters and blood pressure in obese, insulin resistant, hypertensive patients - J Endocrinol Invest. 2006 Dec;29(11):957-61 - "Group A (23) was submitted to irbesartan 150 mg/day, Group B (23) to telmisartan 80 mg/day for 6 months ... Both irbesartan or telmisartan reduced blood pressure and ameliorated the insulin sensitivity, with increased adiponectin values; in Group B, the amelioration of metabolic parameters was greater than in Group A" Telmisartan improves lipid metabolism and adiponectin production but does not affect glycemic control in hypertensive patients with type 2 diabetes - Adv Ther. 2007 Jan-Feb;24(1):146-53 - "Triglyceride levels were significantly decreased, however, and adiponectin levels were significantly increased" Telmisartan reduced blood pressure and HOMA-IR with increasing plasma leptin level in hypertensive and type 2 diabetic patients - Diabetes Res Clin Pract. 2007 Jan 18 - "Fasting IRI and HOMA-IR were significantly decreased after Telmisartan treatment, suggesting the improved insulin sensitivity" The effect of telmisartan on glucose and lipid metabolism in nondiabetic, insulin-resistant subjects - Metabolism. 2006 Sep;55(9):1149-54 - "in insulin-resistant persons 12 weeks of telmisartan result in a significant improvement in glucose metabolism with a predominant improvement in beta-cell function" Blood Pressure Drugs Could Help Halt Pancreatic Cancer Spread, Researchers Find - Science Daily, 12/8/06 - "two types of pressure-lowering drugs -- ACE inhibitors and AT1R blockers -- may help reduce the development of tumor-feeding blood vessels, a process called angiogenesis. Such drugs, they say, may become part of a novel strategy to control the growth and spread of cancer ... In the test tube, Ang II significantly enhanced VEGF production in AT1R-positive cells. Captopril and losartan both blocked this effect" Study Shows Valsartan Reduced Urinary Protein Excretion in Patients with Type 2 Diabetes and High Blood Pressure - Doctor's Guide, 11/20/06 - "In patients with high blood pressure and type 2 diabetes, the blood pressure-lowering medication Diovan® (valsartan) significantly reduced urinary protein excretion, with high doses providing the greatest sustained reduction" 24-hour urine protein - Medline Plus - "Increased urinary protein is usually measured when glomerular disease is suspected. The deterioration in the integrity of the glomerulus allows albumin to permeate in large quantities. Glomerular disease, such as nephrotic syndrome may result in urine protein (mostly urine albumin) of greater than 3.5 gm/day. So-called microalbuminuria with urine albumin levels of 30 to 200 mg/day is considered an early sign of diabetic nephropathy." Improved insulin sensitivity with the angiotensin II-receptor blocker losartan in patients with hypertension and other cardiovascular risk factors - J Hum Hypertens. 2006 Sep 21 - "angiotensin II-receptor blockade with losartan improves glucose metabolism at the cellular level beyond what can be expected by the vasodilatation and blood pressure reduction alone" Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Type 1 Receptor Blockers on the Rate of New-Onset Diabetes Mellitus: A Review and Pooled Analysis - Pharmacotherapy. 2006 Sep;26(9):1297-306 - "The combined occurrence of new-onset diabetes in all 13 studies was 2249 cases among 31,283 patients (7.2%) in the ACE inhibitor or ARB group versus 3230 cases among 35,988 patients (9.0%) in the control group" Cardiovascular Events Reduced in Japanese JIKEI Study With Valsartan - Doctor's Guide, 9/5/06 - "Blood pressure control was equal in both arms of the study, but the difference in outcomes was substantial and there were significant decreases in cardiovascular events with valsartan, specifically stroke, bouts of angina, heart failure and the need for hospitalization due to cardiac events" Short-term administration of an angiotensin-receptor antagonist in patients with impaired fasting glucose improves insulin sensitivity and increases free IGF-I - Eur J Endocrinol. 2006 Aug;155(2):293-6 - "received 100 mg losartan during 8 weeks ... After the treatment period, the HOMA score for insulin resistance had decreased from 5.3 +/- 1.1 to 3.7 +/- 0.9 (P = 0.004) and the 2-h CIGMA score from 23.4 +/- 3.1 to 15.9 +/- 2.1 (P = 0.07). The serum levels of free IGF-I had increased from 57 +/- 18.8 to 134 +/- 31.3 pmol/l" - Does that mean you can more than double you IGF-1 just by taking an ARB instead of hGH? I don't know. See losartan at OffshoreRX.com. - Ben Renal and vascular protective effects of telmisartan in patients with essential hypertension - Hypertens Res. 2006 Aug;29(8):567-72 - "telmisartan is more effective at protecting renal function and vascular endothelial function, and at improving arteriosclerosis than the calcium channel blocker in patients with essential hypertension" ACE Inhibitors and Angiotensin Receptor Antagonists and the Incidence of New-Onset Diabetes Mellitus : An Emerging Theme - Drugs. 2006;66(9):1169-1177 - "These trials have demonstrated an approximately 15-30% reduction in the new onset of diabetes in those receiving ACE inhibitors and ARBs when compared with placebo or other active therapy" Angiotensin Receptor Blocker Added to Previous Antihypertensive Agents on Arteries of Diabetic Hypertensive Patients - Hypertension. 2006 Jun 19 - "After 1 year of treatment, resistance artery media:lumen ratio decreased in the valsartan group (7.9+/-0.5% after versus 9.8+/-0.6% before; P<0.05) but not in the atenolol-treated group" Incidence of Atrial Fibrillation Significantly Reduced by Candesartan Cilexetil Therapy in Heart Failure Patients - Doctor's Guide, 7/5/06 Telmisartan Provides Superior, Powerful Blood Pressure Reduction From Morning to Morning Compared to Other Leading ARBS - Doctor's Guide, 6/15/06 - "telmisartan provides superior, powerful blood pressure reduction from morning to morning compared to other leading angiotensin II receptor blockers" Valsartan the First Blood Pressure Medication in a Large-Scale Clinical Trial to Lower C-Reactive Protein, an Important Marker of Inflammation - Doctor's Guide, 5/26/06 - "The median change in hsCRP from baseline after six weeks in the Diovan group was -0.12 mg/L compared to +0.05 mg/L in the Diovan HCT group, representing a difference between the treatment groups of 13.3%" Valsartan Lowers C-reactive Protein Levels; Combination Doesn't - Doctor's Guide, 5/19/06 - "Paradoxically, adding a diuretic to valsartan (Diovan) allows even more patients to reach blood pressure goals -- but appears to raise levels of C-reactive protein ... the monotherapy patients achieved an 8.9% reduction while the combination patients experienced a 4.4% increase" Reduced Diabetes Likelihood in Hypertensives Starting Valsartan Treatment - Doctor's Guide, 5/18/06 - "Over a mean follow-up of 4.2 years, the risk of diabetes was 11.5% for valsartan versus 14.5% for amlodipine; the odds ratio was 0.77 in favor of valsartan" New treatment strategies for patients with hypertension and insulin resistance - Am J Med. 2006 May;119(5 Suppl 1):S24-30 - "older antihypertensive agents such as thiazide diuretics and beta-blockers have potentially adverse effects on glucose and lipid metabolism and may even the exacerbate the metabolic syndrome and increase risk of type 2 diabetes ... Evidence is accumulating that telmisartan, in addition to blocking the angiotensin II type 1 receptor, activates the peroxisome proliferator-activated receptor (PPAR)-gamma a well-known target for treatment of the metabolic syndrome and diabetes ... the ability of telmisartan both to activate PPAR-gamma and to block the angiotensin receptor may provide added value not only in the treatment of the metabolic syndrome and prevention of type 2 diabetes but also in prevention and treatment of atherosclerotic cardiovascular disease" Telmisartan: The ACE of ARBs? - Sharma 47 (5): 822 -- Hypertension, 3/27/06 - "telmisartan also reduced weight gain, increased total energy expenditure, and increased expression of key mitochondrial enzymes (cyclooxygenase-1 and mitochondrial transcription factor A) in skeletal muscle" New Drug Delays High Blood Pressure - WebMD, 3/14/06 - "the blood-pressure-lowering drug Atacand may be able to delay the development of full-blown hypertension among people whose blood pressure is slightly high ... taking the drug for two years appeared to prime the body to keep blood pressure in check, even when the person stopped the drug for another two years" ACE Inhibitors and ARBs vs. Other Antihypertensives - Medscape, 3/9/06 - "When diabetics and nondiabetics were analyzed together, ACE inhibitors or ARBs were significantly more effective than other antihypertensives in reducing ESRD incidence, serum creatinine levels, and albuminuria, but they had no significant effect on preventing doubling of serum creatinine or reduction in GFR. In diabetics, ACE inhibitors or ARBs were significantly more effective than other antihypertensives only in reducing albuminuria; in nondiabetics, ACE inhibitors or ARBs were more effective than other agents only in reducing albuminuria and serum creatinine levels" Blood pressure control in eldery hypertension - Nippon Rinsho. 2006 Jan;64(1):75-80 - "Because ACE inhibitors/ARBs or Ca blockers increase insulin sensitivity, these drugs should be used as the first choice in cases of elderly hypertensive patients complicated with diabetes mellitus" Valsartan Inhibits Platelets (VIP) Trial - Medscape, 2/3/06 Addition of an angiotensin receptor blocker to full-dose ACE-inhibition: controversial or common sense? - Eur Heart J. 2005 Nov;26(22):2361-7 - "combination of a full-dose ACE-inhibitor and an ARB can be a rational choice in selected patients" - [full article] Olmesartan Improves Insulin Resistance in Chronic Kidney Disease Patients - Doctor's Guide, 11/15/05 Titration-Extension Study Shows Losartan-Based Treatment Significantly Reduced Blood Pressure in Real-Life Practice Settings - Doctor's Guide, 10/24/05 A Debate on the Metabolic Syndrome: Evolving Challenges and Controversies - Medscape, exp. 8/31/07 - "Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are first-line treatments for hypertensive albuminurics with the metabolic syndrome" Preliminary Studies Suggest Potential Metabolic Effects of Micardis (Telmisartan) - Doctor's Guide, 9/9/05 - "The Micardis molecule is structurally similar to the PPAR-gamma activator, pioglitazone,3 which has been approved for the treatment of type 2 diabetes.7 Micardis partially activates PPAR-gamma resulting in metabolic effects that differentiate it from other ARBs, according to preclinical data.1-4 These data demonstrate that Micardis has a beneficial effect on insulin resistance and blood lipids, independent of its effect on the renin-angiotensin-aldosterone system" Angiotensin-converting enzyme inhibitors or Angiotensin receptor blockers for prevention of type 2 diabetes a meta-analysis of randomized clinical trials - J Am Coll Cardiol. 2005 Sep 6;46(5):821-6 - "ACE inhibitors and ARBs were associated with reductions in the incidence of newly diagnosed diabetes by 27% and 23%, respectively, and by 25% in the pooled analysis ... The use of an ACE inhibitor or ARB should be considered in patients with pre-diabetic conditions such as metabolic syndrome, hypertension, impaired fasting glucose, family history of diabetes, obesity, congestive heart failure, or coronary heart disease" Comparison of the effects of valsartan and felodipine on plasma leptin and insulin sensitivity in hypertensive obese patients - Hypertens Res. 2005 Mar;28(3):209-14 - "These results suggest that in hypertensive obese subjects, treatment with valsartan might offer an advantage over treatment with felodipine, since valsartan may help to improve obesity-related disorders in addition to lowering BP" Strategies to Prevent Type 2 Diabetes - Medscape, 8/8/05 - "Valsartan reduced the incidence of new-onset diabetes by 23% ... Traditional beta-blockers worsen insulin sensitivity and increase the risk of developing new diabetes" FDA Approves Diovan (Valsartan) to Reduce Cardiovascular Death in Heart Attack Survivors at High Risk - Doctor's Guide, 8/4/05 - "was a rigorous comparison of Diovan vs. captopril, an ACE inhibitor, vs. the combination of both ... Diovan was reported to improve survival and reduce cardiovascular events including recurrent heart attack and hospitalizations for heart failure in these patients" Antihypertensive, cardiovascular, and pleiotropic effects of angiotensin-receptor blockers - Curr Opin Nephrol Hypertens. 2005 Sep;14(5):435-41 - "it has been shown that treatment with ARBs prevents the development of type 2 diabetes ... ARBs are first-line agents for the treatment of hypertension and cardiovascular diseases. Blocking the renin-angiotensin system with these agents has special advantages due to specific vascular and antiatherosclerotic effects, which contribute to a better cardiovascular and renal protection in patients at risk from or with cardiovascular disease" Stabilization and Regression of Albuminuria in Chinese Patients With Type 2 Diabetes: A One-year Randomized Study of Valsartan Versus Enalapril - Adv Ther. 2005 Mar-Apr;22(2):155-62 - "enalapril and valsartan both reduced blood pressure and albuminuria to a similar extent ... Fewer adverse events were reported with valsartan" Atacand Therapy Can Reduce Risk of Diabetes in Heart Failure Patients - Doctor's Guide, 7/4/05 - "Six percent of patients in the candesartan group were newly diagnosed with diabetes during the study period (median 3.1 year), compared to 7.4% in the placebo group" Effects of irbesartan on intracellular antioxidant enzyme expression and activity in adolescents and young adults with early diabetic angiopathy - Diabetes Care. 2005 Jul;28(7):1690-7 - "Adolescents and young adults with early signs of diabetic angiopathy have defective intracellular antioxidant enzyme production and activity. Treatment with irbesartan can substantially improve the activity and production of these enzymes in skin fibroblasts" Effects of Valsartan Compared to Amlodipine in Prevention of Type 2 Diabetes in High-Risk Hypertensive Patients: Presented at EMH - Doctor's Guide, 6/24/05 - "Valsartan is significantly superior to amlodipine for prevention of new-onset type-2 diabetes in high-risk patients with hypertension" Administration Time-Dependent Efficacy of Valsartan-Atorvastatin Combination in Hyperlipidaemic Patients With Essential Hypertension: Presented at EMH - Doctor's Guide, 6/22/05 - "160-mg/day dose of valsartan ... 10 mg/day of atorvastatin ... combination treatment significantly improved systolic/diastolic blood pressure levels (SBP/DBP) compared to monotherapy (17.1/10.7 vs. 13.9/9.6 mm Hg; P = .027). The same benefit was seen in terms of pulse pressure (6.4 vs. 4.3 mm Hg ... there were large significant increases in efficacy seen with the valsartan/atorvastatin combination dosed at night versus morning (SBP, 23.5 vs. 11.0 mm Hg; DBP, 15.9 vs. 6.8 mm Hg; pulse pressure, 7.8 vs. 4.1 mm Hg" Valsartan Significant Better Than Amlodipine for Improving Long-term Heart-rate Variability in Patients With LVH: Presented at EMH - Doctor's Guide, 6/20/05 Irbesartan/Hydrochlorothiazide Helps Patients with Metabolic Syndrome and Poorly Controlled Hypertension: Presented at ADA - Doctor's Guide, 6/14/05 Novartis Receives EU Marketing Authorization for Diovan to Treat People With Heart Failure - Doctor's Guide, 6/13/05 Fixed-Dose Valsartan Gets Patients to Goal After Other Angiotensin Receptor Blocker Fixed-Dose Failures - Doctor's Guide, 5/25 - "Valsartan was deemed statistically better than either of the two initial drugs" Comparison of the effects of ramipril versus telmisartan in reducing serum levels of high-sensitivity C-reactive protein and oxidized low-density lipoprotein cholesterol in patients with type 2 diabetes mellitus - Am J Cardiol. 2005 Jun 1;95(11):1386-8 - "All regimens were associated with a significant reduction of C-reactive protein and oxidized low-density lipoprotein cholesterol serum levels" Patients Who Fail Anti-Hypertensive Monotherapy Respond to Fixed-Dose Combination of Irbesartan/Hydrochlorothiazide - Doctor's Guide, 5/19/05 FDA Approves Atacand (Candesartan Cilexetil) For Use With An Ace Inhibitor In The Treatment Of Heart Failure - Doctor's Guide, 5/19/05 Telmisartan Superior to Ramipril in Preventing Morning Blood Pressure Rise - Doctor's Guide, 5/19/05 - "Reductions were greater and statistically significant in the highest quartile (34 mmHg), in whom telmisartan reduced systolic surge by 12.4 mmHg and ramipril by 7.1 mmHg" Valsartan Reduces Chance of Diabetes in High-Risk Hypertensive Patients - Doctor's Guide, 5/19/05 - "patients taking valsartan had a 23% lower risk of developing diabetes during the four or more years of the study. The two drugs had previously been shown to be roughly equivalent in reducing the risk of heart attack and stroke" - See valsartan at OffshoreRX.com. Combo Drug Controls Hypertension In Hard-to-treat Patients - Science Daily, 5/18/05 - "the combination pill of irbesartan (an angiotensin II receptor blocker) and a diuretic, hydrochlorothiazide ... the participants' systolic blood pressure (the top number) dropped an average of 21.5 points, from 154.4 to 132.9 points. Their diastolic blood pressure (the bottom number) fell an average of 10.4 points, from 91.3 to 80.9" - Yeah, but what about impotence from the diuretic? Bedtime Dosing of Atorvastatin and Valsartan Together Improves Overall Anti-Hypertensive Effects - Doctor's Guide, 5/17/05 - "When valsartan was dosed by itself during the day, patients averaged a 9 mmHg fall in systolic blood pressure; daytime dosing of both valsartan and atorvastatin resulted in a 17 mmHg reduction in the 24-hour mean of systolic and diastolic BP" Blood Pressure Linked to Erectile Dysfunction - WebMD, 5/16/05 - "Men on older high blood pressure medications (diuretics, beta-blockers) had higher rates and more severe erectile dysfunction than men on newer medications (calcium antagonists, ACE inhibitors, angiotensin II receptor blockers)" ACE Inhibitors or ARBs for Prevention of Type 2 Diabetes: A Meta-analysis of Randomized Clinical Trials - Medscape, 4/18/05 - "the use of valsartan reduced the incidence of new-onset type 2 diabetes by 23%" The Effects of Losartan Compared to Atenolol on Stroke - Medscape, 4/14/05 - "these data suggest that losartan-based treatment reduces CV complications, primarily stroke, when compared to atenolol-based treatment for patients with ISH and high CV risk" FDA Approves Hyzaar (Losartan Potassium-Hydrochlorothiazide) Fixed-Dose Combination - Doctor's Guide, 4/14/05 Evidence-Based Treatment of Hypertension: What's the Role of Angiotensin II Receptor Blockers? - Medscape, 4/8/05 - "The ARBs are highly effective in lowering blood pressure and reducing cardiovascular mortality. They also appear to provide additional renal protection in patients with diabetes, and this effect is independent of their effect on blood pressure. Combinations of ARBs with drugs from other classes such as ACE inhibitors have been found to be highly effective; they may permit lower doses of ACE inhibitors to be used than in monotherapy, which may lower the incidence of dose-related adverse effects. The ARBs themselves are very well tolerated and are not associated with the side-effects known to cause compliance problems with beta blockers, ACE inhibitors and calcium channel blockers such as impotence, dry cough and peripheral oedema" New Data Shows Telmisartan (Micardis/Pritor) Provides Effective and Well-Tolerated Blood Pressure Lowering in Chronic Kidney Disease Patients - Doctor's Guide, 4/4/05 Angiotensin II Receptor Blockers: A New Lease of LIFE? - Medscape, 10/26/04 Losartan and Irbesartan Comparable in Efficacy for Blood Pressure Lowering - Doctor's Guide, 10/8/04 Study Findings Add Further Weight to Effectiveness of Atacand (Candesartan Cilexetil) in Treating Heart Failure - Doctor's Guide, 9/3/04 Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes - Medscape, 8/31/04 - "the angiotensin-converting enzyme (ACE) inhibitor enalapril and the angiotensin-receptor blocker (ARB) telmisartan were equally effective in slowing kidney damage in people with type 2 diabetes, hypertension, and nephropathy" DETAIL Results Show Telmisartan Not Inferior to Enalapril in Renal Protection of Diabetics - Doctor's Guide, 8/31/04 Erythema Multiforme Associated with Candesartan Cilexetil - Medscape, 7/29/04 Antihypertensive Effect of Valsartan Appears Safely Enhanced By Doubling Conventional Dosage - Doctor's Guide, 7/9/04 Valsartan Appears More Effective Than Telmisartan in Patients With Essential Hypertension - Doctor's Guide, 6/25/04 - "At the end of the study, the 24-hour mean BP was statistically lower in the valsartan-treated group compared to telmisartan-treated group" Amlodipine More Effective for Blood Pressure Reduction but Confers Similar Cardiac Outcomes to Valsartan Therapy - Doctor's Guide, 6/18/04 Significant Reduction in Left Ventricular Mass Index, Reactive Oxygen Species Formation and C-Reactive Protein With Valsartan Treatment - Doctor's Guide, 6/18/04 - "Despite very similar effects on BP, there was a significantly higher reduction in LVMI with valsartan compared with amlodipine ... In the valsartan group, CRP levels were significantly reduced" Telmisartan Associated with Greater Left Ventricular Hypertrophy Regression Than Carvedilol - Doctor's Guide, 6/17/04 - "The angiotensin II receptor blocker telmisartan produces significantly greater left ventricular hypertrophy (LVH) regression than does the beta blocker carvedilol in hypertensive patients" Newer Drug Helps Prevent Heart Attack - HealthDay, 6/17/04 - "people taking valsartan had much lower rates of admission to hospital for heart failure. And fewer people in the valsartan group (13 percent) developed type 2 diabetes than those in the amlodipine group (16 percent)" Telmisartan 40 or 80 mg/Hydrochlorothiazide 12.5 mg Fixed –Dose Combinations Can Thwart Early Morning Blood Pressure Surge - Doctor's Guide, 6/15/04 Benicar (Olmesartan Medoxomil) and Benicar HCT (Olmesartan Medoxomil/Hydrochlorothiazide) Therapies Achieve Blood Pressure Goals in Hypertension - Doctor's Guide, 5/26/04 - "at the usual recommended starting doses, approximately twice as many patients treated with Benicar achieved goal blood pressure of less than 140/90 mm Hg compared to Cozaar®(losartan potassium) and Diovan® (valsartan), the two most commonly prescribed angiotensin II receptor blockers (ARBs)" Maximum Dose of Valsartan Appears More Effective than Telmisartan in Lowering Ambulatory Blood Pressure and Pulse Pressure Over 24 hours - Doctor's Guide, 5/25/04 - "the blood pressure reduction in the 24-hour mean was significantly larger for valsartan 160 mg (18.6 and 12.1 mm Hg for systolic and diastolic blood pressure, respectively) than for telmisartan 80 mg (10.8 and 8.4 mm Hg" Losartan Preserves Cerebral Blood Flow in Hypertensive Patients With a History of Stroke - Doctor's Guide, 5/19/04 Atacand (Candesartan Cilexetil) Appears More Effective Than Cozaar (Losartan) at Lowering Blood Pressure - Doctor's Guide, 5/10/04 - "Candesartan was shown to lower systolic and diastolic blood pressure by 2 to 3 mm Hg on average more than losartan potassium when measured at the time of either peak or trough effect" Valsartan May Produce Lower Ambulatory Heart Rate, Greater Lowering of Daytime Systolic Blood Pressure than Amlodipine in Elderly Patients with Systolic Hypertension - Doctor's Guide, 5/6/04 Telmisartan Safe, Effective for the Treatment of Isolated Systolic Hypertension - Doctor's Guide, 5/4/04 Left Ventricular Mass Index Reduced with Low-Dose Valsartan in Patients with Type 2 Diabetes - Doctor's Guide, 4/15/04 Telmisartan Lowers Early Morning Blood Pressure in Patients With Hypertension More Effectively Than Does Valsartan - Doctor's Guide, 4/12/04 - "telmisartan reduced BP during the last 6 h of the dosing period more effectively than did valsartan (-11/-7.6 ± 0.8/0.6 mm Hg vs. -8.7/-5.8 ± 0.8/0.6 mm Hg" Losartan-Based Treatment Appears More Effective In Reducing Strokes In Hypertensives Than Atenolol-Based Treatment - Doctor's Guide, 4/1/04 Telmisartan Safe, Effective for Treatment of Hypertension in a Diverse Population - Doctor's Guide, 3/5/04 Irbesartan More Cost and Survival Effective than Amlodipine in Canadian Patients with Diabetic Neuropathy and Hypertension - Doctor's Guide, 3/4/04 Telmisartan Appears to Offer Additional Benefit to Antihypertensive Regimens - Doctor's Guide, 1/22/04 ARB, ACE Inhibitor, or Both After MI in High-Risk Patients? - Medscape, 1/9/04 Telmisartan Reduces Blood Pressure and Left Ventricular Mass Index in Patients with Hypertension - Doctor's Guide, 1/7/04 - "Telmisartan was significantly more effective in reducing blood pressure and left ventricular mass index (LVMI) than was hydrochlorothiazide in patients with mild-to-moderate hypertension ... Reducing LVM is a primary objective to managing hypertension because of the increased risk of cardiovascular morbidity and mortality associated with increases in LVM" Reduction in Left Ventricular Mass Due to Irbesartan Correlates With Increased Angiotensin II Levels - Doctor's Guide, 12/9/03 Persistent Renoprotection After Irbesartan Withdrawal in Hypertensive Type 2 Diabetics - Doctor's Guide, 11/18/03 Teveten (Eprosartan Mesylate) Effectively Lowers Systolic Blood Pressure, Pulse Pressure in Isolated Systolic Hypertension - Doctor's Guide, 11/14/03 Valsartan Shown as Effective as Captopril for Post-Heart Attack Treatment - Doctor's Guide, 11/10/03 Two Heart Drugs [ARBs & ACE Inhibitors] Found Equally Effective - HealthDay, 11/10/03 - "Overall survival in both groups and among patients who got combined therapy was better than 80 percent ... The incidence of side effects such as cough, taste disturbance and rash was higher among those given both drugs together, and people getting the combined treatment were more likely to stop taking the medications ... valsartan is "a safe and equally effective alternative" for patients who have problems with ACE inhibitor treatment, Mann writes. People with kidney problems, for instance, are usually kept away from these drugs" Irbesartan More Effective Than Amlodipine in Reducing Left Ventricular Mass Index - Doctor's Guide, 11/4/03 - "Several studies have established that LVH is a powerful BP-independent cardiovascular risk factor; however, not all antihypertensive drugs can reverse LVH ... After 3 months, echocardiographically estimated LVMI decreased by 23.2% in the irbesartan-treated patients and 11.4% in the amlodipine-treated patients" Losartan Improves Cognitive Function in Elderly Hypertensive Patients - Doctor's Guide, 10/31/03 - "Patients receiving losartan showed significant improvement in both memory tests, while those receiving atenolol did not shown a difference with treatment. Losartan treatment was associated with a 2.2 point increase in word list memory score and a 2.1 point increase in the word list recall score ... Notably, a greater number of adverse events were reported in patients given atenolol than in those given losartan (31 vs. 8 events)" Telmisartan And Lisinopril Appear Equally Effective In Reducing Blood Pressure and Pulse Pressure - Doctor's Guide, 10/10/03 - "For both TPR and SI measurement techniques, no differences were detected between the two drugs in their effects on systolic and diastolic BP" Renin-Angiotensin System Blockade Produces Multiple Benefits Independent of Blood Pressure Reduction - Doctor's Guide, 9/29/03 - "According to the authors, ACE inhibitors and ARBs, at least in higher- or moderate-risk individuals, "show advantages that are additional to the reduction in blood pressure that they achieve ... We still await new and forthcoming data as to whether the better-tolerated ARBs have benefits equivalent to those of the ACE inhibitors, for which there are now numerous data ... We also await data on the combination of both these classes of drugs, particularly with respect to safety" Candesartan More Effective Than ACE Inhibition Post-Myocardial Infarction - Doctor's Guide, 9/29/03 Losartan Reduces Hospitalizations in Diabetic Heart-Failure Patients - Doctor's Guide, 9/29/03 Drugs Blocking the Renin-Angiotensin System Offer Advantages Beyond Lowering Blood Pressure - Doctor's Guide, 9/15/03 - "According to the authors, ACE inhibitors and ARBs, at least in higher- or moderate-risk individuals, "show advantages that are additional to the reduction in blood pressure that they achieve" High Doses of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Required for Maximum Renoprotection - Doctor's Guide, 9/12/03 - "angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can have significant renoprotective effects, in addition to known antihypertensive benefits ... The optimal dose and strategy for renoprotection using ACEI and ARBs should be guided by titrating to the maximum antiproteinuric effect ... For patients who maintain elevated proteinuria despite high dose monotherapy, they recommend combined use of ACE inhibitors and ARBs" Brain Natriuretic Peptide Changes Are Predictive of Valsartan Treatment Success in Heart Failure - Doctor's Guide, 9/9/03 CHARM Trials Demonstrate Add-On Benefit of Candesartan for Heart Failure - Doctor's Guide, 9/3/03 Effect of losartan on sudden cardiac death in people with diabetes: data from the LIFE study - Lancet. 2003 Aug 23;362(9384):619-20 - "In the losartan group, five (6%) of 86 patients with diabetes and atrial fibrillation during the trial died of sudden cardiac death compared with nine (2%) of 500 in those without atrial fibrillation. The respective figures for the atenolol group were 14 (13%) of 105 and 16 (3%) of 504. Our results suggest losartan affords better protection against cardiac death from arrhythmias for patients with diabetes mellitus than does atenolol" Renin-Angiotensin System Blockers Offers Added Benefits Beyond Blood-Pressure Lowering For Hypertensives - Doctor's Guide, 8/28/03 - "Emerging data on newer drugs that block the renin-angiotensin system, such as the angiotension II type 1 receptor blockers (ARBs) and angiotension-converting enzyme (ACE) inhibitors, indicate added benefits such as reduced mortality, strokes, and myocardial infarction along with decreased blood pressure" Losartan Superior to Atenolol For Reducing Cardiac Death From Arrhythmias In Hypertensive Diabetics - Doctor's Guide, 8/21/03 Losartan More Effective Than Atenolol in Preventing Morbidity and Mortality in Low-Risk Hypertensive Patients - Doctor's Guide, 8/21/03 - "Losartan appears to be more effective than atenolol in preventing cardiovascular morbidity and death - especially fatal and non-fatal stroke - in patients with hypertension but without clinically evident vascular disease. Furthermore, the effect appears to be independent of blood pressure reduction ... In addition, incident diabetes occurred less often in patients treated with losartan" Losartan Causes Greater Regression of Left Ventricular Hypertrophy Compared to Atenolol - Doctor's Guide, 8/8/03 Early Intervention with Atacand (Candesartan) Improves Outcome for Patients with Acute Ischaemic Stroke - Doctor's Guide, 7/28/03 ACE Inhibitors Prevent Diabetes and Cardiovascular Disease by Multiple Mechanisms - Doctor's Guide, 7/25/03 - "ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II ... Angiotensin II increases the production of reactive oxygen species and has several vasoconstrictive effects, including opposition of the vasorelaxant actions of nitric oxide and stimulation of plasminogen activator inhibitor-1 ... Angiotensin II, furthermore, increases arterial stiffness by a variety of mechanisms ... fewer studies have evaluated the effects of angiotensin receptor blockers (ARBs), although these agents may also exert beneficial effects and may act synergistically with ACE inhibitors ... The authors note that, regarding the role of ACE inhibitors in diabetic renal disease, with the exception of ARBs, ACE inhibitors "have been shown to be more effective in reducing proteinuria than any other antihypertensive agents." Telmisartan Effective and Well-tolerated for Renal Failure Patients - Doctor's Guide, 6/20/03 FDA Grants Marketing Approval for Benicar HCT (Olmesartan Medoxomil-Hydrochlorothiazide) Treatment For Hypertension - Doctor's Guide, 6/9/03 Fenofibrate, Losartan Show Additive Benefits with Anti-hyperuricaemic Agents in Gout Patients - Doctor's Guide, 6/4/03 Telmisartan Improves Quality of Life Measurements in Hypertensive Patients - Doctor's Guide, 5/30/03 - "The angiotensin II receptor blocker telmisartan appears to enhance the quality of life for patients who are being treated for high blood pressure ... the scores increased from 77 at baseline to an average of 82.2" Losartan Treatment Effect is Boosted by DASH Diet - Doctor's Guide, 5/26/03 - "For patients receiving losartan, systolic and diastolic blood pressure was significantly reduced from baseline on the control diet (-6.7 + 1.5/-3.7 + 1.0 mm Hg, P < .05), with an even greater effect evident for the DASH diet (-1.7 + 1.5/-6.9 + 1.0 mm Hg, P < .05) ... A reduction in systolic blood pressure in patients receiving placebo occurred on the DASH diet (-5.3 + 1.5 mm Hg, P < .05). No other significant changes to blood pressure levels were observed" - [Abstract] Angiotensin II Receptor Blockers Effective, Better Tolerated than Calcium Channel Blockers in Elderly Patients - Doctor's Guide, 5/21/03 - "Valsartan and amlodipine are both highly effective in controlling blood pressure in patients with isolated systolic hypertension ... However, valsartan offers a significant tolerability advantage as it shows a reduced risk of developing adverse events" Olmesartan Medoxomil Has Equal Efficacy and Safety in Hypertensive Men and Women - Doctor's Guide, 5/21/03 Hypertensive Patients Respond to Telmisartan Titration in Community-Based Trial - Doctor's Guide, 5/20/03 Eprosartan Mesylate Shows Benefits in Elderly with Isolated Systolic Hypertension - Doctor's Guide, 5/20/03 Valsartan Appears to Improve Sexual Function in Men and Women with Hypertension - Doctor's Guide, 5/18/03 - "Men and women being treated with the angiotensin II receptor blocker valsartan for mild-to-moderate hypertension appear to show improvements in sexual function and desire" Patients Respond to Up-titration of Olmesartan - Doctor's Guide, 5/18/03 Candesartan Effectively Reduces Blood Pressure in Elderly Hypertensives - Doctor's Guide, 5/12/03 - "Active anti-hypertensive treatment was given to most patients (84%) in the control group ... A first major cardiovascular event occurred in 242 candesartan patients and in 268 controls. The risk reduction with candesartan was 10.9%. Candesartan-based treatment reduced non-fatal stroke by 27.8% and all stroke by 23.6%" - [Abstract] Eplerenone Superior To Losartan In Black Patients With Hypertension - Doctor's Guide, 4/14/03 Candesartan Improves Congestive Heart Failure - Doctor's Guide, 4/11/03 LIFE Sub-Study Finds Losartan Superior To Atenolol In Atrial Fibrillation - Doctor's Guide, 4/4/03 Basal Nitric Oxide Production, Release Improved By AT(1) Receptor Blockade With Valsartan - Doctor's Guide, 2/19/03 Which Blood Pressure Drug Is Best? - HealthDay, 2/12/03 Amlodipine Appears To Provide Greater Reduction In Blood Pressure Than Does Losartan - Doctor's Guide, 2/6/03 - "Diastolic blood pressure equal to or below 90 mm Hg was achieved by 43.6% of the amlodipine patients and 42.3% of the losartan patients. Seventy-one percent of the amlodipine and 81% of the losartan patients who continued treatment with the original dose reached blood pressure goals ... However, among those patients who required dosage adjustments, a significantly higher number of amlodipine patients reached blood pressure goals. Fifty-nine percent of the amlodipine patients compared with 42%" BP Drug Cozaar Also Prevents Stroke - WebMD, 1/7/03 - "Cozaar reduced the risk of stroke by about 25% compared with atenolol" FDA Advisors Recommend Losartan for Stroke Prevention - Medscape, 1/7/03 Averting Migraines With Few Side Effects - WebMD, 12/31/02 Valsartan Improves Augmentation Index In Essential Hypertension - Doctor's Guide, 12/23/02 BP Lowering May Halt Descent Into Dementia - Clinical Psychiatry News, 12/02 - "those in the candesartan arm had a mean 0.5-point decline in MMSE scores during follow-up, compared with a 6-point drop in those on a diuretic. The cognitive benefit was even more pronounced in patients over age 85" Irbesartan Improves Cardiac Repolarization In Hypertensive Left Ventricular Hypertrophy - Doctor's Guide, 11/26/02 Telmisartan Efficacy in Mild-Moderate Hypertension Confirmed - Doctor's Guide, 11/25/02 Valsartan Produces Sustained Aldosterone Decrease in Heart Failure Patients - Doctor's Guide, 11/18/02 Losartan Reduces Proteinuria in Non-Diabetic Patients with Nephropathy - Doctor's Guide, 11/7/02 Angiotensin Receptor Blocker Plus Angiotensin Converting Enzyme Inhibitor Enhances Angiotensin II Blocking Effect - Doctor's Guide, 11/4/02 Albumin Secretion, Blood Pressure Lowered by Angiotensin II Receptor Blocker Telmisartan - Doctor's Guide, 11/1/02 Incidence of Cardiac Events Similar Between Amlodipine And Irbesartan in Diabetic Patients with Overt Nephropathy - Doctor's Guide, 11/1/02 Angiotensin II Receptor Blockers Reduce Proteinuria In Lupus Nephritis - Doctor's Guide, 10/29/02 New Angiotensin II Blocker Counters Hypertension Effectively And Safely - Doctor's Guide, 10/22/02 Valsartan Improves Survival, Reduces Hospitalisations In Heart Failure Patients Not Taking Ace Inhibitors - Doctor's Guide, 10/16/02 Valsartan's Benefit in Heart Failure Confirmed - Doctor's Guide, 10/4/02 Candesarten Effectively Reduces Proteinuria in Patients with Chronic Glomerulonephritis - Doctor's Guide, 10/1/02 Losartan Superior in Isolated Systolic Hypertension with Left Ventricular Hypertrophy - Doctor's Guide, 9/25/02 Losartan Better Than Atenolol at Reducing Cardiovascular Risk - Medscape, 9/25/02 FDA Approves Avapro (Irbesartan) For The Treatment Of Diabetic Nephropathy (Kidney Disease) In Patients With High Blood Pressure And Type 2 Diabetes - Doctor's Guide, 9/18/02 Lisinopril But Not Losartan Boosts Myocardial Perfusion In Hypertensives With Left Ventricular Hypertrophy - Doctor's Guide, 9/18/02 LIFE Substudy Shows Losartan Superior to Atenolol at Reducing Stroke Risk - Doctor's Guide, 9/16/02 Losartan Superior To Atenolol In Reducing Left Ventricular Hypertrophy In Hypertensives - Doctor's Guide, 9/4/02 Losartan Reduces Incidence of End-Stage Renal Disease in Type 2 Diabetics, Also Lowers Cost Burden - Doctor's Guide, 9/4/02 New Data From Val-HeFT Shows Diovan (Valsartan) Is Highly Cost-Effective In Treating Heart Failure Patients Not Taking ACE Inhibitors - Doctor's Guide, 9/2/02 FDA Approves Blood Pressure Treatment Diovan(R) (valsartan) for Heart Failure - Doctor's Guide, 8/15/02 Lercanidipine and Losartan Effective, Well-Tolerated Monotherapies for Mild to Moderate Hypertension - Doctor's Guide, 8/13/02 Low Dose Valsartan Therapy May Reduce Urinary Albumin Excretion In Type 2 Diabetics With Nephropathy - Doctor's Guide, 7/31/02 Patient Compliance with Antihypertensive Therapy Appears Longer for Those Taking Angiotensin II Antagonists - Doctor's Guide, 7/18/02 - "The researchers found that the class of drug had a statistically significant effect on the patients' persistence of compliance. Angiotensin II antagonists had the highest rate of persistence followed by ACE inhibitors, calcium channel blockers, beta-blockers, and diuretics" Antiproteinuric Effect of Losartan Related to its Haemodynamic Effects - Doctor's Guide, 7/18/02 Cozaar (Losartan) Lowered Risk Of Total Mortality In Patients With Diabetes By 39% Versus Atenolol - Doctor's Guide, 6/27/02 - "treatment with losartan resulted in a 24 per cent reduction in the primary composite endpoint of cardiovascular death, stroke and heart attack compared to the beta-blocker atenolol (p=0.03). Blood pressure and pulse pressure reductions were similar with both therapies. In addition, losartan significantly reduced the risk of cardiovascular death by 37 per cent (p=0.03) and total mortality by 39 per cent ... A 39 per cent reduction in total mortality with losartan is an important observation given that the observed reduction is versus an established antihypertensive, atenolol ... It is widely accepted that elevated systolic blood pressure is an even stronger risk factor for cardiovascular events than diastolic blood pressure" Reducing Hypertension In The Elderly Leads To A Significant Reduction In The Incidence Of Stroke - Doctor's Guide, 6/27/02 Losartan Plus Hydrochlorothiazide Reduces Essential Hypertension - Doctor's Guide, 6/26/02 Severe Fibrosis Appears To Decrease Following Losartan Therapy - Doctor's Guide, 6/6/02 Results Published Demonstrate that Irbesartan Provides Greater Blood Pressure Reduction than Valsartan in Patients with Elevated Blood Pressure - Doctor's Guide, 5/24/02 Losartan Restores Normal Dilation Of The Left Main Coronary Artery After Cold Pressor Test - Doctor's Guide, 5/23/02 Irbesartan More Effective than Atenolol in Reducing Cardiac Electrical Instability - Doctor's Guide, 5/20/02 Impotent Patients on Valsartan Find Increased Interest in Sex; Use Sildenafil More Often - Doctor's Guide, 5/19/02 - "Because the use of sildenafil significantly increased with the use of valsartan, it suggests that angiotensin II antagonism induces an increase in sexual desire in impotent hypertensive men ... It could be related to the reactive stimulation of angiotensin cascade due to AT1 receptors blockade" VALUE trial Shows Lower Diastolic Blood Pressure After One Year in 90% of Patients - Doctor's Guide, 5/19/02 Olmesartan Medoxomil and Amlodipine Equally Effective for Mild to Moderate Hypertension - Doctor's Guide, 5/19/02 Eplerenone Appears Superior to Losartan in Salt-Sensitive Hypertensive Patients - Doctor's Guide, 5/19/02 Losartan Reduces Platelet Activity When Compared to Candesartan in Patients With Diabetes and Hypertension - Doctor's Guide, 5/17/02 Results of a New Study Show That Irbesartan May Provide Additional Benefits For High Risk Patients With High Blood Pressure - Doctor's Guide, 5/16/02 Telmisartan/Hydrochlorothiazide Combination Superior To Telmisartan Alone For Hypertension - Doctor's Guide, 5/13/02 FDA Grants Marketing Approval For Benicar (Olmesartan Medoxomil) For Treatment Of Hypertension - Doctor's Guide, 4/26/02 - "is a member of the rapidly growing angiotensin II receptor blocker (ARB) class ... Studies have shown that Benicar 20 mg once a day, the recommended starting dose, resulted in double-digit blood pressure reduction, lowering systolic blood pressure by an average of 15mm Hg* and diastolic blood pressure by an average of 12mm Hg. In these studies, patients receiving placebo had average reductions in systolic blood pressure of 5.6 mm Hg and in diastolic blood pressure of 6.2mm Hg." Losartan Reduces QT Dispersion In Patients With Mild To Moderate Hypertension - Doctor's Guide, 4/16/02 Combination ACE Inhibitors and Angiotensin II Blockers Decreases Proteinuria in Patients with Diabetic Nephropathy - Doctor's Guide, 4/11/02 Diabetic Hypertensives Benefit More From Losartan Than Atenolol - Doctor's Guide, 3/22/02 Drug for high blood pressure reduces diabetes risk - USA Today, 3/21/02 - "using the drug Cozaar to treat people with high blood pressure reduces their risk of developing diabetes by 25%" LIFE Study Finds Losartan More Effective than Atenolol in Hypertensive Patients - Doctor's Guide, 3/20/02 A Better Blood-Pressure Drug [Cozaar] - WebMD, 3/20/02 Morbidity Risk Reduced When Valsartan Administered In Hypertensive Heart Failure - Doctor's Guide, 3/19/02 Losartan/Quinapril Combination Therapy Suppresses Cardiac Sympathetic Activity - Doctor's Guide, 1/29/02 Eprosartan Reduces Blood Pressure Throughout 24 Hours - Doctor's Guide, 12/27/01 Support Qualified For Valsartan In Chronic Heart Failure - Doctor's Guide, 12/6/01 New Data Support Early Intervention With Atacand (Candesartan Cilexetil) In Acute Ischaemic Stroke - Doctor's Guide, 12/6/01 Stroke Patients Show Significant Risk Reduction When Given Atacand (Candesartan Cilexetil) - Doctor's Guide, 11/29/01 Diovan (Valsartan) Reduces Total Heart Failure Hospitalizations - Doctor's Guide, 11/13/01 Diovan (Valsartan) Significantly Reduces Marker of Heart Failure Severity - Doctor's Guide, 11/12/01 FDA Issues Approvable Letter For Diovan (Valsartan) For Treatment Of Heart Failure - Doctor's Guide, 10/25/01 Losartan Cuts Costs of Kidney Failure and Incidence of End-Stage Renal Disease in Diabetics - Doctor's Guide, 10/17/01 Avapro (Irbesartan) Effectively Stops Progression of Type 2 Diabetic Nephropathy - Doctor's Guide, 10/17/01 Long-term Irbesartan, Amlodipine Normalizes Resistance Artery Structure and Endothelial Function - Doctor's Guide, 9/25/01 Blood Pressure Drug May Help Kidneys - Intelihealth, 9/20/01 - "Doctors found that the medicines, called angiotensin II receptor blockers, forestall complete kidney failure by about two years in diabetics with advanced kidney disease. They predict the effects will be even more dramatic in those with less severe kidney damage, potentially protecting them from ever reaching end-stage disease ... If the data keep getting stronger, it will become a recommendation, because there is very little downside to these drugs ... Angiotensin blockers have fewer side effects than ACE inhibitors, which cause a cough in about 20 percent of users" Cozaar (Losartan) Slows Progression of Kidney Disease in Type 2 Diabetes - Doctor's Guide, 9/19/01 Irbesartan Protects Against Kidney Disease Progression in Hypertension, Type 2 Diabetes - Doctor's Guide, 9/4/01 Blood pressure drug reverses sexual dysfunction - Life Extension Magazine, 7/01 - "the active ingredient in Cozaar and Hyaar (losartan) can significantly improve sex lives of men who suffer from sexual dysfunction" Low-Dose Perindopril/Indapamide Combination More Effective Than Irbesartan Alone - Doctor's Guide, 6/21/01 Long-Term Compliance to Losartan Superior To Other Antihypertensives - Doctor's Guide, 6/20/01 Telmisartan Effective And Well-Tolerated In Long-Term Treatment Of Hypertension - Doctor's Guide, 6/20/01 Candesartan Shown Equivalent To Enalapril In Regressing Left Ventricular Hypertrophy - Doctor's Guide, 6/19/01 Irbesartan Delays Nephropathy In Diabetic Patients - Doctor's Guide, 6/17/01 Better Compliance Found With Once Daily Irbesartan Over Atenolol in Treatment of Pediatric Severe Hypertension - Doctor's Guide, 5/30/01 Cozaar (Losartan) Significantly Reduces Progression of Kidney Disease in Type 2 Diabetics - Doctor's Guide, 5/24/01 Diabetics Get Kidney Protection From ARBs, High Blood Pressure Drugs Reduce Need for Dialysis, Transplant - WebMD, 5/20/01 - "results from three landmark studies of almost 4,000 diabetic patients suggest that a specific class of blood pressure drugs called angiotensin receptor blockers, or ARBs, can protect kidneys and reduce the need for kidney dialysis or transplant" Irbesartan Slows Kidney Disease In Diabetics - Doctor's Guide, 5/20/01 Telmisartan With Hydrochlorithiazide Controls Hypertension - Doctor's Guide, 5/18/01 - "after eight weeks on the FDC, both SBP/DBP dropped by 7.4/3.5 mmHg, compared with the telmisartan 40 mg monotherapy" Diovan (Valsartan) Effective in Reducing Microalbuminuria - Doctor's Guide, 5/17/01 - "Diovan® (valsartan), is more effective in reducing microalbuminuria (p<0.001), an early sign of diabetic kidney disease, compared to the calcium channel blocker, amlodipine" Newest Hypertension Drug, Losartan, May Improve Sexual Function - Doctor's Guide, 5/1/01 Angiotensin II Antagonist Telmisartan Fights Stiffening Arteries In Hypertensive Diabetics - Doctor's Guide, 4/6/01 - "not only effectively lowered blood pressure compared with placebo, but also significantly decreased arterial stiffness" Angiotensin II Antagonist Plus Conventional Treatment Improves Blood Pressure Control, Kidney Function - Doctor's Guide, 4/6/01 - "Adding candesartan cilexetil to conventional therapy significantly reduced albuminuria by a mean of 25 percent, fractional albumin clearance by a mean of 35 percent, 24-hour systolic blood pressure by a mean of 10 mmHg, and GFR by a mean of 5 ml/minute/1.73 m2. The mean reduction in diastolic blood pressure (3 mmHg) was not statistically significant" Carvedilol Reduces But Valsartan May Increase Sexual Activity In Hypertensive Men - Doctor's Guide, 2/1/01 - "carvedilol induces a chronic reduction of sexual activity whereas valsartan, an angiotensin II antagonist, not only does not significantly reduce sexual activity but may even increase it." FDA Approves Micardis HCT (Telmisartan/Hydrochlorothiazide) For Hypertension - Doctor's Guide, 11/21/00 - "Micardis HCT 80/12.5 mg significantly reduced diastolic and systolic blood pressures by an average of 14.9 mmHg and 23.9 mmHg, respectively" Triple Therapy Including Angiotensin Blockers Shows Benefits In Heart Failure Treatment - Doctor's Guide, 11/21/01 - "This finding contradicts the long-held belief that the drugs should not be combined, and means it may be possible to use a form of "triple therapy" for some congestive heart failure patients" Valsartan Provides Significant Reduction In Combined Risk Of Death, Morbidity From Heart Failure - Doctor's Guide, 11/15/00 Atacand HCT (Candesartan Cilexetil-Hydrochlorothiazide), Anti-Hypertensive, Now Available In US - Doctor's Guide, 10/26/00 Angiotensin-converting Enzyme Inhibitors, Beta Blockers May Postpone Kidney Failure - Doctor's Guide, 10/13/00 FDA Approves Atacand HCT (Candesartan Cilexetil HCl) For Hypertension - Doctor's Guide, 9/6/00 Irbesartan Improves Quality Of Life In Hypertensives - Doctor's Guide, 8/24/00 - "although the use of antihypertensive drugs before inclusion of irbesartan appeared to make quality of life worse, the addition of irbesartan produced a positive impact on quality of life" Enalapril And Losartan Reverse Arterial Vessel Stiffening - Doctor's Guide, 8/24/00 Valsartan And Warfarin May Be Co-administered Safely - Doctor's Guide, 8/24/00 Candesartan/Lisonopril Combination Decreases Blood Pressure In Diabetics - Doctor's Guide, 8/23/00 - "The effect of combination therapy was much more than could be achieved by doubling the dose of each of the drugs separately" Olmesartan Decreases Plasma Angiotensin II Levels - Doctor's Guide, 8/22/00 - "Olmesartan was able to significantly decrease both the systolic and diastolic blood pressure in healthy adults to an average of 136/84 mm Hg [from 164/100 mm Hg]" Valsartan Effectively Lowers Blood Pressure in African Americans on High-Salt Diets - Doctor's Guide, 7/18/00 Atacand (Candesartan Cilexetil) Significantly More Effective Than Cozaar (Losartan) In Lowering Blood Pressure - Doctor's Guide, 7/11/00 - "the use of Atacand at the maximum once-daily dose of 32 mg reduced trough sitting diastolic blood pressure (DBP) by 10.9 mm Hg and trough sitting systolic blood pressure (SBP) by 13.3 compared to 8.7 mm Hg and 9.8 mm Hg for the once-daily maximum dose of 100 mg losartan. In the second CLAIM Study, Atacand 32 mg reduced DBP by 10.5 mm Hg and SBP by 13.4 mm Hg compared to 9.1 mm Hg and 10.1 mm HG for 100 mg losartan" Atacand(Candesartan) Effective Antihypertensive, More Tolerable Than Norvasc(Amlodipine) - Doctor's Guide, 5/19/00 - "The angiotensin II receptor blocker (ARB) Atacand® (candesartan cilexetil) demonstrated similar efficacy in lowering blood pressure with significantly less swelling in patients' feet and ankles compared to the most prescribed antihypertensive medication, the calcium channel blocker Norvasc® (amlodipine, Pfizer)" Diovan (Valsartan) Reduces Systolic Hypertension In The Elderly - Doctor's Guide, 3/3/00 Losartan Doesn’t Unseat Reigning Therapy For Heart Failure - Doctor's Guide, 11/11/99 - "The angiotensin II receptor blocker losartan (Cozaar) did not outperform gold-standard ACE inhibitor therapy in the treatment of heart failure in a large, randomized trial, following a smaller trial that suggested it might be more effective." Antihypertensive Teveten Tablets Now Available In The U.S. - Doctor's Guide, 10/18/99 Avalide Available In U.S. For High Blood Pressure Treatment - Doctor's Guide, 5/13/99 - "(irbesartan/hydrochlorothiazide tablets)" Micardis Available In U.S. For Hypertension - Doctor's Guide, 2/22/99 Atacand Available In U.S. For Hypertension - Doctor's Guide, 10/20/98 - "One of the advantages of a medication like Atacand is that the overall incidence of side effects is similar to placebo" FDA-Approved Diovan HCT Combines Two Hypertension Drug Classes - Doctor's Guide, 3/10/99 FDA Advisory Panel Recommends Approval of Verdia For Hypertension - Doctor's Guide, 1/28/98 New Drug [PrDiovan(tm) (valsartan) Puts The Brakes On Hypertension - Doctor's Guide, 12/2/97 Diovan Reduces Left Ventricular Hypertrophy - Doctor's Guide, 7/17/97 Diovan For First-Line Treatment of Hypertension Cleared by FDA - Doctor's Guide, 12/26/96 Related Searches:

Doctor's Guide search of angiotensin II receptor blocker Doctor's Guide (2) search of angiotensin II receptor blocker Doctor's Guide hypertension channel Intelihealth search of angiotensin Life Extension Foundation search Medline search of angiotensin II receptor blocker Medscape search of angiotensin II receptor blocker Nutrition Science News search WebMD search of angiotensin II receptor blocker 70604

Angiotensin II Blockers new research --->

Central ACE & ACE Inhibitors

 * Mass spectral fragmentation reactions of angiotensin-converting enzyme (ACE) inhibitors
 * Mass spectral fragmentation reactions of angiotensin-converting enzyme (ACE) inhibitors: n interesting dissociation process (rearrangement) unique to one of the compounds, lisinopril, has been investigated using isotopic labeling experiments and exact mass measurements. The general nature of the process has been probed through both the positive and negative ion analyses of fourteen related compounds exhibiting structural homolog
 * Cognitive scores improve in patients starting on centrally acting ACE inhibitors, compared to those already established on maintenance treatment. This may have been related to better medication compliance, the effects of improved BP control or increased cerebrovascular perfusion after initial treatment,

Wondering : ACE ARBS BP Statins : Interactions and complexities
<!--- Actions mediated by the renin-angiotensin system may be inhibited at various levels: renin itself may be inhibited, angiotensin-I (A-1) conversion to angiotensin-II (A-II), or binding of A-II at the A-II type 1 (A-II1) receptor. The angiotensin-converting enzyme (ACE) inhibitors and the A-II1 receptor antagonists are now clinically established. Because ACE is a relatively unspecific peptidase which catalyses the breakdown of A-I, bradykinin and neuropeptides like substance P and neurotensin, the effects of ACE inhibitors go far beyond the prevention of A-II production. On the other hand, in certain tissues like vascular and cardiac tissue, A-II is produced by other enzymes, for instance chymase, and ACE inhibitors do not consistently prevent A-II production. The action of A-II1 receptor antagonists may also not be confined to prevention of binding of A-II at the A-II1 receptor, as by rebound more A-II may bind at the A-II type 2 (A-II2) receptor and thus mediate until now not well defined effects. Thus, anti-ischemic actions of these drugs may be related to multiple mechanisms. Inhibition of A-II effects at the A-II1 receptor may prevent systemic and coronary vasoconstriction and growth effects of A-II on various cell types. In addition, A-II may potentiate, by pre- and postsynaptic mechanisms, activation of the sympathetic nervous system. Prevention of breakdown of bradykinin, substance P and neurotensin may result in direct vasodilation or release of nitrous oxide from the endothelium. Thus, growth-inhibiting effects may also be mediated. All these mechanisms seem to direct to a reduction of cardiac load by vasodilation and to a limitation of cardiovascular cell growth. While the systemic circulating renin-angiotensin system is probably responsible for control of cardiac load, local systems seem to control cell growth. Systemic effects seem to depend on activation of the renin-angiotensin system which has been shown in various ischemic syndromes. Activation of various components of the renin-angiotensin system has been demonstrated in myocardial ischemia, acute myocardial infarction and coronary occlusion and reperfusion models as well as in chronic left ventricular dysfunction post-myocardial infarction. While animal models of stress-induced myocardial ischemia have revealed predominantly positive results, clinical studies, which mostly were small and not well controlled, were equivocal. Large clinical trials with ACE inhibitors in acute myocardial infarction showed small benefits over placebo. Hypotension seems to be a critical side-effect in this situation. Experimental models show protective effects of both ACE inhibitors and A-II1 receptor antagonists in the situation of ischemia and reperfusion. New data on large clinical trials in patients at risk of cardiovascular events but normal left ventricular function demonstrate clear benefits of an ACE inhibitor. Large clinical trials in patients with chronic left ventricular dysfunction post-myocardial infarction show reduction of ischemic events.--->
 * Interactions and complexities
 * Angiotensin-converting enzyme in renal and cerebral tissue and implications for successful blood pressure management.
 * Plasma and tissue ACE Activity and ACE Inhibitors e.g. Quinapril tissue ACE -aorta
 * The renin-angiotensin system in the heart and vascular wall: new therapeutic aspects.1994 a deletion polymorphism in the gene encoding ACE is a risk factor in myocardial infarction (MI)
 * Anti-ischemic potential of drugs related to the renin-angiotensin system.
 * Anti-ischemic potential of drugs related to the renin-angiotensin system.
 * Anti-ischemic potential of drugs related to the renin-angiotensin system.
 * Bradykinin-mediated cardiovascular protective actions of ACE inhibitors. A new dimension in anti-ischaemic therapy?
 * Bradykinin-mediated cardiovascular protective actions of ACE inhibitors. A new dimension in anti-ischaemic therapy?
 * The sympathetic nervous system and ischaemic heart disease.
 * The sympathetic nervous system and ischaemic heart disease.


 * Effect of ACE inhibition on neurohormones.
 * Effect of ACE inhibition on neurohormones.


 * Effect of ACE inhibition on myocardial ischaemia.
 * Effect of ACE inhibition on myocardial ischaemia. ACE inhibition improves endothelial function, exerts anti-atherogenic and anti-proliferation activity and modulates sympathetic activity.
 * Vascular protective effects of angiotensin converting enzyme inhibitors and their relation to clinical events.
 * Vascular protective effects of angiotensin converting enzyme inhibitors and their relation to clinical events. ACE inhibitors augment endothelium-dependent relaxation to bradykinin, while those to acetylcholine remain unaffected, at least in the time frame of the published studies, i.e. 3-6 months. In patients with coronary artery disease, however, paradoxical vasoconstriction to acetylcholine is markedly reduced after 6 months of ACE inhibition. After myocardial infarction ACE inhibitors reduce the development of overt heart failure, the occurrence of reinfarction and cardiovascular death in hypertensive patients. These effects have also been demonstrated in a subgroup analysis of the SOLVD (Studies of Left Ventricular Dysfunction) trial. Thus, in summary, ACE inhibitors are an important class of drugs providing cardiovascular protection in patients with increased cardiovascular risk.

BBB Crossing Statins and effecton brain, RAAS ACE ARBS Dementia

 * Pravastatin at 10 mg/day does not decrease plasma levels of either amyloid-β (Aβ) 40 or Aβ 42 in humans

wrong about Lipitor penetrating the BBB. Search on statins and cognative dysfunction : reported (wow 60 cases), the case reports distribute nothing like the market share of statins. Most of the reports involve Lipitor/atorvastatin and Zocor/simvastatin, and one out of 60 was Pravachol; yet the market share of Pravachol/pravastatin is much higher than that.
 * Fat Soluble Versus Water Soluble Statins - fat soluble better!?
 * Statins and cognitive changes in elderly patients-The lipophilic (fat soluble) statins tend to cross the blood-brain barrier to a greater degree than hydrophilic (water soluble) statins. Based on the evidence, hydrophilic statins such as pravastatin (Pravachol) and rosuvastatin (Crestor) seem to be better choice of statin to minimize risk for cognitive complications.
 * Alzheimer’s Disease—Yes,It’s Preventable!
 * Statin-Associated Memory Loss: Analysis of 60 Case Reports and Review of the Literature
 * Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism
 * How Statins Really Work Explains Why They Don't Really Work
 * Amyloid beta toxicity dependent upon endothelial cell state. ? statins might benefit thro this mech besides conventonal endothelial function effect<!---
 * Statins for the prevention of dementia

Statins have been looked at in a number of studies of cognative function, since there is epidemiological suggestion (not proof) that they might *prevent* Alzheimer's. Incidentally, this evidence is much better than a bunch of case reports, so the statistical evidence that statins lessen risk of cognative impairment is far more impressive than the opposite. Observational data suggest that statins deserve further investigation in chemoprevention and therapeutic clinical trials." He added that the use of nonstatin cholesterol-lowering agents was not associated with reduced risk of colorectal cancer, suggesting that the protective effect was due to the statins rather than to the reduction in cholesterol. Gruber also noted that statins inhibit RAS and RhoA, two proteins that are potentially carcinogenic. In vivo and cell culture experiments have demonstrated that treatment with statins reduces production of β-amyloid protein. Since neurons receive only small amounts of exogenous cholesterol, statins that efficiently cross the blood-brain barrier may reduce the amount of neuronal cholesterol below a critical level. Decreased neuronal cholesterol levels inhibit the β-amyloid-forming pathway, which in turn results in reduced capability of β-amyloid to act as a seed for neurofibrillary tangle formation. A widely accepted theory involves myelin. Cholesterol is essential in the formation of myelin. The more lipophilic statins are able to cross the blood-brain barrier and decrease the amount of CNS cholesterol below the critical value necessary for the formation of myelin. Inadequate myelin production results in demyelination of nerve fibers in the CNS, resulting in memory loss. Once the offending statin is removed from the patient's system, myelin stores are replenished and mental status returns to normal. In our two patients, as well as another patient who received simvastatin, mental status returned to normal within 1 month of discontinuing the statin.
 * Simvastatin Protects against Amyloid β and HIV-1 Tat-Induced Promoter Activities of Inflammatory Genes in Brain Endothelial Cells
 * Simvastatin Protects against Amyloid β and HIV-1 Tat-Induced Promoter Activities of Inflammatory Genes in Brain Endothelial Cells : ALL STATINS LIKELY TO DO THIS beneficially; those without ability to cross BBB without internal side effect such as demyelation orther adverse effects etc, that goes along with BBB Crossing.  Aβ(1-40) and HIV-1 Tat protein cross-amplified promoter activities of three different proinflammatory genes in HBMECs. Similar synergistic effects were observed in HBMECs exposed to Aβ in the presence of HIV-1-infected Jurkat cells. It is most interesting that simvastatin effectively attenuated these effects. The present results indicate that Aβ and HIV Tat may synergistically induce inflammatory reactions in brain endothelial cells. In addition, statins may provide a beneficial influence by reducing these effects at the BBB level.
 * Dementia Prevention. Cognitive Impairment Associated: Atorvastatin and Simvastatin: Discussion
 * Dementia Prevention. Cognitive Impairment Associated: Atorvastatin and Simvastatin: Two epidemiologic studies indicated a decreased prevalence of Alzheimer's disease associated with statin therapy. Dementia was defined as the loss of both cognitive and intellectual functions. Although most studies have referred to statins as possibly preventing dementia of the Alzheimer's type, it is often difficult to distinguish the difference between dementia and isolated cognitive impairment. Thus, the statins' effects are referred to as cognitive impairment; a decline in intellectual function may not always a part.

In addition to demyelination of nerves in the CNS, nerves in the peripheral nervous system may be affected. Patients may experience tingling sensations of the extremities and loss of the sense of touch secondary to peripheral nervous system demyelination. Our second patient experienced some peripheral adverse effects. Diagnosing a patient with statin-induced dementia is complicated since many patients at risk for this complication also fit the profile of other types of dementia. The most important risk factor in the assessment of statin-induced dementia is, of course, the presence and temporal association of a statin. Statins with the greatest lipophilicity -- simvastatin and atorvastatin -- more easily cross the blood-brain barrier, which may affect memory. In a previously published report identifying simvastatin-associated memory loss, simvastatin was discontinued and pravastatin begun. The patient did not experience memory loss while taking pravastatin, which is highly hydrophilic and less likely to cross the blood-brain barrier. According to the myelin theory, pravastatin would be much less likely to cause statin-induced dementia and might have been a more appropriate choice in our two patients.

Onset of statin-induced dementia appears to occur within 1 year of the start of treatment, with memory impairment progressively worsening. This gradual onset helps to distinguish statin-induced dementia with the dementia usually associated with acute onset, such as with a stroke. Other causes of gradual onset of dementia, such as Alzheimer's disease, depression, and hypothyroidism, must be considered. Statin-induced dementia may be distinguished by the complete reversal of symptoms that occurs after statin discontinuation. Both of our patients, as well as the one in the previously published report,[1] returned to their baseline mental status within 1 month of statin discontinuation.
 * Statins Show Promise in Protecting Against Alzheimer's
 * Statins Show Promise in Protecting Against Alzheimer's: There was no association for nonstatin cholesterol-lowering drugs. However, there was for statins. Compared with the nonuse of cholesterol-lowering drugs, statin use was associated with a 43 percent lower risk of Alzheimer's.

Notably, the link between statin use and a reduced risk of Alzheimer's was the same whether the statins were lipophilic (having an affinity for lipids and probably capable of easily crossing the blood-brain barrier into the brain) or hydrophilic (having an affinity for water and probably not so adept at crossing the barrier). Further, the protective effect was observed regardless of statin dosage or duration of use. An abstract of “Statins Are Associated With a Reduced Risk of Alzheimer Disease Regardless of Lipophilicity. The Rotterdam Study” is posted at http://jnnp.bmj.com/cgi/content/abstract/jnnp.2008.150433v1. Could They Actually Help Dementia? Irrespective of BBB Crossing ability, Statins cause improvement in endothelial function even at a relative lowest dose being used clinically; effect not necessary dependent short term on cholesterol lowering; latter effect helps long term to prevent or reverse arteriosclerosis, thereby improving circulation to brain.
 * Can Statin Medications Cause Memory Loss?
 * Can Statin Medications Cause Memory Loss? BBB Crossing ability varies; e.g. Simvastatin crosses more than Pravastatin and hence the former has more memory loss which is thought to be reversible.
 * Can Statin Medications Cause Memory Loss? BBB Crossing ability varies; e.g. Simvastatin crosses more than Pravastatin and hence the former has more memory loss which is thought to be reversible.


 * Simvastatin-Associated Memory Loss


 * Statins Show Promise in Protecting Against Alzheimer's! -statins might be able to protect against Alzheimer's earlier in the disease process in persons who do not yet have any cognitive impairment
 * Side Effects and Dangers of Statin Drugs
 * Which Statin Should I Take?
 * Statins Prevent You from Getting Dementia?-5-year follow-up, persons who had used statins were about half as likely as those who did not use statins to develop dementia. experts suggest that brain permeant (crossing blood-brain-barrier) statins (such as simvastatin) might be far more effective than statins that don't get into the brain (atorvastatin). People should take statins only for purposes they are originally indicated for, that is: for cholesterol-lowering.
 * Statins Prevent You from Getting Dementia?-5-year follow-up, persons who had used statins were about half as likely as those who did not use statins to develop dementia. experts suggest that brain permeant (crossing blood-brain-barrier) statins (such as simvastatin) might be far more effective than statins that don't get into the brain (atorvastatin). People should take statins only for purposes they are originally indicated for, that is: for cholesterol-lowering.

BLOOD-BRAIN BARRIER DRUG TARGETING: THE FUTURE OF BRAIN DRUG DEVELOPMENT
BLOOD-BRAIN BARRIER DRUG TARGETING: THE FUTURE OF BRAIN DRUG DEVELOPMENT
 * |Statins, Aggression, and Risky Behavior

BBB Crossing & non Crossing ARB(s) and effect on brain, RAAS & Dementia

 * Franz Volhard Lecture. Renin-angiotensin system: a dual tissue and hormonal system for cardiovascular control.


 * Franz Volhard Lecture. Renin-angiotensin system: a dual tissue and hormonal system for cardiovascular control


 * Clinical Profile of Eprosartan: A Different Angiotensin II Receptor Blocker-only that crosses BBB

BBB Crossing ACE Inhibitors, though Amyloid-Plaquogenic, reported Preventing Progress of Dementia: Attempt at Conundum Redux

 * Omapatrilat could have some advantages over lisinopril in the treatment of patients with congestive heart failure.
 * Most of the ACE inhibitors on the market today are non-selective towards the two active sites of ACE because their binding to the enzyme is based mostly on the strong interaction between the zinc atom in the enzyme and the strong chelating group on the inhibitor. The resolution of the 3D structure of germinal ACE, which has only one active site that corresponds with C-domain of the somatic ACE, offers a structural framework for structure-based design approach.  Although N- and C-domain have comparable rates in vitro of ACE hydrolyzing, it seems like that in vivo the C-domain is mainly responsible for regulating blood pressure. This indicates that C-domain selective inhibitors could have similar profile to that of a current non-selective inhibitors.  Angiotensin I is mainly hydrolyzed by the C-domain in vivo but bradykinin is hydrolyzed by both active sites.  Thus, by developing a C-domain selective inhibitor would permit some degradation of bradykinin by the N-domain and this degradation could be enough to prevent accumulation of excess bradykinin which has been observed during attacks of angioedema.  C-domain selective inhibition could possibly result in specialized control of blood pressure with less vasodilator-related adverse effects.  N-domain selective inhibitors on the other hand give the possibility of opening up novel therapeutic areas.  Apparently, the N-domain doesn’t have a big role in controlling blood pressure but it seems to be the principal metabolizing enzyme for AcSDKP, a natural haemoregulatory hormone.


 * In Vitro and In Vivo Inhibition of the 2 Active Sites of ACE by Omapatrilat, a Vasopeptidase Inhibitor
 * The vasopeptidase inhibitor omapatrilat inhibits both neutral endopeptidase and angiotensin-converting enzyme (ACE). The in vitro and in vivo inhibitory potency of omapatrilat and the specific ACE inhibitor fosinopril toward the 2 active sites of ACE (called N- and C-domains) was investigated with the use of 3 substrates: angiotensin I, which is equally cleaved by the 2 ACE domains; hippuryl-histidyl-leucine, specific synthetic substrate of the C-domain in high- salt conditions; and a newly synthesized specific substrate of the N-domain designed by acetylating the lysine residue of AcSDKP. In vitro, omapatrilat was 5 times more potent than fosinoprilat in inhibiting angiotensin I hydrolysis. Omapatrilat inhibited similarly both N- and C-domain hydrolysis, whereas fosinoprilat was slightly more specific for the N-domain. The in vivo selective inhibitory potency of single oral doses of 10 mg omapatrilat and 20 mg fosinopril were investigated in a double-blind, placebo-controlled, cross-over study in 9 mildly sodium-depleted normotensive subjects. In accordance with the in vitro results, fosinopril appeared to be more specific for the N-domain than the C-domain in vivo, since plasma and urine AcSDKP concentrations were significantly higher than those observed with omapatrilat. This study shows that it is possible to assess separately in vitro and in vivo the selectivity of ACE or ACE/neutral endopeptidase inhibitors. A differential selectivity may explain some peculiar properties observed with some ACE inhibitors.


 * AcSDKP
 * Angiotensin converting enzyme domain structure and properties
 * Structure of angiotensin I-converting enzyme. The inhibitor complex does provide insights into the network of hydrogen-bonding and ionic interactions in the active site as well as the mechanism of ACE substrate hydrolysis. The three-dimensional structure of ACE now paves the way for the rational design of a new generation of domain-selective ACE inhibitors.
 * Abeta40 protects non-toxic Abeta42 monomer from aggregation.
 * The N-terminal active centre of human angiotensin-converting enzyme degrades Alzheimer amyloid beta-peptide.
 * ACE N & C domains in competition

T= Trandolapril
 * Potency For C domain ( BP ) .....................   T>     L > E > C  Lisinopril, Enalaprilat, Captopril
 * Potency For N domain(Aß42-40 converting inhibition) T>     C > E > L

Aβ42-to-Aβ40-converting activity is solely found in the N-domain of ACE and the angiotensin-converting activity is found predominantly in the C-domain of ACE. The N-linked glycosylation is essential for both Aβ42-to-Aβ40- and angiotensin-converting activities and that unglycosylated ACE rapidly degraded. The domain-specific converting activity of ACE suggests that ACE inhibitors could be designed to specifically target the angiotensin-converting C-domain, without inhibiting the Aβ42-to-Aβ40-converting activity of ACE or increasing neurotoxic Aβ42.
 * ACE Inhibiting BP activity is solely in C domain where.........Lisinopril is the strongest C: L>E>C
 * Aß42-40 converting inhibition is solely in N domain where Captopril is the strongest...... N: C>E>L
 * Omapatrilat could have some advantages over lisinopril in the treatment of patients with congestive heart failure.


 * ACE angiotensin-converting enzyme
 * Aβ amyloid β-protein
 * F-ACE full-domain ACE
 * N-ACE N-terminal domain ACE
 * C-ACE C-terminal domain ACE
 * C-ACE C-terminal domain ACE


 * The upregulation of ACE activity can be a novel therapeutic strategy for AD.


 * ACE inhibitors could be designed to specifically target the angiotensin-converting C-domain, without inhibiting the Aβ42-to-Aβ40-converting activity of ACE or increasing neurotoxic Aβ42

''' Centrally Active ACE Inhibitors May Help Prevent Dementia -coming soon -! can? non central ACE & possibly other Non ACE antihypertensives, be more preventive? Why recent study finds otherwise? FACTORS IN CONSTRUCT. ACE Degrades/converts Amyloid Aβ42 ( fibrillogenic, plaque forming ! ) to favorable Aβ40 more soluble possibly 'removable', but inflammatory in situ (and further smaller fragments which are considered inflammatory and possibly even more damaging ), amyloid & Central acting (BBB crossing) ACE Inhibitors thus likely to increase dementia; anti-inflammatory effects of ACE Inhibitors likely to decrease dementia, Acute effect of ACE on Ach likely to increase short term acuity confusing the picture for evaluation ''' The following Construct development in progress and involve all these and more points in hypothesis development.
 * Centrally acting ACE Inhibitors have acute Ach effects helping in mental acuity short term during which measurement may be biased and the long term effect of amyloid Aβ42 accumulation may be masked in testing; favorable anti-inflammatory effect not withstanding, long term more  Aβ42 is deposited or not converted to more soluble, disposable or removable Aβ40. Vascular Aβ42  vs  Aβ40 to be considered and could be important along with the favorable anti-inflammatory effect.
 * Acute, Chronic and Chronic with short term non use ( washed off ) use of ACE considering short term acuity enhancing effects of Ach.
 * Acute, Chronic and Chronic with short term non use ( washed off ) use of ACE considering short term acuity enhancing effects of Ach.
 * Acute, Chronic and Chronic with short term non use ( washed off ) use of ACE considering short term acuity enhancing effects of Ach.
 * Acute, Chronic and Chronic with short term non use ( washed off ) use of ACE considering short term acuity enhancing effects of Ach.

ALL above to be considered in both below: along with congruency of the two studies with each other and restrospective congruency with prior knowledge base of studies and general understanding of the science.
 * Difference between Aβ42 ? more in nerves and ? Aβ40  more in vessel
 * Aβ42 vs  Aβ40
 * Pleomorphism and genetics of ACE
 * RAAS -Systemic vs Local and interactions and cross influence
 * ACE Inhibitors: BBB crossing vs Non crossing
 * Non-BBB crossing ACE negative effect studies ie if increased dementia, then..
 * Other enzyme systems besides ACE


 * Currently reported study in Archives of Intl Med July 09-BBB crossing ACE reduce Dementia needs explanation.... Standby
 * Current AII AT1 Inhibitors -Sartan--retrospective VA study expl and corroboration standby......

<!---

Genetics
Autosomal-dominant mutations in APP cause hereditary early-onset Alzheimer's disease, likely as a result of altered proteolytic processing. Increases in either total Aβ levels or the relative concentration of both Aβ40 and Aβ42 (where the former is more concentrated in cerebrovascular plaques and the latter in neuritic plaques) have been implicated in the pathogenesis of both familial and sporadic Alzheimer's disease. Due to its more hydrophobic nature, the Aβ42 is the most amyloidogenic form of the peptide. However the central sequence KLVFFAE is known to form amyloid on its own, and probably forms the core of the fibril.

The "amyloid hypothesis", that the plaques are responsible for the pathology of Alzheimer's disease, is accepted by the majority of researchers but is by no means conclusively established. Intra-cellular deposits of tau protein are also seen in the disease, and may also be implicated. The oligomers that form on the amyloid pathway, rather than the mature fibrils, may be the cytotoxic species.

http://cme.medscape.com/viewarticle/706868?src=cmemp

From Medscape Medical News CME Centrally Active ACE Inhibitors May Help Prevent Dementia CME News Author: Janis Kelly

August 3, 2009 — New observational data from the Cardiovascular Health Study show that centrally active angiotensin-converting enzyme (ACE) inhibitors reduce cognitive decline by 65% per year of exposure, an effect that is likely due to their ability to cross the blood-brain barrier.

"If confirmed in a randomized clinical trial, our findings would add another potential therapeutic option" for prevention of cognitive decline and related diseases, lead author Kaycee M. Sink, MD, from Wake Forest University School of Medicine, in Winston-Salem, North Carolina, told Medscape Neurology.

The study is published in the July 13 issue of Archives of Internal Medicine.

Class of ACE Inhibitor Important

Dr. Sink and colleagues used data from the Cardiovascular Health Study to determine whether cumulative exposure to ACE inhibitors was associated with a lower risk for incident dementia, cognitive decline, or incident disability in instrumental activities of daily living (IADLs), compared with treatment with other antihypertensive agents in 1054 patients with treated hypertension and no congestive heart failure.

The study included 414 subjects who had taken ACE inhibitors and 640 who had taken other antihypertensive medications. The researchers found no association between exposure to all ACE inhibitors and risk for dementia, difference in cognitive-function scores, or odds of disability in IADLs.

However, analysis according to type of ACE inhibitor showed a different effect. The results showed centrally active ACE inhibitors were associated with 65% less decline in cognitive-function scores per year of exposure.

The data also reveal that non–centrally active ACE inhibitors were associated with a greater risk for incident dementia and greater odds of disability in IADLs compared with other antihypertensive medications.

Centrally active ACE inhibitors included captopril (Capoten, Bristol-Myers Squibb), fosinopril (Monopril, Bristol-Myers Squibb), lisinopril, perindopril, ramipril (Altace, King Pharmaceuticals), and trandolapril (Mavik, Abbott Laboratories). Non–centrally active ACE inhibitors included benazepril (Lotensin, Novartis Pharmaceuticals), enalapril (Vasotec, Merck), moexipril (Univasc, Schwarz Pharma), and quinapril (Accupril, Pfizer).

The study did not include enough people taking angiotensin receptor blockers to extend the analysis to those drugs, said Dr. Sink.

Reduced Incidence Likely Not Due to Antihypertensive Effect

"Our most important findings in this observational study were that centrally acting ACE inhibitors were associated with a 65% reduction in cognitive decline per year of taking the centrally active ACE inhibitors," said Dr. Sink.

"In addition, compared with participants with high blood pressure who took other types of blood-pressure–lowering medications, non–centrally active ACE inhibitors did not have this effect and might be associated with a greater risk for incremental dementia, and that cumulative (or chronic) exposure to ACE inhibitors may be needed to achieve the protective effect," Dr. Sink said.

The researchers suspect that this difference is due primarily not to the antihypertensive effects of centrally acting ACE inhibitors but to their effect on the brain's intrinsic renin-angiotensin system, which is involved in memory and cognition.

Stimulation of the renin-angiotensin system also mediates activation of inflammatory cytokines that have been implicated in degenerative dementias, explained Dr. Sink.

The researchers also suspect that the slight increase in dementia risk associated with the non–centrally acting ACE inhibitors in this comparison was probably a sign that they are "simply less helpful in the prevention of dementia and IADL disability than other antihypertensive drug classes combined."

Due to the huge public-health implications of finding an intervention that could more than halve dementia risk in the elderly population, confirmation of these observational findings in a randomized clinical trial is needed.

"Randomizing older adults with hypertension to a centrally active ACE inhibitor vs a non–centrally active ACE inhibitor would test the hypothesis that centrally active ACE inhibitors have protective benefits on cognition beyond the effects of blood-pressure control," said Dr. Sink.

Should Patients Switch Medications?

Whether clinicians should switch their hypertensive patients to a centrally acting ACE inhibitor must be decided on a case-by-case basis, said Dr. Sink.

"Because there are often multiple reasons for a particular choice of antihypertensive drug in any particular patient, the decision about switching blood-pressure medications should be discussed between patient and provider.

"However, if the patient does not have a contraindication for an ACE inhibitor, then switching to a centrally active ACE inhibitor is a reasonable choice. In addition, for those already on ACE inhibitors, our study results would support the use of a centrally active ACE inhibitor over a non–centrally active one," Dr. Sink said.

Asked by Medscape Neurology to comment on the findings, Ihab Hajjar, MD, from the Institute for Aging Research and assistant professor of medicine at Harvard Medical School, in Boston, Massachusetts, said that this study adds to the support for clinical trials.

"This is the right time to study ACE inhibition on cognitive function. However, it is important to select the appropriate drug [agents that cross the blood-brain barrier] and the appropriate population [hypertensives and other high-risk groups]," Dr. Hajjar said in an interview.

However, he emphasized that lowering blood pressure is the most important goal for managing high-risk elderly patients and that the choice of drug is secondary.

"Drugs that inhibit the renin angiotensin system seem to have a preferential effect on cognition compared with other antihypertensives. As a third issue, antihypertensives that cross the blood-brain barrier may also have an even superior effect to other non–blood-brain-barrier-penetrating drugs. This is true not only for those without cognitive impairment but also for those with dementia and Alzheimer's disease," Dr. Hajjar said.

Study investigator David C. Goff Jr, MD, PhD, from Wake Forest University, has a research grant from Merck. The study was supported in part by the National Heart, Lung, and Blood Institute; the National Institute of Neurological Disorders and Stroke; and the National Institute on Aging.

Arch Intern Med. 2009;169:1195-1202. Abstract

Clinical Context

Hypertension is an important risk factor for the development of dementia. An association has been noted between use of antihypertensive agents and a reduced risk for dementia, but mixed results have been reported on the protective effect of blood pressure reduction on cognitive decline and dementia. The brain is known to possess an intrinsic renin-angiotensin system, and centrally acting ACE inhibitors may be involved in the protective effect on dementia.

This is a prospective multicenter, population-based cohort study of cardiovascular risk factors in community-dwelling older adults to examine the association between ACE inhibitors as a class and centrally and non–centrally acting ACE inhibitors on the risk for dementia and cognitive decline in older people in the United States.

Study Highlights

Included in analysis were 1054 participants from among 5888 participants of the Cardiovascular Health Study, selected for absence of dementia at baseline and hypertension treated with medications. Excluded were those with congestive heart failure and prevalent dementia at baseline. At baseline, all participants received magnetic resonance imaging, physical examination, cognitive and functional assessments, and laboratory tests. The predictor was ACE inhibitor use, and ACE inhibitors were further classified into centrally acting and non–centrally acting. Centrally acting ACE inhibitors were captopril, fosinopril, perindopril, ramipril, and trandolapril. Non–centrally acting ACE inhibitors were benazepril, enalapril, moexipril, and quinapril. The study start was when participants received magnetic resonance imaging, and study end was defined as date of dementia diagnosis, last evaluation, or time of loss to follow-up. Primary outcome was all-cause dementia consisting mainly of Alzheimer's disease and vascular dementia. Secondary outcomes were cognitive decline measured by the Modified Mini-Mental State Examination (3MSE) and IADLs. IADLs were assessed in 6 areas: shopping, meal preparation, money management, telephone use, and light and heavy housework. The 3MSE used an 100-point scale with higher scores indicating better cognitive performance. Average age at baseline was 75 years, 64% were women, and 76% were white. 54% reported no alcohol use, 11% to 22% had type 2 diabetes, and 18% had a history of coronary artery disease. Of 414 participants exposed to ACE inhibitors, 224 took only centrally acting and 138 only non–centrally acting, with the remaining taking both. Those using centrally acting ACE inhibitors had a higher baseline 3MSE score (93.2 vs 01.7 points). At median follow-up of 6 years, mean exposure to all ACE inhibitors was 3.24 years with mean exposure to centrally acting ACE inhibitors of 3.06 years and non–centrally acting ACE inhibitors of 2.70 years. 38% of ACE inhibitor users were continuous users with no difference in duration of use between the centrally and non–centrally acting groups. There were 158 cases of incident dementia, with 11 among those never exposed to ACE inhibitors and 47 among those exposed to all ACE inhibitors. Relative risk (RR) for dementia in ACE inhibitor users vs other antihypertensive drug users was 1.01. When analyzed by centrally vs non–centrally acting ACE inhibitors, centrally acting agents reduced the RR for dementia by 20% per year of exposure, for a hazard ratio (HR) of 1.73 for 3 years. HR for dementia for non–centrally acting ACE inhibitors vs other antihypertensives was 1.20. There was no significant difference in decline in 3MSE scores between ACE inhibitor users and non-ACE inhibitor users. When analyzed by centrally and non–centrally acting ACE inhibitors vs other antihypertensives, centrally acting agents were associated with 65% less decline per year of exposure. For IADL disability, ACE inhibitors as a class had higher risk for disability vs other antihypertensives. When non–centrally acting ACE inhibitors were examined, there was a 56% greater risk for IADL disability at 3 years vs non-ACE inhibitor drugs. HR for non–centrally acting ACE inhibitors on impaired IADL vs other antihypertensives was 1.16. Centrally acting ACE inhibitors did not show a negative impact on IADLs. The authors concluded that all outcomes favored centrally acting ACE inhibitors and that protective effects of ACE inhibitors on dementia and cognitive decline were restricted to centrally acting ACE inhibitors.

Clinical Implications

ACE inhibitors as a class vs other antihypertensive agents are not associated with protection against dementia, cognitive decline, or disability in IADLs. Centrally acting ACE inhibitors are associated with a reduced risk for dementia, cognitive decline, and disability in IADLs vs non–centrally acting ACE inhibitors and other antihypertensive agents.

Alzheimer's-beta amyloid, tau protein,-- Drug Rember, Methylene Blue
Alzheimer's researchers are divided on whether the disease is caused by 'beta amyloid' (a peptide found in Alzheimer brains) or by 'tau protein' (normally used for cellular scaffolding, but can aggregate out of control and destroy neurons). Today in Chicago a new drug has been announced that stops tau aggregation and appears to have halted Alzheimer's-related decline in 300 clinical trial patients. The drug is known as 'rember.


 * Revised Amyloid Cascade Hypothesis:ADDLs(from amyloid beta derived diffusible ligands, by Acumen’s founders for diffusible, nonfibrillar ligands derived from Abeta1-42)ADDLs, the amyloid hypothesis and Alzheimer’s disease

Angiotensin Receptor Blockers lower progression of Alzheimer's Disease- ! explanation coming and Construct integration in progress
http://www.ncbi.nlm.nih.gov/pubmed/16601566
 * http://www.ncbi.nlm.nih.gov/pubmed/16075377 Brain angiotensin II: new developments, unanswered questions and therapeutic opportunities.2005
 * http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1574085/ Angiotensin AT2 receptors: cardiovascular hope or hype?
 * SHORT Explanation for this: mech related to above ACE AND ACE Inhibitors and BP dynamics and AII INHIBITORS. Standby for full expl......
 * Amelioration of cerebrovascular dysfunction with an angiotensin receptor blocker could be a novel therapeutic strategy for the early stage of Alzheimer disease.

http://www.physorg.com/print136426165.html Angiotensin receptor blockers are lower incidence, progression of Alzheimer's disease July 28th, 2008 in Medicine & Health / Diseases Researchers at Boston University School of Medicine (BUSM) have, for the first time, found that angiotensin receptor blockers (ARBs)—a particular class of anti-hypertensive medicines—are associated with a striking decrease in the occurrence and progression of dementia. Data from this study will be presented this weekend (July 27) at the 2008 International Conference on Alzheimer's disease in Chicago. Using data from the Decision Support System Database of the U.S. Department of Health System Veterans Affairs (with information on more than 5 million people), researchers looked at records from patients using ARBs, and compared them with subjects who had a similar health status, but were taking different medications. They found patients taking ARBs had about a 35-40 percent lower chance of getting Alzheimer's disease or dementia. The researchers also examined patients who were already suffering from Alzheimer's disease or dementia, and found those subjects had up to a 45 percent lower chance of developing delirium, being admitted to nursing homes or dying. Patients who appeared to benefit particularly well from use of ARBs were those who had experienced strokes before or during the course of their illness. According to the researchers these results suggest that ARBs might protect against developing Alzheimer's disease and dementia. "For those who already have dementia, use of ARBs might delay deterioration of brain function and help keep patients out of nursing homes," said lead presenter Benjamin Wolozin, MD, PhD, a professor of pharmacology at BUSM. "The study is particularly interesting because we compared the effects of ARBs to other medications used for treating blood pressure or cardiovascular disease. This suggests that ARBs are more effective than other blood pressure and cardiovascular medications for preventing Alzheimer's disease or dementia," he added. Although the researchers are unsure why ARBs might be so beneficial, they believe one possibility suggested by prior studies on animal models is that ARBs help prevent nerve cell injury from blood vessel damage or help promote nerve cell recovery after blood vessel damage. Damage to blood vessels is thought to reduce brain capacity and promote dementia, so reducing this damage might prevent the occurrence or progression of dementia. Source: Boston University


 * Dynamics & Flux Between Amyloid β fragments Beta amyloid & Blood Pressure & Autonomous System-   Dementia as a Case Study

ACE-I vs angiotensin II receptor antagonists vs Vasopeptidase inhibitor (VPI)

 * Comparison of vasopeptidase inhibitor omapatrilat and angiotensin receptor blocker candesartan on extracellular matrix, myeloperoxidase, cytokines, and ventricular remodeling during healing after reperfused myocardial infarction
 * Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) transcriptional regulation by Oct-1 in human endothelial cells: implications for atherosclerosis LOX 1 AngII curcumin

Treatment with losartan reversed interstitial fibrosis and the expression of collagen 1alpha (I) and transforming growth factor-beta1 in the hearts of cTnT-Q(92) mice. These findings suggest that losartan has the potential to reverse or attenuate interstitial fibrosis, a major predictor of sudden cardiac death, in human patients with HCM.
 * Angiotensin II blockade reverses myocardial fibrosis in a transgenic mouse model of human hypertrophic cardiomyopathy.

DHA EPA FISH OIL & ARRHYTHMIAS



 * EPA DHA have dual effects via different basic ion channel level activity; facilitates and opposes arrhythmias by the differing mechanisms...


 * summation: circulating epa dha cause arrthymis but less so if already incorporated in tisue of heart-- slow progressive incorporation may help sudden- if noy used to fish oil-- would cause arrthymias

Eicosanoid Junction

 * Polyunsaturated fatty acid active eicosanoid pathways and downstream products including Resolvins
 * Rate limiting steps.. absolute amount of respective Omega 3 needed to bring about corresponding step inhibition of Omega series on defined amount of latter... conceptually maximum permissible omega 6 amounts at each step considering prior statement... competitive inhibition... benefits and harm of products of each stem at individual step and collectively with slip-slop cross interaction of the step products as well as further derivatives e.g. aspirin triggered e.g. Resolvin etc in both normal physiology, patho-physiology, pharmaco and dietary inter-action both in normality as well as disease(s)

Particular oils
The following triglyceride vegetable oils account for almost all worldwide production, by volume. All are used as both cooking oils and as SVO or to make biodiesel. According to the USDA, the total world consumption of major vegetable oils in 2007/08 was:

Note that these figures include industrial and animal feed use. The majority of European rapeseed oil production is used to produce biodiesel, or used directly as fuel in diesel cars which may require modification to heat the oil to reduce its higher viscosity. The suitability of the fuel should come as little surprise, as Rudolf Diesel's original engine to ran on peanut oil as well as mineral oil.

Other significant triglyceride oils include:


 * Corn oil, one of the most common cooking oils. As of 2006, the US produced about 1.09 million metric tons of corn oil, which is used for cooking oil, salad dressing, margarine, mayonnaise, prepared goods like spaghetti sauce and baking mixes, and to fry prepared foods like potato chips and French fries.


 * Grape seed oil, used in cooking and cosmetics
 * Hazelnut oil and other nut oils
 * Linseed oil, from flax seeds
 * Rice bran oil, from rice grains
 * Safflower oil, a flavorless and colorless cooking oil
 * Sesame oil, used as a cooking oil, and as a massage oil, particularly in India
 * Açaí palm oil, used in culinary and cosmetics
 * Jambú oil, is extracted from the flowers, leaves and stem from jambu (Acmella oleracea), contains spilanthol
 * Graviola oil, derived from Annona muricata
 * Tucumã oil, from Astrocaryum aculeatum is used to manufacture soap.
 * Brazil nut oil, culinary and cosmetics use
 * Carapa oil, pharmaceutical use and anti-mosquito candle
 * Buriti oil, from Mauritia flexuosa, used in cosmetics (skin and hair care)
 * Passion fruit oil, derived from Passiflora edulis, has varied applications in cosmetics manufacturing and for uses as a human or animal food.
 * Pracaxi oil, obtained from Pentaclethra macroloba, cosmetics use
 * Solarium oil, derived from chloroplasts, various applications in cooking

Vitamin E
Below are topics that can be linked to VIT E - possibly in one of the pages as appropriate expanding the pages cross referencing without undue burden on context of the pages!
 * https://en.wikipedia.org/w/index.php?title=Special:WhatLinksHere/Vitamin_E&limit=500 - see the roster and try find Cytochrome P450 IF IT HAS BEEN LINKED - IF NOT AND SIMILAR NUMEROUS ITEMS ARE ALSO LINKABLE SOME HAVING ONEWAY MENTION IN AN ARTICLE THAT IS RELATED IN SOME WAY BUT NOT CROSS-LINKED AS IN TRADITIONAL WHAT LINKS--- SO A NEED FOR "WHAT CAN BE LINKED HERE" EXISTS... THE CATEGORY CAN BE FUTHER DEFINED AS WHICH DIRECTION MENTION FOR LINKABILITY EXIST AND LINKING AND INSERTING RELEVANT RELATED CONTENT DETERMINES WHERE THE VOID EXIST AND WHICH PAGE IT IS TO BE INSERTED -- IT IS POSSIBLE THAT THE WHAT CAN BE LINKED CAN BE ON ANY OF THE TWO PAGES AND A MERE MENTION ON ONE PAGE AS TO THE NAME OF OTHER IS ENOUGH OF A PROPMT FOR THE EDITOR TO CONNECT WITH THE OTHER PAGE


 * WhatCanBeLinkedHere/Vitamin_E Cytochrome P450
 * WhatCanBeLinkedHere/Vitamin_E Cytochrome P450


 * Tocopherols, Tocotrienols-i.e. Tocos... Respective Isomers, their individual actions and counteractions in combination.


 * TOCOTRIENOLS-- MECH OF ACTION - BELOW ARE INVOLVED


 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956867/


 * kinases  Kinase
 * receptors  Receptor
 * apoptosis regulators Apoptosis Negative regulators of apoptosis Proteolytic caspase cascade: Killing the cell
 * transcription factors Transcription factor
 * growth factors Growth factor
 * enzymes  Enzyme
 * cytokines Cytokine


 * others below


 * akt Protein kinase B
 * apo-A  Apolipoprotein
 * CD-4 CD4
 * RAS Ras superfamily
 * Raf-1 c-Raf
 * Cycline-D1 Cyclin D1
 * Cycline-D2 Cyclin D2
 * Cycline E Cyclin E
 * CYP1A1 Cytochrome P450, family 1, member A1
 * CYP3A4 CYP3A4
 * CYP3A5 CYP3A5
 * Cyt-C Cytochrome c
 * PGE-2 Prostaglandin E2
 * TX-B2 Thromboxane B2



INTERACTIONS


 * Glutathione S-transferase P1-1    GSTP1
 * Src  Proto-oncogene tyrosine-protein kinase Src
 * Steroid & Xenobiotic Receptor  Xenobiotic-sensing receptor      Steroid hormone receptor
 * HMG-CoA Reductase HMG-CoA reductase
 * a-tocopherol Associated Protein      https://en.wikipedia.org/w/index.php?title=Special%3ASearch&search=a-tocopherol+Associated+Protein&go=Go   not found**


 * Estrogen Receptor-Beta Estrogen receptor beta
 * P-glycoprotein P-glycoprotein
 * 12-lipoxygenase ALOX12
 * Human Serum Albumin Human serum albumin
 * Alfa-tocopherol Transfer Protein     https://en.wikipedia.org/w/index.php?title=Special:Search&search=Alfa-tocopherol+Transfer+Protein&go=Go   not found*

Prostate cancer
work in progress-- see in edit mode

VEGETARIAN/VEGAN SOURCES OF PROTEINS

 * Lentil - to use this article on lentil to develop the article using Wikipedia's "What Links here" feature and this will illustrate the power of Wikipedia; in essence, knowledge is connected by various points whether it be cause and effect which would be understandable and possibly derivable ( just by looking at the tile of the subject in "What Links here" table from prior knowledge of the subject -- the feature becomes so powerful to quickly gather various ideas exploding one's knowledge repository- the author reads indexes for rapid review of any subject and where new thing appear can go and read that) just by a prompt of the words/titles( which are Wikipedia article page names ) being presented in "What Links here". Developing article can take various differing route ( say if project given to 100 developer- if "What Links here" is used there may be lot of similar info incorporated but the form of the article will differ based on incorporation other presentation aids such as tables and such and which also can be found in Wikipedia as an example from other articles or if the article is not found it can be developed-- see section just below as boxes and link as the section name - other differing attributes are ideas around subject which are priceless ( such as this section paragraph or that all article should have translated names in various languages of the world possibly with audio also ) whether Wikipedia is used or not ultimate aim is also to recognize that Wikipedia is an on-going welcoming improvement construct; even if article is totally developed with information from outside sources the said "What Links here" is an important attribute and should be visited and all connected articles be improved as well with the newly developed article; can't wait re-hash that the value of the  "What Links here" is so great that the newly developed article will need to be revised most of the time even if just launched with the new connections of "What Links here" unless no new connections were found or attached which would be rare and possibly a mistake most of the time.  "What Links here" Ruleth!

Dal - is not linked in the what Links here table in Lentil article, possibly, as an adopted Indian language name into English lexicon-- consider that as an example that needs linkage improvement and compare the two article which are for some common subject commonality and presentations and content ideas which can be crossed between articles as to the various differing points and attributes e.g. tables of nutritional content is given in one and the worm disease affecting agriculture in other etc.
 * https://www.lentils.org/about-lentils/

== Languages of Wikipedia copy from left column-- spelt wheat page-- need a table with lang in coumn#1 and the topic and/or word of the page- so at least 3 columns are defined. Italiano : https://it.wikipedia.org/wiki/Triticum_spelta  -- so, 3 or more column table is needed on all pages of food nutrition and such where the page topic and/or the word translated to other languages & this table gets link in all such language pages- the original word or tittle of topic in two different columns as applicable be indicated--- all pages will have the same link and any lang that needs addition be added to the master title link for uniformity. See further below for a table which can be modified: Has 40 major lang groups each with >45 million speakers. See in edit mode ==

Alemannisch العربية Asturianu Български Brezhoneg Català Cebuano Čeština Dagbanli Dansk Deutsch Eesti Ελληνικά Эрзянь Español Esperanto Euskara فارسی Français Galego 한국어 Hornjoserbsce Hrvatski Ido Bahasa Indonesia Íslenska Italiano עברית Latina Latviešu Lëtzebuergesch Lietuvių Lombard Magyar Македонски مصرى Bahasa Melayu Nederlands Nedersaksies 日本語 Norsk bokmål Norsk nynorsk Occitan Polski Português Română Русский Scots Simple English Slovenščina Српски / srpski Suomi Svenska தமிழ் Татарча / tatarça Türkçe Українська Tiếng Việt Walon Winaray 粵語 中文



"What Links here" Ruleth!

 * https://en.wikipedia.org/w/index.php?title=Special:WhatLinksHere/Vitamin_E&limit=500 - see the roster and try find Cytochrome P450 IF IT HAS BEEN LINKED - IF NOT AND SIMILAR NUMEROUS ITEMS ARE ALSO LINKABLE SOME HAVING ONEWAY MENTION IN AN ARTICLE THAT IS RELATED IN SOME WAY BUT NOT CROSS-LINKED AS IN TRADITIONAL WHAT LINKS--- SO A NEED FOR "WHAT CAN BE LINKED HERE" EXISTS... THE CATEGORY CAN BE FUTHER DEFINED AS WHICH DIRECTION MENTION FOR LINKABILITY EXIST AND KINKING AND INSERTING RELEVANT RELATED CONTENT DETERMINES WHERE THE VOID EXIST AND WHICH PAGE IT IS TO BE INSERTED -- IT IS POSSIBLE THAT THE WHAT CAN BE LINKED CAN BE ON ANY OF THE TWO PAGES AND A MERE MENTION ON ONE PAGE AS TO THE NAME OF OTHER IS ENOUGH OF A PROPMT FOR THE EDITOR TO CONNECT WITH THE OTHER PAGE


 * WhatCanBeLinkedHere/Vitamin_E Cytochrome P450
 * WhatCanBeLinkedHere/Vitamin_E Cytochrome P450


 * Lentil - to use this article on lentil to develop the article using Wikipedia's "What Links here" feature and this will illustrate the power of Wikipedia; in essence, knowledge is connected by various points whether it be cause and effect which would be understandable and possibly derivable ( just by looking at the tile of the subject in "What Links here" table from prior knowledge of the subject -- the feature becomes so powerful to quickly gather various ideas exploding one's knowledge repository- the author reads indexes for rapid review of any subject and where new thing appear can go and read that) just by a prompt of the words/titles( which are Wikipedia article page names ) being presented in "What Links here". Developing article can take various differing route ( say if project given to 100 developer- if "What Links here" is used there may be lot of similar info incorporated but the form of the article will differ based on incorporation other presentation aids such as tables and such and which also can be found in Wikipedia as an example from other articles or if the article is not found it can be developed-- see section just below as boxes and link as the section name - other differing attributes are ideas around subject which are priceless ( such as this section paragraph or that all article should have translated names in various languages of the world possibly with audio also ) whether Wikipedia is used or not ultimate aim is also to recognize that Wikipedia is an on-going welcoming improvement construct; even if article is totally developed with information from outside sources the said "What Links here" is an important attribute and should be visited and all connected articles be improved as well with the newly developed article; can't wait re-hash that the value of the  "What Links here" is so great that the newly developed article will need to be revised most of the time even if just launched with the new connections of "What Links here" unless no new connections were found or attached which would be rare and possibly a mistake most of the time.  "What Links here" Ruleth!


 * Dal - is not linked in the "What Links Here" table in Lentil article-- consider that as an example that needs linkage improvement and compare the two articles which are for some common subject commonality and presentations and content ideas which can be crossed between articles as to the various differing points and attributes e.g. tables of nutrition content is given in one and the worm disease affecting agriculture in other etc.

Joint Task
<!--- Osteoarthritis Osteoarthritis is a distressingly common joint disease that causes localized inflammation with possibly crippling consequences. By age 70, most people (up to 70 percent) will be affected to some degree by osteoarthritis (Kasper DL et al 2004). In the elderly, osteoarthritis of the knee is the leading cause of disability; it is estimated that 100,000 Americans are unable to walk independently, even from the bedroom to the bathroom, because of osteoarthritis in their knees or hips (Kasper DL et al 2004).

In most cases, the cause of osteoarthritis is not known, although it can be secondary to injury, repetitive joint use, or conditions such as obesity. Contrary to what many people believe, however, osteoarthritis is not a normal part of aging. It is a disease that should be treated aggressively at the earliest symptoms.

Unfortunately, conventional medicine has never developed an effective approach to treating osteoarthritis. Many people with a mild case of osteoarthritis are simply told to ignore the condition and to avoid doing any activities that may cause pain or discomfort. People who have a more severe case of osteoarthritis are in an even worse position. The drugs most often used to combat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as ibuprofen, can cause gastrointestinal upset, while prescription NSAIDs, such as rofecoxib and valdecoxib, were recently discovered to raise the risk of heart attack and stroke and were removed from the market by their manufacturers.

While the search for a drug that is a “magic bullet” continues, there is a wealth of data on the value of natural therapies to treat osteoarthritis. Natural anti-inflammatory agents have been found to reduce the swelling and pain associated with osteoarthritis, while other nutrients supply the underlying building blocks of joints and reduces the oxidative damage caused by the loss of joint cartilage.

The Life Extension Foundation’s osteoarthritis program can be summed up simply—take early, aggressive action. Because osteoarthritis is the rule rather than the exception, all adults should consider instituting a joint-supporting, anti-inflammatory nutrient program as soon as possible.

The Dangers of Osteoarthritis Unlike rheumatoid arthritis, which is characterized by systemic inflammation, osteoarthritis is a localized disease that occurs only in the affected joints.

With osteoarthritis, the thin layer of cartilage between the joints gradually erodes and wears away. As the protective layer of cartilage vanishes, the bone beneath becomes pitted and uneven, and the structural integrity of the joint is destroyed. Movement can become extremely painful and, in the worst cases, people who have severe osteoarthritis can no longer take care of themselves on a day-to-day basis.

In a normal joint, the ends of adjoining bones are covered by smooth cartilage that offers little friction. The whole joint is covered with special tissue called synovial tissue, which secretes synovial fluid to lubricate the cartilage and ensure that the joint continues to function smoothly. Cartilage is a firm, gel-like substance that acts as a shock absorber. Joints can withstand enormous pressure by releasing water from the cartilage.

During osteoarthritis, it is thought that the cells that synthesize collagen (and the proteoglycans that comprise cartilage) cease to function correctly. Over time, the cartilage begins to retain water and swell, becoming soft and eventually cracking. Next, tiny cavities form in the bone beneath the cartilage. The bone may overgrow the edges of the joint, resulting in bumps (osteophytes) that restrict movement. In the final stages, the cartilage becomes rough and pitted.

The symptoms of osteoarthritis include aching joint pain that is aggravated by use. In advanced osteoarthritis, pain may interfere with sleep. In some patients, synovitis, or inflammation of the synovial membrane, may be caused by shards of bone in the joint.

To diagnose osteoarthritis, physicians typically rely on symptoms. It is important that a physician differentiate osteoarthritis from other joint diseases. X-rays may be taken to make sure the diagnosis is correct. Osteoarthritis may be characterized by bone enlargement and narrowing of the joint space. Otherwise, laboratory studies are rarely helpful in diagnosing osteoarthritis.

Nutrition: An Early Approach to Osteoarthritis The value of nutrients is well known when it comes to arthritis. Even conventional textbooks recommend that people with osteoarthritis consume a diet rich in natural anti-inflammatory, antioxidant, and joint-supporting nutrients, and avoid eating pro-inflammatory foods that are high in sugar, saturated fats, and trans fatty acids.

Omega-3 Fatty Acids. The benefit of omega-3 fatty acids is well known in the treatment of people who have osteoarthritis. Clinical studies over the past two decades have proved again and again the value of omega-3 fatty acids in treating inflammatory conditions ranging from atherosclerosis to osteoarthritis. In people who have osteoarthritis, increased consumption of omega-3 fatty acids and adequate intake of monounsaturated fatty acids such as those found in olive oil (and decreased consumption of omega-6 fatty acids) can improve symptoms and even sometimes allow a reduction in the use of NSAIDs (Miggiano GA et al 2005). These fatty acids have many positive effects, including influencing cellular metabolic functions, supporting cell membrane structure, and directly reducing the expression of pro-inflammatory cytokines (Zak A et al 2005). The most potent of the omega-3 fatty acids containing oils are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found in abundance in cold-water fish (Mori TA et al 2004).

Soybean and Avocado Oil. In Europe, avocado and soybean oil unsaponifiable (ASU) is sold as a drug for osteoarthritis. In the United States, ASU is available as a dietary supplement. Studies have shown that ASU inhibits interleukin-1 (IL-1) and stimulates collagen synthesis (Mauviel A et al 1991). It also reduces the production of other inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-8 (IL-8), and prostaglandin E2 (Henrotin YE et al 1998). In a 3-month study of 260 people, aged 45 to 80 years, who had osteoarthritis of the knee, ASU was shown to yield significant improvements compared to placebo (Appelboom T et al 2001). Another 3-month human trial of ASU versus placebo found a reduced need for NSAIDs among study subjects who took 300 milligrams per day (mg/day) of ASU (Blotman F et al 1997).

Curcumin. Curcumin is a component of turmeric and is an anti-inflammatory compound that inhibits both COX-2 and lipoxygenase enzyme activity, along with decreasing levels of IL-1 beta (IL-1b) (Banerjee M et al 2003; Plummer SM et al 1999). A study investigating capsaicin from red pepper and curcumin found that these two nutrients decrease the production of pro-inflammatory cytokines. Curcumin and capsaicin also inhibited the secretion of collagenase, hyaluronidase, and elastase, which are linked to the breakdown of cartilage that characterizes osteoarthritis. Researchers concluded that curcumin and capsaicin can influence inflammatory mediators (Joe B et al 1997).

Some studies revealed that users of curcumin supplements were not getting optimal benefits from the extract. The reason is that, for curcumin to be effectively assimilated into the bloodstream, it must be combined with small amounts of piperine (a component of black pepper). Piperine has been shown to enhance the serum concentration, the bioavailability, and the extent of absorption of curcumin in humans without any adverse effects.

Ginger. Ginger is an anti-inflammatory and antirheumatic agent used in ayurveda, a form of holistic medicine traditional to India (Srivastava KC et al 1992). Ginger extract blocks activation of proinflammatory mediators (Frondoza CG et al 2004). In a 3-month to 2.5-year study that investigated the effects of powdered ginger on patients who had either rheumatoid arthritis or osteoarthritis, approximately 75 percent of the patients experienced pain relief and decreased swelling, and there were no reports of adverse effects (Srivastava KC et al 1992). A similar study of more than 240 patients who had osteoarthritis of the knee demonstrated a significant reduction in osteoarthritis symptoms (Altman RD et al 2001). A study examining the mechanism of action of ginger extract demonstrated that 100 micrograms per milliliter (mcg/mL) significantly inhibited the activation of COX-2 and tumor necrosis factor (TNF), in addition to suppressing prostaglandin-E2 production (Frondoza CG et al 2004).

Nobiletin. Flavonoids are natural compounds found in a wide variety of fruits and vegetables. Bioflavonoids from citrus fruits such as oranges, tangerines, and grapefruits have been found to exert anti-inflammatory effects (Manthey JA et al 2001; O’Leary KA et al 2004).

The bioflavonoid nobiletin was first isolated from orange peel in 1938. Nobiletin has been shown to be a powerful anti-inflammatory agent (Lin N et al 2003; Murakami A et al 2000a; Tanaka S et al 2004). Early studies revealed that nobiletin significantly inhibits production of nitric oxide and superoxide, two powerful free radicals involved in promoting inflammation.

The flavonoid nobiletin has been found to selectively down-regulate COX-2 without interfering with COX-1 (O'Leary KA et al 2004). In mouse macrophages, nobiletin was also shown to suppress production of prostaglandin E2 while interfering with pro-inflammatory cytokines such as IL-1(b), TNF-alpha, and IL-6 (Ishiwa J et al 2000).

In addition, nobiletin demonstrated great anti-inflammatory activity (Murakami A et al 2000b). Through its effects in reducing inflammation, nobiletin may help to protect against a host of age-related problems, including joint discomfort, cardiovascular problems, and other inflammation-induced disorders.

Nettle Leaf. A study investigating the effects of nettle leaf extract demonstrated that the stinging nettle leaf extract Hox alpha significantly suppressed IL-1(b)–induced expression of matrix metalloproteinase, which is linked to cartilage degradation (Schulze-Tanzil G et al 2002). An extract of nettle leaf is well known for its positive effects in the treatment of rheumatic diseases and its capacity for partial inhibition of leukotriene and prostaglandin. A laboratory study examining the effects of 5 mg/mL of nettle leaf extract on TNF and IL-1 in human whole blood demonstrated significant reductions in these cytokines. After 24 hours, they decreased by 50 percent and 100 percent, respectively. After 60 hours, inhibition rates were 40 percent and 100 percent, respectively (Obertreis B et al 1996).

S-Adenosylmethionine. S-adenosylmethionine (SAMe) is the activated form of the amino acid methionine. It is naturally converted to cysteine in the body. SAMe protects synovial cells by reversing glutathione depletion, thus supporting levels of an important internal antioxidant (Lieber CS et al 2002). In addition to its antioxidant protection, it may protect synovial cells by blocking the enzymes that degrade cartilage. It may also protect the important cartilage proteins and proteoglycans in the joint lining.

In the laboratory, SAMe increases the number of cartilage cells and proteoglycans (protein). This suggests that SAMe treatment may help reverse the underlying process of osteoarthritis by stimulating cartilage to grow (Barcelo HA et al 1990; Kalbhen DA et al 1990). The other main component of the joint is synovial fluid, which acts as a lubricant. In two studies comparing SAMe to NSAIDs, test results demonstrated that SAMe was generally more effective and better tolerated than the NSAIDs (Glorioso S et al 1985; Vetter G 1987). SAMe alleviates the pain and functional limitation of osteoarthritis, in addition to rebuilding joint cartilage (Soeken KL et al 2002).

Joint-Protective Agents Effective treatment of osteoarthritis includes the protection of the cartilage and synovial fluid in the joint against further destruction. In addition, it is important to stimulate anabolic restoration of joint cartilage and synovial fluid. Chondroprotective agents are compounds the body produces to regenerate cartilage and maintain healthy joint function. Chondroprotective agents protect and restore joint cartilage by a variety of mechanisms. They enhance development of chondrocytes, enhance the synthesis of synovial fluid, and inhibit free-radical damage to proteins and joint cartilage degradation by autoimmune processes.

Hyaluronic Acid. Hyaluronic acid is a joint lubricant. Several randomized clinical studies have examined the role of hyaluronic acid in relieving osteoarthritis symptoms, especially in patients who have osteoarthritis of the knee. In one study, four groups of patients with osteoarthritis of the knee were randomly assigned to treatment. One group performed exercises; one group performed exercises and received pulse ultrasound therapy (for pain); and one group performed exercises, received pulse ultrasound therapy, and received injections of hyaluronic acid. The fourth group was the control group. All three treatment groups showed progress, but the group receiving hyaluronic acid showed the greatest progress, measured by walking speed and decrease in disability (Huang MH et al 2005). Other studies have found that intra-articular hyaluronic acid injections are well tolerated in patients who have osteoarthritis of the knee and confer benefits that last up to 19 weeks after the last injection (Theiler R et al 2005). This treatment is effective in mild to severe cases of osteoarthritis of the knee (Neustadt D et al 2005). Hyaluronic acid injections have also been shown to relieve pain and disability in other arthritic joints, including the ankle (Salk R et al 2005).

Glucosamine. Glucosamine is a naturally occurring substance. It is synthesized by chondrocytes for the purpose of producing joint cartilage. In osteoarthritis, glucosamine synthesis is defective, and supplementation with glucosamine has proven to be beneficial. The body uses the supplemental glucosamine to synthesize the proteoglycans and the water-binding glycosaminoglycans in the cartilage matrix. In addition to providing raw material, the presence of glucosamine seems to stimulate the chondrocytes to produce more proteoglycans and glycosaminoglycans. Glucosamine also inhibits certain enzymes such as collagenase and phospholipase, which destroy cartilage. By blocking pathogenic mechanisms that lead to articular degeneration, glucosamine delays the progression of the disease and relieves symptoms, even for weeks after termination of the treatment. Among the natural therapies for osteoarthritis, glucosamine sulfate is probably the best known. Commercial sources of glucosamine are from the exoskeleton of certain shellfish and are available as glucosamine sulfate and N-acetylglucosamine.

Glucosamine has been shown to be almost totally free of adverse effects, particularly when compared to NSAIDs. A 4-week study of more than 170 patients who had osteoarthritis of the knee compared the effects of glucosamine sulfate at a dose of 1500 mg/day to 1200 mg/day of ibuprofen. Glucosamine relieved the symptoms as effectively as ibuprofen and was significantly better tolerated than ibuprofen. The safety and tolerability of glucosamine is because of its specific actions on the pathogenic structural and biochemical mechanisms of osteoarthritis without inhibition of the cyclooxygenases. Glucosamine sulfate is a good alternative therapy for osteoarthritis (Qiu GX et al 1998).

As with most natural remedies, the therapeutic effect of glucosamine is not immediate. It usually takes from 1 to 8 weeks to appear. Once achieved, it tends to persist for a notable time even after discontinuation of the treatment. The probable reason is that glucosamine is incorporated into rebuilding the cartilage itself.

Chondroitin Sulfate. Chondroitin sulfate is a major structural component of articular cartilage. It is a very large molecule, composed of repeated units of glucosamine sulfate. Like glucosamine, chondroitin sulfate stimulates the production of cartilage. Likewise, it has the ability to prevent enzymes from dissolving cartilage. Chondroitin sulfate inhibits free radicals that degrade joint cartilage and collagen. It improves blood circulation to joints, which enables antioxidants and glucosamine to enter inflamed joints to stimulate the repair process required for the regression of osteoarthritis. Although the intestinal absorption of chondroitin sulfate is much lower than that of glucosamine (10 to 15 percent versus 90 to 98 percent), a few studies have shown very good results (reducing pain and increasing range of motion) from long-term treatment with chondroitin sulfate.

A 3-year study investigated the effects of 800 mg of chondroitin sulfate on a group of people with osteoarthritis of finger joints. The results indicated that the chondroitin sulfate was well tolerated, significantly reduced pain, and increased joint mobility. In addition, the joints were protected from further erosive osteoarthritis (Verbruggen G et al 1998).

Improvement in walking time was studied in 80 patients with osteoarthritis of the knee. In this 6-month, double-blind study, the chondroitin sulfate dosage was 400 mg twice daily. The minimum time to perform a 20-meter walk showed a constant reduction of time only in the group who took chondroitin. Lower consumption of pain-killing drugs and excellent tolerability was also observed (Bucsi L et al 1998).

Sulfur. Animal studies have shown that joints affected by osteoarthritis have lower sulfur content (Rizzo R et al 1995). Arthritic mice given the sulfur-containing nutrient methylsulfonylmethane (MSM) experience less joint degeneration (Murav'ev I et al 1991). In a double-blind trial in people with osteoarthritis, study participants who received MSM by itself experienced significant pain relief (Lawrence RM 1998).

In a 2004 study, a combination of glucosamine and MSM was found to be more effective in improving the signs and symptoms of osteoarthritis than either agent alone (Usha PR et al 2004). After 12 weeks of treatment, the average pain score in the group that took only the glucosamine dropped from 1.74 to 0.65—a 63 percent reduction. In the group that took only MSM, the average pain score fell from 1.53 to 0.74—a 52 percent reduction. However, in the group that took both glucosamine and MSM, the average pain score dropped from 1.7 to 0.36—an astounding reduction of 79 percent! The researchers also found that the combination therapy had a faster effect on pain and inflammation than either glucosamine or MSM alone.

In another study, 50 patients with osteoarthritis, aged 40 to 76 years, were given 3 grams (g) of MSM or placebo twice daily for 12 weeks. At the end of the study, researchers concluded that the patients taking MSM experienced significant declines in pain and disease status (Kim LS et al 2006).

Green Tea Extracts. There is ample evidence to suggest that compounds found in green tea, including the polyphenol epigallocatechin gallate (EGCG), can interfere with the progression of osteoarthritis. During osteoarthritis, IL-1(b) causes an inflammatory response that enhances the expression and activity of matrix metalloproteinases, which are known to degrade cartilage. Studies have already shown that green tea extracts inhibited the expression of inflammatory cytokines in arthritic joints. Now newer studies are suggesting that EGCG can also inhibit the expression of IL-1(b) and matrix metalloproteinases (Ahmed S et al 2004). In a study of osteoarthritis, researchers found that EGCG was a potent inhibitor of IL-1(b)–induced cartilage damage (Singh R et al 2003). Additional studies have found that EGCG from green tea inhibits both IL-1(b) and the inflammatory cytokines COX-2 and inducible nitric oxide synthase, which are induced by IL-1(b) (Ahmed S et al 2002). Overall, laboratory studies have found that EGCG was nontoxic and that green tea consumption was effective at preventing osteoarthritis and may benefit patients who have osteoarthritis by reducing inflammation and slowing the breakdown of cartilage (Adcocks C et al 2002).

Antioxidants and Osteoarthritis According to the newest research, oxidative stress seems to play a role in osteoarthritis (and rheumatoid arthritis) (Podoprigorova VG et al 2005; Regan E et al 2005). Researchers found that human cartilage in patients with osteoarthritis was significantly deficient in superoxide dismutase, a major free-radical scavenger (Regan E et al 2005).

Because this research is so new, however, few studies have been conducted on the effectiveness of antioxidant supplementation in relieving symptoms and in slowing the progression of the disease. Nevertheless, because of the clear connection between oxidative stress and both rheumatoid arthritis and osteoarthritis, the Life Extension Foundation believes that people with either form of arthritis should maintain a healthy intake of antioxidants by taking vitamin E and vitamin C and other supplements that support glutathione levels such as N-acetylcysteine (NAC).

The Problem With Conventional Treatment Although nutritional approaches are the best option, millions of people still rely on prescription medications to manage their arthritis. Unfortunately, there just isn’t a good solution when it comes to the standard prescription drugs. Even the best of them have serious drawbacks. Drugs used to treat arthritis include:

NSAIDs. These drugs represent the mainstay of conventional treatment for arthritis. Over-the-counter NSAIDs, such as naproxen, ibuprofen, and others, operate by inhibiting the cyclooxygenase enzymes (COX-1 and COX-2), which convert arachidonic acid to pro-inflammatory prostaglandins. Adverse effects of over-the-counter NSAIDs include gastrointestinal upset, since the COX-1 enzyme is also partly responsible for protecting the lining of the stomach by maintaining its mucosal lining. In an attempt to reduce this side effect, prescription selective COX-2 inhibitors were introduced. These drugs, including rofecoxib, valdecoxib, and celecoxib, were equally as effective as the older NSAIDs, without the side effects. In 2004, however, rofecoxib was linked to an increased risk of heart attack and cerebrovascular events. Rofecoxib was subsequently removed from the market by its manufacturer. Not long after, valdecoxib was also voluntarily removed because of the increased risk of cardiovascular events. Celecoxib is still on the market, but the Food and Drug Administration demanded that a strong black-box warning be added to its label, warning people who take this drug of the increased potential for heart attack. Corticosteroids. Prednisone, a corticosteroid, is used mainly as a treatment for rheumatoid arthritis. In severe cases of osteoarthritis, prednisone will be injected directly into the affected joints. Corticosteroids have significant adverse effects, and great caution should be used when taking them. Injections should be spaced months apart to avoid joint degeneration. Long-term systemic corticosteroid use is associated with a wide range of metabolic abnormalities, including weight gain, osteoporosis, stress fractures, stretch marks, and adrenal gland failure. Narcotics. Narcotics such as codeine and morphine are sometimes used to control pain in acute flare-ups of osteoarthritis. These drugs must be used in the short term because of the risk of dependency. Acetaminophen. Acetaminophen is a painkiller, as opposed to an anti-inflammatory. This drug is widely available over the counter, yet few people are aware of the significant danger of long-term acetaminophen use, which can cause liver toxicity. The Life Extension Foundation does not recommend acetaminophen. In addition to these medications, physicians may recommend surgery for patients with severely damaged joints who have not responded to aggressive treatment. In this case, joint replacement may be recommended as a last resort.

Life Extension Foundation Recommendations People who have osteoarthritis often benefit from exercise, including stretching and strength exercises. These exercises help to build the muscles around affected joints. Muscle weakness is a major cause of disability in people who have osteoarthritis.

It is extremely important that people with osteoarthritis launch their nutritional program as early in the disease process as possible. The goal is to provide nutrients to help rebuild damaged bone and cartilage. The following nutrients are recommended:

EPA and DHA—1400 milligrams (mg)/day of EPA and 1000 mg/day of DHA ASU—300 to 600 mg/day Curcumin—900 mg/day, with 5 mg of piperine Ginger—60 mg/day Bioflavonoids—300 mg/day, including nobiletin Nettle leaf extract—375 to 500 mg/day SAMe—400 to 1200 mg/day Glucosamine—1500 mg/day Chondroitin—1000 mg/day MSM—1000 to 3000 mg/day Green tea extract—725 mg/day of green tea powder, yielding at least 246 mg of EGCG Vitamin C—1 to 3 grams (g)/day Vitamin E—400 International Units (IU)/day, with 200 mg of gamma-tocopherol NAC—600 mg/day Hyaluronic acid—Most published studies have examined the benefits of intra-articular injections of hyaluronic acid. This treatment is effective in treating osteoarthritis of major joints. Discuss hyaluronic acid therapy with your physician.

Osteoarthritis Safety Caveats An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

Chondroitin Sulfate

Consult your doctor before taking chondroitin if you are taking warfarin sodium or if you have hemophilia. Chondroitin can have antithrombotic activity. Use a salt-free chondroitin preparation if you need to restrict your salt intake. Chondroitin can cause gastrointestinal symptoms such as epigastric distress, nausea, and diarrhea. Curcumin

Do not take curcumin if you have a bile duct obstruction or a history of gallstones. Taking curcumin can stimulate bile production. Consult your doctor before taking curcumin if you have gastroesophageal reflux disease (GERD) or a history of peptic ulcer disease. Consult your doctor before taking curcumin if you take warfarin or antiplatelet drugs. Curcumin can have antithrombotic activity. Always take curcumin with food. Curcumin may cause gastric irritation, ulceration, gastritis, and peptic ulcer disease if taken on an empty stomach. Curcumin can cause gastrointestinal symptoms such as nausea and diarrhea. EPA/DHA

Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking EPA/DHA with warfarin may increase the risk of bleeding. Discontinue using EPA/DHA 2 weeks before any surgical procedure. Ginger

Do not take ginger if you have a bile duct obstruction or gallstones. Ginger may stimulate bile production. High doses of ginger (6 grams or more) can cause damage to the stomach lining and ulcers. Ginger can cause anllergic skin reactions. Consult your doctor before taking ginger if you take blood thinners such as warfarin (Coumadin). Ginger can increase the risk of bleeding. Glucosamine

Consult your doctor before taking glucosamine if you have diabetes. It is unknown if glucosamine will increase insulin resistance in humans but glucosamine has been shown to increase insulin resistance in healthy animals and in animals with diabetes. Animals given intravenous glucosamine were found to have a significantly decreased rate of glucose uptake in their skeletal muscle (this effect was not observed, however, in animals given oral glucosamine). If you have diabetes, are overweight, or have difficulty with glucose tolerance and take glucosamine under medical advisement, monitor your blood glucose level frequently. Your doctor will need to adjust your medication levels accordingly. Glucosamine can cause gastrointestinal symptoms such as nausea and iarrhea. Green Tea

Consult your doctor before taking green tea extract if you take aspirin or warfarin (Coumadin). Taking green tea extract and aspirin or warfarin can increase the risk of bleeding. Discontinue using green tea extract 2 weeks before any surgical procedure. Green tea extract may decrease platelet aggregation. Green tea extract contains caffeine, which may produce a variety of symptoms including restlessness, nausea, headache, muscle tension, sleep disturbances, and rapid heartbeat. MSM

MSM can cause headache or gastrointestinal symptoms such as nausea and diarrhea. NAC

NAC clearance is reduced in people who have chronic liver disease. Do not take NAC if you have a history of kidney stones (particularly cystine stones). NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes. Consult your doctor before taking NAC if you have a history of peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal barrier. NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea. SAMe

Consult your doctor before taking SAMe if you have bipolar disorder. See your doctor frequently if you take SAMe and you have bipolar disorder. Consult your doctor before taking SAMe if you take antidepressants. See your doctor frequently if you take SAMe in place of or in addition to antidepressants. Consult your doctor before taking SAMe if you have cancer. Nucleic acid methylation patterns may change in people who have cancer and take SAMe. Do not take SAMe if you are undergoing gene therapy. SAMe can cause anxiety, hyperactive muscle movement, insomnia, hypomania, and gastrointestinal symptoms such as nausea and diarrhea. Vitamin C

Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute. Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C. Vitamin E

Consult your doctor before taking vitamin E if you take warfarin (Coumadin). Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure. Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia. Discontinue using vitamin E 1 month before any surgical procedure. For more information see the Safety Appendix --->

WikiProject India Newsletter, Volume IV, Issue 2 – July 2009
To stop receiving this newsletter, or to receive it in a different format, please list yourself in the appropriate section here. Delivered automatically by --  Tinu  Cherian BOT  - 15:19, 18 July 2009 (UTC)

Bantva Manavadar Disambiguation and Improvement Project
Bantva, Manavadar, Bantva Manavadar ,  Sardargarh Bantva

Unicode In typesetting technical literature β.Unicode number for β is U+03B2, and with &beta; or &#946; the β is coded in HTML.
In typesetting technical literature, it is a commonly made mistake to use the German letter ß as a replacement for the β. The two letters resemble each other superficially, but they are unrelated. This substitution looks extremely unprofessional to the eyes of German or Greek readers. The Unicode number for β is U+03B2, and with &beta; or &#946; the β is coded in HTML. The internal version, ϐ, is encoded as U+03D0 in Unicode or &#976; in HTML. S

Boxes & Tags
To reference this article in your paper, please copy and paste the following text: Katsuko S Furukawa, Masato Sato, Toshihiro Nagai Stephanie Ting, Joji Mochida and Takashi Ushida (2010). Scaffold-free Cartilage Tissue by Mechanical Stress Loading for Tissue Engineering, Tissue Engineering, Daniel Eberli (Ed.), ISBN: 978-953-307-079-7, InTech, Available from: http://www.intechopen.com/articles/show/title/scaffold-free-cartilage-tissue-by-mechanical-stress-loading-for-tissue-engineering
 * How to Reference

To place a link on your website or a blog, please copy and paste the following HTML code: Scaffold-free Cartilage Tissue by Mechanical Stress Loading for Tissue Engineering
 * How to Link


 * see in edit mode -under development - needs

<!---  The table below shows the latest PPP and PPP per capita data for Commonwealth countries and territories of the member countries. Most figures (including for the world) are 2019 estimates from the International Monetary Fund. Other figures are estimates from The World Factbook of the Central Intelligence Agency (for GDP and GDP per capita ), and are noted beside the figures along with the year of estimate.

Click on one of the small triangles in the headings to re-order the list according to that category.

Note: The figures for the dependent territories are slightly outdated (e.g. the GDP per capita figure for the Cayman Islands is from 2004), therefore they may not be easily compared with more recent figures for sovereign states.



Current members
All dates below are provided by the Commonwealth of Nations Secretariat members list, and population figures are as of 1 February 2020.

A. Unless otherwise noted, independence was gained from the United Kingdom on the date (shown in column 2) of joining the Commonwealth.

B. Not a member of the Commonwealth Foundation.

C. Though Pakistan celebrates 14 August 1947 as its independence day, independence was officially granted at midnight, 15 August 1947. Therefore, its date of joining the Commonwealth would be 15 August 1947.

D. Geographically a part of Asia, considered a European country in political geography.

E. Constitutional monarchy that operates under a Westminster system. The monarch is not the same individual as the British monarch, hence making it not a Commonwealth realm.

F. In geology, the Maltese Islands is located on the African Plate. The island group lies approx. 200 km south of the boundary between the African Plate and the Eurasian Plate. In political geography, Malta is considered a European country.

-->



WP:WikiProject Aviation/Contest/Submissions/Pateurology2
Hello. I noticed you recently created in the article space by mistake. This may have been a typographical error, but in case it was not, let me summarise what you did incorrectly. In Wikipedia, every page is in a namespace. The namespace is by default "Article", otherwise known as "Main". You created your page in the articlespace, because you neglected or misspelled the namespace prefix "Wikipedia:" before the name of your page. Even as minute a detail as this can cause problems. In the future, please be careful of this. Don't worry about the page - I have moved it into the correct namespace, and marked the resultant redirect for deletion. If you have questions, please feel free to ask them on my talkpage, or go to the help desk. Thank you.  Intelligent  sium  02:19, 5 November 2009 (UTC)
 * A moved the page to WikiProject Aviation/Contest/Submissions/Patelurology2, fixing the spelling mistake in your username. I've also added you to the points board at WikiProject Aviation/Contest/History/2009, and to the WikiProject Aviation/Contest/Users template. - Trevor MacInnis contribs 19:50, 5 November 2009 (UTC)

Aircraft redirects
Thank you for you help with aircraft articles but can I ask you not to create re-directs from aircraft type articles to the aircraft company as you have done with Short Biplane No. 1 and others. The red link helps us to know which articles have not been created and creating the redirect as you have can be misleading. If you have any questions then please ask at WP:AIRCRAFT, Thanks. MilborneOne (talk) 15:50, 8 November 2009 (UTC)

Working page moved to your userspace
Hpwdy; I stumbled across a 'working page' of yours that seemed to have founf its way into the main encyclopaedia. I have moved it to User:Patelurology2/Article Preparation page for Alumni of Rajkumar College, Rajkot for you. - TB (talk) 19:51, 12 December 2009 (UTC)

Speedy deletion nomination of ( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians
A tag has been placed on ( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians, requesting that it be speedily deleted from Wikipedia. This has been done under section G11 of the criteria for speedy deletion, because the page seems to be unambiguous advertising which only promotes a company, product, group, service or person and would need to be fundamentally rewritten in order to become an encyclopedia article. Please read the guidelines on spam as well as FAQ/Business for more information. You may also wish to consider using a Wizard to help you create articles - see the Article Wizard.

If you think that this notice was placed here in error, you may contest the deletion by adding  to the top of the page that has been nominated for deletion (just below the existing speedy deletion or "db" tag), coupled with adding a note on the talk page explaining your position, but be aware that once tagged for speedy deletion, if the page meets the criterion, it may be deleted without delay. Please do not remove the speedy deletion tag yourself, but don't hesitate to add information to the page that would render it more in conformance with Wikipedia's policies and guidelines. Lastly, please note that if the page does get deleted, you can contact one of these admins to request that they userfy the page or have a copy emailed to you. ▒ Wirεłεşş ▒ Fidεłitұ ▒ Ćłâşş ▒ Θnε ▒ ―Œ  ♣Łεâvε Ξ мεşşâgε♣ 19:47, 25 December 2009 (UTC)

Articles for deletion nomination of ( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians
I have nominated ( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians, an article that you created, for deletion. I do not think that this article satisfies Wikipedia's criteria for inclusion, and have explained why at Articles for deletion/( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians. Your opinions on the matter are welcome at that same discussion page; also, you are welcome to edit the article to address these concerns. Thank you for your time.Please contact me if you're unsure why you received this message. tedder (talk) 19:51, 29 December 2009 (UTC)

( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians redirect
I have reverted the edit that converted this page to a redirect. I suspect that it was done as a sort poor-man's deletion after I removed the speedy deletion tag. I don't see that such a redirect makes sense. Either the page should be brought up at WP:AFD and community consensus sought for the deletion, or it should be retained.

Many list-of-people articles limit themselves to "notable" people, in this case it would be "notable alumni". This is generally taken to mean people that have an article on Wikipedia, or who ought to or might have an article. You might want to consider recasting the list in this way.

The notability and significance of this list is at best marginal by Wikipedia standards IMO. You may well see the list nominated for deletion at WP:AFD, if it is, the outcome could go either way.

I will add a link from the school article to the list.

Please not that admins have no greater authority as editors than any other editor, but it is always best to discuss rather than fight. The list talk page would be a good place to discuss such issues. DES (talk) 19:59, 29 December 2009 (UTC)

Articles for deletion/( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians

 * Admin Comment Note many of the "notable alumni" are simply bluelinks because they are piped to a city or name. For instance, Tedder of Portland. tedder (talk) 21:37, 29 December 2009 (UTC)
 * My Comment: Hoping this comment is appropriate and allowed Place name used for temporary link for the place which each of those are/were rulers/Kings of the place pending creation of specific page.


 * ....while numerous people in it are apparently notable enough to be included on Wikipedia, this is a rather trivial article and it would be more logical to create a Rajkumar College Alumni category instead, into which the relevant people can be added. KaySL (talk) 20:01, 29 December 2009 (UTC)
 * My comment: Agree with title Rajkumar College Alumni ( category ).


 * Merge any missing notable alumni and list of principals back to Rajkumar College, Rajkot. The red linked people should not be merged. TerriersFan (talk) 22:21, 31 December 2009 (UTC)
 * My comment: Agree, red linked notables not be merged. This page was created to avoid the clutter on the main page of The Rajkumar College, Rajkot; page created after at least four pages were started under my Usepage feature. On starting of deletion proceedings other pages were started at same location; community effort will be largely by the Alumni; discussion mode on talk page will need to be used and the alumni will be informed about other instructional matters through talk page as well as Alumni E-mailgroup circuit.
 * ...if the college is notable enough for an article here -- and I think it is -- then a list of notable and somewhat notable alumni is a reasonable extension of that article. The page could be improved but I see no need to delete it. DES (talk) 20:30, 29 December 2009 (UTC)
 * My comment: Improvements are being attempted to this page around general aspects of Alumni; intent for creation of this page was to separate the list from page save the most notable category which righly has been left by the first Admin on main page, so that clutter can be avoided and also link to   page preparation page under my userspace can be established; I infer that the latter cannot be linked as per guidelines?;it was de-linked by the first Admin. Anyway, Alumni capable of completion of these page will now have a started page ready to input; my first attempt months ago to start first page was met with Auto-deletion, then the Userspace feature came to attention; upto that time all the material gathered was somewhere else; casting a page gives avenue to completion someday; not all likely to be completed soon; inertia ruleth supreme and current limited manpower in background further help from all the Alumni will be needed considering Alumni In Memoriam; institution is 130 years old.
 * See also talk pages of college and the list page for recent postings regarding above.
 * User:Patelurology2/Article Preparation page for Alumni of Rajkumar College, Rajkot
 * Rajkumar College, Rajkot
 * ( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians

Talkback
KaySL (talk) 19:22, 5 January 2010 (UTC)

Color Box
HOW TO create a color box syntax -- see in edit mode

RED AND WHITE BOX

"Bipolar" Heading and foot note construction of a Wikipedia's Wikitable e.g. ACEI equivalents
Bipolar refers to the heading of table at the top and at the bottom: comes handy if in a print run half the table is printed so that header or the trailer table info is sufficient to decipher the info

ACEI equivalents
The ACE inhibitors have different strengths with different starting dosages. Dosage should be adjusted according to the clinical response.

MH370 WIND SPEED ALONG STRAIGHT PATH 1941 TO 2241 AND 0011
The WINDS have different strengths with different DIRECTIONS.WIND COMPONENT TAIL OR HEAD should be adjusted accordingly.


 * Wind component KNOTS *WIND sin DIFF FROM PATH *Search (bing.com)* e.g. 23 sin 87 - Search (bing.com) e.g. 23 sin 87 - Search (bing.com)

User:Patelurology2/Kolki disambiguation
User:Patelurology2/Kolki disambiguation

Talkback
--RrburkeekrubrR 19:22, 30 January 2010 (UTC)

Non Free Images in your User Space
Hey there Patelurology2, thank you for your contributions! I am a bot alerting you that Non-free files are not allowed in the user or talk-space. I removed some images that I found on User talk:Patelurology2. In the future, please refrain from adding fair-use images to your user-space drafts or your talk page. See a log of images removed today here, shutoff the bot here and report errors here. Thank you, -- DASHBot (talk) 04:33, 3 February 2010 (UTC)

Aviation Contest
Hi Patelurology2! This note is to inform you that your Aviation Contest submissions page has been archived from the previous round! You are now free to add submissions for this round! Note: This next round will run from January through February, so feel free to update your submission page with work from both months! Thanks, and happy editing! (Note: I will not be watching this space. If you have any questions, feel free to ask at the Contest discussion page. -SidewinderX (talk) 14:11, 3 February 2010 (UTC)

RKC Rajkot Alumni
Signed:Patelurology2 (talk) 18:07, 9 February 2010 (UTC)
 * User:Patelurology2/RKC Rajkot Alumni
 * Alumni are requested to list notables in the format below; follow the example of the few visible entries, when you are inserting data. Use the link above to access the page for inserting entries.

Orphaned non-free image File:Swaasthya Mar2010 (1).jpg
 Thanks for uploading File:Swaasthya Mar2010 (1).jpg. The image description page currently specifies that the image is non-free and may only be used on Wikipedia under a claim of fair use. However, the image is currently orphaned, meaning that it is not used in any articles on Wikipedia. If the image was previously in an article, please go to the article and see why it was removed. You may add it back if you think that that will be useful. However, please note that images for which a replacement could be created are not acceptable for use on Wikipedia (see our policy for non-free media).

If you have uploaded other unlicensed media, please check whether they're used in any articles or not. You can find a list of "file" pages you have edited by clicking on the "my contributions" link (it is located at the very top of any Wikipedia page when you are logged in), and then selecting "File" from the dropdown box. Note that any non-free images not used in any articles will be deleted after seven days, as described on criteria for speedy deletion. Thank you.  • ɔ   ʃ   →  03:10, 7 May 2010 (UTC)

Orphaned non-free image File:Swaasthya march 2010.pdf
 Thanks for uploading File:Swaasthya march 2010.pdf. The image description page currently specifies that the image is non-free and may only be used on Wikipedia under a claim of fair use. However, the image is currently orphaned, meaning that it is not used in any articles on Wikipedia. If the image was previously in an article, please go to the article and see why it was removed. You may add it back if you think that that will be useful. However, please note that images for which a replacement could be created are not acceptable for use on Wikipedia (see our policy for non-free media).

PLEASE NOTE:


 * I am a bot, and will therefore not be able to answer your questions.
 * I will remove the request for deletion if the file is used in an article once again.
 * If you receive this notice after the image is deleted, and you want to restore the image, click here to file an un-delete request.
 * To opt out of these bot messages, add  to your talk page.
 * If you believe the bot has made an error, please turn it off here and leave a message on my owner's talk page.

Thank you. DASHBot (talk) 05:37, 20 May 2010 (UTC)

Orphaned non-free image File:Shushrushahospital.org logo.jpg
 Thanks for uploading File:Shushrushahospital.org logo.jpg. The image description page currently specifies that the image is non-free and may only be used on Wikipedia under a claim of fair use. However, the image is currently orphaned, meaning that it is not used in any articles on Wikipedia. If the image was previously in an article, please go to the article and see why it was removed. You may add it back if you think that that will be useful. However, please note that images for which a replacement could be created are not acceptable for use on Wikipedia (see our policy for non-free media).

PLEASE NOTE:


 * I am a bot, and will therefore not be able to answer your questions.
 * I will remove the request for deletion if the file is used in an article once again.
 * If you receive this notice after the image is deleted, and you want to restore the image, click here to file an un-delete request.
 * To opt out of these bot messages, add  to your talk page.
 * If you believe the bot has made an error, please turn it off here and leave a message on my owner's talk page.

Thank you. DASHBot (talk) 05:38, 21 May 2010 (UTC)

Speedy deletion nomination of ( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians
A tag has been placed on ( List of ) Alumni, Principals and Teachers of The Rajkumar College,Rajkot- RKCians requesting that it be speedily deleted from Wikipedia. This has been done under section A3 of the criteria for speedy deletion, because it is an article with no content whatsoever, or whose contents consist only of external links, a "See also" section, book references, category tags, template tags, interwiki links, a rephrasing of the title, or an attempt to contact the subject of the article. Please see Wikipedia:Stub for our minimum information standards for short articles. Also please note that articles must be on notable subjects and should provide references to reliable sources that verify their content. You may wish to consider using a Wizard to help you create articles - see the Article Wizard.

If you think that this notice was placed here in error, you may contest the deletion by adding  to the top of the page that has been nominated for deletion (just below the existing speedy deletion or "db" tag - if no such tag exists then the page is no longer a speedy delete candidate and adding a hangon tag is unnecessary), coupled with adding a note on the talk page explaining your position, but be aware that once tagged for speedy deletion, if the page meets the criterion, it may be deleted without delay. Please do not remove the speedy deletion tag yourself, but don't hesitate to add information to the page that would render it more in conformance with Wikipedia's policies and guidelines. Lastly, please note that if the page does get deleted, you can contact one of these admins to request that they userfy the page or have a copy emailed to you. Steamroller Assault (talk) 22:07, 29 May 2010 (UTC)

WikiProject India Newsletter Volume V, Issue no. 1 - (June 2010)
This newsletter is automatically delivered by -- <em style="font-family:Kristen ITC;color:#ff0000"> Tinu  <em style="font-family:Kristen ITC;color:#ff0000">Cherian BOT  - 02:36, 1 July 2010 (UTC)

Alumni of Indian Public Schools Conference
Alumni of Indian Public Schools Meet in New York.

Dec 4, 2009 ... New York. IT could easily have turned out ... At the first meet- ing of the Indian Public Schools' ... sul General of India in New York. RKCian in attendance.

Mr. Pramod Sharma who taught at the Doon School, Dehra Dun, Mayo College, Ajmer and also at ... Ajmer and the Chairman of the Indian Public Schools Conference. ... “I am very happy to be joining the excellent medical team at New York ... Meet Miss Mumbai. Model-Actress Tisca Arora-Chopra, who is currently seen as ... iskaa.org/whatsnew.htm - Cached

Nov 18, 2009 ... Alumni of Indian Public Schools Meet in New York ... School, Doon School,Mayo College, Daly College and others met for a Unique Pan Public .. RKC Rajkot included

Youtube of Alumni of Indian Public Schools Meet in New York, Nov 18, 2009

Main sponsor Law firm's article for Alumni of Indian Public Schools Meet in New York, Nov 18, 2009

Other links in Google serach for Alumni of Indian Public Schools Meet in New York

Mountain Travel, Acute Mountain Sickness

 * Outdoor Action Guide to High Altitude: Acclimatization and Illnesses, by Rick Curtis, Director, Outdoor Action Program, Last Page update 07/07/1999
 * Coming down for air...AMS (Manali-Leh)... you better acclimatize! article/weblog by ' vistet '
 * Manali Leh
 * A Drop in Elevation : The Manali -Leh road is only open 3 months at most every year and is a major artery for ... He had a topographical map of the area and wanted to hike upto a ...
 * The schedule for cycling the road from Manali to Leh: This is the final day before we start on the Manali-Leh road, ... The arrival at Zingzingbar is one of relief - and it's also a nice spot for those wanting a ... Depending on the map you carry, this minor feature of a double humped 17000 .... does all the boasting about altitude that you might feel the need for.
 * Never underestimate the Himalayas: WWF assistance around Leh Manali
 * Rohtang Pass 13054ft, Nakee La 15547, La Chaling la 16616, Taklang La 17582, Leh 17582ft
 * Highetst point on this hightest motorable road on earth is 39 Km beyond Leh : Leh to NUBRA VALLEY passes over KHARDUNG LA (the highest motorable road in the world) at 5602 M / 18,390 Ft, around 39 km from Leh.

Cycling In The UK & Portugal

 * Cycling In The UK & Portugal
 * Bicycling in Portugal Google Search
 * Bicycling in Portugal
 * Bicycling in Portugal
 * Packaged cycling tours- many self-guided
 * Cycling Portugal
 * Less Air in tire to cross travel over cobble stoned ancient area even in metropolis
 * Right- and left-hand traffic UK to Portugal change in handedness to get accustomed to  *Handedness and Bicycles
 * Essay type article more than cars // also about the trip described: Cars. You just can't get around them. Even in stories about bicycle travel they play a big role. Often there are too may of them, and at other times you have to use one, to get to the spot where you want to start riding your bike. That was the case in this case. I'll try to make it short, just a short factual description. But it bears including, because of the potential consequences. This is still a report about a bicycle tour. It just takes a little while to get to the bicycle part.
 * Self Guided tour father & Son: 750 km may 26-June 9, 2007 southern Portugal from Lisbon

:Pub sch example
<!--- Yadavindra Public School, is located in Patiala, Punjab, India. ] Considered among the top rung of Indian Public Schools, Yadavindra Public School, Patiala popularly known as YPS Patiala, is an English Medium Co-Educational Boarding-cum-Day school founded in 1948 by the late H H Maharaja Yadavindra Singh.
 * [http://www.ypspatiala.in/ Yadavindra Public School, is located in Patiala, Punjab, India

Over the last six decades, YPS has grown to a student strength of 1600 and staff strength of 100.

The school prepares students for the Indian Certificate of Secondary Education (Class X) and the Indian School Certificate (Class XII) Examinations conducted by the Council for the Indian School Certificate Examinations, New Delhi which is successor to the Local Examinations Syndicate of the Cambridge University (UK).

YPS is a member of the Indian Public Schools' Conference and is affiliated to CISCE.
 * YPS has given rise to many achievers in Armed Forces, Business, Civil Services, Judiciary, Politics, Sports, Science & Technology and other fields.

A partial list of our eminent alumni can be viewed by visiting this page.

YPS invites OYs to update their profile by visiting this section of the website. You may also download this file which contains contact details of few AYOSA members. The School has an active old students organization, members include erstwhile students of Aitchison College, Lahore. Students can opt for life membership on leaving school. The Association has regular get-togethers. A key contribution of OYs is the School Hospital which was built by Old Students Association of Aitchison/Yadavindra (AYOSA) Aitchison Yadavindra Old Students Association' can be contacted on ayosapatiala@gmail.com. Please visit Ayosa Patiala  on Facebook (http://www.facebook.com) and interact with other alumni members. Dear Alumni, Please fill in the following form and submit if you wish to make changes to your details available with YPS. Data entry is compulsory for fields marked with * Name * Gender MaleFemale Date of Birth * Year of Joining * Year of Leaving * Examination Passed * House * Boarder/Day Scholar * Marital Status * No of Children Occupation * Achievements after leaving YPS * Present Address * City * Pincode * State * Country * Phone (Mobile) * Phone (Office) * Phone (Residence) * Email * Permanent Address * City * Pincode * State * Country *
 * Old Aitchisonians/Yadavindrians - Update Status - Step 1


 * EMINENT YADAVINDRIANS

Yadavindrians outshine all others when it comes to representation, be it Armed forces, politics, civil services or any other diverse fields. Even after four decades many of their track & field records remain unbeaten at the ‘All India Inter Public School Athletic meets’. A score of 13-0 win in hockey over a renowned public school in the hills is also a record of sorts. Armed Forces - Army - Air Force IFS Civil Services IPS Educationists Judiciary Politics MLA's PCS & Allied Services Sports - Unbeaten Inter House Athletics Record Holders - Athletics - Boxing - Cricket - Hockey - Shooting Science & Technology - IIT Graduates - Doctors Prominent in Diverse Fields Limca Book of Records Religious Glamour World Armed Forces Top Army Top •Lt Gen R Kochar •Lt Gen (Retd) HS Panag (Member Armed Forces Tribunal) •Lt Gen (Retd) NS Brar (Member Armed Forces Tribunal) •Maj Gen BS Grewal •Maj Gen (Retd) CS Panag •Major Gen (Retd) JS Sidhu •Brig (Retd) HS Bath •Brig (Retd) SS Sidhu •Brig(retd) Daljit Singh Dhillon •Brig (Retd) RS Sidhu •Brig (Retd) Ashok Pathak •Brig Manvindra Singh Jaiswal, (author as well). •Colonel(Retd) Harinder Singh Attari (First Yadavindra Gold medalist & School Captain 1951) Air Force Top •Air Mshl (Retd) KD Singh •Air Vice Mshl(Retd) Manpreet Singh Brar •Air Vice Mshl (Dr) GS Joneja IFS Top •His Highness Maharaja Yadavindra Singh Ji, Ambassador to Italy 1955-56,Ambassador to The Netherlands 1971 to 1974. •H.E, Sardar Swashpawan Singh, Indian Foreign Service (Retd) : Ambassador and Permanent Representative of India to the Offices of the United Nations in Geneva; Ambassador of India to Kuwait. Civil Services Top •Sardar Hardev Singh Chhina IAS (Retd) former Chief Secretary Punjab & an Aitchisonian •Sardar Trilochan Singh IAS (Retd), former Chief Secretary, Haryana. •Sardar SS Bedi IRS (Retd) Former Commissioner, Customs & Excise •Mr.Ravi Bhushan Budhiraja IAS (Retd) Vice Chairman, Maharashtra State Services Tribunal •Sardar Gurpartap Singh IRS (Retd) former Commissioner Income Tax •Mr. Rajan Kashyap IAS (Retd) former Chief Secretary, Punjab •Sardar Mandeep Singh Rai IRS (Retd) •Mr Ajay Agnihotri IRS •Sardar Gurnihal Singh Pirzada IAS •Sardar Rajdip Singh Puri IRS (Retd) •Sardar KBS Sidhu IAS (Second in merit in all India Civil Services) •Mr Madhukar Gupta IAS (Rajasthan Cadre) •Shri Anirudh Tewari IAS •Sardar Harjitinder Singh Grewal IAS •Sardar Ajit Singh Pannu IAS •Sardar Parneet Singh Sachdeva IRS •Sardar Aneet Singh Dullat GM, Indian Railway Traffic Services & IR TC •Sardar GS Hira IRAS, Financial Controller, Kapurthala Coach Factory. •Mr Jagjivan IRS IPS Top •Sardar MPS Aulakh IPS (Retd) former DGP,Punjab Cadre •Sardar NPS Aulakh IPS (DGP, Punjab&NSG) •Sardar Amarjot Singh Gill IPS (DGP Rajasthan) •Mr Dinkar Gupta (IPS) Punjab •Dr Mandeep Singh Tuli IPS (Sikkim Cadre) •Mr. Gyaneshwar Singh IPS ( HP Cadre) Educationists Top It was their dedication and sincere efforts which transformed our lives from what we came to what we are; we owe it to them and our alma mater. •Late Sardar SPS Brar •Sardar Ajit Singh Jawanda, former Principal YPS Judiciary Top •Justice SS Sodhi (Former Chief Justice Allahabad High Court) Politics Top •Late Sardar Harcharan Singh Brar(Aitchisonian) Governor of Orissa & Haryana & Chief Minister of Punjab. •Late Capt Kanwaljit Singh former finance minister of Punjab. •Shri Pawan Kumar Bansal, four times MP & twice as Union Minister. •Sardar Navjot Singh Sidhu three times MP, cricketer& a TV personality. •Shri Vijayendra Singla MP MLA's Top •Late S. Kirpal Singh Libra (MLA) •Sardar Brijbhupinder Singh, former minister Punjab •Sardar Hardeepinder singh Dhillon (MLA) •Sardar Ajitinder Singh Mofar(MLA) •Sardar Jeetmohinder Singh Sidhu(MLA) •Sardar Bikramjit Singh Majithia(MLA) •Sardar Raninder Singh, budding politician (son of Capt Amarinder Singh.) PCS & Allied Services Top •Mr.HMS Rosha- Commissioner Excise & Taxation •Sardar Tejinderpal Singh Sidhu PCS •Sardar KBS Mann PCS •Capt YS Matta AETC •Sardar Rajbachan Singh Sandhu PP (SP) •Sardar Bhupinderjit Singh Virk PP (SP) •Sardar Karminder Singh Brar, Punjab Legal Services •Sardar Nareshinder Singh Boparai (Former Dy Advocate Gen Punjab) •Sardar Amarjit Singh Gill, (Former MD Punjab land Mortgage Bank & Asst Registrar Coop Societies) •Sardar Daljit Singh Mangat PCS •Ms Jaswinder Kaur Sidhu PCS •Mr Varinder Singh brar PP •Mr. Bikramjit Singh Brar PP (National Boxing Champion) •Sardar Rajinder Singh Sidhu Excise & Taxation Sports Top Unbeaten Inter House Athletics Record Holders Top Dawning the Yadavindra colors is considered most prestigious for the records measure up to the national records in many events. Many remain unbeaten even after over 40 years and the one in shot put covers half a century next year. Thus they rightfully deserve a place in our history. Event Timing/Distance Holder House Year 100 Mtrs 10.8 secs Late Sardar Sukhdev Singh Mann DRH 1966 200 Mtrs 22.6 secs Col (Retd) RPS Brar DRH 1967 400 Mtrs 51.5 secs Late Sardar Sukhdev Singh Mann DRH 1965 800 Mtrs 2 min 4.7 secs Sardar Jaspal Singh Virk DRH 1983 1500Mtrs 4 min 27.3 secs Sardar Jaspal Singh Virk DRH 1984 110 Mtrs hurdles 15 secs Sardar Jugeshinder Singh DRH 1985 Long Jump 6.42 mtrs Sardar Manjit Singh Sidhu DRH 1967 High Jump 1.75 mtrs Sardar Gurpreet Singh Sekhon DRH 1969 Triple Jump 15.5 mtrs Sardar Manjit Singh Sidhu DRH 1965 Pole Vault 3 mtrs 22.6 cms Sardar Harbans Singh Gill PH 1978 Shot Put 12.46 mtrs Sardar Amardaljit Singh PH 1960 Discuss Throw 39.07 mtrs Sardar Paramjit Singh Bahia MH 1968 Javelin Throw 49.9 mtrs Sardar Harbans Singh Gill PH 1978 Athletics Top •Jugeshinder Singh (1975-1986) Represented India whilst in school in 110 Mtrs hurdles at the World Junior Athletic Meet at Kuala Lumpur in June, 1986.

•Sikanderjeet Singh, Discus & Shot put Boxing Top •Mr Bikramjit Singh Brar PP- National gold medalist Cricket Top •Lt Col K Rai Singh, played for the first Indian cricket team post independence. Later ADC to HH Maharaja Yadavinder Singh Ji. •Sardar Navjot Singh Sidhu (1968-82) Played cricket for India under 19 in 1981 & for Indian team from 1983 onwards. •Late Shri Dhruv Pandove, World record holder, youngest to score a century in first class cricket at the age of 14 yrs& 294 days, 137 runs in a Ranji Trophy.

•Mr Ashutosh Kaushal(1977-81) Played cricket for India under 19 in 1981. •Mr Reetinder Singh Sodhi (Captain - World cup winners India juniors team) •Mr Parry Goel played for Indian team under 17 in UK •Mr GS Chahal Played for Indian team under 17 in UK  Hockey Top •Sardar Surjit Singh Panesar (1955-57) Represented Kenya in hockey at three Olympics. •Sardar Jagdeep Singh Phoolka (Member Indian Hockey team at Bangkok Asian Games 1966) •Sardar Sukhbir Singh Grewal, represented Indian Hockey team as Centre forward for many years, later he was the National Coach for the Indian team

•Mr Jaswinder Wassan ( Member of Hong Kong hockey team ) Shooting Top •Raja Randhir Singh(1952-63)Represented India in shooting at five Olympics & five Asiads. Secretary General Indian Olympic Association. •Ms Harveen Sarao, International Shooter 10 mtrs Air Pistol, World universities Championship – Gold & Silver , World Championship-Bronze , Asian Games – Silver , SAF Games in Bangladesh-Gold. Science & Technology Top YPS has the highest representation in IITs, medical colleges & other renowned professional institutions; just a short list of some of our alumni who graduated from these institutions is as follows: IIT Graduates Top •Mr. Balraj Singh DhillonChief Engineer(Retd) PSEB •Mr. Prem Parkash Pangotra-IIT(Delhi)-1970 •Mr.Anupam Garg-1971,IIT(D) •Mr.Anup K Jain,1971, IIT(D) •Mr Anmol Singh Biring IIT- Delhi •Mr Harsh Puri-1972,IIT, Delhi •Sardar Gurpreet Arora (School of Architecture, Ahmedabad) Doctors Top •Dr Satbir Bakshi US Navy Dr Baljeet Singh Sidhu (USA),Orthopedican •Dr Gurdeep Jawal •Dr Baljinder Singh Sidhu Eye Surgeon, Liverpool ,UK •Dr Malkit Singh Kingra •Dr IS Virdi (Thoracic Surgeon Apollo Hospital) First surgeon cleared to practice in three continents •Dr Bhagwant Singh Ratta •Dr Mandeep Singh Sethi •Dr Tony Singh Ratta •Dr Rajeev Agarwal, Orthopidiatian •Dr Mahesh Sehgal, USA •Dr Mandeep Dhillon Surgeon &Senior Prof, Head of Dept Orthopedics- PGIMER CHD. •Dr Mandeep Singh Sidhu •Dr Manpreet Singh Thind, plastic surgeon. •Dr Updesh Singh Bedi Prominent in Diverse Fields Top •Ms Parmeshwar Godrej •Mr. Suresh Modi, Industrialist •Mr IS Bhore, former VP UB group •Mr Ravinder Singh Rekhi, former head Mcdonalds SE Asia •Sardar Malvinder S Bhinder(Industrialist) MD, Agro Dutch •Sardar Harmeet Singh Batra, Business. •Mr Jagdev S Gill- Owner Reebok SE Asia •Ms Neelkamal Puri (Writer) •Mr Roopinder Singh Sandhu, Asst Editor, the Tribune & a writer. •Sardar Harbinder Singh Bhullar, lawyer Supreme Court •Ms Sugna Ramakumar Kapoor, Lawyer Supreme court •Sardar Rajbrinder Singh Chahal, Lawyer High Court •Mr Inder Singh Sidhu VP, CISCO, USA •Mr Harinder Singh Grewal Country Head, Airtel. •Mr.Mandeep Singh Butter (Bobby) CMD, IONNOR a highly successful IT company. Limca Book of Records Top •Ex-Wg Cdr MS Mander- For achievements in aviation. Religious Top •Baba Hardev Singh Ji of Nirankari sect Glamour World Top •Mr Gugu Gill, film actor •Mr Gulzar Inder Singh Chahal, Film actor •Mr. Bikramjit singh Bhullar, Film director •Mr.Harshmeep Singh Kang, Film actor --->

WikiProject India Newsletter Volume V, Issue no. 2 - November 2010
This newsletter is automatically delivered by User:Od Mishehu AWB, operated by עוד מישהו Od Mishehu 09:58, 24 November 2010 (UTC)

Translators needed for Huggle/Whitelist

 * Translators needed for Huggle/Whitelist

I stumbled upon the following link associated with one of page under my page protection and just released ( at : http://www.google.com/search?q=User%3APatelurology2%2FThe+White+eagle&btnG=Search&hl=en ) as searched under Google and showed Huggle/Whitelist as a page where I was listed ( searched by control F function on a cryptic page). Seems this is a list of contributors who have been deemed to be non-vandals. This page and associated pages need translation in many languages and you can dissemenate this info.

Huggle/Whitelist - Noted myself on Huggle White list on Jan 13, 2011

Proposed deletion of Expeditions of The Rajkumar College, Rajkot Students and Alumni


The article Expeditions of The Rajkumar College, Rajkot Students and Alumni has been proposed for deletion&#32; because of the following concern:
 * Not notable, see WP:VRS, WP:FIRST.

While all contributions to Wikipedia are appreciated, content or articles may be deleted for any of several reasons.

You may prevent the proposed deletion by removing the notice, but please explain why in your edit summary or on the article's talk page.

Please consider improving the article to address the issues raised. Removing will stop the proposed deletion process, but other deletion processes exist. The speedy deletion process can result in deletion without discussion, and articles for deletion allows discussion to reach consensus for deletion.  Chzz  ► 20:49, 14 February 2011 (UTC)

User:Patelurology2/Shushrusha Citizens' Co-operative Hospital, Shivaji Park, Mumbai
Hi. The draft as it currently stands is unacceptable because it is inherently promotional in tone. Were this moved to article space, the most likely scenario is that it would be speedy deleted under criterion G11: unambiguous advertising or promotion. I suggest you look at articles for individual hospitals in Category:Hospitals to get a better sense of the tone expected. Every article on this project needs to stick to the fundamental principles of neutral point of view and a lot of work is necessary before the current draft satisfies these requirements. Furthermore, material should be attributable to a reliable published source that is independent of the subject. This is not the case in the first half of the current draft. Best, Pichpich (talk) 16:14, 3 May 2011 (UTC)

Talk:Air France Flight 447
Apology Patelurology2 but I have had to remove your last post at Talk:Air France Flight 447 as it has stopped subsequent messages from displaying. If you would like to check the code and preview before you re-add it again, thanks. MilborneOne (talk) 13:31, 4 June 2011 (UTC)

AF447 Integration of Time-line information from multiple sources

 *  Work in progress: pending addition of box(es) for source and reliability symbols before merginging mainly ACARS events inserted first but are separated enbloc.

Events are tagged to time of occurence; collation done from different source and listed events are from different time period; though, this difference has significance, it is not separated by the time of recognition of the event, e.g. before or after finding and studying the black boxes, would be a major demarcation. Respecting the postulating learned opinion at the time of expression of that opinion from whatever information is then available to formulate that opinion and is presented as was expressed at one time; the same opinion could change based on newly found information subsequently; sequential interpretation of this is needed on ongoing basis. Even as this investigation winds down to a conclusion, the said conclusion may be revisable in the future based on then available new information, technology etc akin to the concept of DNA analysis of modern era aiding reexamination of past investigations.



<!--- Findings from the flight data recorderOn 27 May 2011, the BEA released an update on its investigation,[140] describing the history of the flight as recorded by the flight data recorder. At 3 hour 55 minutes absolute time (time from planned departure), the captain woke the second pilot and said: "[...] he's going to take my place". After having attended the briefing between the two co-pilots, the captain left the cockpit to rest at 4 hours 1 minute 46 seconds. At 4 hours 6 minutes absolute time, the pilot warned the cabin crew that they were about to enter an area of turbulence. 4 minutes later, the pilots turned the plane slightly to the left and decreased its speed from Mach 0.82 to Mach 0.8 due to increased turbulence.

At 4 hours 10 minutes and 5 seconds absolute time, the autopilot and the auto-thrust systems disengaged. The pilot made a left nose-up input, as the plane began rolling to the right. The plane's stall warning sounded twice. 10 seconds later, the plane's recorded airspeed dropped sharply from 275 knots to 60 knots. The plane's angle of attack increased, and the plane started to climb. The left-side instruments then recorded a sharp rise in airspeed to 215 knots. This change was not displayed by the Integrated Standby Instrument System until a minute later (the right-side instruments are not recorded by the recorder). The pilot continued making nose-up inputs. The trimmable horizontal stabilizer (THS) moved from 3 to 13 degrees nose-up in about 1 minute, and remained in that latter position until the end of the flight.

At around 4 hours 11 minutes into the flight, the plane had climbed to its maximum altitude of around 38,000 feet. There, its angle of attack was 16 degrees, and the thrust levers were in the TO/GA detent (fully forward). At 4 hours 11 minutes 40 seconds, the captain re-entered the cockpit. The angle of attack had then reached 40 degrees, and the plane had descended to 35,000 feet with the engines running at almost 100% N1 (the rotational speed of the front intake fan, which delivers most of a turbofan engine's thrust). The stall warnings stopped, as all airspeed indications were now considered invalid due to the high angle of attack. Roughly 20 seconds later, the pilot decreased the plane's pitch slightly, air speed indications became valid and the stall warning sounded again. From there until the end of the flight, the angle of attack never dropped below 35 degrees. During the last minutes, the thrust levers were in the IDLE detent position. The engines were always working, and responsive to commands.

The recordings stopped at 4 hours 14 minutes and 28 seconds absolute time, or 3 hours 45 minutes after takeoff. At that point, the plane's ground speed was 107 knots, and it was descending at 10,912 feet per minute, with the engines' N1's at 55%. Its pitch was 16.2 degrees (nose up), with a roll angle of 5.3 degrees left. During its descent the plane had turned more than 180 degrees to the right to a compass heading of 270 degrees. The plane was stalled during its entire 3 minute 30 second descent from 38,000 feet.

While the incorrect airspeed data was the apparent cause of the disengagement of the autopilot, the reason why the pilots lost control of the aircraft remains a mystery, in particular because the pilot would normally try to lower the nose in case of stall.[166][167][168]. Multiple sensors provide the pitch (attitude) information and there was no indication any of them were malfunctioning [169].

--->

<!--- In October 2011, a transcript of the voice recorder was leaked and published in the book Erreurs de Pilotage (Pilot Error) by Jean Pierre Otelli, According to the book, one of the co-pilots caused the accident by incorrectly pulling back on his stick when the aircraft went into a stall. The BEA and Air France both condemned the release of this information however, calling it "sensationalized and unverifiable information" that "impairs the memory of the crew and passengers who lost their lives."

Official analysis from the BEA of the transcript is yet to be published. --->

<!---{| class="wikitable collapsible collapsed" width=60% style="background: #fffaef; border: 1px dotted gray;" !style="background:#ffdead;" colspan = 5 |ACARS Messages during final 4 minutes of flight.
 * -align = center |
 * Time (UTC) || Code1 ||style="width:120px" | Message || Source and/or Meaning || align = center |Δt sec
 * align = center | 2:10:10 || align = center | 2210 020 || AUTO FLT AP OFF || Autoflight system - autopilot spontaneously shut off || align = center | 0
 * align = center | 2:10:16 || align = center | 2262 010 || AUTO FLT REAC W/S DET FAULT || Autoflight system - unavailability of the reaction to wind shear detection function6 || align = center |-
 * align = center | 2:10:23 || align = center | 2791 005 || F/CTL ALTN LAW || Flight control - switching [from normal law]'' to alternate flight control law.' || align = center | -
 * align = center | 2:10:29 2:10:41 || align = center |  2283 002  2283 012 || FLAG ON CAPT PFD SPD LIMIT  FLAG ON F/O PFD SPD LIMIT || Disappearance of the display of the characteristic speeds (in particular VLS [low speed limit] and green dot [most economical speed]) on the Captain and First Officer [primary flight displays] PFDs, with display of the SPD LIM flag at the bottom of the speed scales. This message indicates the unavailability of the [flight management and guidance envelope computer] FMGEC’s characteristic speed calculation function. || align = center |-3
 * align = center | 2:10:34 || align = center Colspan = 2| #0210/+2.98-30.59 || At 2:10 the the geographic coordinates of F=GZCP was N2.98 W30.59 || align = center |-3
 * align = center | 2:10:47 || align = center | 2230 025 || AUTO FLT A/THR OFF || Autoflight system - autothrust spontaneously shut off || align = center |-
 * align = center | 2:10:54 || align = center | 3443 005 || NAV TCAS FAULT || Navigation system - indicates that the [Terrain crash avoidance system] TCAS is inoperative.4|| align = center | -
 * align = center | 2:11:00 2:11:15 || align = center | 2283 001  2283 011 || FLAG ON CAPT PFD FD  FLAG ON F/O PFD FD || Disappearance of the Flight Director on the PFDs, Captain and First Officer sides, and display of the red FD flag || align = center | -5
 * align = center | 2:11:21 || align = center | 2723 020 || F/CTL RUD TRV LIM FAULT || ..unavailability of the rudder deflection limitation calculation function. The limitation value remains frozen at the current value at the time of the failure. || align = center |-
 * -style="background:#fffabf"
 * align = center | 2:11:49 || align = center | 3411 15* || EFCS2 1, EFCS1, AFS... PROBE-PITOT 1X2 / 2X3 / 1X3 (9DA), HARD || ..transmitted by the FCDC2 (EFCS2), means that the FCPCs (or PRIMs) triggered one of the speed monitoring processes: they have detected a decrease of more than 30 kt in one second of the “polled” speed value. The three ADRs were considered valid by the EFCS2 at the time the monitoring was triggered, because the prior rejection of an ADR would have generated a class 2 fault message and there would therefore have been an asterisk in front of the source. In this case, the “polled” value is the median value. Flight control systems are now operating under 'alterate law 2'. || align = center | 99
 * -style="background:#fffabf"
 * align = center | 2:11:55 || align = center | 2793 34* || EFCS1 X2, EFCS2X... FCPC2 (2CE2)/ WRG:ADIRU1 BUS ADR1-2 TO FCPC2,HARD || Source:Captain's Electronic Flight Control System (EFCS 1). indicates that [First Officer's flight control primary computer] FCPC 2 no longer considers as valid the information that is delivered to it by ADR 1 (via bus 2).4 || align = center | -
 * align = center | 2:12:10 2:12:16 || align = center | 3412 001  3412 011  || FLAG ON CAPT PFD FPV  FLAG ON F/O PFD FPV || Disappearance of the FPV (bird) on the PFDs, Captain and First Officer sides, and display of the red FPV flag.|| align = center | -5
 * align = center | 2:12:51 || align = center | 3410 400 || NAV ADR DISAGREE || the EFCSs have rejected an ADR, and then identified an inconsistency between the two remaining ADRs on one of the monitored parameters. || align = center | 161
 * -style="background:#fffabf"
 * align = center | 2:13:08 || align = center | 3422 00* || ISIS 1... ISIS(22FN - 10FC) SPEED OR MACH FUNCTION || Source: integrated standby information system (ISIS). internal failure at the level of the CAS or Mach elaboration function or CAS or Mach values that are outside certain limits.|| align = center | 178
 * -style="background:#fffabf"
 * align = center | 2:13:14 || align = center | 3412 34* || IR2 1, EFCS1X, IR1, IR3... ADIRU2 || Source: inertia reference 2 (A component of the First Officer's ADIRU).4 || align = center | -
 * align = center | 2:13:45 || align = center | 2790 025 || F/CTL PRIM 1 FAULT || Flight control - This message indicates that FCPC1 (PRIM 1) has stopped functioning. This shutdown could be the result of a command or of a failure. || align = center | 2157
 * align = center | 2:13:51 || align = center | 2790 004 || F/CTL SEC 1 FAULT || Flight control - This message indicates that [Captain's flight control secondary computer] FCSC1 (SEC 1) has stopped functioning. This shutdown could be the result of a command or of a failure. || align = center | -
 * align = center | 2:14:14 || align = center | 3410 360 || MAINTENANCE STATUS ADR 2 || Source: First officer's Air data reference which is part of ADIRU-2 || align = center | 244
 * -style="background:#fffabf"
 * align = center | 2:14:20 || align = center | 2283 34* || AFS 1... FMGEC1(1CA1), INTERMITTENT || Autoflight system - an intermittent fault in the captain's flight manangement guidance envelope computer, occurs for less than 2.5 seconds.4 || align = center | -
 * align = center | 2:14:26 || align = center | 2231 002 || ADVISORY CABIN VERTICAL SPEED || Cabin Airhandling system - Flashing of the cabin vertical speed indicator on the SD’s PRESS page. .. indicates a cabin altitude variation greater, as an absolute value, than 1,800 ft/min for five seconds. || align = center | -
 * -style="background:#fffabf"
 * colspan = 5 |*Failures appear on gold background
 * colspan = 5 |1 The last two numbers of the all codes, not shown, are "06" and refer to warnings or failures that occurred above 800ft MSL. The WN########## and FLR########## date and time stamps were removed as the times are given by the satellite that received the transmission from F-GZCP . 2 The messages were at least five or six seconds apart, which can be explained by the limited rate of communication by satellite.  3 Note: A position report message (AOC type) was received at 2 h 10 min 34 s, between two maintenance messages. 4 According to BEA the message is not fully explained. 5 There are two possible reasons for the longer gaps: either the aircraft did not have any messages to transmit, or it no longer had the means for doing so (loss of satellite communication performance, for example). . 6 Italicised text are quotes from the 07-02-2009 BEA Interim report. 7 The gap observed between the message sent at 2 h 13 min 14 s and the one sent at 2 h 13 min 45 s is due, at least in part, to a temporary interruption in the communication link between the aircraft and the satellite
 * }
 * align = center | 2:13:14 || align = center | 3412 34* || IR2 1, EFCS1X, IR1, IR3... ADIRU2 || Source: inertia reference 2 (A component of the First Officer's ADIRU).4 || align = center | -
 * align = center | 2:13:45 || align = center | 2790 025 || F/CTL PRIM 1 FAULT || Flight control - This message indicates that FCPC1 (PRIM 1) has stopped functioning. This shutdown could be the result of a command or of a failure. || align = center | 2157
 * align = center | 2:13:51 || align = center | 2790 004 || F/CTL SEC 1 FAULT || Flight control - This message indicates that [Captain's flight control secondary computer] FCSC1 (SEC 1) has stopped functioning. This shutdown could be the result of a command or of a failure. || align = center | -
 * align = center | 2:14:14 || align = center | 3410 360 || MAINTENANCE STATUS ADR 2 || Source: First officer's Air data reference which is part of ADIRU-2 || align = center | 244
 * -style="background:#fffabf"
 * align = center | 2:14:20 || align = center | 2283 34* || AFS 1... FMGEC1(1CA1), INTERMITTENT || Autoflight system - an intermittent fault in the captain's flight manangement guidance envelope computer, occurs for less than 2.5 seconds.4 || align = center | -
 * align = center | 2:14:26 || align = center | 2231 002 || ADVISORY CABIN VERTICAL SPEED || Cabin Airhandling system - Flashing of the cabin vertical speed indicator on the SD’s PRESS page. .. indicates a cabin altitude variation greater, as an absolute value, than 1,800 ft/min for five seconds. || align = center | -
 * -style="background:#fffabf"
 * colspan = 5 |*Failures appear on gold background
 * colspan = 5 |1 The last two numbers of the all codes, not shown, are "06" and refer to warnings or failures that occurred above 800ft MSL. The WN########## and FLR########## date and time stamps were removed as the times are given by the satellite that received the transmission from F-GZCP . 2 The messages were at least five or six seconds apart, which can be explained by the limited rate of communication by satellite.  3 Note: A position report message (AOC type) was received at 2 h 10 min 34 s, between two maintenance messages. 4 According to BEA the message is not fully explained. 5 There are two possible reasons for the longer gaps: either the aircraft did not have any messages to transmit, or it no longer had the means for doing so (loss of satellite communication performance, for example). . 6 Italicised text are quotes from the 07-02-2009 BEA Interim report. 7 The gap observed between the message sent at 2 h 13 min 14 s and the one sent at 2 h 13 min 45 s is due, at least in part, to a temporary interruption in the communication link between the aircraft and the satellite
 * }
 * -style="background:#fffabf"
 * colspan = 5 |*Failures appear on gold background
 * colspan = 5 |1 The last two numbers of the all codes, not shown, are "06" and refer to warnings or failures that occurred above 800ft MSL. The WN########## and FLR########## date and time stamps were removed as the times are given by the satellite that received the transmission from F-GZCP . 2 The messages were at least five or six seconds apart, which can be explained by the limited rate of communication by satellite.  3 Note: A position report message (AOC type) was received at 2 h 10 min 34 s, between two maintenance messages. 4 According to BEA the message is not fully explained. 5 There are two possible reasons for the longer gaps: either the aircraft did not have any messages to transmit, or it no longer had the means for doing so (loss of satellite communication performance, for example). . 6 Italicised text are quotes from the 07-02-2009 BEA Interim report. 7 The gap observed between the message sent at 2 h 13 min 14 s and the one sent at 2 h 13 min 45 s is due, at least in part, to a temporary interruption in the communication link between the aircraft and the satellite
 * }
 * }

--->

{| class="wikitable collapsible collapsed" width=60% style="background: #fffaef; border: 1px dotted gray;" !style="background:#ffdead;" colspan = 5 | AF447 Collation & Integration of Time-line information from multiple sources. : further development needed...
 * - align=center

<!--- David Kaminski-Morrow on May 27, 2011 9:09 PM | Permalink | Comments (10) | TrackBacks (0) |ShareThis France's Bureau d'Enquetes et d'Analyses has released details of the final few minutes of flight AF447, following the two-year recovery effort to retrieve the Airbus A330's flight-data and cockpit-voice recorders. Presented here are the main sections of the BEA's statement (in bold) and an explanation of the significance of each point:

01:35:46

The controller asked the crew to maintain FL350 and to give their estimated time at TASIL.

Flight AF447 is told to keep cruising at 35,000ft and inform Brazilian air traffic control when it expects to reach the waypoint 'TASIL' - the entry point into Senegalese airspace, where responsibility for watching over the flight will transfer to the control centre in Dakar.

01:55

The Captain woke the second co-pilot and said "[...] he's going to take my place".

On a long flight it is normal practice to carry an extra pilot to allow one of the crew - the captain in this case - to rest. Of the two pilots left in charge, one had 4,479h on A330/340s, and was the most experienced of the three on the A330 in terms of flight time, although all of the captain's time on the type had been in command.

01:59:32-02:01:46

The Captain attended the briefing between the two co-pilots, during which the PF said, in particular "the little bit of turbulence that you just saw [...] we should find the same ahead [...] we're in the cloud layer unfortunately we can't climb much for the moment because the temperature is falling more slowly than forecast" and that "the logon with Dakar failed".

The pilot flying the A330 highlights the relatively high air temperature outside the aircraft. Higher temperatures mean the air is less dense and reduces the ability of the wing to generate lift, meaning the aircraft would be unable to sustain flight at a higher altitude.

The pilot also mentions that the aircraft has been unable to connect with Dakar air traffic control ahead of crossing the airspace boundary between Brazil and Senegal. This absence of contact, close to the transfer point, may be significant in the context of the subsequent failure to realise that AF447 had gone missing.

02:08:07

The airplane began a slight turn to the left, the change in relation to the initial route being about 12 degrees. The level of turbulence increased slightly and the crew decided to reduce the speed to about Mach 0.8.

Probably to avoid an area of heavier turbulence, about which they were aware, the crew deviated from the flightpath. The A330 nevertheless encountered turbulence and the crew chose to slow the aircraft from Mach 0.82 to Mach 0.8. This is normal practice when penetrating storm clouds, in order to prevent the aircraft's speed from slipping outside of design limits in rough air.

02:10:05

The autopilot then auto-thrust disengaged and the PF said "I have the controls".

Investigators have not confirmed why the autopilot and autothrust disengaged, although this is a normal response of the A330 if its computers detect inconsistency in the airspeed data received from the pitot tubes on the nose.

The airplane began to roll to the right and the PF made a left nose-up input. The stall warning sounded twice in a row.

While the pilot appears to have rolled the aircraft to the left, to counter a roll to the right, he also pulled the aircraft's nose upwards - for reasons yet to be explained. This would have put the A330 into a climb, but the aircraft already had little flexibility to climb higher, because of the temperature, and the slower speed would have further reduced the lift available from the wings. The stall warning was the first indication that the A330 was struggling to maintain lift.

The recorded parameters show a sharp fall from about 275 kt to 60 kt in the speed displayed on the left primary flight display (PFD), then a few moments later in the speed displayed on the integrated standby instrument system (ISIS).

On the captain's side of the aircraft - his seat occupied by a relief pilot - the airspeed on the cockpit display suddenly appeared to fall. This also occurred to the backup, or standby, display. These readings did not necessarily mean the aircraft had actually slowed to 60kt; the displays are fed information from the pitot tubes on the nose, and a blockage in the tubes - from ice, for example - could have generated useless data in the airspeed computers.

02:10:16

The PNF said "so, we've lost the speeds" then "alternate law [...]".

The non-flying pilot realises that the airspeed information is unreliable and that the aircraft has switched, as designed, to following less rigid flight control laws. Critically these laws no longer automatically protect the aircraft from reaching high angles of attack, at which it risks stalling.

The airplane's pitch attitude increased progressively beyond 10 degrees and the plane started to climb. The PF made nose-down control inputs and alternately left and right roll inputs. The vertical speed, which had reached 7,000 ft/min, dropped to 700 ft/min and the roll varied between 12 degrees right and 10 degrees left. The speed displayed on the left side increased sharply to 215 kt (Mach 0.68). The airplane was then at an altitude of about 37,500 ft and the recorded angle of attack was around 4 degrees.

Positioned increasingly nose-up, the A330 climbs rapidly by 2,500ft - the investigators have not clarified whether the climb was intentional - but the pilot then reduces the climb by pushing the control sidestick nose-down.

The captain's displayed airspeed suddenly leaps to 215kt. It is unclear whether this figure is reliable; if it is, the aircraft has slowed dramatically.

02:10:50

The PNF tried several times to call the Captain back.

The non-flying pilot appears to consider the situation serious enough to warrant recalling the captain.

02:10:51

The stall warning was triggered again. The thrust levers were positioned in the TO/GA detent and the PF maintained nose-up inputs. The recorded angle of attack, of around 6 degrees at the triggering of the stall warning, continued to increase.

The A330's angle of attack is too high, and the aircraft is losing the battle to sustain lift, as demonstrated by the stall alarm, yet the pilot is still keeping the nose pointing upwards - in apparent contradiction to a basic principle of flight: escaping a stall requires the nose to be pushed down, in order to regain a smooth, fast airflow over the wings.

Even though the crew pushes the engines to full power, the high altitude probably renders this ineffective. The resulting thrust is still not enough for the heavy aircraft to generate enough lift in the thinner air.

At the time Air France's procedures for an A330 stall alarm required pilots to increase thrust immediately, to take-off/go-around power, and reduce pitch attitude. Airbus and other airframers have since drawn up different procedures to prioritise reducing angle of attack rather than powering out of a stall.

The trimmable horizontal stabilizer (THS) passed from 3 to 13 degrees nose-up in about 1 minute and remained in the latter position until the end of the flight. Around fifteen seconds later, the speed displayed on the ISIS increased sharply towards 185 kt; it was then consistent with the other recorded speed. The PF continued to make nose-up inputs. The airplane's altitude reached its maximum of about 38,000 ft, its pitch attitude and angle of attack being 16 degrees.

The aircraft automatically trims itself to correspond with the nose-up attitude. In the meantime the standby airspeed indicator's reading suddenly rises, bringing it into line with the reading on the captain's display; the two speeds have been inconsistent for less than a minute.

Despite the stall condition the flying pilot still holds the nose of the aircraft upwards.

02:11:40

The Captain re-entered the cockpit. During the following seconds, all of the recorded speeds became invalid and the stall warning stopped.

The altitude was then about 35,000 ft, the angle of attack exceeded 40 degrees and the vertical speed was about -10,000 ft/min. The airplane's pitch attitude did not exceed 15 degrees and the engines' N1's were close to 100%. The airplane was subject to roll oscillations that sometimes reached 40 degrees. The PF made an input on the sidestick to the left and nose-up stops, which lasted about 30 seconds.

All of its lift having been sapped, the aircraft virtually free-falls from its peak altitude of 38,000ft. With its nose still pitched up, and the pilot still giving nose-up commands, it drops at 180km/h on a steep trajectory downwards. Although the A330's engines are operating at high power, the stall attitude prevents restoration of smooth airflow over the wings. The stall warning had only stopped because the system ignored the extreme readings being generated by the aircraft's predicament.

02:12:02

The PF said "I don't have any more indications", and the PNF said "we have no valid indications". At that moment, the thrust levers were in the IDLE detent and the engines' N1's were at 55%. Around fifteen seconds later, the PF made pitch-down inputs. In the following moments, the angle of attack decreased, the speeds became valid again and the stall warning sounded again.

At this point, shortly after the captain re-entered the cockpit, comes the first indication of an attempt to unstall the aircraft, as the pilot starts pushing the nose down. The engines are throttled back to idle power, possibly to aid the rescue by reducing the tendency for thrust at lower altitude to pitch the aircraft up. The decrease in angle of attack and the return of valid speeds - which in turn bring back the stall warning - suggest the beginning of a recovery.

02:13:32

The PF said "we're going to arrive at level one hundred". About fifteen seconds later, simultaneous inputs by both pilots on the sidesticks were recorded and the PF said "go ahead you have the controls". The angle of attack, when it was valid, always remained above 35 degrees.

The A330 descends towards 10,000ft. The pilot surrenders control to another member of the crew - not necessarily the captain - but the angle of attack is still excessive and the aircraft is still falling rapidly.

02:14:28

AF447 runs out of altitude and time. Having failed to recover from the stall, it pancakes onto the ocean surface at 200km/h and disintegrates.

Categories:Air Transport, Aircraft, Safety Tags:AF447, Air France 0 TrackBacks Listed below are links to blogs that reference this entry: AF447: After two long years, six short minutes.

TrackBack URL for this entry: http://www.flightglobal.com/cgi-bin/mt/mt-tb.cgi/200797 10 Comments By Nik on June 1, 2011 9:39 AM | Reply We now have to learn from this accident.

Misjudged situation caused other crash such as probe icing on take off that led to an indicated airspeed rising rapidly and the crew failing to recognise the discrepancy of the indicator pulled the plane to stall. This accident is used for icing danger awareness training.

The issue are for the airline training:

- Why a fully trained crew failed to understand the stalled situation and how to prepare crews to face abnormal attitude with partial instrument panel at high altitude.

- Could any additional technical solution (incidence indicator) have helped the crew?

And issue for the manufacturer:

- Did the PNF see what the PF stick inputs were (I doubt it)? Is sidestick without feedback a relevant option for future aircraft?

Finally and above anything to my point of view:

There have been similar airspeed indication incident on the same type in other company within the preceding few months and every time the crew reported difficulty to maintain flightpath. Did the manufacturer give adequate feedback to airlines, and if so, did the airlines take any action to inform the crew so they can get prepared with this kind of situation ahead (that's finally the main purpose of the pilot job: get prepared for dramatic situation that will certainly never happen).

By Anton Beeckman on June 3, 2011 5:52 PM | Reply The BEA report, released on May 27 2011, states: “The trimmable horizontal stabilizer (THS) passed from 3 to 13 degrees nose-up in about 1 minute and remained in the latter position until the end of the flight.”

With regard to these THS data, can you answer the following questions:

1. Is it correct that this would always happen automatically, or are there factors not mentioned, that would imply the THS was set manually?

2. If the THS setting did happen automatically, was the pilot’s manual nose-up stick input, the only factor leading to the (nose-up) auto-trim action? Or, put differently: were there no other factors to be taken into account with regard to the THS position ?

3. Suppose the THS got stuck (not necessarily mechanically speaking, but rather “software-stuck”) in the nose-up 13 deg. position, what chances would the crew have had, if they had pushed the sticks in the full nose-down position ? In other words, if the aircraft found itself in a fully stalled position, would it have been possible to recover from the stall, with a THS in a 13 deg nose-up position ?

Thanks in advance for your answers.

By David Kaminski-Morrow on June 3, 2011 7:09 PM | Reply 1. Is it correct that this would always happen automatically, or are there factors not mentioned, that would imply the THS was set manually?

While there is no formal confirmation over the THS behaviour, auto-trim would have been functioning and manual trim is rare. Probability overwhelmingly favours a scenario in which the auto-trim brought the THS into the 13deg position automatically - in the same way that there was a full-up auto-trim of the THS in the Perpignan A320 accident on 27 Nov 2008:

http://www.bea.aero/docspa/2008/d-la081127.en/pdf/d-la081127.en.pdf

It's worth reading this report to see the similarities - and differences - to AF447. Manual trim is hardly ever required and there is no indication that the THS was trimmed manually.

2. If the THS setting did happen automatically, was the pilot’s manual nose-up stick input, the only factor leading to the (nose-up) auto-trim action? Or, put differently: were there no other factors to be taken into account with regard to the THS position ?

My understanding is that the auto-trim responds to the pilot's pitch input.

3. Suppose the THS got stuck (not necessarily mechanically speaking, but rather “software-stuck”) in the nose-up 13 deg. position, what chances would the crew have had, if they had pushed the sticks in the full nose-down position ? In other words, if the aircraft found itself in a fully stalled position, would it have been possible to recover from the stall, with a THS in a 13 deg nose-up position ?

Again, I'd refer you to the Perpignan A320 crash analysis by the BEA. The THS in that case would have responded if the elevators had been driven past their neutral position - but that did not happen.

"The nose down commands applied by the Captain on the sidestick brought the elevators, due to the load factor, to the neutral position, without however pushing them to the stops. Consequently, the trimmable stabilizer did not move even though the flight control law was normal." (p49)

"The elevators must go beyond the neutral position before the auto trim function adjusts the position of the stabilizer." (p49)

By Alex Erochenko on June 4, 2011 2:21 AM | Reply First of all, blessings for all lives lost in that tragic accident. I can immagine those 4 minutes seemed like 4 hours for the pilots.

It is evident that they had a clear case of "unreliable airspeed" and followed by a stall down to the ocean. You have to do extensive reseach to judge in the right manner what happened, everything indicates that the pilots did not recognize in time what went on in order to apply immediately the Unreliable Airspeed procedure which at that altitude and heavy G weight does not leave room for error plus if you add turbulence to it (report says had none).

THS operates automatically on the 'bus, you pull back on the sidestick and there it trims to attain the new attitude since this is automatic.

The fly-by-wire protections were lost, so the case is the plane can trim itself to the stall if you keep putting back presure.

Anyways, what it really suspicious to me is that all 3 ADR (air data ref) units failed to give the right indications the pitot heaters work with 110V heating elements that heat-up the probes to the point in which the metal color turns kind of violet showing how hot they can get at altitude.

So, ice on all the probes... impossible you have like 4 different ones: 1 for ADR#1, 1 for ADR#2, 1 for ADR#3, the last one for the ISIS (Standby attitude indicator altimeter & airspeed) one sistem could eventually fail.

All 4, hard to believe.. by the way.. all of these systems are digitally controlled the only old fashioned one is the ISIS, I believe (mechanical, like normal airspeed indicator in a small plane).

There have been cases in which a similar situation happened and pressing the "probe-window heat button" saved the day.

Probe window heat is automatic, you never mess with that button unless the window and pitots are iced up on a cold morning, first flight of the day...

Otherwise, when the PF sets the throttles to TOGA or FLEX for takeoff the electrical anti-icing kicks on for the remainder of the flight. So, this system was automatically turned on but for some strange reason many times when you have strange speed indication, if you turn this one switch to 'on' it tells something to the computers controlling the anti-ice for the probes and window that normalizes airpeed indications (even though they are already being heated from takeoff).

I am not trying to say that I know what happened, this is just an input from exprience of other pilots have had. I strongly believe the onboard computers threw something that was not really happening, the system believed it and that's why the autopilot renders the plane to the pilots.

By Anton Beeckman on June 4, 2011 8:24 AM | Reply Many thanks for your clear answers !

By AirBoss on June 15, 2011 2:56 AM | Reply What was the Centre of Gravity (% MAC) at time of the incident, was the tail trim tank in use, and was there any attempt to pump it dry and in so doing move the C of G forward?

By David Kaminski-Morrow on June 15, 2011 9:56 AM | Reply There has been no final figure on the centre of gravity.

But the interim report into the accident gave a balance of 23.3% of the MAC, for a forward limit of 22.7% and an aft limit of 36.2% at take-off.

After take-off the fuel control system automatically adjusts the centre of gravity using the trim tank - there has been no suggestion that this did not occur on AF447.

Investigators have previously estimated that, shortly before the accident, the balance would have been 37.3-37.8%, which was "within the limits of the operating envelope".

There has been no indication of any abnormal action involving pumping fuel from the trim tank.

AirBoss replied to David Kaminski-Morrow on June 15, 2011 12:52 PM | Reply Thanks, David. 38% MAC being the limit, that's close, if "within the limits...".

By H. Bennett on June 17, 2011 10:17 PM | Reply With the wing stalled, and the tailplane at +13 degrees relative to datum, would it not be even more deeply stalled, and the elevator completely ineffective? The classic condition for a "deep stall" (tailplane within "shadow" of stalled wing) perhaps need not necessarily be present for an irrecoverable situation to exist. Or am I just hopelessly out of date?

By Private Pilot on June 20, 2011 3:01 AM | Reply The initial crash report draws no conclusions, but it's fairly clear that pilot error was a fundamental cause, due to improper reaction to the stall warning horn. The pilot pulled the nose up repeatedly and according to the report, maintained the nose up attitude (due to control inputs) for the entire 4 minute duration of the rapid descent.

This sounds like the same pilot error that was made by the Continental Connection pilot landing in Buffalo .... he overpowered the stick shaker to pull the nose up when the stall warning sounded, causing an aggravated stall at just 1,000 feet.

It's hard to believe that 3 experienced pilots could make such a basic mistake and not correct it over a 4 minute period, yet that's what the report implies.

Leave a comment Want a user picture? Get a Gravatar!

Name Email Address URL Remember personal info? Comments (You may use HTML tags for style)

Subscribe to comments by e-mail? --->
 * The last two numbers of the all codes, not shown, are "06" and refer to warnings or failures that occurred above 800ft MSL. The WN########## and FLR########## date and time stamps were removed as the times are given by the satellite that received the transmission from F-GZCP. 2 The messages were at least five or six seconds apart, which can be explained by the limited rate of communication by satellite.  3 Note: A position report message (AOC type) was received at 2 h 10 min 34 s, between two maintenance messages. 4 According to BEA the message is not fully explained. 5 There are two possible reasons for the longer gaps: either the aircraft did not have any messages to transmit, or it no longer had the means for doing so (loss of satellite communication performance, for example). . 6 Italicised text are quotes from the 07-02-2009 BEA Interim report. 7 The gap observed between the message sent at 2 h 13 min 14 s and the one sent at 2 h 13 min 45 s is due, at least in part, to a temporary interruption in the communication link between the aircraft and the satellite

AF447 - meshing BEA timeline and ACARS together
Let me clarify my comments on AF447 talk page. I dont think the two should be meshed together. The FDRs and FVRs should not be meshed together either. The reason is that the ACARS in reporting errors in both the sensor and ADIRU system at the basal level of computational systems of the AC. The data on the FDR is often unreliable as a result. There are several sources of data, some data that was obtained from the external ports (e.g. pitots) is unreliable. The BEA reports gives us information that the aircraft could not distinquish a true stall situation (AOA too high) relative to false stall. The pilots statements are reliable indicators of the state of aircraft. There are several perplexing statements in that report. With alternate law and direct law the copilot dialed that trim elevation to the maximum setting and continued the pull back the aircraft (this would have changed the horizontal G-forces substantially).

ACARS is reporting, not the direction of the error, but that something unexpected happened that needed to be looked into later. Some of these were equipment failures if not temporary under the environment that they were subjected. The data recorder is not actively filtering out bad data, but the pilots are seeing both good and bad data. At a couple of points they remark they have lost all indicators, and we should take that as they say it, the altimeter may have been reported properly on the recorder (i dont know if this is GPS or altimeter data), but the pilots may have been seeing something else. The pilots actions are not in accord with the flight data, they appear to be responding do a different set of circumstance of which we are not aware of. Indicators of this are the fact that the aircraft is trimmed to max (can only occur under direct law), and the stick is constantly being nosed-up, even when downsticking cause the stall horn, indicating that pilots were trying to intentionally dissipating alot of kinetic and thermodynamic energy in the aircraft manually, to do a belly flop on the atlantic. Either they were completely unaware of the deceleration and loss of altitude, as the report superficially suggests or something else, unreported, had happened to the aircraft. The critical thing is that if we take the BEA FDR at face value the aircraft slowed from 540 MPH to 120 MPH in approximately 40 seconds that is a 0.45 g horizontal deceleration that would not be missed by the pilots unless something else explains this. Thus the deceleration was either intentional or the speed data was never accurate until close to hitting the atlantic. As for the altimeter data, I don't know if the BEA is reporting GPS or pressure altimetry. They do report a GS close to the ground, but IAS = GS at sea level and 0 winds, whereas GPS AS (GS) is GS at all levels.

The most important thing that will be confusing to the reader, it appears and is interpreted by the BEA that the aircraft is in a permanent stall (from 38,000 feet to the point it crashed); however the stall horn only sounds occasionally. It appears to be the case because the stall indicator is dependent on a minimum IAS of 60 knts, and at a AOA of 40 degrees, even with unblocked pitot tubes the AC was incapable or producing a consistent stall signal. Thus multiple interpretive signals are not reporting accurately to the FDR.

Personally I would not put alot into a comprehensive table until the BEA can reconcile the ACARS, VDR, FDR and pilot actions.PB666 yap 01:14, 24 June 2011 (UTC)

Scratch Pads

 * Digvijaysinhji Polish links:

Nine plants had considerable evidence of therapeutic effect, viz:see in edit mode


 * Ayurveda

Shilapuspha (Didymocarpus pedicellata) Pasanabheda (Saxifraga ligulata Syn. Bergenia ligulata / Bergenia ciliata) Manjishtha (Rubia cordifolia) Nagarmusta (Cyperus scariosus) Apamarga (Achyranthes aspera) Gojiha (Onosma bracteatum) Sahadevi (Vernonia cinerea) Pdrs.Shilajeet (Purified) Hajrul yahood bhasma

--->

mcolors:

http://en.wikipedia.org/wiki/Web_colors use table system for badges:see in edit mode




 * intake table simpler badge skeleton:see in edit mode

RED WHITE BOX see in edit mode work copy below
 * {| class=wikitable style="text-align:center;"

! align=center|Boys||||||||Girls !colspan=10 |KG
 * align=center |Gohilwar||Halar||Jhalawar||Sorath||Gohilwar||Halar||Jhalawar||Sorath
 * align=center |Gohilwar||Halar||Jhalawar||Sorath||Gohilwar||Halar||Jhalawar||Sorath

!colspan=12 |Prep !colspan=12 |Junior !colspan=12 |Senior
 * align=center |Gohilwar||Halar||Jhalawar||Sorath||Gohilwar||Halar||Jhalawar||Sorath
 * align=center |Gohilwar||Halar||Jhalawar||Sorath||Gohilwar||Halar||Jhalawar||Sorath
 * align=center |Gohilwar||Halar||Jhalawar||Sorath||Gohilwar||Halar||Jhalawar||Sorath
 * align=center |Gohilwar||Halar||Jhalawar||Sorath||Gohilwar||Halar||Jhalawar||Sorath
 * align=center |Gohilwar||Halar||Jhalawar||Sorath||Gohilwar||Halar||Jhalawar||Sorath
 * }
 * }

http://www.ontariocanolagrowers.ca/Publications/dietarychart.pdf DIETARY FAT Fatty acid content normalized to 100 per cent Safflower oil Sunflower oil Corn oil Olive oil Soybean oil Peanut oil Cottonseed oil Lard* Beef tallow* Palm oil Butterfat* Coconut oil 7% 21% 11% 61% 10% 76% Trace 14% 12% 71% 1% 16% 13% 57% 29% 15% 9% 75% 15% 54% 8% 23% 19% 33% 48% 27% 54% 19% 43% 9% 47% 48% 49% 51% 10% 39% 68% 28% 91% 7% Trace Trace Trace 1% 2% 3% 2% 1% 1% 1% 1%
 * Comparison of Dietary Fats in development
 * Comparison of Dietary Fats in development


 * Kolki

WikiProject India Tag & Assess 2012 Contest
Hello friends, we are a number of editors from WikiProject India have got together to assess the many thousands of articles under the stewardship of the project, and we'd love to have you, a fellow member, join us. These articles require assessment, that is, the addition of a WikiProject template to the talk page of an article, assessing it for quality and importance and adding a few extra parameters to it.

As of March 11, 2012, 07:00 UTC, WikiProject India has 95,998 articles under its stewardship. Of these 13,980 articles are completely unassessed (both for class and importance) and another 42,415 articles are unassessed for importance only. Accordingly, a Tag & Assess 2012 drive-cum-contest has begun from March 01, 2012 to last till May 31, 2012.

If you are new to assessment, you can learn the minimum about how to evaluate from Part One of the Assessment Guide. Part Two of the Guide will help you learn to employ the full functionality of the talk page template, should you choose to do so.

You can sign up on the Tag & Assess page. There are a number of awards to be given in recognition of your efforts. Come & join us to take part in this exciting new venture. You'll learn more about India in this way.

& (Drive coordinators)

Delivered per [//en.wikipedia.org/w/index.php?title=Wikipedia:Bot_requests&oldid=481419438#Message_to_take_part_in_Assessment_Drive request] on Bot requests. The Helpful  Bot  01:29, 12 March 2012 (UTC)

Wiki Med
Hi I'm contacting you because, as a participant at Wikiproject Medicine, you may be interested in a new non-profit organization we're forming at m:WikiMed. Our purpose is to help improve the range and quality of free online medical content, and we'll be working with like-minded organizations, such as the World Health Organization, professional and scholarly societies, medical schools, governments and NGOs - including Translators Without Borders. Hope to see you there! Anthonyhcole (talk) 04:20, 20 December 2012 (UTC)

The Wikipedia Library now offering accounts from Cochrane Collaboration (sign up!)
The Wikipedia Library gets Wikipedia editors free access to reliable sources that are behind paywalls. Because you are signed on as a medical editor, I thought you'd want to know about our most recent donation from Cochrane Collaboration. Cheers, Ocaasit &#124; c 20:30, 16 June 2013 (UTC)
 * Cochrane Collaboration is an independent medical nonprofit organization that conducts systematic reviews of randomized controlled trials of health-care interventions, which it then publishes in the Cochrane Library.
 * Cochrane has generously agreed to give free, full-access accounts to 100 medical editors. Individual access would otherwise cost between $300 and $800 per account.
 * If you are still active as a medical editor, come and sign up :)

Disambiguation link notification for July 29
Hi. Thank you for your recent edits. Wikipedia appreciates your help. We noticed though that when you edited Ranjitsinh Pratapsinh Gaekwad, you added a link pointing to the disambiguation page Kirti Mandir (check to confirm | fix with Dab solver). Such links are almost always unintended, since a disambiguation page is merely a list of "Did you mean..." article titles. Read the FAQ* Join us at the DPL WikiProject.

It's OK to remove this message. Also, to stop receiving these messages, follow these opt-out instructions. Thanks, DPL bot (talk) 11:41, 29 July 2013 (UTC)

The Wikipedia Library needs you!
We hope The Wikipedia Library has been a useful resource for your work. TWL is expanding rapidly and we need your help!

With only a couple hours per week, you can make a big difference for sharing knowledge. Please sign up and help us in one of these ways: Sign up now Send on behalf of The Wikipedia Library using MediaWiki message delivery (talk) 04:31, 7 July 2015 (UTC)
 * Account coordinators: help distribute free research access
 * Partner coordinators: seek new donations from partners
 * Communications coordinators: share updates in blogs, social media, newsletters and notices
 * Technical coordinators: advise on building tools to support the library's work
 * Outreach coordinators: connect to university libraries, archives, and other GLAMs
 * Research coordinators: run reference services

ArbCom elections are now open!
Hi, You appear to be eligible to vote in the current Arbitration Committee election. The Arbitration Committee is the panel of editors responsible for conducting the Wikipedia arbitration process. It has the authority to enact binding solutions for disputes between editors, primarily related to serious behavioural issues that the community has been unable to resolve. This includes the ability to impose site bans, topic bans, editing restrictions, and other measures needed to maintain our editing environment. The arbitration policy describes the Committee's roles and responsibilities in greater detail. If you wish to participate, you are welcome to review the candidates' statements and submit your choices on the voting page. For the Election committee, MediaWiki message delivery (talk) 14:04, 24 November 2015 (UTC)

ArbCom elections are now open!
Hi, You appear to be eligible to vote in the current Arbitration Committee election. The Arbitration Committee is the panel of editors responsible for conducting the Wikipedia arbitration process. It has the authority to enact binding solutions for disputes between editors, primarily related to serious behavioural issues that the community has been unable to resolve. This includes the ability to impose site bans, topic bans, editing restrictions, and other measures needed to maintain our editing environment. The arbitration policy describes the Committee's roles and responsibilities in greater detail. If you wish to participate, you are welcome to review the candidates' statements and submit your choices on the voting page. For the Election committee, MediaWiki message delivery (talk) 14:11, 24 November 2015 (UTC)

MfD nomination of User:Patelurology2/C450s
User:Patelurology2/C450s, a page which you created or substantially contributed to, has been nominated for deletion. Your opinions on the matter are welcome; you may participate in the discussion by adding your comments at Wikipedia:Miscellany for deletion/User:Patelurology2/C450s and please be sure to sign your comments with four tildes ( ~ ). You are free to edit the content of User:Patelurology2/C450s during the discussion but should not remove the miscellany for deletion template from the top of the page; such a removal will not end the deletion discussion. Thank you. North America1000 10:32, 18 January 2016 (UTC)

Patelurology2 (talk) 22:22, 24 January 2016 (UTC)
 * see the article page for comment as the page is being created and see the contents in edit mode

Speedy deletion nomination of User:Patelurology2/Toiip


A tag has been placed on User:Patelurology2/Toiip, requesting that it be speedily deleted from Wikipedia. This has been done under section G11 of the criteria for speedy deletion, because the page seems to be unambiguous advertising which only promotes a company, product, group, service or person and would need to be fundamentally rewritten in order to become encyclopedic. Please read the guidelines on spam and FAQ/Organizations for more information.

If you think this page should not be deleted for this reason, you may contest the nomination by visiting the page and clicking the button labelled "Contest this speedy deletion". This will give you the opportunity to explain why you believe the page should not be deleted. However, be aware that once a page is tagged for speedy deletion, it may be removed without delay. Please do not remove the speedy deletion tag from the page yourself, but do not hesitate to add information in line with Wikipedia's policies and guidelines. If the page is deleted, and you wish to retrieve the deleted material for future reference or improvement, then please contact the deleting administrator. North America1000 10:40, 18 January 2016 (UTC)

Patelurology2 (talk) 22:20, 24 January 2016 (UTC)
 * see the article page for comment as the page is being created and see the contents in edit mode

MfD nomination of User:Patelurology2/Toiip
User:Patelurology2/Toiip, a page which you created or substantially contributed to, has been nominated for deletion. Your opinions on the matter are welcome; you may participate in the discussion by adding your comments at Wikipedia:Miscellany for deletion/User:Patelurology2/Toiip and please be sure to sign your comments with four tildes ( ~ ). You are free to edit the content of User:Patelurology2/Toiip during the discussion but should not remove the miscellany for deletion template from the top of the page; such a removal will not end the deletion discussion. Thank you. North America1000 10:34, 21 January 2016 (UTC)


 * see the article page for comment as the page is being created and see the contents in edit mode

Patelurology2 (talk) 22:21, 24 January 2016 (UTC)

Re-initiating INCOTM
It's been almost an year since "Indian collaboration of the month" was active. Firstly we need to restart this as soon as possible for development of India-related articles to greater heights. The members page was blanked, where many of them are inactive. This mass message is to all the members of WikiProject India, about this and interested editors interested will sign up. After this message gets delivered, we'll wait for 7 days before we start a discussion under a thread on the collaboration's talk page, among the members. The discussion will include what to clean-up of sub-pages, a new set of guidelines for smooth and uninterrupted functioning of the collaboration etc. Please keep all the discussions under this thread only, so that it will easier for future reference. MediaWiki message delivery (talk) 00:19, 23 March 2017 (UTC)

Invitation to join the Wikipedia:WikiProject Military history/Incubator/Indian military history
You are invited to join the Indian military history work-group, an initiative of the Military history WikiProject. This group is to exclusively deal with the topics related to Indian military. If you're interested, please add you name to the participants list. Ignore if you are already a member. MediaWiki message delivery (talk) 14:06, 23 March 2017 (UTC)

Wiki Loves Indian defence services
You are requested to participate in the discussion of Wiki Loves Indian defence services on the talk page of WikiProject India. MediaWiki message delivery (talk) 04:44, 24 March 2017 (UTC)

Wikigraphists Bootcamp (2018 India)
Greetings,

It is being planned to organize Wikigraphists Bootcamp in India, please fill out the survey form to help the organizers. Your responses will help organizers understand what level of demand there is for the event (how many people in your community think it is important that the event happens). At the end of the day, the participants will turn out to have knowledge to create drawings, illustrations, diagrams, maps, graphs, bar charts etc. and get to know to how to tune the images to meet the QI and FP criteria. For more information and link to survey form, please visit Talk:Wikigraphists Bootcamp (2018 India). MediaWiki message delivery (talk) 12:45, 15 January 2018 (UTC)

Supporting Indian Wikipedia Program resource distribution
In 2017 - 2018, the Wikimedia Foundation and Google working in close coordination with the Centre for Internet and Society (CIS), Wikimedia India chapter (WMIN) and user groups will pilot a program encouraging Wikipedia communities to create locally relevant and high-quality content in Indian languages. This program (Code name: Project Tiger) will:
 * (a) Support active and experienced Wikipedia editors through the donation of laptops and stipends for internet access and
 * (b) Sponsor a language-based contest that aims to address existing Wikipedia content gaps.

The objective of the program is to provide laptops and internet stipends for existing editors who need support to contribute more actively. 50 basic model Acer Chromebooks and Internet stipends for 100 contributors are available for distribution. Provided resources are the sole property of the beneficiaries and should be used for the betterment of the movement.

If you're an active Wikimedian, and interested to receive support from this project, please apply. It will take around 10 minutes of your time, and will ask descriptive questions about your contribution to Indic Wikimedia projects.


 * Apply at: Supporting Indian Language Wikipedias Program#Apply for support
 * Last date for submitting applications is 11th February 2018, 11:59 IST.

MediaWiki message delivery (talk) 08:12, 8 February 2018 (UTC)

Project Tiger Writing Contest
In 2017 – 2018, the Wikimedia Foundation and Google working in close coordination with the Centre for Internet and Society (CIS), Wikimedia India Chapter (WMIN) and user groups from India, are piloting a program encouraging Wikipedia communities to create locally relevant and high-quality content in Indian languages. This program will (a) support active and experienced Wikipedia editors through the donation of laptops and stipends for internet access and (b) sponsor a language-based contest that aims to address existing Wikipedia content gaps.

Phase (a) has been completed, during which active contributors were awarded laptops and internet stipends. Phase (b) will be a contest in which editors will come together and develop a writing contest focused on content gaps. Each month three individual prizes will be awarded to each community based on their contribution for the month. The prizes worth 3,000 INR, 2000 INR, and 1,000 INR, will be awarded to the top contributors for each month. The contest started at March 1, 2018, 0:00, and will end at May 31, 2018, 23:59 (IST). Useful links are as follows:


 * Sign up at: Project Tiger Writing Contest/Participants
 * List of the articles can be referred at: Project Tiger Writing Contest/Topics
 * Submit/report your articles/contributions at: https://tools.wmflabs.org/fountain/editathons/project-tiger-2018-en
 * For more details, rules, FAQ etc. kindly refer: Project Tiger Writing Contest

Looking forward your participation, all the best. MediaWiki message delivery (talk) on behalf of Krishna Chaitanya Velaga (talk &bull;&#32;mail) at 22:21, 21 March 2018 (UTC).

WikiProject India
<div style="background-image: -moz-linear-gradient(left, #ED7A32, white, white, green); background-image: -ms-linear-gradient(left, #ED7A32, white, white, green); background-image: -o-linear-gradient(left, #ED7A32, white, white, green); background-image: -webkit-linear-gradient(left, #ED7A32, white, white, green); background-image: linear-gradient(left, #ED7A32, white, white, green);> WikiProject India

'Namaste'', Patelurology2. We would like to inform you about the recent changes to the WikiProject. As you may know, the old newsletter for WikiProject India ceased circulation in 2010. Now we have re-launched the newsletter in a new way. As a member, you are cordially invited to subscribe to the newsletter. Thank you.''' <div style="; width: 400px; text-align: center; margin-right: 1em; border: 1px solid /777777;padding:0.5em 1.0em; background:#F5D020;background-image: radial-gradient(#FFDD00,#FBB034)"> Subscribe

Newsletter discussion

Contribute

Subscribe/Unsubscribe

Archive

Sent by on behalf of WikiProject India. Go here to remove your name if you wish to opt-out of future mailings. MediaWiki message delivery (talk) 18:56, 14 October 2019 (UTC)

Your draft article, User:Patelurology2/AlumniGMCM


Hello, Patelurology2. It has been over six months since you last edited the Articles for Creation submission or Draft page you started, "AlumniGMCM".

In accordance with our policy that Wikipedia is not for the indefinite hosting of material deemed unsuitable for the encyclopedia mainspace, the draft has been nominated for deletion. If you plan on working on it further, or editing it to address the issues raised if it was declined, simply and remove the, , or  code.

If your submission has already been deleted by the time you get there, and you wish to retrieve it, you can request its undeletion by following the instructions at this link. An administrator will, in most cases, restore the submission so you can continue to work on it.

Thank you for your submission to Wikipedia! — python coder (talk &#124; contribs) 23:34, 8 February 2021 (UTC)

Disambiguation link notification for February 22
Hi. Thank you for your recent edits. An automated process has detected that when you recently edited Nawab of Junagarh, you added a link pointing to the disambiguation page Mangrol. Such links are usually incorrect, since a disambiguation page is merely a list of unrelated topics with similar titles. (Read the FAQ* Join us at the DPL WikiProject.)

It's OK to remove this message. Also, to stop receiving these messages, follow these opt-out instructions. Thanks, DPL bot (talk) 06:17, 22 February 2021 (UTC)

Speedy deletion nomination of Major Sheikh of Mangrol
Hello Patelurology2,

I wanted to let you know that I just tagged Major Sheikh of Mangrol for deletion, because it seems to be a test. Did you know that the Wikipedia Sandbox is available for testing out edits?

If you feel that the article shouldn't be deleted and want more time to work on it, you can [//en.wikipedia.org/w/index.php?title=&action=edit&section=new&preload=Template:Hangon_preload&preloadtitle=This+page+should+not+be+speedy+deleted+because...+ contest this deletion], but don't remove the speedy deletion tag from the top.

You can leave a note on my talk page if you have questions. Thanks!

Message delivered via the Page Curation tool, on behalf of the reviewer.

signed, Iflaq  (talk) 16:09, 3 June 2021 (UTC)

The WikiEagle - January 2022
MediaWiki message delivery (talk) 16:36, 1 January 2022 (UTC)

Links to user pages and sandboxes
Please do not introduce links in actual articles to user pages or sandboxes, as you did at Chandraseniya Kayastha Prabhu and Karnik. Since these pages have not been accepted as articles, user pages, sandboxes and drafts are not suitable for linking in articles. and such links are contrary to the Manual of Style. These links have been deleted, please do not re-add any such links, thank you - Arjayay (talk) 14:27, 2 February 2022 (UTC)

ArbCom 2022 Elections voter message
<div class="ivmbox " style="margin-bottom: 1em; border: 1px solid #AAA; background-color: ivory; padding: 0.5em; display: flex; align-items: center; "> Hello! Voting in the 2022 Arbitration Committee elections is now open until 23:59 (UTC) on. All eligible users are allowed to vote. Users with alternate accounts may only vote once.

The Arbitration Committee is the panel of editors responsible for conducting the Wikipedia arbitration process. It has the authority to impose binding solutions to disputes between editors, primarily for serious conduct disputes the community has been unable to resolve. This includes the authority to impose site bans, topic bans, editing restrictions, and other measures needed to maintain our editing environment. The arbitration policy describes the Committee's roles and responsibilities in greater detail.

If you wish to participate in the 2022 election, please review the candidates and submit your choices on the voting page. If you no longer wish to receive these messages, you may add to your user talk page. MediaWiki message delivery (talk) 00:40, 29 November 2022 (UTC)


 * User:Patelurology2/Arvchive1

ArbCom 2023 Elections voter message
<div class="ivmbox " style="margin-bottom: 1em; border: 1px solid #AAA; background-color: ivory; padding: 0.5em; display: flex; align-items: center; "> Hello! Voting in the 2023 Arbitration Committee elections is now open until 23:59 (UTC) on. All eligible users are allowed to vote. Users with alternate accounts may only vote once.

The Arbitration Committee is the panel of editors responsible for conducting the Wikipedia arbitration process. It has the authority to impose binding solutions to disputes between editors, primarily for serious conduct disputes the community has been unable to resolve. This includes the authority to impose site bans, topic bans, editing restrictions, and other measures needed to maintain our editing environment. The arbitration policy describes the Committee's roles and responsibilities in greater detail.

If you wish to participate in the 2023 election, please review the candidates and submit your choices on the voting page. If you no longer wish to receive these messages, you may add to your user talk page. MediaWiki message delivery (talk) 00:31, 28 November 2023 (UTC)

Disambiguation link notification for March 24
An automated process has detected that when you recently edited Elliot Macnaghten, you added a link pointing to the disambiguation page Rajkumar College.

(Opt-out instructions.) --DPL bot (talk) 18:11, 24 March 2024 (UTC)


 * Corrected Patelurology2 (talk) 23:55, 24 March 2024 (UTC)


 * }