atenolol + bendroflumethiazide (TenBen / Amoretic LD / Amoretic)

Recurrent Cardiac Arrest in a Pediatric Patient with Hypertrophic Cardiomyopathy and a Myocardial Bridge: Player or Spectator?

Lodeiro Carlos A CA, Boyd Chelsea C, Menillo Alexandra A, Eilers Lindsay F LF et al.

Myocardial bridge (MB) is common in patients with hypertrophic cardiomyopathy (HCM), and can reduce coronary flow leading to myocardial ischemia, fibrosis, and malignant ventricular arrhythmias resulting in sudden cardiac arrest (SCA). However, MB has not been previously reported as an isolated, modifiable cause of recurrent SCA in pediatric HCM. To describe a case of HCM with recurrent SCA found to have left anterior descending (LAD) coronary artery MB, with resolution of recurrent SCA after MB unroofing. A 13-year-old male with HCM had an epicardial implantable cardioverter defibrillator (ICD) placed after his first SCA at age 8. Atenolol was started after his second SCA at age 12. After a third SCA he was transitioned to Nadolol and Mexiletine, and underwent transvenous ICD implantation due to delayed shock secondary to under-sensing on epicardial system. He had two additional episodes of SCA, for which he was started on Amiodarone and transferred to our institution for transplant evaluation in the setting of biventricular systolic dysfunction. During transplant evaluation, exercise stress test suggested the presence of ischemia. Cardiac catheterization revealed a 6 cm proximal LAD MB, with near occlusion during systole (Figure 1). He underwent LAD unroofing and remained asymptomatic at baseline activity level with no further episodes of SCA during the subsequent follow-up. MB can cause significant compression leading to compromised coronary flow and myocardial ischemia distinct from the intrinsic underlying cardiomyopathy in HCM. Modifiable causes should be considered in cases of recurrent SCA, as treatment may alter prognostic implications.

Analysis of real water samples with AQbD microextraction using thymol-based NADES: implications of uncontrolled hypertension risk in Egypt.

Elbalkiny Heba T HT, Nasry Elsaiad E, Nayer Marina M, Ahmed Sohaila S et al.

The global burden of hypertension and its severe form, resistant hypertension, affecting up to 20% of 1.4 billion adults worldwide, drives mass consumption of multiple drugs. Consequently, antihypertensive agents from different classes enter aquatic environments, yet simultaneous extraction of such chemically diverse drugs remains challenging. This work developed a green analytical method for the simultaneous determination of three model antihypertensive agents from distinct classes, namely, furosemide, atenolol, and lisinopril, in water samples. The method employed dispersive liquid-liquid microextraction using a thymol-based natural deep eutectic solvent selected for its superior hydrophobicity and tunability across varying analyte polarities and acid-base characteristics. Extraction was optimized via Box-Behnken design, followed by HPLC-UV analysis on a phenyl column with gradient elution (detection at 220 nm). The validated method showed good linearity (furosemide: 2-100 µg L-1, lisinopril: 5-100 µg L-1, and atenolol: 0.1-50 µg L-1) with LODs of 0.18, 0.66, and 0.031 µg L-1, respectively. The practical applicability of the developed method was evaluated by analyzing real water samples collected from multiple sites across Egypt. The results revealed detectable concentrations of the target pharmaceuticals in several samples, confirming the presence of these contaminants in Egyptian water systems. Specifically, furosemide was detected at 4.72 µg L-1, atenolol at 0.43 µg L-1, and lisinopril at 7.21 µg L-1 in samples collected from Giza. A comprehensive greenness assessment using the GAPI, AGREE, BAGI, and EVG tools confirmed strong alignment with sustainable chemistry principles. By enabling multi-class extraction of antihypertensive drugs with a low-ecological-footprint NADES-based protocol, this method addresses a critical gap as no prior NADES-based method exists for these three therapeutic classes together, supporting environmental monitoring and clean water objectives.

Impact of chronic beta-blocker versus renin-angiotensin inhibitor use on outcomes after blunt pelvic trauma.

Dhalla Zeyanna Z, Nunn Kaitlin K, Teoh Victoria V, Arellano Diana D

Chronic cardiovascular medications, including β-blockers and renin-angiotensin system inhibitors, may modify the physiologic response to trauma. The purpose of this study is to compare outcomes of pelvic fracture patients with preinjury β-blockers versus renin-angiotensin system inhibitor use after blunt pelvic trauma. A retrospective cohort study was conducted using TriNetX. Data was collected from 2015 to 2025, with a total sample size of n = 442,947 distributed across 16 comparison groups. Propensity score matching was applied to yield equitable cohorts based on medical comorbidities. Patient groups were mutually exclusive, such that individuals were classified as taking either a β-blocker or a renin-angiotensin system inhibitor, with exclusion of patients receiving both therapies or an antiplatelet treatment. Comparisons were made with outcomes that include hemorrhage, infections, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, respiratory ventilation, and mortality. The β-blocker group demonstrated higher rates of adverse events, including hemorrhage, infections, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, respiratory ventilation, and mortality, relative to the renin-angiotensin system inhibitor group. The differences were most pronounced when renin-angiotensin system inhibitors were compared with metoprolol and labetalol, where nearly all outcomes were significantly worse in the β-blocker cohorts. In contrast, no significant differences were observed when compared with carvedilol or atenolol. Prior use of β-blockers is correlated with significantly worse rates of hemorrhage, infection, and thromboembolic events after a traumatic pelvic fracture when compared with renin-angiotensin system inhibitors. This could be due to renin-angiotensin system inhibitors attenuating the post-traumatic inflammatory response system by blocking angiotensin II, which causes inflammation, oxidative stress, endothelial dysfunction, and vasoconstriction. These findings suggest that chronic cardiovascular therapy type may influence post-pelvic trauma outcomes, underscoring the need for further investigation.

Enalapril, Atenolol, Alendronate and DRESS Syndrome - A Case Report.

Olsson S Bertil SB, Ehinger Mats M