Jugular Vein Distention (JVD): Causes and Treatments
Cancer, Diabetes, Hypertension, TB Drugs Added To BIR's VAT-exempt List
THE Bureau of Internal Revenue (BIR) said it updated the list of drugs exempt from value-added tax (VAT) to include treatments for cancer, diabetes, and hypertension.
In a memorandum circular, the BIR said other such medicines treat kidney disease, mental illness and tuberculosis (TB), as classified by the Food and Drug Administration (FDA).
The update also features the removal of one hypertension drug from the list.
According to the circular, two medicines for cancer were added to the VAT-exempt list — Panitumumab and Fulvestrant.
It also added five diabetes medicines: Teneligliptin (as hydrobromide hydrate), Sitagliptin (as phosphate monohydrate) + Metformin Hydrochloride; Sitagliptin (50mg); Sitagliptin (100mg); and Metformin Hydrochloride.
It also included Atorvastatin Calcium and Atorvastatin + Fenofibrate, which are medicines for high cholesterol.
Also joining the VAT-exempt list are the hypertension drugs Clonidine hydrochloride in solution for injection and in tablet form; as well as Lisinopril as dihydrate in 5mg, 10mg, and 20mg tablets.
Medicines for kidney disease included Mannitol; Tolvaptan in 15mg and 30mg tablets; and Alpha Ketoanalogues + Essential Amino Acids.
It also added one medicine for mental illness, Desvenlafaxine (as succinate monohydrate) and two for tuberculosis, Bedaquiline (as Fumarate) and Isoniazid + Pyridoxine Hydrochloride.
Meanwhile, it removed from the VAT-exempt list Macitentan, a hypertension treatment.
The updated list will take effect upon the issuance of a FDA advisory, the BIR added. — Luisa Maria Jacinta C. Jocson
Hypertension: Mounjaro, Zepbound Weight Loss Drugs May Help Lower Blood Pressure
Researchers are reporting that people who took tirzepatide, a type 2 diabetes and obesity medication, showed a significant reduction in blood pressure levels after 36 weeks.
They reported their findings in a study published today in the journal Hypertension.
Tirzepatide, which was originally indicated for the treatment of diabetes and sold under the trade name Mounjaro, was approved for the treatment of obesity under the name Zepbound in November 2023.
Due to well-established links between obesity and cardiovascular conditions, researchers are taking a closer look at how tirzepatide and similar drugs, such as semaglutide (Ozempic and Wegovy), known as GLP-1 RAs can impact heart health.
Tirzepatide is a combination of GLP-1 RA and GIP, which simulate hormones in the body that affect insulin production, blood glucose, digestion, and feelings of satiety or fullness.
In their research letter, the scientists said that blood pressure improved in people who took tirzepatide over 36 weeks, compared to study participants who took a placebo.
However, the researchers said they did not establish a dose-dependent improvement, meaning that individuals who took more of the drug did not see better results than those who took less of it.
Additionally, it is also unclear from the research whether blood pressure decreased solely due to weight loss or if there was an additional mechanism at work due to the medication.
Experts do say that the findings hint at further benefits of the drug beyond diabetes and obesity.
"These are statistically significant and clinically meaningful reductions in blood pressure," said Dr. Matthew Alexander, an assistant professor of medicine at Vanderbilt University Medical Center in Tennessee who wasn't affiliated with the research.
"Reductions in ambulatory blood pressure in this sub-study provide key evidence for blood pressure lowering with tirzepatide," he told Medical News Today. "This included reductions in not only 24-hour and daytime blood pressure but also nighttime blood pressure, which has additional important prognostic significance."
The blood pressure research was a sub-study of the SURMOUNT-1 trial, a randomized, placebo-controlled trial investigating tirzepatide's effects on weight loss. The trial was funded by Eli Lilly and Company, the manufacturer of Mounjaro and Zepbound.
In the sub-study, which was conducted from December 2019 to April 2022, scientists enrolled 600 participants who were given different doses of tirzepatide (5mg, 10mg, and 15mg) or a placebo.
The groups were split almost evenly with about 150 participants in each. The average age of individuals in the study was 45 years old. Most were women (68%) and either white (66%) or Hispanic (25%).
At the end of the study nearly 500 participants in the study had valid blood pressure data to report.
On average, individuals who took tirzepatide lowered their 24-hour systolic blood pressure (the top number in a blood pressure reading) compared with placebo. Specific dosage of the drug affected blood pressure as follows: The 5mg tirzepatide group saw a 7 point decrease compared to baseline while there was a 10 point drop for the 10mg group and 8 points for 15mg.
Tirzepatide also lowered 24-hour diastolic blood pressure (the bottom number) compared to a placebo. The 5mg group experienced a 2 point decrease while there was a nearly 3 point drop for the 10mg group and less than a 1 point change for the 15mg group.
The effects of the drug on blood pressure were apparent during both daytime and nighttime blood pressure readings, researchers said.
Dr. Sun Kim, an associate professor of medicine in the endocrinology division at Stanford Medicine in California who wasn't affiliated with the research, told Medical News Today that it would have been nice to see a linear association between blood pressure and dosage.
"Because we know that part of the mechanism for blood pressure lowering is due to weight loss, we would expect greater decrease in blood pressure with more weight loss and higher dose of tirzepatide… In the current study, blood pressure lowering was greatest with tirzepatide 10mg," she said.
The study also identified an expected increase in 24-hour heart rate of between 2 and 6 beats per minute respectively for each dose after 36 weeks. Prior studies have also noted this association.
Questions persist regarding whether the observed effects on blood pressure are attributed solely to weight loss or if the drug itself plays a direct role.
"It's certainly at least mostly a blood pressure effect. It could be that there's some direct effect of the drug," said Dr. James de Lemos, a study author and a professor in the Department of Internal Medicine and Chief of the Division of Cardiology at UT Southwestern Medical Center in Texas.
The study utilized 24-hour ambulatory blood pressure readings, which de Lemos called "the gold standard" for assessing blood pressure.
Unlike the more common in-office blood pressure measurement, which only gives a single reading at a single point in time, 24-hour ambulatory blood pressure readings take readings throughout the day and night.
"These are blood pressure machines that you take home with you that measure blood pressure very frequently and give a more comprehensive assessment of blood pressure than office-based measurements," de Lemos told Medical News Today.
According to the latest guidelines from the American Heart Association, hypertension (high blood pressure) is classified as any reading of 130/80 or higher. A healthy blood pressure range should be below 120/80.
For individuals with obesity and diabetes, the findings could show promise in tackling a host of serious co-morbidities such as metabolic syndrome.
"We're entering an era for the first time where pharmacologic treatment of obesity and diabetes may yield tangible benefits in terms of long-term cardiac outcomes," said de Lemos.
Obese People Can Lower Blood Pressure With Weight-loss Drug Zepbound
The weight-loss drug Zepbound provides more health benefits than dropping pounds and controlling diabetes, a new study shows. It also appears to help people with obesity manage their high blood pressure, results show. File photo by Alexis C. Glenn/UPILicense Photo
The weight-loss drug Zepbound provides more health benefits than dropping pounds and controlling diabetes, a new study shows.
It also appears to help people with obesity manage their high blood pressure, results show.
Patients taking Zepbound (tirzepatide) experienced a significant reduction in their systolic blood pressure, the top number in a blood pressure reading, according to a study published Monday in the journal Hypertension.
Systolic blood pressure is a stronger predictor for heart-related death than the diastolic bottom number, researchers said in background notes.
"Although tirzepatide has been studied as a weight-loss medication, the blood pressure reduction in our patients in this study was impressive," said lead researcher Dr. James de Lemos, chair of cardiology at UT Southwestern Medical Center in Dallas.
Tirzepatide works by mimicking two hormones in the body that stimulate insulin secretion and sensitivity after a person eats. The drug helps slow down digestion, reduce appetite and regulate blood sugar levels.
For the study, 600 adults with obesity were assigned to take either a placebo or varying doses of tirzepatide, which is administered through injection.
After 36 weeks, results showed that:
Participants taking 5 mg of tirzepatide had an average systolic blood pressure reduction of 7.4 mm Hg
People taking 10 mg had an average systolic blood pressure reduction of 10.6 mm Hg
Participants taking 15 mg had an average systolic blood pressure reduction of 8 mm Hg
"While it is not known if the impact on blood pressure was due to the medication or the participants' weight loss, the lower blood pressure measures seen with tirzepatide rivaled what is seen for many hypertension medications," de Lemos said in a journal news release.
The blood-pressure-lowering effects of tirzepatide showed up in blood pressure measures taken both during the day and at night, researchers said. Nighttime systolic blood pressure is a stronger predictor for heart-related death than daytime readings.
"Overall, these data are encouraging that novel weight-loss medications are effective at reducing body weight and they are also effective at improving many of the cardiometabolic complications of obesity, including hypertension, type 2 diabetes and dyslipidemia [high cholesterol], among others," said Dr. Michael Hall, chair of medicine at the University of Mississippi Medical Center in Jackson, Miss.
"While the impact of each of these beneficial effects is individually important, many of these obesity-related complications act synergistically to increase the risk of cardiovascular disease," added Hall, who was not involved in the study. "Thus, strategies that mitigate multiple obesity-related complications may reduce the risk of cardiovascular events."
More studies are needed to determine Zepbound's long-term impact on heart attack, heart failure and other heart-related health issues, Hall added.
"Also, studies are needed to investigate what happens to blood pressure when medications like tirzepatide are discontinued -- does the blood pressure rebound and go back up, or does it remain lowered?" Hall wondered.
The study was funded by Eli Lilly and Co., the manufacturer of tirzepatide.
More information
Yale School of Medicine has more about weight-loss drugs.
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