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Choi JY, Kim H, Chun S, Jung YI, Yoo S, Oh IH, Kim GS, Ko JY, Lim JY, Lee M, Lee J, Kim KI. Information technology-supported integrated health service for older adults in long-term care settings. BMC Med 2024; 22:212. [PMID: 38807210 PMCID: PMC11134747 DOI: 10.1186/s12916-024-03427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. METHODS We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. RESULTS We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups. CONCLUSIONS The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization. TRIAL REGISTRATION Clinical Research Information Service, KCT0004360. Registered on 21 October 2019.
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Affiliation(s)
- Jung-Yeon Choi
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Young-Il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Gi-Soo Kim
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minho Lee
- Healthcare Convergence R&D Center, ezCaretech Co. Ltd, Seoul, Republic of Korea
| | - Jongseon Lee
- Healthcare Convergence R&D Center, Healthconnect Co. Ltd, Seoul, Republic of Korea
| | - Kwang-Il Kim
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Departments of Internal Medicine, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Kyeongi-do, 13620, Republic of Korea.
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Kim HC, Lee H, Lee HH, Son D, Cho M, Shin S, Seo Y, Kim EJ. Korea Hypertension Fact Sheet 2023: analysis of nationwide population-based data with a particular focus on hypertension in special populations. Clin Hypertens 2024; 30:7. [PMID: 38424634 PMCID: PMC10905929 DOI: 10.1186/s40885-024-00262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The Korea Hypertension Fact Sheet 2023, presented by the Korean Society of Hypertension, offers an overview of the prevalence and management of hypertension, along with recent trends. METHODS Data for the Fact Sheet were derived from the Korea National Health and Nutrition Examination Survey spanning 1998 to 2021, and the National Health Insurance Big Data from 2002 to 2021. RESULTS As of 2021, hypertension affected 28.0% of Korean adults aged 20 and older, totaling approximately 12.3 million individuals, with 5.3 million (43.5%) aged 65 or older. Among those with hypertension, awareness stood at 74.1%, treatment rates at 70.3%, and control rates at 56.0%. Over the years, the number of hypertension diagnoses increased from 3.0 million in 2002 to 11.1 million in 2021. During the same period, the utilization of antihypertensive medications rose from 2.5 million to 10.5 million, with treatment adherence also improving from 0.6 million to 7.8 million individuals. In 2021, the predominant antihypertensive drug class was angiotensin receptor blockers (75.1%), followed by calcium channel blockers (61.7%), diuretics (23.4%), and beta blockers (15.3%). Notably, 60.2% of all antihypertensive prescriptions involved combination therapy with at least two classes of antihypertensive medication. There was a positive trend towards stricter blood pressure control targets (systolic/diastolic blood pressure < 130/80 mmHg) among elderly hypertensive patients, as well as those with diabetes, obesity, and high-risk hypertension. However, this trend declined in individuals aged 80 years or older and those with chronic kidney disease in recent years. CONCLUSION In Korea, hypertension management is making strides, yet the total number of hypertensive individuals is rising. Effectively addressing the growing population of elderly hypertensive patients and the persistently low treatment rates among younger individuals with hypertension is a critical challenge. Additionally, developing more efficient and customized policies for blood pressure control and cardiovascular disease prevention is imperative.
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Affiliation(s)
- Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Institute for Innovation in Digital Healthcare, Yonsei University Health System, Seoul, Republic of Korea.
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyeok-Hee Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dasom Son
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Minsung Cho
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Sojung Shin
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Yeeun Seo
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Eun-Jin Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University Health System, Seoul, Republic of Korea
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Lim HS, Han H, Won S, Ji S, Park Y, Lee HY. Sex differences in the applicability of Western cardiovascular disease risk prediction equations in the Asian population. PLoS One 2024; 19:e0292067. [PMID: 38295132 PMCID: PMC10830057 DOI: 10.1371/journal.pone.0292067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/12/2023] [Indexed: 02/02/2024] Open
Abstract
AIMS Cardiovascular diseases (CVDs) are the most common cause of death, but they can be effectively managed through appropriate prevention and treatment. An important aspect in preventing CVDs is assessing each individual's comprehensive risk profile, for which various risk engines have been developed. The important keys to CVD risk engines are high reliability and accuracy, which show differences in predictability depending on disease status or race. Framingham risk score (FRS) and the atherosclerotic cardiovascular disease risk equations (ASCVD) were applied to the Korean population to assess their suitability. METHODS A retrospective cohort study was conducted using National Health Insurance Corporation sample cohort from 2003 to 2015. The enrolled participants over 30 years of age and without CVD followed-up for 10 years. We compared the prediction performance of FRS and ASCVD and calculated the relative importance of each covariate. RESULTS The AUCs of FRS (men: 0.750; women: 0.748) were higher than those of ASCVD (men: 0.718; women: 0.727) for both sexes (Delong test P <0.01). Goodness of fits (GOF) were poor for all models (Chi-square P < 0.001), especially, underestimation of the risk was pronounced in women. When the men's coefficients were applied to women's data, AUC (0.748; Delong test P<0.01) and the GOF (chi-square P = 0.746) were notably improved in FRS. Hypertension was found to be the most influential variable for CVD, and this is one of the reasons why FRS, having the highest relative weight to blood pressure, showed better performance. CONCLUSION When applying existing tools to Korean women, there was a noticeable underestimation. To accurately predict the risk of CVD, it was more appropriate to use FRS with men's coefficient in women. Moreover, hypertension was found to be a main risk factor for CVD.
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Affiliation(s)
- Hee-Sook Lim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, Republic of Korea
| | - Hyein Han
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- RexSoft Corps, Seoul, Republic of Korea
| | - Sungin Ji
- Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yoonhyung Park
- Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Hwang S, Choi JW. Association between excessive alcohol consumption and hypertension control in hypertensive patients. Chronic Illn 2023; 19:625-634. [PMID: 35593078 DOI: 10.1177/17423953221102626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purposes of this study were to investigate the association between excessive alcohol consumption and control of hypertension and the associations stratified by sex, age, and duration of hypertension among Korean adults who were diagnosed with hypertension under medication. METHODS This study was cross-sectional design with a secondary data analysis using national data from the Korea National Health and Nutrition Evaluation Survey (KNHANES) collected from 2013 to 2018, including 4278 participants who were diagnosed with hypertension under medication. A multiple logistic regression analysis was conducted to evaluate the associations between excessive alcohol consumption and hypertension control while controlling for potential confounding variables. RESULTS The hypertensive patients who consumed excessive alcohol were more associated with uncontrolled hypertension (OR, 1.31; 95% CI, 1.04-1.65) than those who do not consumed excessive alcohol. Specially, Excessive consumption of alcohol in men and young adults (<65 years) and short duration of hypertension (<5 years) were significantly more associated with uncontrolled hypertension compared to their counterparts. DISCUSSION To improve blood pressure (BP) control in hypertensive patients, healthcare plan should be focused to modifiable risk factors and the intervention for unhealthy alcohol consumption should be part of comprehensive treatment for hypertension.
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Affiliation(s)
- Sinwoo Hwang
- Korea Armed Forces Nursing Academy, Daejeon, Republic of Korea
| | - Jae Woo Choi
- Health Insurance Research Institute, National Health Insurance Service, Gangwon, Republic of Korea
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Kim IS, Kim S, Yoo TH, Kim JK. Diagnosis and treatment of hypertension in dialysis patients: a systematic review. Clin Hypertens 2023; 29:24. [PMID: 37653470 PMCID: PMC10472689 DOI: 10.1186/s40885-023-00240-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/24/2023] [Indexed: 09/02/2023] Open
Abstract
In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies widely among studies because of differences in the definition of hypertension and the methods of used to measure blood pressure (BP), i.e., peri-dialysis or ambulatory BP monitoring (ABPM). Recently, ABPM has become the gold standard for diagnosing hypertension in dialysis patients. Home BP monitoring can also be a good alternative to ABPM, emphasizing BP measurement outside the hemodialysis (HD) unit. One thing for sure is pre- and post-dialysis BP measurements should not be used alone to diagnose and manage hypertension in dialysis patients. The exact target of BP and the relationship between BP and all-cause mortality or cause-specific mortality are unclear in this population. Many observational studies with HD cohorts have almost universally reported a U-shaped or even an L-shaped association between BP and all-cause mortality, but most of these data are based on the BP measured in HD units. Some data with ABPM have shown a linear association between BP and mortality even in HD patients, similar to the general population. Supporting this, the results of meta-analysis have shown a clear benefit of BP reduction in HD patients. Therefore, further research is needed to determine the optimal target BP in the dialysis population, and for now, an individualized approach is appropriate, with particular emphasis on avoiding excessively low BP. Maintaining euvolemia is of paramount importance for BP control in dialysis patients. Patient heterogeneity and the lack of comparative evidence preclude the recommendation of one class of medication over another for all patients. Recently, however, β-blockers could be considered as a first-line therapy in dialysis patients, as they can reduce sympathetic overactivity and left ventricular hypertrophy, which contribute to the high incidence of arrhythmias and sudden cardiac death. Several studies with mineralocorticoid receptor antagonists have also reported promising results in reducing mortality in dialysis patients. However, safety issues such as hyperkalemia or hypotension should be further evaluated before their use.
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Affiliation(s)
- In Soo Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Pyungan-dong, Dongan-gu, Anyang, 431-070, Korea
| | - Sungmin Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Pyungan-dong, Dongan-gu, Anyang, 431-070, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - Jwa-Kyung Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Pyungan-dong, Dongan-gu, Anyang, 431-070, Korea.
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Meinert F, Thomopoulos C, Kreutz R. Sex and gender in hypertension guidelines. J Hum Hypertens 2023; 37:654-661. [PMID: 36627514 PMCID: PMC10403347 DOI: 10.1038/s41371-022-00793-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023]
Abstract
This paper reviews 11 current and previous international and some selected national hypertension guidelines regarding sex and gender-related differences. Those differences can be attributed to biological sex and to gender differences that are determined by socially constructed norms. All reviewed guidelines agree on a higher hypertension prevalence in men than in women. They also concur that evidence does not support different blood pressure thresholds and targets for treatment between men and women. Differences refer in addition to the differences in epidemiological aspects to differences in some morphometric diagnostic indices, e.g., left ventricular mass or the limits for daily alcohol intake. Concerning practical management, there are hardly any clear statements on different procedures that go beyond the consensus that blockers of the renin-angiotensin system should not be used in women of childbearing age wishing to become pregnant. Some further sex-specific aspects are related to differences in tolerability or drug-specific side effects of BP-lowering drugs. There is also a consensus about the need for blood pressure monitoring before and during the use of contraceptive pills. For management of pregnancy, several guidelines still recommend no active treatment in pregnant women without severe forms of hypertension, despite a wide consensus about the definition of hypertension in pregnancy. A disparity in treatment targets when treating severe and non-severe hypertension in pregnancy is also observed. Overall, sex-specific aspects are only very sparsely considered or documented in the evaluated guidelines highlighting an unmet need for future clinical research on this topic.
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Affiliation(s)
- Fabian Meinert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany.
| | | | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
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Shin D, Choi J, Lee HY. Suboptimal control status of young hypertensive population. Clin Hypertens 2023; 29:13. [PMID: 37122032 PMCID: PMC10150511 DOI: 10.1186/s40885-023-00237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
The prevalence of hypertension (HT) among young adults aged 18 to 39 years is estimated to be 3.7% to 8.6% worldwide. Although the prevalence of HT in young adults is lower than that of the overall population, those with HT are at substantially increased risk of cardiovascular events compared to those without HT. HT in young adults should be taken with even more caution as longer exposure to higher blood pressure leads to a higher lifetime risk of HT-mediated organ damage. However, young patients with HT show low awareness of HT compared to older patients. Also, they are more prone to show low treatment adherence despite the good efficacy of the treatment. Other risk factors that hinder HT control among young adults include alcohol intake, smoking, low physical activity, emotional stress, job stress, metabolic syndrome, and obesity. This review aimed to illustrate the suboptimal control status of the young hypertensive population and to propose strategies for improvement.
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Affiliation(s)
- Donghun Shin
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - JungMin Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Ihm SH, Park JH, Kim JY, Kim JH, Kim KI, Lee EM, Lee HY, Park S, Shin J, Kim CH. Home blood pressure monitoring: a position statement from the Korean Society of Hypertension Home Blood Pressure Forum. Clin Hypertens 2022; 28:38. [PMID: 36180964 PMCID: PMC9526300 DOI: 10.1186/s40885-022-00218-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Home blood pressure measurement (HBPM) has the advantage of measuring blood pressure (BP) multiple times over a long period. HBPM effectively diagnoses stress-induced transient BP elevations (i.e., white coat hypertension), insufficient BP control throughout the day (i.e., masked hypertension), and even BP variability. In most cases, HBPM may increase self-awareness of BP, increasing the compliance of treatment. Cumulative evidence has reported better improved predictive values of HBPM in cardiovascular morbidity and mortality than office BP monitoring. In this position paper, the Korean Society of Hypertension Home Blood Pressure Forum provides comprehensive information and clinical importance on HBPM.
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Affiliation(s)
- Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine and Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ju-Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Ho Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Shin J, Kim KI. A clinical algorithm to determine target blood pressure in the elderly: evidence and limitations from a clinical perspective. Clin Hypertens 2022; 28:17. [PMID: 35701854 PMCID: PMC9199158 DOI: 10.1186/s40885-022-00202-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/22/2022] [Indexed: 01/14/2023] Open
Abstract
As the elderly population is growing rapidly, management of hypertension in South Korea faces major challenges because the proportion of elderly hypertension patients is also increasing. The characteristics of this population are also much more complex than younger patients. Elderly hypertension is characterized by wide variations in (1) fitness or biological age, (2) white-coat effect, (3) poor functional status or frailty, (4) dependency in activities of daily living or institutionalization, (5) orthostatic hypotension, and (6) multiple comorbidities. All of these should be considered when choosing optimal target blood pressure in individual patients. Recent randomized clinical trials have shown that the benefits of intensive blood pressure control for elderly patients is greater than previously thought. For generalization of these results and implementation of the guidelines based on these studies, defining the clinician’s role for individualization is critically important. For individualized decisions for target blood pressure (BP) in the elderly with hypertension, four components should first be checked. These consist of (1) the minimum requirement of functional status and capability of activities of daily living, (2) lack of harmful evidence by the target BP, (3) absence of white-coat hypertension, and (4) standing systolic BP ≥ 110 mmHg without orthostatic symptoms. Risk of decreased organ perfusion by arterial stenosis should be screened before starting intensive BP control. When the target BP differs among comorbidities, the lowest target BP should be given preference. After starting intensive BP lowering therapy, tolerability should be monitored, and the titration should be based on the mean level of blood pressure by office supplemented by out-of-office BPs. Applications of the clinical algorithms will be useful to achieve more standardized and simplified applications of target BP in the elderly.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Internal Medicine, Geriatric Center, Seoul National University Bundang Hospital, 82 Gumi-ro, Bundang-gu, 13620, Seongnam, Korea.
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Kim WS, Choi Y, Kim N, Lim SH, Noh G, Kim KW, Park J, Jo H, Yoon H, Shin CM, Park YS, Lee DH. Long-term effect of the eradication of Helicobacter pylori on the hemoglobin A1c in type 2 diabetes or prediabetes patients. Korean J Intern Med 2022; 37:579-590. [PMID: 34991230 PMCID: PMC9082431 DOI: 10.3904/kjim.2021.194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The long-term effect of Helicobacter pylori eradication on the metabolic syndrome or diabetes are unclear. The aim of this study was to evaluate the effect of H. pylori eradication on glycemic control in type 2 diabetes mellitus (T2DM) or prediabetes mellitus (preDM). METHODS A total of 124 asymptomatic subjects with T2DM or preDM were divided into H. pylori-negative (n = 40), H. pylori-positive with non-eradicated (n = 34), and eradicated (n = 50) groups. We measured H. pylori status (culture, histology, and rapid urease test) and glycated hemoglobin A1c (A1C) levels and followed-up at the 1st year and the 5th year of follow-up. RESULTS The A1C levels significantly decreased in the eradicated group compared to the negative group and the non-eradicated groups (at the 1st year, p = 0.024; at the 5th year, p = 0.009). The A1C levels decreased in male, and/or subjects < 65 years of age in subgroup analyses (in male subjects, p = 0.047 and p = 0.020 at the 1st and the 5th year; in subjects < 65 years of age, p = 0.028 and p = 0.006 at the 1st and the 5th year; in male subjects < 65 years of age, p = 0.039 and p = 0.032 at the 1st and the 5th year). The eradication of H. pylori was related to the decrease in A1C values throughout the follow-up period, compared to the non-eradicated group (p = 0.017). CONCLUSION H. pylori eradication was related to the decreasing of A1C levels in patients with T2DM or preDM over a long-term follow-up period, especially in male and subjects < 65 years of age.
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Affiliation(s)
- Won Seok Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yonghoon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seon Hee Lim
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center and Healthcare Research Institute, Seoul, Korea
| | - Gitark Noh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jaehyung Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyeongho Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Wang X, Carcel C, Woodward M, Schutte AE. Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure. Stroke 2022; 53:1114-1133. [PMID: 35344416 DOI: 10.1161/strokeaha.121.035852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia
| | - Cheryl Carcel
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (C.C.)
| | - Mark Woodward
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)
| | - Aletta E Schutte
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,School of Population Health (A.E.S.), University of New South Wales, Sydney, Australia.,Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
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12
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Choi JY, Chun S, Kim H, Jung YI, Yoo S, Kim KI. Analysis of blood pressure and blood pressure variability pattern among older patients in long-term care hospitals: an observational study analysing the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) dataset. Age Ageing 2022; 51:6540143. [PMID: 35253050 DOI: 10.1093/ageing/afac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES There are limited data regarding blood pressure (BP) variability among older adults living in long-term care hospitals (LTCHs). We aimed to collect data from LTCH and analyse BP characteristics and its variability among these patients using a novel platform. METHODS The Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) platform was used to construct a daily BP dataset using data of 394 older patients from 6 LTCHs. BP variability was expressed as coefficient of variation (CV = standard deviation/mean of BP × 100). Physical frailty and cognitive function were evaluated using the K-FRAIL questionnaire and the Cognitive Performance Scale of the interRAI Long-Term Care Facilities tool, respectively. RESULTS From September 2019 to September 2020, 151,092 BP measurements, 346.5 (IQR 290.8-486.3) measurements per patient, were included. The mean BP was 123.4 ± 10.8/71.3 ± 6.5 mmHg. BP was significantly lower in frail patients (122.2 ± 11.3/70.4 ± 6.8 mmHg) than in pre-frail/robust patients (124.4 ± 10.4/72.1 ± 6.1 mmHg, P < 0.05). However, CV of systolic (10.7 ± 2.3% versus 11.3 ± 2.3%, P = 0.005) and diastolic (11.6 ± 2.3% versus 12.4 ± 2.4%, P < 0.001) BP was higher in frail patients. The mean BP was lower, but BP variability was higher in patients with cognitive impairment. The mean BP, but not BP variability, was higher in treated hypertensive patients, as the number of antihypertensive medications increased. CONCLUSION Older patients with physical or cognitive frailty had lower BP but higher BP variability. Relationship among frailty, increased BP variability and adverse clinical outcomes should be investigated.
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Affiliation(s)
- Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Institute on Aging, Seoul National University, Seoul, Republic of Korea
| | - Young-il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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13
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Lee CW, Lee JK, Choi YJ, Kim H, Han K, Jung JH, Kim DH, Park JH. Blood pressure and mortality after percutaneous coronary intervention: a population-based cohort study. Sci Rep 2022; 12:2768. [PMID: 35177716 PMCID: PMC8854698 DOI: 10.1038/s41598-022-06627-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/02/2022] [Indexed: 12/01/2022] Open
Abstract
Revascularization procedures, including percutaneous coronary intervention (PCI), for coronary artery disease (CAD) are increasingly performed in Korea. However, studies on blood pressure control targets in these patients remain insufficient. To assess the relationship between baseline blood pressure and all-cause mortality in CAD patients who underwent PCI. A population-based retrospective cohort study based on the national claims database of the Korean National Health Insurance System, which represents the entire Korean population. A total 38,330 patients with a history of PCI for CAD between 2005 and 2008 were recruited and followed up for all-cause mortality until December 31, 2017. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and they were classified into eight SBP and DBP groups each. The hazard ratios (HRs) for all-cause mortality were measured for each group. The pattern of SBP and DBP in this population followed a J-curve relationship for all-cause mortality, with the nadir point at 119 and 74 mmHg, respectively. In subjects aged > 60 years, high SBP (≥ 160 mmHg) and high DBP (≥ 90 mmHg) were significantly related to death. Moreover, in subjects aged > 60 years, low DBP (< 70 mmHg) was significantly related to mortality. There is a J-curve relationship between baseline blood pressure and all-cause mortality in patients who underwent PCI, and intensive lowering of blood pressure may be beneficial for these patients. However, the elderly population needs more attention as excessive BP lowering, particularly DBP, could instead increase the risk of death.
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Affiliation(s)
- Chung-Woo Lee
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Joo Kyung Lee
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeon Joo Choi
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Hyunjin Kim
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Hoon Kim
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea.
| | - Joo-Hyun Park
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea.
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14
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Baffour-Awuah B, Pearson MJ, Smart NA, Dieberg G. Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study. Hypertens Res 2022; 45:483-495. [PMID: 35017680 PMCID: PMC8752388 DOI: 10.1038/s41440-021-00839-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/18/2021] [Accepted: 11/05/2021] [Indexed: 01/21/2023]
Abstract
Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts' consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.
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Affiliation(s)
- Biggie Baffour-Awuah
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia.
| | - Melissa J. Pearson
- grid.1020.30000 0004 1936 7371Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
| | - Neil A. Smart
- grid.1020.30000 0004 1936 7371Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
| | - Gudrun Dieberg
- grid.1020.30000 0004 1936 7371Biomedical Sciences, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
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15
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Rey-García J, Townsend RR. Large Artery Stiffness: A Companion to the 2015 AHA Science Statement on Arterial Stiffness. Pulse (Basel) 2021; 9:1-10. [PMID: 34722350 DOI: 10.1159/000518613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022] Open
Abstract
Large artery stiffness (LAS) has proven to be an independent risk factor for cardiovascular disease and mortality. Nevertheless, the position of current hypertension guidelines regarding the usefulness of assessing LAS differs across different continents. In general, European Guidelines recognize pulse wave velocity (PWV) as a marker of target organ damage but do not recommend its systematic use in general population. Asian guidelines consider PWV as a recommended test at diagnosis of hypertension, in contrast to North American guidelines that do not state any position about its usefulness. However, PWV predicts cardiovascular events, and several studies have shown that it improves risk classification adjusting for established risk factors especially for intermediate-risk patients. Finally, some advances have been made related to treatments affecting LAS. Dietary interventions such as sodium restriction and exercise-based interventions have a modest effect in reducing LAS. Pharmacological interventions, such as statins, or more recent advances with mineralocorticoid blocker seem to have a beneficial effect. Last, controversial effects of renal denervation on LAS have been found. Our goal here is to update the reader on LAS on these areas since the 2015 American Heart Association Scientific Statement.
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Affiliation(s)
- Jimena Rey-García
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.,Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Lee HY, Kim KI, Ihm SH, Rhee MY, Sohn IS, Park S, Jeon ES, Song JM, Pyun WB, Sung KC, Kim MH, Kim SH, Kim SY, Kim SJ, Kim EJ, Shin J, Lee SY, Chun KJ, Jeong JO, Chae SC, Yoo KD, Choi YJ, Park YH, Kim CH. A Randomized, Double-blind, Active-controlled, Two Parallel-Group, Optional Titration, Multicenter, Phase IIIb Study to Evaluate the Efficacy and Safety of Fimasartan Versus Perindopril Monotherapy With and Without a Diuretic Combination in Elderly Patients With Essential Hypertension. Clin Ther 2021; 43:1746-1756. [PMID: 34503866 DOI: 10.1016/j.clinthera.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The efficacy and tolerability of fimasartan in elderly patients have not been fully evaluated. This study was therefore conducted to determine the efficacy and tolerability of fimasartan compared with perindopril in elderly Korean patients aged >70 years with essential hypertension (defined by a mean sitting systolic blood pressure [SBP] ≥140 mm Hg). METHODS This randomized, double-blind, active-controlled, 2 parallel-group, optional titration, multicenter, Phase IIIb trial (FITNESS [Fimasartan in the Senior Subjects]) enrolled 241 patients from 23 cardiac centers in the Republic of Korea between August 2017 and December 2019. After the placebo run-in period, treatment started with fimasartan 30 mg or perindopril arginine 2.5 mg once daily at a 1:1 ratio; if BP was not controlled at week 4, the dose was doubled. If BP was not controlled at week 8, a diuretic combination (fimasartan 60 mg/hydrochlorothiazide 12.5 mg or perindopril arginine 5 mg/indapamide 1.25 mg) was administered. After 16 weeks of the double-blind treatment, the patients with controlled BP participated in an 8-week open-label extension study, with the 2 groups unified by fimasartan 60 mg with or without hydrochlorothiazide 12.5 mg for 8 weeks. The primary outcome was a change in SBP for 8 weeks. The secondary outcomes included a change in sitting diastolic BP (DBP) for 8 weeks and changes in SBP and DBP for 4, 16, and 24 weeks. FINDINGS At week 8, mean SBP significantly decreased from baseline in both groups: -14.2 (14.4) mm Hg in the fimasartan group and -9.0 (16.1) mm Hg in the perindopril group. The difference between the 2 groups was 5.4 (2.1) mm Hg, indicating the noninferiority of fimasartan to perindopril. Moreover, fimasartan exhibited a higher BP-lowering effect than perindopril (P = 0.0108). In addition, reductions in SBP and DBP from baseline to weeks 4, 8, and 16 were significantly greater in the fimasartan group than in the perindopril group, although the SBP reduction was comparable at week 16. Both groups reported an excellent mean compliance rate of 97.4% (4.7%) through week 16. During the study period, 82 adverse events were reported in 52 patients, 40 in the fimasartan group and 42 in the perindopril group (P = 0.4647). Dizziness was the most commonly reported adverse event (7 cases). Remarkably, only 1 case of orthostatic hypotension was reported during the study period. IMPLICATIONS In elderly patients with essential hypertension, fimasartan 30 to 60 mg with a possible hydrochlorothiazide 12.5-mg combination was noninferior to perindopril 2.5 to 5 mg with a possible indapamide 1.25-mg combination. Furthermore, fimasartan exhibited higher BP-lowering efficacy than perindopril. There was no difference in tolerability between the 2 groups. Clinicaltrials.gov Identifier: NCT03246555.
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Affiliation(s)
- Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sang Hyun Ihm
- Department of Internal Medicine, The Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon-si, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University Health System, Severance Hospital, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Dong-A University Hospital, Busan, Republic of Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Seoul National University Borame Medical Center, Seoul, Republic of Korea
| | - Seok-Yeon Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Republic of Korea
| | - Shin-Jae Kim
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Eung Ju Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of Medicine, Kyungpuk National University, Daegu, Republic of Korea
| | - Ki Dong Yoo
- Department of Internal Medicine, The Catholic University of Korea, ST. Vincent's Hospital, Suwon-si, Republic of Korea
| | - Young Jin Choi
- Department of Internal Medicine, Sejong Hospital, Bucheon-si, Republic of Korea
| | - Yong Hwan Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-si, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
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17
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Sohn IS. Development of a Korean-specific cardiovascular risk model in a cohort at high-risk of hypertension. Korean J Intern Med 2021; 36:1059-1060. [PMID: 34503317 PMCID: PMC8435495 DOI: 10.3904/kjim.2021.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Correspondence to Il Suk Sohn, M.D. Department of Cardiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea Tel: + 82-2-440-6108 Fax: +82-2-440-7699 E-mail:
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18
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Liu M, Zhang S, Chen X, Guo Y, Zhong X, Xiong Z, Lin Y, Zhou H, Huang Y, Zhang Z, Wang L, Zhuang X, Liao X. Appraisal of Guidelines for the Management of Blood Pressure in Patients with Diabetes Mellitus: The Consensuses, Controversies and Gaps. Diabetes Metab J 2021; 45:753-764. [PMID: 33894700 PMCID: PMC8497930 DOI: 10.4093/dmj.2020.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. METHODS Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. CONCLUSION The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.
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Affiliation(s)
- Menghui Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Shaozhao Zhang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiaohong Chen
- Department of Otorhinolaryngology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiangbin Zhong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Zhenyu Xiong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yifen Lin
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Huimin Zhou
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yiquan Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Zhengzhipeng Zhang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Lichun Wang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
- Xiaodong Zhuang, https://orcid.org/0000-0001-6508-8507, Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China E-mail:
| | - Xinxue Liao
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
- Corresponding authors: Xinxue Liao, https://orcid.org/0000-0001-7631-1866, Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China E-mail:
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19
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Herberth J, Soliman KM, Fülöp T, Basile JN. How We Got Where We Are in Blood Pressure Targets. Curr Hypertens Rep 2021; 23:33. [PMID: 34110518 DOI: 10.1007/s11906-021-01143-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW While we started clinical trials evaluating the benefit of lowering systolic BP's >160 mm Hg and diastolic BPs of <130 mm Hg, the latest guideline suggests a target of <130/80 mm Hg in those with hypertension. This article summarizes exactly how we got to where we are looking over the last half-century. RECENT FINDINGS Our understanding of systolic and diastolic blood pressure targets to improve cardiovascular outcomes has changed substantially over the past 5 decades. Regarding diastolic blood pressure targets to improve cardiovascular outcomes, initially the VA1 in 1967 had set the goal to <115 mmHg. Over time, several studies including the VA2, Hypertension Optimal Treatment (HOT), and United Kingdom Prospective Diabetes Study Group 38 (UKPDS38) highlighted even greater cardiovascular benefit with lower diastolic targets <80 mmHg, especially in diabetic patients. Of equal importance, multiple studies have focused the attention to systolic blood pressure targets. Starting in 1948 with the Framingham study, passing through the Systolic Hypertension in the Elderly Program (SHEP), Syst-Eur and Syst-China trials, all have set the systolic blood pressure goal <150 mmHg. Most recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed an improved cardiovascular outcome with a systolic blood pressure target <140 mmHg in patients with type 2 diabetes, while the Systolic Blood Pressure Intervention Trial (SPRINT) in non-diabetic patients moved it closer to 120 mmHg. There is "no one size fits all" when it comes to blood pressure targets to improve cardiovascular outcomes. To progress our understanding of individual blood pressure goals, future studies might develop a more standardized approach to highlight characteristics such as design and end point definitions while allowing clinical practitioners greater latitude to adapt guideline recommendations to individual patient characteristics and clinical needs.
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Affiliation(s)
- Johann Herberth
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA
- Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Karim M Soliman
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA.
| | - Tibor Fülöp
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA
- Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Jan N Basile
- Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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20
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Lee HY, Oh GC, Sohn IS, Park S, Shin J, Pyun WB, Cho MC. Suboptimal Management Status of Younger Hypertensive Population in Korea. Korean Circ J 2021; 51:598-606. [PMID: 34085433 PMCID: PMC8263293 DOI: 10.4070/kcj.2020.0542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/13/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertension (HTN) is the most contributable risk factor for cardiovascular disease. May Measurement Month (MMM) is a global initiative to raise awareness of HTN and act as a temporary solution to the lack of screening programs worldwide. METHODS An opportunistic cross-sectional survey of participants aged ≥18 was carried out in May 2019. Over 10,000 participants were recruited in the MMM 2019 Korea, with a slogan of "A simple measure to save lives - #checkyourpressure." RESULTS A total of 9,950 participants with valid clinical blood pressure (BP) data were used for analysis. All participants were Korean in ethnicity. The mean age was 57.2±21.2 years, 57.8% were females, and the mean body mass index was 23.4±3.3 kg/m². Among the enrolled population, 20.1% were less than 30 years old, and 5.0% were 30-39 years old. 37.0% of the participants reported a previous diagnosis of HTN, and 91.3% of those diagnosed were on antihypertensive medications. Notably, more than 20% of the participants had not measured their BP during the last 12 months, and the awareness rate in the young hypertensive participants (aged <40) was less than 10%. Among hypertensive participants, the treatment rate was 69.3%, and the control rate among those taking medications was 61.2%. CONCLUSION MMM 2019 Korea campaign reported high BP control rates in individuals with HTN, reaching 60%. However, the awareness rate in young hypertensive participants was less than 10% along with suboptimal management status. The MMM 2019 Korea again raised the importance of regular BP measurement in the younger population.
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Affiliation(s)
- Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyu Chul Oh
- Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Il Suk Sohn
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
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21
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Smartphone / smartwatch-based cuffless blood pressure measurement : a position paper from the Korean Society of Hypertension. Clin Hypertens 2021; 27:4. [PMID: 33494809 PMCID: PMC7831256 DOI: 10.1186/s40885-020-00158-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
Smartphone technology has spread rapidly around the globe. According to a report released by the Korea Information Society Development Institute, about 95% of Koreans aged more than 30 years old owned smartphones. Recently, blood pressure (BP) measurement using a photoplethysmography-based smartphone algorithm paired with the smartwatch is continuously evolving. In this document, the Korean Society of Hypertension intends to remark the current results of smartphone / smartwatch-based BP measurement and recommend optimal BP measurement methods using a smartphone device. We aim to increase the likelihood of success in implementing these new technologies into improved hypertension awareness, diagnosis, and control.
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22
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Jin S, Heo JH, Kim BJ. Effects of White-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test. KOSIN MEDICAL JOURNAL 2020. [DOI: 10.7180/kmj.2020.35.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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23
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Meng X, Xu X. What Is the Ideal Blood Pressure Treatment Target for Primary Prevention and Management of Atrial Fibrillation? Front Cardiovasc Med 2020; 7:586183. [PMID: 33330646 PMCID: PMC7728604 DOI: 10.3389/fcvm.2020.586183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Xiaoyong Xu
- Department of Cardiovascular Disease, Ningbo Medical Center Lihuili Hospital, Ningbo, China
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24
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Association between Use of Hydrochlorothiazide and Nonmelanoma Skin Cancer: Common Data Model Cohort Study in Asian Population. J Clin Med 2020; 9:jcm9092910. [PMID: 32916988 PMCID: PMC7563303 DOI: 10.3390/jcm9092910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Although hydrochlorothiazide (HCTZ) has been suggested to increase skin cancer risk in white Westerners, there is scant evidence for the same in Asians. We analyzed the association between the use of hydrochlorothiazide and non-melanoma in the Asian population using the common data model. METHODS A retrospective multicenter observational study was conducted using a distributed research network to analyze the effect of HCTZ on skin cancer from 2004 to 2018. We performed Cox regression to evaluate the effects by comparing the use of HCTZ with other antihypertensive drugs. All analyses were re-evaluated using matched data using the propensity score matching (PSM). Then, the overall effects were evaluated by combining results with the meta-analysis. RESULTS Positive associations were observed in the use of HCTZ with high cumulative dose for non-melanoma skin cancer (NMSC) in univariate analysis prior to the use of PSM. Some negative associations were observed in the use of low and medium cumulative doses. CONCLUSION Although many findings in our study were inconclusive, there was a non-significant association of a dose-response pattern with estimates increasing in cumulative dose of HCTZ. In particular, a trend with a non-significant positive association was observed with the high cumulative dose of HCTZ.
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25
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Adams J, Hosseini M, Peng W, Sibbritt D. Health care utilisation and out-of-pocket expenditure associated with hypertension: an analysis of Australian adults from the 45 and Up Study. J Hum Hypertens 2020; 34:833-840. [DOI: 10.1038/s41371-020-0363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022]
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Liu J. Highlights of the 2018 Chinese hypertension guidelines. Clin Hypertens 2020; 26:8. [PMID: 32377372 PMCID: PMC7193361 DOI: 10.1186/s40885-020-00141-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background Blood pressure (BP) are uncontrolled in over 80% hypertensive population in China, indicating a compelling need for a pragmatic hypertension management strategy. The 2018 Chinese hypertension guidelines issued in 2019, after 3 years revision. During the periods, the latest United States (US) and European guidelines successively published, bringing new thoughts, wisdoms and schemes on hypertension management. This review aims to summarize the highlights of the new Chinese guidelines. Main text Despite the fact that the 2017 US hypertension guidelines changed hypertension definition from ≥140/90 mmHg to 130/80 mmHg, the Chinese hypertension guidelines did not follow suit, and maintained 140/90 mmHg as the cut-point of for diagnosis of hypertension. A combined, cardiovascular risks and BP levels-based antihypertensive treatment algorithm was introduced. Five classes of antihypertensive drugs, including β-blockers were recommended as initiation and maintenance of BP-lowering therapy. Initiating combination therapy, including single pill combination (SPC) was indicated in high-risk patients or those with grade 2 or 3 hypertension. For those with grade 1 hypertension (BP ≥ 140/90 mmHg), an initial low-dose antihypertensive drugs combination treatment could be considered. Conclusions China has never stopped exploring the best strategy for improving hypertension control. Based on clinical evidence and expertise, the newest Chinese guidelines and expert consensus will be of help in guiding physicians and practitioners to provide better management of hypertension in China.
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Affiliation(s)
- Jing Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044 China
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27
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Shin J, Cho MC. Updated Reasons and Clinical Implications of New Korean Hypertension Guidelines for Cardiologists. Korean Circ J 2020; 50:476-484. [PMID: 32281319 PMCID: PMC7234851 DOI: 10.4070/kcj.2019.0338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Abstract
Leaving behind substantial reflections or skepticisms on the shortage of evidences about blood pressure (BP) thresholds for antihypertensive drug therapy and target BPs, major hypertensive guidelines including Korean hypertension guidelines were recently updated for earlier and more intensive control of BP. Because hypertension is one of the major risk factors for death, stroke, cardiovascular (CV) disease, heart failure, and cognitive impairment, substantial improvement of hypertension management is necessary to reduce disease and socioeconomic burdens and to promote CV health. Theoretically, earlier intervention in terms of age and BP level and thorough control of BP into within normal range would prevent or delay major adverse CV events. Revised hypertension guidelines were developed by the American College of Cardiology/American Heart Association, Korean Society of Hypertension, European Society of Cardiology/European Society of Hypertension, and Japanese Society of Hypertension in order. In this article, recent updates and clinical significances of the Korean hypertension guidelines will be discussed with comparison of foreign hypertension guidelines and considerable changes in the management of hypertension will be introduced for cardiologists and general practitioners.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
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28
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Kwun JS, Kim SH, Kang SH, Yoon CH, Lee HY, Kim KI, Youn TJ, Chae IH, Kim CH. Potential impact of 2018 Korean Society of Hypertension guidelines on Korean population: a population-based cohort study. Clin Hypertens 2020; 26:3. [PMID: 32021699 PMCID: PMC6995175 DOI: 10.1186/s40885-020-0137-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/12/2020] [Indexed: 02/03/2023] Open
Abstract
Background The Korean Society of Hypertension (KSH) revised the local guidelines for hypertension in 2018. The present study sought to evaluate the potential impact of the 2018 KSH guidelines on hypertension management status among the Korean population in terms of prevalence of hypertension, antihypertensive medical treatment recommendations, and control status in Korean adults. Methods We used data from the Korea National Health and Nutrition Examination Survey to estimate the number and percentage of Korean adults who have hypertension according to blood pressure (BP) classification, are recommended to receive antihypertensive medical treatment, and are receiving medical treatment and have BP in the optimal range according to the new recommendations. Adults aged 30 years or older who participated in the survey between 2013 and 2015 were selected for this study. Results The prevalence of hypertension was 30.5% among Korean adults aged 30 years or older. The percentage of subjects who are recommended to be treated with antihypertensive medications substantially increased from 32.5 to 37.8%, which translates to 1.6 million adults. Among the hypertensive patients who were receiving medical treatment, 38.6% were shown to have adequate BP levels as recommended by the 2018 KSH guidelines compared with 51.8% according to the previous 2013 guidelines. Conclusions The present study reports the potential impact of the 2018 KSH guidelines on the prevalence of hypertension, antihypertensive medical treatment recommendations, and control status for Korean adults. The 2018 KSH guidelines recommend more intensive BP control compared with previous guidelines. This study suggests that there is large scope for improvement in hypertension management in the Korean population.
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Affiliation(s)
- Ju-Seung Kwun
- 1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 13620 South Korea.,2Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Sun-Hwa Kim
- 1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 13620 South Korea
| | - Si-Hyuck Kang
- 1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 13620 South Korea.,2Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Chang-Hwan Yoon
- 1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 13620 South Korea.,2Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Hae-Young Lee
- 2Department of Internal Medicine, Seoul National University, Seoul, South Korea.,3Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Kwang-Il Kim
- 2Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Jin Youn
- 1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 13620 South Korea.,2Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - In-Ho Chae
- 1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do 13620 South Korea.,2Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Cheol-Ho Kim
- 2Department of Internal Medicine, Seoul National University, Seoul, South Korea
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Park S. Ideal Target Blood Pressure in Hypertension. Korean Circ J 2019; 49:1002-1009. [PMID: 31646769 PMCID: PMC6813156 DOI: 10.4070/kcj.2019.0261] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 01/02/2023] Open
Abstract
In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure (BP) lowering was associated with significant reduction in composite cardiovascular (CV) outcomes in hypertension. Subsequently, several meta-analyses have corroborated the findings from SPRINT and these benefits were more prominent in subjects with higher cardiovascular risk at baseline. As such, the recent American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline and the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guideline recommended the lowering of target BP to less than 130/80 mmHg in most hypertensive subjects. However, one should keep in mind the potential harm of too much BP lowering. Post hoc analysis of clinical trials have demonstrated increased cardiovascular mortality and events with too much BP lowering. Therefore, although intensive BP lowering may be beneficial in further reducing CV outcomes, too much reduction below 120/70 mmHg may actually harmful. In conclusion, although intensive BP lowering to achieve target BP below 130/80 mmHg is beneficial in reducing CV outcomes, one should do so cautiously as to avoid adverse events. As such, the first target of anti-hypertensive treatment should be to achieve BP lowering below 140/90 mmHg. Once that target is achieved, one could target BP below 130/80 mmHg keeping in mind to avoid signs of organ hypoperfusion such as orthostatic hypotension, orthostatic dizziness, weakness and serum creatinine elevation.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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