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Guo S, Liu X, Gu Z, Sun J, Cao Y, Zhu W. Association of hypertension burden with stroke risk in patients with heart failure with preserved ejection fraction. Heliyon 2024; 10:e27551. [PMID: 38510032 PMCID: PMC10950593 DOI: 10.1016/j.heliyon.2024.e27551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Whether the hypertension burden is associated with stroke incidence is inconclusive. In this study, we aimed to investigate the relationship between hypertension burden and stroke risk in patients with heart failure with preserved ejection fraction (HFpEF). Methods HFpEF patients from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were divided into three groups (low, medium, and high risk) according to their hypertension burden values. Higher hypertension burden risk represented the longer duration of hypertension. We evaluated the association of hypertension burden with stroke risk using Fine and Gray's competing risk models. Results A total of 3431 HFpEF patients (mean age: 68.5 ± 9.58 years, 51.6% females) were enrolled. During a median follow-up of 3.3 years, per 10-point increase in hypertension burden was associated with any stroke (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08-1.21), new-onset stroke (HR 1.14, 95% CI 1.07-1.21), and ischemic stroke (HR 1.10, 95% CI 1.02-1.17). When hypertension burden was analyzed as a categorical variable, any stroke risk was increased in the medium- (HR 1.59, 95% CI 1.01-2.40) and high-risk (HR 3.19, 95% CI 2.05-4.97) groups when compared with the low-risk group. For the outcomes of new-onset (HR 2.92, 95% CI 1.80-4.74) and ischemic stroke (HR 2.46, 95% CI 1.41-4.29), similar results were observed in patients with high-versus low-risk hypertension burden. Conclusions Increasing hypertension burden was associated with an increased risk of stroke, suggesting that shortening hypertension duration might appropriately minimize the stroke incidence in HFpEF patients.
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Affiliation(s)
- Siyu Guo
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, PR China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510030, PR China
| | - Zhenbang Gu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, PR China
| | - Junyi Sun
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, PR China
| | - Yalin Cao
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, 550001, PR China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, PR China
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Bray EP, Georgiou RF, Hives L, Iqbal N, Benedetto V, Spencer J, Harris C, Clegg A, Williams N, Rutter P, Watkins C. Non-pharmacological interventions for the reduction and maintenance of blood pressure in people with prehypertension: a systematic review protocol. BMJ Open 2024; 14:e078189. [PMID: 38253457 PMCID: PMC10806604 DOI: 10.1136/bmjopen-2023-078189] [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: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Prehypertension is defined as blood pressure that is above the normal range but not high enough to be classed as hypertension. Prehypertension is a warning of development of hypertension as well as a risk for cardiovascular disease, heart attack and stroke. In the UK, non-pharmacological interventions are recommended for prehypertension management but no reviews have focused on the effectiveness of these types of interventions solely in people with prehypertension. Therefore, the proposed systematic review will assess the clinical effectiveness and cost-effectiveness of non-pharmacological interventions in reducing or maintaining blood pressure in prehypertensive people. METHODS AND ANALYSIS This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases/trial registries that will be searched to identify relevant randomised controlled trials (RCTs) and economic evaluations include Medline, EMBASE, CINAHL, PsycINFO, CENTRAL, the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Cochrane Library, Scopus and the International HTA Database. Search terms have been identified by the team including an information specialist. Three reviewers will be involved in the study selection process. Risk of bias will be evaluated using the Cochrane risk-of-bias tool for RCTs and the Consensus Health Economic Criteria list for economic evaluations. Findings from the included studies will be tabulated and synthesised narratively. Heterogeneity will be assessed through visual inspection of forest plots and the calculation of the χ2 and I2 statistics and causes of heterogeneity will be assessed where sufficient data are available. If possible, we plan to investigate differential effects on specific subgroups and from different types of interventions using meta-regression. Where relevant, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) will be used to assess the certainty of the evidence found. ETHICS AND DISSEMINATION Ethical approval is not needed. Results will be published in a peer-reviewed journal, disseminated via the wider study website and shared with the study sites and participants. REGISTRATION DETAILS The review is registered with PROSPERO (CRD420232433047).
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Affiliation(s)
- Emma P Bray
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | | | - Lucy Hives
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nafisa Iqbal
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Joseph Spencer
- Research Facilitation and Delivery Unit, University of Central Lancashire, Preston, UK
| | - Cath Harris
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire, Preston, UK
| | - Nefyn Williams
- Primary Care, Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Paul Rutter
- Pharmacy Practice, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Caroline Watkins
- Stroke Research Team, University of Central Lancashire, Preston, UK
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Gao Q, Li L, Bai J, Fan L, Tan J, Wu S, Cai J. Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults. Chin Med J (Engl) 2024; 137:63-72. [PMID: 37319412 PMCID: PMC10766249 DOI: 10.1097/cm9.0000000000002669] [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: 08/06/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population. METHODS Participants with stage 1 hypertension ( n = 69,509) or normal BP ( n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis. RESULTS During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13-1.25) for primary outcome, 1.24 (95% CI, 1.05-1.46) for MI, 1.45 (95% CI, 1.33-1.59) for stroke, and 1.11 (95% CI, 1.04-1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85-0.96). CONCLUSIONS Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.
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Affiliation(s)
- Qiannan Gao
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Liuxin Li
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jingjing Bai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Luyun Fan
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Jiangshan Tan
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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Hives L, Georgiou RF, Spencer J, Benedetto V, Clegg A, Rutter P, Watkins C, Williams N, Bray EP. Risk reduction intervention for raised blood pressure (REVERSE): protocol for a mixed-methods feasibility study. BMJ Open 2023; 13:e072225. [PMID: 37258072 DOI: 10.1136/bmjopen-2023-072225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Around 40% of adults have pre-hypertension (blood pressure between 120-139/80-89), meaning they are at increased risk of developing hypertension and other cardiovascular disease-related conditions. There are limited studies on the management of pre-hypertension; however, guidance recommends that it should be focused on lifestyle modification rather than on medication. Self-monitoring of blood pressure could allow people to monitor and manage their risk status and may allow individuals to modify lifestyle factors. The purpose of this study is to determine the feasibility and acceptability, to both healthcare professionals and people with pre-hypertension, of blood pressure self-monitoring. METHODS AND ANALYSIS A prospective, non-randomised feasibility study, with a mixed-methods approach will be employed. Eligible participants (n=114) will be recruited from general practices, pharmacies and community providers across Lancashire and South Cumbria. Participants will self-monitor their blood pressure at home for 6 months and will complete questionnaires at three timepoints (baseline, 6 and 12 months). Healthcare professionals and participants involved in the study will be invited to take part in follow-up interviews and a focus group. The primary outcomes include the willingness to engage with the concept of pre-hypertension, the acceptability of self-monitoring, and the study processes. Secondary outcomes will inform the design of a potential future trial. A cost-analysis and cost-benefit analysis will be conducted. ETHICS AND DISSEMINATION Ethics approval has been obtained from London-Fulham NHS Research Ethics Committee, the University of Central Lancashire Health Ethics Review Panel and the HRA. The results of the study will be disseminated via peer-reviewed publications, feedback to service users and healthcare professionals, and to professional bodies in primary care and pharmacy. TRIAL REGISTRATION NUMBER ISRCTN13649483.
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Affiliation(s)
- Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Rachel F Georgiou
- Stroke Research Team, School of Nursing, University of Central Lancashire, Preston, UK
| | - Joseph Spencer
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Andrew Clegg
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Paul Rutter
- Faculty of Science and Health, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Caroline Watkins
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emma P Bray
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
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Peng N, Kuang M, Peng Y, Yu H, Zhang S, Xie G, Sheng G, Zou Y. Associations between TyG-BMI and normal-high blood pressure values and hypertension: cross-sectional evidence from a non-diabetic population. Front Cardiovasc Med 2023; 10:1129112. [PMID: 37168658 PMCID: PMC10164981 DOI: 10.3389/fcvm.2023.1129112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
Objective Triglyceride glucose body mass index (TyG-BMI) has been shown to be strongly associated with a variety of chronic diseases. However, little is known about the associations between TyG-BMI and normal-high blood pressure (BP) values and hypertension (HTN). Method The current study was cross-sectional in design and included 15,464 non-diabetic participants recruited between 1994 and 2016 in the NAGALA (NAfld in the Gifu Area, Longitudinal Analysis) study. Associations between TyG-BMI and normal-high BP values and HTN were assessed using multivariate logistic regression. The ability of the TyG index, BMI, and their combined index TyG-BMI to identify normal-high BP values and HTN was compared by receiver operating characteristic (ROC) curves. Results Among the 15,464 eligible non-diabetic participants, 28.56% (4,416/15,464) and 6.23% (964/15,464) had normal-high BP values and HTN, respectively. Multivariate logistic regression analysis showed positive correlations between BMI, TyG index, TyG-BMI and normal-high BP values/HTN; after standardized regression coefficients, TyG-BMI had the strongest association with normal-high BP values and HTN compared to BMI and TyG index. In the fully adjusted model, the odds ratio (OR) value corresponding to the relationship between TyG-BMI and HTN/normal-high BP values was 2.35; when TyG-BMI was used as a categorical variable, compared with the lowest quartile of TyG-BMI the regression coefficient for the association of the highest quartile of TyG-BMI with normal-high BP values increased by 426%, while the regression coefficient for the association with HTN increased by 527%. In further spline regression analysis, we also found that there was a linearly positive correlation between TyG-BMI and systolic BP/diastolic BP (SBP/DBP), which supported the linear trend between TyG-BMI and HTN/normal-high BP values (P-trend <0.0001). In addition, ROC analysis showed that TyG-BMI had good diagnostic values for both normal-high BP values and HTN, and TyG index combined with BMI can significantly improve the ability of a single index to identify normal-high BP values and HTN. Conclusion In the non-diabetic population, TyG-BMI showed a significant positive correlation with both normal-high BP values and HTN, and TyG-BMI was of higher value for the identification of both normal-high BP values and HTN compared to BMI and TyG index alone.
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Affiliation(s)
- Nan Peng
- Department of Cardiology, Jiangxi Provincial People's Hospital, Medical College of Nanchang University, Nanchang, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Maobin Kuang
- Department of Cardiology, Jiangxi Provincial People's Hospital, Medical College of Nanchang University, Nanchang, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yi Peng
- Department of Cardiology, Jiangxi Provincial People's Hospital, Medical College of Nanchang University, Nanchang, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hang Yu
- Department of Emergency, Guangfeng District People's Hospital, Shangrao, China
| | - Shuhua Zhang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Guobo Xie
- Department of Cardiology, Jiangxi Provincial People's Hospital, Medical College of Nanchang University, Nanchang, China
| | - Guotai Sheng
- Department of Cardiology, Jiangxi Provincial People's Hospital, Medical College of Nanchang University, Nanchang, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Correspondence: Yang Zou
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Prevalence and incidence of arterial hypertension and its risk factors in the 7,525 person-years Congolese adult population between 2012 and 2019 : results of the Bukavu observational study. Rev Epidemiol Sante Publique 2022; 70:9-16. [DOI: 10.1016/j.respe.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
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Kow CS, Hasan SS, Wong PS, Verma RK. Concordance of recommendations across clinical practice guidelines for the management of hypertension in Southeast Asia with internationally reputable sources. BMC Cardiovasc Disord 2021; 21:354. [PMID: 34320925 PMCID: PMC8317337 DOI: 10.1186/s12872-021-02054-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to assess the rate of concordance, and to investigate sources of non-concordance of recommendations in the management of hypertension across CPGs in Southeast Asia, with internationally reputable clinical practice guidelines (CPGs). METHODS CPGs for the management of hypertension in Southeast Asia were retrieved from the websites of the Ministry of Health or cardiovascular specialty societies of the individual countries of Southeast Asia during November to December 2020. The recommendations for the management of hypertension specified in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guideline were selected to be the reference standards; the recommendations concerning the management of hypertension in the included CPGs in Southeast Asia were assessed if they were concordant with the reference recommendations generated from both the 2017 ACC/AHA guideline and the 2018 ESC/ESH guideline, using the population (P)-intervention (I)-comparison (C) combinations approach. RESULTS A total of 59 reference recommendations with unique and unambiguous P-I-C specifications was generated from the 2017 ACC/AHA guideline. In addition, a total of 51 reference recommendations with unique and unambiguous P-I-C specifications was generated from the 2018 ESC/ESH guideline. Considering the six included CPGs from Southeast Asia, concordance was observed for 30 reference recommendations (50.8%) out of 59 reference recommendations generated from the 2017 ACC/AHA guideline and for 31 reference recommendations (69.8%) out of 51 reference recommendations derived from the 2018 ESC/ESH guideline. CONCLUSIONS Hypertension represents a significant issue that places health and economic strains in Southeast Asia and demands guideline-based care, yet CPGs in Southeast Asia have a high rate of non-concordance with internationally reputable CPGs. Concordant recommendations could perhaps be considered a standard of care for hypertension management in the Southeast Asia region.
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Affiliation(s)
- Chia Siang Kow
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
| | - Pei Se Wong
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Rohit Kumar Verma
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.
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Sun S, Liu XC, He GD, Lo K, Feng YQ, Huang YQ. The Non-linear Relationship Between Normal Range Systolic Blood Pressure and Cardiovascular or All-Cause Mortality Among Elderly Population. Front Cardiovasc Med 2021; 8:677189. [PMID: 34386527 PMCID: PMC8353072 DOI: 10.3389/fcvm.2021.677189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim was to explore the association of normal range SBP with cardiovascular and all-cause mortality in older adults without hypertension. Methods: Participants aged ≥ 65 years without hypertension and those had an SBP level between 90 and 129 mmHg were included from the National Health and Nutrition Examination Survey (1999-2014). SBP was categorized into: 90-99, 100-109, 110-119, and 120-129 mmHg. Multivariate Cox regression was performed with hazard ratio (HR) and 95% confidence interval (CI). Results: Of the 1,074 participants, 584 were men (54.38%). Compared with participants with SBP level ranged 110 to 119 mmHg, the HRs for all-cause mortality risk was 1.83 (95% CI: 1.04, 3.23) for SBP level ranged 90 to 99 mm Hg, 0.87 (95% CI: 0.54, 1.41) for SBP level ranged 100 to 109 mmHg, and 1.30 (95% CI: 0.96, 1.75) for SBP level ranged 120 to 129 mmHg (P for trend = 0.448), and the HR for cardiovascular mortality risk was 3.30 (95% CI: 0.87, 12.54) for SBP level ranged 90 to 99 mmHg, 0.35(95% CI: 0.08, 1.56) for SBP level ranged 100 to 109 mmHg, and 1.75 (95% CI: 0.78, 3.94) for SBP level ranged 120 to 129 mm Hg (P for trend = 0.349) after confounders were adjusted. Conclusion: These were a nonlinear association of normal range SBP level with all-cause and cardiovascular death in older adults.
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Affiliation(s)
- Shuo Sun
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo-Dong He
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, United States.,Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
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Abstract
OBJECTIVE No long-term follow-up study has investigated the effect of blood pressure (BP) on cardiovascular disease mortality and morbidity in firefighters. To investigate the effects of BP on the risk of major adverse cardiovascular events (MACEs) using a national representative population-matched cohort. METHODS We enrolled all firefighters (N = 8242) and 28 678 referent controls aged more than 40 years who underwent baseline health examinations in 2002 and 2003. Records of hospitalization and mortality until 2015 were checked. To evaluate the causal effect of BP on MACE, subcohort analysis using a propensity score-matched (PSM) cohort with respect to job classification (firefighter vs. control) was performed. RESULTS Hypertension significantly increased the risk of MACEs compared with normal BP in both firefighters and the age--sex matched cohort, but in participants with elevated BP, significantly increased risk of MACEs [hazards ratio 1.41, 95% confidence interval (CI) 1.06-1.88] was observed only among firefighters. In the PSM cohort, firefighters had a significantly higher risk of death or hospitalization from MACEs (hazard ratio 1.29, 95% CI 1.14-1.47), myocardial infarction (hazard ratio 1.24, 95% CI 1.07-1.43), and ischemic stroke (hazard ratio 1.43, 95% CI 1.12-1.82) than controls. Firefighters with elevated BP (hazard ratio 1.58, 95% CI 1.04-2.40), stage 1 (hazard ratio 1.24, 95% CI 1.00-1.52), and stage 2 (hazard ratio 1.39, 95% CI 1.13-1.71) hypertension had higher risk of MACEs than PSM controls. CONCLUSION Firefighters showed significantly higher cardiovascular risk than referent controls when comparing those within the same BP category, suggesting that firefighters with elevated BP and hypertension may be at high risk of adverse prognosis.
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Lin PY, Chang CC, Tung CY, Chu WH, Tong FG. Risk factors of prehypertension and hypertension among workers at public elderly welfare facilities in Taiwan: A cross-sectional survey. Medicine (Baltimore) 2021; 100:e24885. [PMID: 33663118 PMCID: PMC7909213 DOI: 10.1097/md.0000000000024885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
The prevalence and factors that influence prehypertension and hypertension in workers at elderly welfare facilities remain unknown. This study investigated prehypertension and hypertension as well as the relevant factors affecting the development of these conditions in workers at elderly welfare facilities.A cross-sectional survey was conducted among 242 workers at 3 elderly welfare facilities in northern Taiwan. A structured questionnaire survey comprising demographic characteristics, job characteristics, burnout inventory, and health information was employed for data collection. Chi-Squared tests and multinomial logistic regression were adopted to analyze the correlation between research variables and blood pressures as well as relevant factors influencing prehypertension and hypertension.The results indicated that sex, age, education level, type of work shift, work-related burnout, and body mass index of the research participants were significantly correlated with prehypertension and hypertension. The results of multinominal logistic regression demonstrated that being male, being older, being a nonnurse assistant, being obese, working in shifts, and having moderate or severe work-related burnout were associated with higher risks of prehypertension and hypertension. The interaction between age and being a nonnurse assistant was statistically significant. Compared with nonnurse assistants, nurse assistants aged ≥55 years had a relatively low risk of prehypertension and hypertension.Age, job characteristics, work-related burnout, and obesity of workers in elderly welfare facilities were the major risk factors for prehypertension and hypertension.
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Affiliation(s)
- Pei-Ying Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City
- Taitung Hospital, Ministry of Health and Welfare, Taitung County
| | - Chia-Chen Chang
- Department of Senior Citizen Service Business, College of Human Ecology and Design, St. John's University, New Taipei City
| | - Chen-Yin Tung
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City
| | - Wan-Hsia Chu
- Taipei City Haoran Senior Citizens Home, Taipei City, Taiwan
| | - Fu-Guan Tong
- Taipei City Haoran Senior Citizens Home, Taipei City, Taiwan
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Wu S, Song Y, Chen S, Zheng M, Ma Y, Cui L, Jonas JB. Blood Pressure Classification of 2017 Associated With Cardiovascular Disease and Mortality in Young Chinese Adults. Hypertension 2020; 76:251-258. [PMID: 32520626 DOI: 10.1161/hypertensionaha.119.14239] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The American College of Cardiology/American Heart Association introduced new guidelines for blood pressure (BP) classification in 2017. We explored associations between the newly defined categories and eventual cardiovascular disease (CVD) events, stroke, and all-cause mortality in young Chinese adults. In the community-based Kailuan Study, 16 006 participants aged 18 to 40 years and examined at baseline in 2006/2007 underwent 2-yearly follow-up examinations up to 2016 to 2017. Taking the highest BP reading recorded by manual sphygmomanometry at baseline in 2006 to 2007, we categorized the BP according to the new guidelines. Outcome parameters were CVD events, stroke, and all-cause mortality. During follow-up (mean: 10.9±0.63 years), we observed 458 events (CVD, 167; stroke, 119; and all-cause death, 172). After multivariable adjustment, hazard ratios for CVD events were for elevated BP 0.80 (95% CI, 0.28-2.30), stage 1 hypertension 1.82 (95% CI, 1.12-2.94), and stage 2 hypertension 3.54 (95% CI, 2.18-5.77) versus normal BP. Similar results were obtained for stroke and all-cause death. In Cox regression analysis with BP category entered as time-dependent covariate, stage 1 hypertension was not associated with increased risk (P>0.10). In the subgroup of individuals taking antihypertensive medication during follow-up, none of the BP categories was significantly associated with the incidence of CVD events. During a mean follow-up of 10.9 years, the newly defined category of stage 1 hypertension in young untreated Chinese adults aged <40 years at baseline was associated with an increased risk for CVD, stroke, and all-cause mortality. This increased risk occurred, however, after progression to stage 2 hypertension. The data may help validating the new BP classification system for young adult Chinese.
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Affiliation(s)
- Shouling Wu
- From the Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China (S.W.)
| | - Yongjian Song
- Graduate School of North China University of Science and Technology, Tangshan, China (Y.S., M.Z., Y.M.)
| | - Shuohua Chen
- Health Department of Kailuan Group, Tangshan, China (S.C.)
| | - Mengyi Zheng
- Graduate School of North China University of Science and Technology, Tangshan, China (Y.S., M.Z., Y.M.)
| | - Yihan Ma
- Graduate School of North China University of Science and Technology, Tangshan, China (Y.S., M.Z., Y.M.)
| | - Liufu Cui
- Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, China (L.C.)
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (J.B.J.)
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2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2020; 74:2661-2706. [PMID: 31732293 DOI: 10.1016/j.jacc.2019.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Outcomes in adults with systolic blood pressure between 130 and 139 mmHg in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial and Systolic Blood Pressure Intervention Trial. J Hypertens 2020; 38:1567-1577. [PMID: 32371767 DOI: 10.1097/hjh.0000000000002437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with stage 1 systolic hypertension have increased risk of cardiovascular disease (CVD) events. METHODS Using Cox models, we assess the effect of targeting an intensive SBP goal of less than 120 mmHg compared with standard SBP goal of less than 140 mmHg on the risk of CVD events in adults with stage 1 systolic hypertension with diabetes mellitus enrolled in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) (n = 1901) and without diabetes mellitus enrolled in Systolic Blood Pressure Intervention Trial (SPRINT) (n = 3484) that used identical SBP goal interventions. OUTCOMES In ACCORD BP, the primary composite CVD outcome was the first occurrence of myocardial infarction, stroke, or CVD mortality. In SPRINT, the primary composite CVD outcome was the first occurrence of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or CVD mortality. RESULTS In SPRINT, targeting an intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.75 (95% confidence interval, 0.58-0.98); events 1.78 vs. 2.37%/year]. In ACCORD BP, the relationships of SBP goal with the primary CVD outcome was modified by the glycemia goal intervention (interaction P = 0.039). In the standard glycemia subgroup (A1c target 7-7.9%), intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.61 (0.40-0.94); events 1.63 vs. 2.56%/year]. In the intensive glycemia subgroup (A1c target <6%), the risk of the primary CVD outcome was not significantly different between groups [hazard ratio 1.20 (0.76-1.89); events 1.91 vs. 1.60%/year]. CONCLUSION Targeting an intensive SBP goal significantly reduced the risk of CVD events in patients with stage 1 systolic hypertension without diabetes and with diabetes on standard glycemia goal.
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Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. Intracranial Atherosclerosis and Stage 1 Hypertension Defined by the 2017 ACC/AHA Guideline. Am J Hypertens 2020; 33:92-98. [PMID: 31433051 DOI: 10.1093/ajh/hpz138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/04/2019] [Accepted: 08/14/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) released a new, stricter definition of stage 1 hypertension which was previously considered prehypertension. However, impacts of the novel stage 1 hypertension on deleterious target-organ outcomes are still controversial. In this study, we evaluated the relationship between this newly defined stage 1 hypertension and the presence of intracranial atherosclerosis (ICAS) lesions in neurologically healthy participants. METHODS We assessed consecutive participants in routine health checkups between January 2006 and December 2013. Blood pressure (BP) was classified according to the 2017 ACC/AHA hypertension guideline, and ICAS was defined as occlusion or ≥50% stenosis of intracranial vessels on flight magnetic resonance angiography. RESULTS Among 3,111 healthy participants (mean age: 56 years, sex: 54% men), 85 (3%) had ICAS lesions. In multivariate analysis, stage 1 hypertension (adjusted odds ratio: 2.46, 95% confidence interval: 1.10-5.51, P = 0.029) remained an independent predictor of ICAS after adjustment for confounders. Stage 2 hypertension showed a higher odds ratio and a lower P value, indicating a dose-response effect. Age and HbA1c level were also significantly associated with ICAS, independent of the BP categories. The ICAS lesion burden showed a dose-response effect across the BP categories (P for trend <0.001), whereas ICAS lesion location did not (P for trend = 0.699). CONCLUSIONS We demonstrated that stage 1 hypertension, defined according to the 2017 ACC/AHA guideline, was associated with a higher prevalence and burden of ICAS lesions in a neurologically healthy population.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Han-Yeong Jeong
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
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Scutelnic A, Streit S, Sarikaya H, Jung S, Heldner MR. [Primary Prevention of Acute Stroke]. PRAXIS 2020; 109:277-289. [PMID: 32183656 DOI: 10.1024/1661-8157/a003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Primary Prevention of Acute Stroke Abstract. Strokes are frequent. Vascular risk factors are increasing the stroke risk. Most vascular risk factors are treatable. Their therapy is important in the primary prevention of stroke. According to the INTERSTROKE study, arterial hypertension, inactivity, overweight, dyslipidemia, smoking, unhealthy diet, cardiac pathologies such as major arrhythmia, diabetes mellitus, stress/depression and overconsumption of alcohol are the most important treatable vascular risk factors. In this article, we will also report on at present less well known treatable vascular risk factors such as sleep apnea, atheromatosis of the aortic arch and of arteries supplying the brain, migraine with aura and chronic inflammatory disorders and infections.
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Affiliation(s)
- Adrian Scutelnic
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Sven Streit
- Berner Institut für Hausarztmedizin (BIHAM), Inselspital, Universitätsspital und Universität Bern, Bern
| | - Hakan Sarikaya
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Simon Jung
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Mirjam R Heldner
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
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McLaren RA, Atallah F, Persad VVD, Narayanamoorthy S, Gougol N, Silver M, Minkoff H. Pregnancy outcomes among women with American College of Cardiology- American Heart Association defined hypertension. J Matern Fetal Neonatal Med 2019; 34:4097-4102. [PMID: 31875736 DOI: 10.1080/14767058.2019.1704250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To compare the rate of adverse pregnancy outcomes of women with hypertension defined by the ACC-AHA guidelines, women with hypertension defined by ACOG guidelines, and normotensive women.Methods: A historical cohort study of women with singleton, nonanomalous pregnancies who presented before 20 weeks for their first prenatal visit between 1 January 2014 and 31 January 2016 with (a) hypertension defined by ACC-AHA (systolic blood pressure 130 mmHg and/or diastolic blood pressure of 80 mmHg documented), (b) hypertension defined by ACOG (systolic blood pressure of 140 mmHg and/or diastolic blood pressure of 90 mmHg documented) and (c) women documented to be normotensive. Primary outcomes were preeclampsia and small for gestational age. Fisher's exact test was used to compare demographics and risk factors between the groups. Multivariable logistic regression analysis was used to predict the association of preeclampsia within the groups adjusting for additional risk factors.Results: A total of 252 women were included. Of these, 92 (36.5%) had hypertension by ACC-AHA, 34 (13.5%) by ACOG and 126 (50%) were normotensive. Sixty percent of women with the ACOG definition developed preeclampsia compared to 45.1% of women with the ACC-AHA definition and 17.1% in the control group (p < .001). The rate of preeclampsia among women with hypertension by ACC-AHA criteria was not significantly different from the rate among women with hypertension by ACOG criteria (p = .288). Differences in small for gestational age among the groups were not significant (ACOG: 20%, ACC-AHA: 11.1%, normotensive: 9.8%, p = .423).Conclusion: Women with hypertension defined by ACC-AHA have a rate of developing preeclampsia that is similar to that of women with hypertension defined by ACOG.
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Affiliation(s)
- Rodney A McLaren
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Vashisht V D Persad
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Nikou Gougol
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael Silver
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.,Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. Cerebral Small Vessel Disease and Stage 1 Hypertension Defined by the 2017 American College of Cardiology/American Heart Association Guidelines. Hypertension 2019; 73:1210-1216. [PMID: 31067203 DOI: 10.1161/hypertensionaha.119.12830] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although the American College of Cardiology/American Heart Association guidelines have introduced a novel definition of hypertension in their 2017 hypertension guidelines, the influence of novel stage 1 hypertension on cerebrovascular diseases remains unclear. In this study, we evaluated the relationship between stage 1 hypertension, as defined by the 2017 American College of Cardiology/American Heart Association guidelines and cerebral small vessel disease in a healthy population. We assessed consecutive health checkup participants without the use of antihypertensive medication between 2006 and 2013. White matter hyperintensity volumes were rated using semiautomated quantitative methods. The presence of lacunes, cerebral microbleeds, and enlarged perivascular spaces was also measured as cerebral small vessel disease lesions. We classified the blood pressure of all participants according to the 2017 American College of Cardiology/American Heart Association guidelines. A total of 2460 participants were evaluated. In adjusted linear and logistic regression analyses, stage 1 hypertension was independently associated with white matter hyperintensity volume (β=0.158; 95% CI, 0.046-0.269; P=0.006), presence of lacune (adjusted odds ratio, 1.66; 95% CI, 1.00-2.73; P=0.048), and deep cerebral microbleeds (adjusted odds ratio, 2.50, 95% CI, 1.08-5.79; P=0.033). Stage 2 hypertension showed higher coefficients or adjusted odds ratio values and lower P values in all analyses of white matter hyperintensity volumes, lacunes, and deep cerebral microbleeds, indicating dose-response effects across blood pressure categories. Stage 1 hypertension according to the 2017 American College of Cardiology/American Heart Association guidelines is associated with cerebral small vessel disease lesions, especially in white matter hyperintensity lesions, lacunes, and deep cerebral microbleeds.
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Affiliation(s)
- Ki-Woong Nam
- From the Department of Neurology (K.-W.N., H.-Y.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea (H.-M.K.)
| | - Han-Yeong Jeong
- From the Department of Neurology (K.-W.N., H.-Y.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Jin-Ho Park
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Hyuktae Kwon
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Su-Min Jeong
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
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Casey DE, Thomas RJ, Bhalla V, Commodore-Mensah Y, Heidenreich PA, Kolte D, Muntner P, Smith SC, Spertus JA, Windle JR, Wozniak GD, Ziaeian B. 2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2019; 12:e000057. [PMID: 31714813 DOI: 10.1161/hcq.0000000000000057] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Associations of blood pressure categories according to the 2017 American College of Cardiology/American Heart Association hypertension guideline and long-term blood pressure change with incident cardiovascular disease in middle-aged and elderly Chinese. J Hypertens 2019; 37:2007-2014. [DOI: 10.1097/hjh.0000000000002137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e426-e483. [PMID: 30354655 DOI: 10.1161/cir.0000000000000597] [Citation(s) in RCA: 356] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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22
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Wang Q, Chao H, Zheng S, Tan I, Butlin M, Avolio A, Zuo J. Impact of new hypertension guidelines on target organ damage screening in a Shanghai community-dwelling population. J Clin Hypertens (Greenwich) 2019; 21:1450-1455. [PMID: 31532579 DOI: 10.1111/jch.13677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/30/2019] [Accepted: 08/03/2019] [Indexed: 11/27/2022]
Abstract
Recently, the 2017 ACC/AHA released new hypertension guidelines and proposed a redefinition of hypertension from 140/90 to 130/80 mm Hg. This study assesses the impact of the lower threshold for hypertension diagnosis on the association of hypertension with target organ damage (TOD). Health checks were conducted in a community-dwelling population in Shanghai in 2017 (N = 10 826; 43.26% mean, age 62 ± 12 years [range 29-95 years]). Subclinical TOD indices were quantified in terms of left ventricular hypertrophy (LVH) by electrocardiogram (Sokolow-Lyon standard), estimated glomerular filtration rate (eGFR), and presence of proteinuria. Information on clinical TOD was obtained by questionnaire. Arteriosclerotic cardiovascular disease (ASCVD) was determined by the 2013 ACC/ AHA recommended guidelines. Compared to the higher threshold (140/90 mm Hg), the lower threshold (130/80 mm Hg) was associated with variable rates of increased detection of hypertension and TOD: (a) Hypertension: incidence of hypertension, 29.5% (51.8%-81.5%) increase in persons with hypertension if the threshold of 130/80 mm Hg is used; (b) Subclinical TOD: LVH, 20.8%; eGFR (30-60 mL/min per 1.73 m2 ), 23.7%; proteinuria, 23.5%; (c) Clinical TOD: chronic kidney disease (CKD) IV (eGFR<30 mL/min per 1.73 m2 ), 3.1%; diabetes (fasting glucose ≥7.0 mmol/L or HbA1C>7.0%), 24.3%; stroke, 26.4%; chronic heart disease, 28.1%; acute myocardial infarction, 19.5% (69.4% to 88.9% of total of 36); ASCVD ≥10%, 29.3%. The lower threshold was associated with a significantly higher detection rate of clinical and subclinical TOD of approximately 20% compared to the higher threshold. 15%-20% of TOD and 29% of ASCVD were also found below the lower threshold of hypertension.
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Affiliation(s)
- Qian Wang
- Department of Geriatric Medicine, Shanghai Jiaotong School of Medicine, Ruijin Hospital North, Shanghai, China
| | - Huijuan Chao
- Department of Geriatric Medicine, Shanghai Jiaotong School of Medicine, Ruijin Hospital North, Shanghai, China
| | - Shuping Zheng
- Jiading District Jiangqiao Community Health Service Center, Shanghai, China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Junli Zuo
- Department of Geriatric Medicine, Shanghai Jiaotong School of Medicine, Ruijin Hospital North, Shanghai, China.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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23
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The association of stage 1 hypertension defined by the 2017 ACC/AHA hypertension guideline and subsequent cardiovascular events among adults <50 years. J Hum Hypertens 2019; 34:233-240. [DOI: 10.1038/s41371-019-0242-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023]
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24
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Kim S, Chang Y, Kang J, Cho A, Cho J, Hong YS, Zhao D, Ahn J, Shin H, Guallar E, Ryu S, Sung KC. Relationship of the Blood Pressure Categories, as Defined by the ACC/AHA 2017 Blood Pressure Guidelines, and the Risk of Development of Cardiovascular Disease in Low-Risk Young Adults: Insights From a Retrospective Cohort of Young Adults. J Am Heart Assoc 2019; 8:e011946. [PMID: 31140347 PMCID: PMC6585354 DOI: 10.1161/jaha.119.011946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There are limited outcome studies of hypertension among young adults, especially using the new blood pressure (BP) categories from the American College of Cardiology and the American Heart Association. We examined associations between the new BP categories and the risk of incident cardiovascular disease (CVD) in low‐risk and young adults. Methods and Results A cohort study was performed in 244 837 Korean adults (mean age, 39.0 years; SD, 8.9 years) who underwent a comprehensive health examination at Kangbuk Samsung Hospital from January 1, 2011, to December 31, 2016; they were followed up for incident CVD via linkage to the Health Insurance and Review Agency database until the end of 2016, with a median follow‐up of 4.3 years. BP was categorized according to the new American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines. During 924 420.7 person‐years, 1435 participants developed new‐onset CVD (incidence rate of 16.0 per 104 person‐years). The multivariable‐adjusted hazard ratios (95% CIs ) for CVD comparing elevated BP, stage 1 hypertension, stage 2 hypertension, treated and strictly controlled (systolic BP/diastolic BP <130/80 mm Hg with antihypertensive use), treated and controlled (systolic BP 130–139 and diastolic BP 80 to 89 mm Hg with antihypertensive use), treated uncontrolled, and untreated hypertension to normal BP were 1.37 (1.11–1.68), 1.45 (1.26–1.68), 2.12 (1.74–2.58), 1.41 (1.12–1.78), 1.97 (1.52–2.56), 2.29 (1.56–3.37) and 1.93 (1.53–2.45), respectively. Conclusions In this large cohort of low‐risk and young adults, all categories of higher BP were independently associated with an increased risk of CVD compared with normal BP, underscoring the importance of BP management even in these low‐risk populations.
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Affiliation(s)
- Seolhye Kim
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Yoosoo Chang
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,2 Department of Occupational and Environmental Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea
| | - Jeonggyu Kang
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Ara Cho
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Juhee Cho
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea.,4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Yun Soo Hong
- 4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Di Zhao
- 4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Jiin Ahn
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hocheol Shin
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,5 Department of Family Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul South Korea.,6 Division of Cardiology Department of Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Eliseo Guallar
- 3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea.,4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Seungho Ryu
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,2 Department of Occupational and Environmental Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea
| | - Ki-Chul Sung
- 6 Division of Cardiology Department of Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Kobalava ZD, Troitskaya EA, Kolesnik EL. New Guidelines on Management of Arterial Hypertension: Key Similarities and Differences. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-1-105-114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Steady increase in worldwide prevalence of hypertension and hypertension-related cardiovascular morbidity and mortality necessitate new approaches to the management of hypertensive patients. It`s important to recognize that despite several differences the convergence of the 2017 ACC/AHA (US) and 2018 ESC/ESH (European) guidelines is greater now than ever before. The present review focuses on the key similarities and differences of these two documents. Among similarities we analyzed positions regarding the importance of cardiovascular risk evaluation for treatment initiation and choice of optimal treatment strategy: blood pressure (BP) treatment thresholds; drugs of choice for the initiation of antihypertensive therapy and treatment targets in different groups including elderly patients. Among key differences we analyzed sections concerning the classification of BP levels and target BP levels in patients with chronic kidney disease. In conclusion, we may say that in many ways the guidelines are just a different interpretation of the same data. There is no doubt in the importance of lowering high BP and evaluation and correction of high cardiovascular risk. One of the main purposes is to focus attention on younger patients with hypertension.
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Affiliation(s)
| | | | - E. L. Kolesnik
- Peoples’ Friendship University of Russia (RUDN University)
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Kang J, Chang Y, Kim S, Sung KC, Shin H, Ryu S. Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults. Atherosclerosis 2019; 282:188-195. [DOI: 10.1016/j.atherosclerosis.2018.11.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/14/2018] [Accepted: 11/22/2018] [Indexed: 12/13/2022]
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Park S. Management plans for populations with normal-to-hypertensive blood pressures: risks and benefits of antihypertensive drug treatment in populations previously defined as having high-normal blood pressure. Korean J Intern Med 2019; 34:44-49. [PMID: 30612417 PMCID: PMC6325426 DOI: 10.3904/kjim.2018.382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022] Open
Abstract
Recent changes in American and European guidelines on the management of arterial hypertension have caused a considerable shift in the landscape of hypertension management. The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg. In contrast, the 2018 European guideline maintains the diagnostic threshold of hypertension at 140/90 mmHg. However, despite their differences in thresholds for diagnosis of hypertension, both guidelines are in agreement that treatment should be considered in patients with BPs in the range of 130 to 139/80 to 89 mmHg if they have high cardiovascular risk. The results from the Systolic Blood Pressure Intervention Trial (SPRINT) study and recent meta-analyses suggest that BP lowering with antihypertensive treatment may be beneficial in reducing cardiovascular event rates in subjects with high-normal BP or stage 1 hypertension according to the new American guideline. However, intensive BP lowering is associated with increased incidence of treatment-associated adverse events, and evidence suggests that BP lowering below 120/70 mmHg increases the risk of cardiovascular events. In this review, we discuss the evidence supporting antihypertensive treatment in subjects with high-normal BP and discuss the specific subgroup of subjects that might benefit from BP lowering.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Sungha Park, M.D. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1975 Fax: +82-2-393-6884 E-mail:
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28
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Arterial Stiffness in Early Phases of Prehypertension. UPDATES IN HYPERTENSION AND CARDIOVASCULAR PROTECTION 2019. [DOI: 10.1007/978-3-319-75310-2_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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29
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Son JS, Choi S, Kim K, Kim SM, Choi D, Lee G, Jeong SM, Park SY, Kim YY, Yun JM, Park SM. Association of Blood Pressure Classification in Korean Young Adults According to the 2017 American College of Cardiology/American Heart Association Guidelines With Subsequent Cardiovascular Disease Events. JAMA 2018; 320:1783-1792. [PMID: 30398603 PMCID: PMC6248107 DOI: 10.1001/jama.2018.16501] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Among young adults, the association of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) High Blood Pressure Clinical Practice Guidelines with risk of cardiovascular disease (CVD) later in life is uncertain. OBJECTIVE To determine the association of blood pressure categories before age 40 years with risk of CVD later in life. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study from the Korean National Health Insurance Service consisted of 2 488 101 adults aged 20 through 39 years with blood pressure measurements taken twice from 2002 through 2005. Starting from January 1, 2006, participants were followed up until the date of CVD diagnosis, death, or December 31, 2015. EXPOSURES Participants were categorized by blood pressure readings: normal (systolic, <120 mm Hg; diastolic, <80 mm Hg), elevated (sytolic, 120-129 mm Hg; diastolic, <80 mm Hg), stage 1 hypertension (systolic, 130-139 mm Hg; diastolic, 80-89 mm Hg), and stage 2 hypertension (systolic, ≥140 mm Hg; diastolic, ≥90 mm Hg). MAIN OUTCOMES AND MEASURES The primary outcome was CVD defined as 2 or more days of hospitalization due to CVD or death due to CVD. The secondary outcomes were coronary heart disease (CHD) and stroke. RESULTS The study population consisted of 2 488 101 participants (median age, 31 years [interquartile range, 27-36 years], 789 870 women [31.7%]). A total of 44 813 CVD events were observed during a median follow-up duration of 10 years. Men with baseline stage 1 hypertension compared with those with normal blood pressure had higher risk of CVD (incidence, 215 vs 164 per 100 000 person-years; difference, 51 per 100 000 person-years [95% CI, 48-55]; adjusted hazard ratio [HR], 1.25 [95% CI, 1.21-1.28]), CHD (incidence, 134 vs 103 per 100 000 person-years; difference, 31 per 100 000 person-years [95% CI, 28-33]; adjusted HR, 1.23 [95% CI, 1.19-1.27]), and stroke (incidence, 90 vs 67 per 100 000 person-years; difference, 23 per 100 000 person-years [95% CI, 21-26]; adjusted HR, 1.30 [95% CI, 1.25-1.36]). Women with baseline stage 1 hypertension compared with those with normal blood pressure had increased risk of CVD (incidence, 131 vs 91 per 100 000 person-years; difference, 40 per 100 000 person-years [95% CI, 35-45]; adjusted HR, 1.27 [95% CI, 1.21-1.34]), CHD (incidence, 56 vs 42 per 100 000 person-years; difference, 14 per 100 000 person-years [95% CI, 11-18]; adjusted HR, 1.16 [95% CI, 1.08-1.25]), and stroke (incidence, 79 vs 51 per 100 000 person-years; difference, 28 per 100 000 person-years [95% CI, 24-32]; adjusted HR [1.37, 95% CI, 1.29-1.46]). Results for state 2 hypertension were consistent. CONCLUSIONS AND RELEVANCE Among Korean young adults, stage 1 and stage 2 hypertension, compared with normal blood pressure, were associated with increased risk of subsequent cardiovascular disease events. Young adults with hypertension, defined by the 2017 ACC/AHA criteria, may be at increased risk of cardiovascular disease.
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Affiliation(s)
- Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Daein Choi
- Pyeongchang Bongpyeong Public Health Center, Pyeongchang, South Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Health Promotion Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seong Yong Park
- Big Data Steering Department, National Health Insurance Service, Wonju, South Korea
| | - Yeon-Yong Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, South Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary. ACTA ACUST UNITED AC 2018; 12:579.e1-579.e73. [DOI: 10.1016/j.jash.2018.06.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018. [DOI: 10.1161/hyp.0000000000000065 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4425] [Impact Index Per Article: 737.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Affiliation(s)
- C Venkata S Ram
- Apollo Institute for Blood Pressure Management, World Hypertension League/South Asia Office, Apollo Hospitals, and Apollo Medical College, Hyderabad, India; Texas Blood Pressure Institute, DNA, UTSW Medical School, Dallas, USA; India Campus Macquarie University, Medical School Sydney, Australia.
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:e13-e115. [PMID: 29133356 DOI: 10.1161/hyp.0000000000000065] [Citation(s) in RCA: 1526] [Impact Index Per Article: 218.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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35
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:1269-1324. [PMID: 29133354 DOI: 10.1161/hyp.0000000000000066] [Citation(s) in RCA: 2080] [Impact Index Per Article: 297.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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36
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:2199-2269. [PMID: 29146533 DOI: 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 602] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:e127-e248. [PMID: 29146535 DOI: 10.1016/j.jacc.2017.11.006] [Citation(s) in RCA: 2965] [Impact Index Per Article: 423.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hedén Ståhl C, Lind M, Svensson A, Kosiborod M, Gudbjörnsdottir S, Pivodic A, Clements M, Rosengren A. Long-term excess risk of stroke in people with Type 2 diabetes in Sweden according to blood pressure level: a population-based case-control study. Diabet Med 2017; 34:522-530. [PMID: 27885698 PMCID: PMC5363349 DOI: 10.1111/dme.13292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/14/2023]
Abstract
AIMS To estimate the risk of stroke in people with Type 2 diabetes with different blood pressure levels compared with the risk in the general population in Sweden. METHODS This prospective case-control study included 408 076 people with Type 2 diabetes, aged ≥ 18 years, and free of prior stroke, registered in the Swedish National Diabetes Register 1998-2011. Age- and sex-matched control subjects (n = 1 913 507) without stroke from the general population were included. Stroke diagnoses were retrieved using International Classification of Disease codes from the Swedish patient and death registers. Cox hazard ratios and 95% confidence intervals (CIs) were estimated at six different blood pressure levels. RESULTS During a median follow-up of 4 years, 19 548 (4.8%) people with Type 2 diabetes and 61 690 (3.2%) without diabetes were diagnosed with stroke, corresponding to an adjusted hazard ratio of 1.43 (95% CI 1.41-1.46) for people with Type 2 diabetes as a group. Compared with people without diabetes, the risk of stroke for people with Type 2 diabetes with different blood pressure levels was significantly higher, starting at blood pressure levels > 130/80 mmHg. Hazard ratios for stroke were 1.20 (95% CI 1.16-1.24), 1.47 (95% CI 1.43-1.50), and 1.97 (95% CI 1.90-2.03) for blood pressure categories of 130-139/80-89 mmHg, 140-159/90-99 mmHg and ≥ 160/≥ 100 mmHg, respectively, after adjustment for age, sex, diabetes duration, being born in Sweden, maximum education level and baseline comorbidities. CONCLUSIONS People with Type 2 diabetes and blood pressure < 130/80 mmHg had a risk of stroke similar to that of the general population.
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Affiliation(s)
- C. Hedén Ståhl
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
| | - M. Lind
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
- Department of MedicineNU‐Hospital OrganizationUddevallaSweden
| | - A.‐M. Svensson
- Centre of Registers in the Västra Götaland RegionGothenburgSweden
| | - M. Kosiborod
- Saint Luke's Mid America Heart InstituteUniversity of Missouri–Kansas City School of MedicineMOUSA
| | | | - A. Pivodic
- Statistiska KonsultgruppenGothenburgSweden
| | - M. Clements
- University of Missouri–Kansas City School of Medicine and Children's Mercy HospitalKansas CityMOUSA
- University of Kansas School of MedicineKansas CityMOUSA
| | - A. Rosengren
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 5994] [Impact Index Per Article: 856.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke. Hypertension 2016; 67:1126-32. [DOI: 10.1161/hypertensionaha.116.07098] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022]
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ZHANG LIANGMIN, HE DEHUA, LIN JINXIU. Prehypertensive treatment with losartan, however not amlodipine, leads to long-term effects on blood pressure and reduces the risk of stroke in spontaneously hypertensive stroke-prone rats. Mol Med Rep 2015; 13:1304-10. [DOI: 10.3892/mmr.2015.4641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/10/2015] [Indexed: 11/05/2022] Open
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Song HY, Nam KA. Effectiveness of a Stroke Risk Self-Management Intervention for Adults with Prehypertension. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:328-35. [DOI: 10.1016/j.anr.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/26/2015] [Accepted: 09/16/2015] [Indexed: 12/25/2022] Open
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Jang E, Baek Y, Kim Y, Park K, Lee S. Sasang constitution may act as a risk factor for prehypertension. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:231. [PMID: 26169174 PMCID: PMC4501065 DOI: 10.1186/s12906-015-0754-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/30/2015] [Indexed: 11/10/2022]
Abstract
Background Prehypertension (pre-HTN), similar to hypertension, has been associated with an elevated risk of cardiovascular disease. The aim of this study was to determine whether the Sasang constitution (SC) types could also be independent risk factors for pre-HTN. Methods A total of 2,806 eligible subjects, older than 20 years old from 25 medical clinics, participated. Clinical data, including the blood pressure, age, height, weight, and data from blood tests, were collected. One-way ANOVA with Scheffé’s post-hoc analysis and the chi-square test were used, according to the SC and sex. Logistic regression was used to generate the odds ratios (ORs) and 95 % confidence interval (CI) for pre-HTN. Results The pre-HTN prevalence rates of the Soeumin type, Soyangin type and Tae-eumin type were 59.4 %, 60.1 % and 74.9 %, respectively, in men (p < 0.001) and 41.7 %, 44.4 % and 58.3 % in women (p < 0.001). The Soyangin type was not more associated with increased ORs than the Soeumin type in any of the subjects with pre-HTN. Even after adjusting for sex, BMI, FBG, TC, TGs, HDL, and LDL, the Tae-eumin type in men was associated with increased ORs of pre-HTN compared with the Soeumin type (OR 1.57, 95 % CI 1.03–2.39), but the Tae-eumin type in women was not associated with pre-HTN. Conclusions This study suggested that the Tae-eumin type combined with sex might be significantly and independently associated with pre-HTN, especially high pre-HTN.
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Boeckner LS, Young TD, Pullen CH, Dizona P, Hageman PA. Dietary mineral intakes of rural midlife to older adult women with prehypertension in Midwestern United States. J Nutr Health Aging 2015; 19:13-9. [PMID: 25560811 DOI: 10.1007/s12603-014-0482-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Midlife to older rural women with prehypertension are at increased risk for hypertension and its impact on cardiovascular health with advancing age. Because modification of dietary factors could help alleviate risk, the objective of this study was to explore calcium, magnesium, potassium and sodium intakes of midlife to older rural women, with identification of their top food sources. DESIGN Survey of baseline dietary intake data of women and comparison to standard recommendations. SETTING Rural Midwestern United States. PARTICIPANTS 289 rural women, age 40-69, with prehypertension who volunteered for lifestyle modification to reduce blood pressure. MEASUREMENTS Baseline nutrition data using the Block Health Habit and History Questionnaire were collected over a twelve-month rolling enrollment period from rural women with prehypertension. Mineral intakes were calculated and compared to recommended standards. Top ten foods contributing to each mineral were identified. RESULTS The percent of women who met the Recommended Dietary Allowance (RDA)/Adequate Intake (AI) recommendations for their age groups ranged from a high 42.9% for magnesium to a low of 4.2% for potassium. Mean intakes of calcium, magnesium and potassium were all below recommended levels and sodium intakes were above recommendation. CONCLUSION Midlife to older rural US women with prehypertension were eating some of the foods that would help them meet mineral recommendations. As a preventive approach to reducing hypertension risk, clinical practice could include advising on ways to increase both commonly and less commonly consumed nutrient-rich foods with awareness of what is typically available in the rural area.
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Affiliation(s)
- L S Boeckner
- Linda S. Boeckner, 119 Ruth Leverton, University of Nebraska-Lincoln, Lincoln, NE 68583-0808, Phone: 402-472-7634,
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El Tallawy HN, Farghaly WM, Badry R, Hamdy NA, Shehata GA, Rageh TA, Metwally NA, Hassan EM, Elsayed SS, Yehia MA, Soliman WT. Epidemiology and clinical presentation of stroke in Upper Egypt (desert area). Neuropsychiatr Dis Treat 2015; 11:2177-83. [PMID: 26346729 PMCID: PMC4552260 DOI: 10.2147/ndt.s87381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stroke is a common cause of morbidity and mortality worldwide. Four out of five strokes occur in the low- and middle-income countries. This study aims to find lifetime prevalence of stroke in Upper Egypt and to identify clinical presentations and possible risk factors of stroke in this population. METHODS This is a door-to-door (every door) study conducted on all inhabitants in Al Kharga district (representative of western desert) and Al Quseir city (representative of eastern desert). The study was conducted in two stages, and every stage consisted of three phases (screening, diagnostic, and investigatory). RESULTS The total lifetime prevalence of stroke was 8.5/1,000 in the population aged 20 years and more. It increased with advancing age and was higher among males than females among all age groups except in the childbearing period (20 years to <40 years of age). Lifetime prevalence of ischemic stroke (7.2/1,000) was higher than hemorrhagic stroke (1.1/1,000). Hemiparesis and hemiplegia were the commonest presentation of stroke. Headache, vomiting, and vertigo were found to be significantly more common accompaniments of hemorrhagic stroke. The most common risk factor was hypertension, followed by hyperlipidemia and diabetes mellitus. CONCLUSION The total lifetime prevalence of stroke in the population aged 20 years and more in Upper Egypt (desert area) lies within the range that is recorded in developing countries. Clinical presentation and risk factors are similar to those recorded from developing and developed countries.
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Affiliation(s)
- Hamdy N El Tallawy
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
| | - Wafaa M Farghaly
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
| | - Reda Badry
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
| | - Nermin A Hamdy
- Department of Neurology, El Minia University, El-Minia City, Egypt
| | - Ghaydaa A Shehata
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
| | - Tarek A Rageh
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
| | - Nabil A Metwally
- Department of Neurology, Al-Azhar University (Assuit Branch), Assiut, Egypt
| | - Enas M Hassan
- Department of Neurology, El Minia University, El-Minia City, Egypt
| | - Sayed S Elsayed
- Department of Neurology, El Minia University, El-Minia City, Egypt
| | - Mohamed A Yehia
- Department of Neurology, El Minia University, El-Minia City, Egypt
| | - Wael T Soliman
- Department of Neurology, El Minia University, El-Minia City, Egypt
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4431] [Impact Index Per Article: 443.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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48
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Wang D, Zhou Y, Guo Y, Wang C, Wang A, Jin Z, Gao X, Wu S, Zhao X, Jonas JB. Arterial pre-hypertension and hypertension in intracranial versus extracranial cerebrovascular stenosis. Eur J Neurol 2014; 22:533-9. [PMID: 25516072 DOI: 10.1111/ene.12611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Y. Zhou
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Y. Guo
- Department of Epidemiology and Biostatistics; School of Population Health; University of Queensland; Brisbane QLD Australia
| | - C. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - A. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Z. Jin
- Department of Emergency Medicine; Anzhen Hospital; Capital Medical University; Beijing Institute of Heart Lung and Blood Vessels; Beijing China
| | - X. Gao
- Channing Laboratory; Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Nutrition; Harvard University School of Public Health; Boston MA USA
| | - S. Wu
- Department of Cardiology; Kailuan Hospital; Tangshan China
| | - X. Zhao
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - J. B. Jonas
- Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing China
- Key Laboratory of Ophthalmology and Visual Science; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht- Karls-University; Heidelberg Germany
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Lin MP, Towfighi A. Stroke
Literature Synopses: Clinical Science. Stroke 2014. [DOI: 10.1161/strokeaha.114.006489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michelle P. Lin
- From the Department of Neurology, University of Southern California, Los Angeles; and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Amytis Towfighi
- From the Department of Neurology, University of Southern California, Los Angeles; and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
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