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Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, Park S, Shin J, Kim YK. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens 2023; 29:11. [PMID: 36788612 PMCID: PMC9930285 DOI: 10.1186/s40885-023-00234-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.
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Affiliation(s)
- Hack-Lyoung Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- grid.410899.d0000 0004 0533 4755Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Shin Young Ahn
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-il Kim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- grid.411597.f0000 0004 0647 2471Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Hoon Lee
- grid.258803.40000 0001 0661 1556Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jong-Moo Park
- grid.255588.70000 0004 1798 4296Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Eun Joo Cho
- grid.488414.50000 0004 0621 6849Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Park
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Kwon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.
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Holanger M, Kjeldsen SE, Jamerson K, Julius S. Smoking and overweight associated with masked uncontrolled hypertension: a Hypertension Optimal Treatment (HOT) Sub-Study. Blood Press 2020; 30:51-59. [PMID: 32633143 DOI: 10.1080/08037051.2020.1787815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The Hypertension Optimal Treatment (HOT) Study investigated the relationship between target office diastolic blood pressure (BP) ≤80, ≤85 or ≤90 mmHg and cardiovascular morbidity and mortality in 18,790 patients aged 50-80 years. The home BP sub-study enrolled 926 patients and the aim was to clarify whether the separation into the BP target groups in the office prevailed in the out-of-office setting. The present study aimed to identify variables that characterised masked uncontrolled hypertension (MUCH) and white coat uncontrolled hypertension (WUCH). MATERIAL AND METHODS The sub-study participants took their home BP when office BP had been up titrated. The cut-off for normal or high BP was set to ≥135/85 mmHg at home and ≥140/90 mmHg in the office. We analysed data by using multivariate and stepwise multivariate logistic regression with home and office BP combinations as the dependent variables. RESULTS WUCH was associated with lower body mass index (BMI) (odds ratio (OR) 0.92, 95% confident intervals (CIs) 0.88-0.96, p < 0.001). MUCH was associated with smoking (OR 1.89, 95% CIs 1.25-2.86, p = 0.0025) and with lower baseline heart rate (OR 0.98, 95% CIs 0.97-0.99, p = 0.03) and higher BMI (OR 1.03, CIs 1.00-1.06, p = 0.04). MUCH remained associated with smoking (OR 2.76, 95% CIs 1.76-4.35, p < 0.0001) also when using ≥140/90 mmHg as the cut-off for both home and office BP. MUCH was also associated with higher BMI (OR 1.05, 95% CIs 1.01-1.09, p = 0.009) while WUCH was associated with lower BMI (OR 0.93, 95% CIs 0.90-0.97, p = 0.0005) when using ≥140/90 mmHg as a cut-off. CONCLUSION Our data support that 'reversed or masked' treated but uncontrolled hypertension (MUCH) is common and constitutes about 25% of treated hypertensive patients. This entity (MUCH) is rather strongly associated with current smoking and overweight while uncontrolled white coat (office) hypertension (WUCH) is associated with lower BMI.
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Affiliation(s)
- Magnus Holanger
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, University of Oslo Hospital, Oslo, Norway.,Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Kenneth Jamerson
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
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Sex differences in masked hypertension: the Coronary Artery Risk Development in Young Adults study. J Hypertens 2020; 37:2380-2388. [PMID: 31246891 DOI: 10.1097/hjh.0000000000002175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the association of sex with masked hypertension, defined by out-of-clinic hypertension based on ambulatory blood pressure monitoring (ABPM) among adults without hypertension based on blood pressure (BP) measured in the clinic, after adjusting for potential confounders. METHODS We evaluated sex differences in the prevalence of masked hypertension and the difference between awake, or alternatively 24-h, ambulatory BP and clinic BP using multivariable adjusted models among 658 participants who underwent 24-h ABPM and had clinic SBP/DBP less than 140/90 mmHg during the Year 30 Exam of the Coronary Artery Risk Development in Young Adults study. RESULTS The mean age ± standard deviation (SD) of the participants was 54.8 ± 3.7 years, 58.4% were women, and 58.2% were black. The prevalence of any masked hypertension was 37.5% among women and 60.6% among men. In a model including adjustment for demographics, cardiovascular risk factors, antihypertensive medication, and clinic BP, the prevalence ratios (95% confidence intervals) comparing men versus women were 1.39 (1.18-1.63) for any masked hypertension, and 1.60 (1.28-1.99), 1.71 (1.36-2.15), and 1.40 (1.13-1.73) for masked awake, 24-h and asleep hypertension, respectively. In a fully adjusted model, the differences between mean awake ambulatory BP and clinic BP were 2.75 [standard error (SE) 0.92] mmHg higher for SBP and 3.61 (SE 0.58) mmHg higher for DBP among men compared with women. CONCLUSION The prevalence of masked hypertension on ABPM was high in both men and women. Male sex was an independent predictor of masked hypertension.
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Masked Hypertension: A Systematic Review. Heart Lung Circ 2020; 29:102-111. [DOI: 10.1016/j.hlc.2019.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/15/2019] [Accepted: 08/04/2019] [Indexed: 12/22/2022]
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Kim HC, Ihm SH, Kim GH, Kim JH, Kim KI, Lee HY, Lee JH, Park JM, Park S, Pyun WB, Shin J, Chae SC. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension. Clin Hypertens 2019; 25:16. [PMID: 31388451 PMCID: PMC6670210 DOI: 10.1186/s40885-019-0121-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/03/2019] [Indexed: 02/08/2023] Open
Abstract
The Korean Society of Hypertension guideline defines hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, where the effectiveness of pharmacological treatment has been established. It is confirmed that higher blood pressure levels are associated with increased risk of cardiovascular disease and mortality also in the Korean population. About one third of Korean adults aged 30 years or older are estimated to have hypertension, and the prevalence of hypertension gradually increases as the age increases. The awareness, treatment, and control rates of hypertension are generally improving in Korea, but more efforts are required to increase awareness and treatment among younger patients with hypertension and to improve lifestyle modification compliance at all ages. More studies are required to determine the magnitude and impact of white coat hypertension and masked hypertension in the Korean population.
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Affiliation(s)
- Hyeon Chang Kim
- 1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Hyun Ihm
- 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gheun-Ho Kim
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Ju Han Kim
- 4Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, South Korea
| | - Kwang-Il Kim
- 5Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hae-Young Lee
- 6Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jang Hoon Lee
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 South Korea
| | - Jong-Moo Park
- 8Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Sungha Park
- 9Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wook Bum Pyun
- 10Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jinho Shin
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Shung Chull Chae
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 South Korea
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Ku E, Hsu RK, Tuot DS, Bae SR, Lipkowitz MS, Smogorzewski MJ, Grimes BA, Weir MR. Magnitude of the Difference Between Clinic and Ambulatory Blood Pressures and Risk of Adverse Outcomes in Patients With Chronic Kidney Disease. J Am Heart Assoc 2019; 8:e011013. [PMID: 31014164 PMCID: PMC6512117 DOI: 10.1161/jaha.118.011013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Obtaining 24-hour ambulatory blood pressure ( BP ) is recommended for the detection of masked or white-coat hypertension. Our objective was to determine whether the magnitude of the difference between ambulatory and clinic BP s has prognostic implications. Methods and Results We included 610 participants of the AASK (African American Study of Kidney Disease and Hypertension) Cohort Study who had clinic and ambulatory BPs performed in close proximity in time. We used Cox models to determine the association between the absolute systolic BP ( SBP ) difference between clinic and awake ambulatory BPs (primary predictor) and death and end-stage renal disease. Of 610 AASK Cohort Study participants, 200 (32.8%) died during a median follow-up of 9.9 years; 178 (29.2%) developed end-stage renal disease. There was a U-shaped association between the clinic and ambulatory SBP difference with risk of death, but not end-stage renal disease. A 5- to <10-mm Hg higher clinic versus awake SBP (white-coat effect) was associated with a trend toward higher (adjusted) mortality risk (adjusted hazard ratio, 1.84; 95% CI, 0.94-3.56) compared with a 0- to <5-mm Hg clinic-awake SBP difference (reference group). A ≥10-mm Hg clinic-awake SBP difference was associated with even higher mortality risk (adjusted hazard ratio, 2.31; 95% CI, 1.27-4.22). A ≥-5-mm Hg clinic-awake SBP difference was also associated with higher mortality (adjusted hazard ratio, 1.82; 95% CI, 1.05-3.15) compared with the reference group. Conclusions A U-shaped association exists between the magnitude of the difference between clinic and ambulatory SBP and mortality. Higher clinic versus ambulatory BPs (as in white-coat effect) may be associated with higher risk of death in black patients with chronic kidney disease.
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Affiliation(s)
- Elaine Ku
- 1 Division of Nephrology Department of Medicine University of California, San Francisco San Francisco CA.,2 Division of Pediatric Nephrology Department of Pediatrics University of California, San Francisco San Francisco CA
| | - Raymond K Hsu
- 1 Division of Nephrology Department of Medicine University of California, San Francisco San Francisco CA
| | - Delphine S Tuot
- 3 Division of Nephrology Department of Medicine University of California, San Francisco Zuckerberg San Francisco General Hospital San Francisco CA
| | - Se Ri Bae
- 1 Division of Nephrology Department of Medicine University of California, San Francisco San Francisco CA
| | - Michael S Lipkowitz
- 4 Division of Nephrology and Hypertension Department of Medicine Georgetown University Washington DC
| | - Miroslaw J Smogorzewski
- 5 Division of Nephrology and Hypertension Department of Medicine University of Southern California Los Angeles CA
| | - Barbara A Grimes
- 6 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA
| | - Matthew R Weir
- 7 Division of Nephrology Department of Medicine University of Maryland Baltimore MD
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Kim S, Park JJ, Lee SA, Cho Y, Yoon YE, Oh IY, Yoon CH, Suh JW, Cho YS, Youn TJ, Cho GY, Chae IH, Lee HY, Shin J, Park S, Choi DJ. Diagnostic accuracy of manual office blood pressure measurement in ambulatory hypertensive patients in Korea. Korean J Intern Med 2018; 33:113-120. [PMID: 28602060 PMCID: PMC5768545 DOI: 10.3904/kjim.2016.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/04/2016] [Accepted: 10/05/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Currently, office blood pressure (OBP) is the most widely used method of measuring blood pressure (BP) in daily clinical practice. However, data on the diagnostic accuracy of OBP in reference to ambulatory blood pressure (ABP) are scarce in Korea. METHODS In retrospective and prospective cohorts, manual OBP and ABP measurements were compared among ambulatory hypertensive patients. Hypertension was defined as systolic OBP ≥ 140 mmHg and/or diastolic OBP ≥ 90 mmHg, and systolic ABP ≥ 130 mmHg and/or diastolic ABP ≥ 80 mmHg. RESULTS In the retrospective cohort (n = 903), the mean OBP1 (before ABP measurement) was higher than ABP in both systolic (138 ± 17 mmHg vs. 123 ± 13 mmHg, p < 0.001) and diastolic (84 ± 12 mmHg vs. 78 ± 11 mmHg, p < 0.001) measurements. Interestingly, there was only a weak correlation between OBP and ABP (r2 = 0.038, p < 0.001). The overall discordance rate of OBP compared to ABP, which is the reference method for measuring BP, was 43.9%. The prospective cohort (n = 57) showed similar results. In a subgroup analysis, male patients had higher false negative results (masked or under-treated hypertension) than did female patients (26.1% vs. 17.8%, p = 0.003), whereas female patients had a higher false positive rate (white-coat or over-treated hypertension) than did male patients (28.7% vs. 15.2%, p < 0.001). CONCLUSIONS The diagnostic accuracy of manual OBP is low in reference to ABP. Men and women have different patterns of discordance. These findings indicate that management of hypertensive patients with manual OBP measurements may be suboptimal and encourages the use of ABP in ambulatory hypertensive patients.
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Affiliation(s)
- Sehun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung-Ah Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeonyee E. Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to Dong-Ju Choi, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7007 Fax: +82-31-787-7041 E-mail:
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Bloomfield DA, Park A. Decoding white coat hypertension. World J Clin Cases 2017; 5:82-92. [PMID: 28352632 PMCID: PMC5352963 DOI: 10.12998/wjcc.v5.i3.82] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/13/2016] [Accepted: 12/01/2016] [Indexed: 02/05/2023] Open
Abstract
There is arguably no less understood or more intriguing problem in hypertension that the "white coat" condition, the standard concept of which is significantly blood pressure reading obtained by medical personnel of authoritative standing than that obtained by more junior and less authoritative personnel and by the patients themselves. Using hospital-initiated ambulatory blood pressure monitoring, the while effect manifests as initial and ending pressure elevations, and, in treated patients, a low daytime profile. The effect is essentially systolic. Pure diastolic white coat hypertension appears to be exceedingly rare. On the basis of the studies, we believe that the white coat phenomenon is a common, periodic, neuro-endocrine reflex conditioned by anticipation of having the blood pressure taken and the fear of what this measurement may indicate concerning future illness. It does not change with time, or with prolonged association with the physician, particularly with advancing years, it may be superimposed upon essential hypertension, and in patients receiving hypertensive medication, blunting of the nighttime dip, which occurs in about half the patients, may be a compensatory mechanisms, rather than an indication of cardiovascular risk. Rather than the blunted dip, the morning surge or the widened pulse pressure, cardiovascular risk appears to be related to elevation of the average night time pressure.
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Yoon IC, Choi HM, Oh DJ. Which dialysis unit blood pressure is the most accurate for predicting home blood pressure in patients undergoing hemodialysis? Korean J Intern Med 2017; 32:117-124. [PMID: 27052263 PMCID: PMC5214727 DOI: 10.3904/kjim.2015.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/25/2015] [Accepted: 10/03/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We investigated which dialysis unit blood pressure (BP) is the most useful for predicting home BP in patients undergoing hemodialysis (HD). METHODS Patients undergoing HD who had been treated > 3 months were included in this study. Exclusion criteria were hospitalized patients with acute illness and changes in dry weight and anti-hypertensive drugs 2 weeks before the study. We used the dialysis unit BP recording data, such as pre-HD, intra-HD, post-HD, mean pre-HD, and post-HD (pre-post-HD), mean pre-HD, intra-HD, and post-HD (pre-intra-post-HD) BP. Home BP (the same period of dialysis unit BP) was monitored as a reference method during 2 weeks using the same automatic oscillometric device. Patients were asked to record their BP three times daily (wake up, between noon and 6:00 PM, and at bedtime). RESULTS Significant differences were detected between home systolic blood pressure (SBP) and pre-HD, post-HD, and intra-HD SBP (p = 0.003, p = 0.001, p = 0.016, respectively). In contrast, no differences were observed between home SBP and pre-intra-post-HD and pre-post-HD SBP (p = 0.235, p = 0.307, respectively). Areas under the receiver operating characteristic curve for pre-intra-post-HD and prepost-HD SBP with 2-week home BP as the reference standard were 0.812 and 0.801, respectively. CONCLUSIONS These results suggest that pre-intra-post-HD and pre-post-HD SBP had similar accuracy for predicting mean 2-week home SBP in HD patients. Therefore, pre-intra-post-HD and pre-post-HD SBP should be useful for predicting home SBP in HD patients if ambulatory or home BP measurements are unavailable.
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Affiliation(s)
| | | | - Dong-Jin Oh
- Correspondence to Dong-Jin Oh, M.D. Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, 55 Hwasu-ro 14beon-gil, Deokyang-gu, Goyang 10475, Korea Tel: +82-31-810-5420 Fax: +82-31-969-0500 E-mail:
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Inan B, Ates I, Ozkayar N, Kundi H, Topcuoglu C, Dede F, Sennaroglu E. Are increased oxidative stress and asymmetric dimethylarginine levels associated with masked hypertension? Clin Exp Hypertens 2016; 38:294-8. [PMID: 27018581 DOI: 10.3109/10641963.2015.1089883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this study, our aim was to determine total oxidative stress and asymmetric dimethylarginine (ADMA) levels in patients with masked hypertension (MHT) and to examine their association with blood pressure. METHODS Fifty patients diagnosed with MHT and 48 healthy volunteers without any known chronic diseases have been included in this study. RESULTS When compared to the control group, patients with MHT had higher levels of mean ADMA (p < 0.001), total oxidant status (TOS) (p < 0.001), and oxidative stress index (OSI) (p < 0.001), and a lower mean total antioxidant status (TAS) (p < 0.001) level. While a positive correlation was determined between the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with ADMA, TOS, and OSI levels, a negative correlation was determined with the TAS level. During the stepwise multivariable logistic regression analysis, age (OR = 1.221; p = 0.003), body mass index (OR = 1.512; p = 0.005), low density lipoprotein (OR = 0.925; p = 0.016), ADMA (OR = 1.200; p = 0.002), and OSI (OR = 3.750; p = 0.002) levels were determined to be the predictors of MHT. During the linear regression analysis, it was determined that the independent risk factors of SBP and DBP are ADMA and OSI, and the independent risk factor of TOS, OSI, and ADMA is SBP. Our study found out that oxidative stress and ADMA levels of patients with MHT are higher than those of the control group. ADMA and OSI were determined to be predictors of MHT. CONCLUSION Based on these results, it could be said that oxidative stress, and therefore the ADMA level, could have an effect on the etiopathogenesis of MHT.
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Affiliation(s)
- Bayram Inan
- a Internal Medicine Department , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Ihsan Ates
- a Internal Medicine Department , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Nihal Ozkayar
- b Nephrology Department , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Harun Kundi
- c Cardiology Department , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Canan Topcuoglu
- d Biochemistry Department , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Fatih Dede
- b Nephrology Department , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Engin Sennaroglu
- a Internal Medicine Department , Ankara Numune Training and Research Hospital , Ankara , Turkey
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Choi SI, Kim SK, Park S, Kim JH, Ihm SH, Kim GI, Kim WS, Pyun WB, Kim YM, Shin J. Prevalence of resistant hypertension and associated factors for blood pressure control status with optimal medical therapy using Korean ambulatory blood pressure monitoring registry data. Clin Hypertens 2016; 22:8. [PMID: 26893941 PMCID: PMC4750808 DOI: 10.1186/s40885-016-0045-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/21/2016] [Indexed: 12/29/2022] Open
Abstract
Background Resistant hypertension (RH) may be one of the cause of the plateau in improving the control rate in hypertension (HT) management. The misdiagnosis of RH by clinic blood pressure (BP) is important clinical problem. Aim of the study were to investigate the prevalence of RH by ambulatory blood pressure monitoring (ABPM) and the factor associated with control status of ambulatory BPs. Methods For 1230 subjects taking one or more antihypertensive medication (AHM) enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, the prevalence of RH was calculated which was defined as uncontrolled BP by three AHM classes including diuretic or BP in need of four or more AHM classes. The prevalence determined by clinic versus ambulatory BP was compared. Results The age was 59.3 ± 12.5 years, and 44.3 % were female (n = 1230). Among them 72 subjects were taking three AHM drugs including diuretics and 105 subjects were taking four or more AHM classes. With uncontrolled daytime ambulatory BP in 41 among 72 subjects, prevalence of RH was 11.9 % (146/1230). By using nighttime BP criteria, there was significant difference in the prevalence of RH for clinic versus nighttime BP (146/177 vs. 159/177, p = 0.0124). For control status of daytime BP, masked uncontrolled BP was 16.9 % and controlled BP with white-coat effect was 14.1 %. For nighttime BP control status, odd ratios for smoking (0.624), drinking (1.512), coronary artery disease (0.604), calcium antagonist (1.705), and loop diuretics (0.454) were all significant. Conclusion The prevalence itself was 11.9 % by daytime BP and it was significantly higher when using nighttime BP criteria. Control status of daytime BP was misclassified in 31.0 %. Smoking, drinking, coronary artery disease, calcium antagonist, and loop diuretics were associated with nighttime BP control status.
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Affiliation(s)
- Sung Il Choi
- Cardiology division, Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-Ku, Seoul, #133-792 South Korea
| | - Soon Kil Kim
- Cardiology division, Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-Ku, Seoul, #133-792 South Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University, School of Medicine, Seoul, Korea
| | - Ju Han Kim
- Department of Internal Medicine, Chonnam University, School of Medicine, GwangJu, Korea
| | - Sang Hyun Ihm
- Department of Internal Medicine, Catholic University, College of Medicine, Bucheon, Korea
| | - Gwang-Il Kim
- Department of Internal Medicine, Seoul National University, School of Medicine, Bundang, Korea
| | - Woo Shik Kim
- Department of Internal Medicine, Kyung Hee University, School of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jinho Shin
- Cardiology division, Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-Ku, Seoul, #133-792 South Korea
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Shin J, Park SH, Kim JH, Ihm SH, Kim KI, Kim WS, Pyun WB, Kim YM, Choi SI, Kim SK. Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group. Korean J Intern Med 2015; 30:610-9. [PMID: 26354055 PMCID: PMC4578037 DOI: 10.3904/kjim.2015.30.5.610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/22/2014] [Accepted: 09/04/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/AIMS The detection of white coat hypertension (WCH), treated normalized hypertension, and masked hypertension (MH) is important to improve the effectiveness of hypertension management. However, whether global cardiovascular risk (GCR) profile has any effect on the discordance between ambulatory blood pressure (ABP) and clinic blood pressure (CBP) is unknown. METHODS Data from 1,916 subjects, taken from the Korean Multicenter Registry for ABP monitoring, were grouped according to diagnostic and therapeutic thresholds for CBP and ABP (140/90 and 135/85 mmHg, respectively). GCR was assessed using European Society of Hypertension 2007 guidelines. RESULTS The mean subject age was 54.1 ± 14.9 years, and 48.9% of patients were female. The discordancy rate between ABP and CBP in the untreated and treated patients was 32.5% and 26.5%, respectively (p = 0.02). The prevalence of WCH or treated normalized hypertension and MH was 14.4% and 16.0%, respectively. Discordance between ABP and CBP was lower in the very high added-risk group compared to the moderate added-risk group (odds ratio [OR], 0.649; 95% confidence interval [CI], 0.487 to 0.863; p = 0.003). The prevalence of WCH or treated normalized hypertension was also lower in the very high added-risk group (OR, 0.451; 95% CI, 0.311 to 0.655). CONCLUSIONS Discordance between ABP and CBP was observed more frequently in untreated subjects than in treated subjects, and less frequently in the very high added-risk group, which was due mainly to the lower prevalence of WCH or treated normalized hypertension.
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Affiliation(s)
- Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Ha Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Hyun Ihm
- Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Shik Kim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sung-il Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Soon Kil Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Correspondence to Soon Kil Kim, M.D. Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Korea Tel: +82-31-560-2233 Fax: +82-31-560-2182 E-mail:
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Shin J, Park JB, Kim KI, Kim JH, Yang DH, Pyun WB, Kim YG, Kim GH, Chae SC. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology and diagnosis of hypertension. Clin Hypertens 2015; 21:1. [PMID: 26893915 PMCID: PMC4745140 DOI: 10.1186/s40885-014-0012-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023] Open
Abstract
The standardized techniques of blood pressure measurement in the clinic are emphasized and the indications for ambulatory and/or home blood pressure monitoring are specified more broadly. The epidemiologic findings specific to Korean population related to blood pressure are reviewed. Cardiovascular risk of hypertensive patients are stratified based upon the data of a Korean population cohort study.
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Affiliation(s)
- Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Bae Park
- Division of Cardiology, Department of Medicine, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, School of Medicine, Seoul National University, Bundang, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Wook Bum Pyun
- Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Gweon Kim
- Division of Cardiology, Department of Internal Medicine, Dongkuk University College of Medicine, Ilsan, Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Takah N, Dzudie A, Ndjebet J, Wawo G, Kamdem F, Monkam Y, Luma H, Ngu KB, Kengne AP. Ambulatory blood pressure measurement in the main cities of Cameroon: prevalence of masked and white coat hypertension, and influence of body mass index. Pan Afr Med J 2014; 19:240. [PMID: 25848455 PMCID: PMC4377287 DOI: 10.11604/pamj.2014.19.240.4887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/18/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Identifying White Coat Hypertension (WCH) may avoid inappropriate commitment of individuals to lifelong and costly blood pressure (BP) lowering medications’. We assessed the prevalence and determinants of WCH in urban clinical settings in Cameroon. Methods Participants were a consecutive sample of adults, who underwent ambulatory BP measurements (ABPM) for the diagnosis of hypertension and evaluation of treatmentin three referral cardiac clinics in the cities of Yaounde and Douala, between January 2006 and July 2011. WCH was defined as an office-based systolic (or diastolic) BP ≥ 140(90) mmHg together with an average day time ambulatory systolic (and diastolic) BP < 135(85) mmHg. Results Of the 500 participants included, 188 (37.6%) were women, 230 (46%) were nonsmokers and 53 (10.6%) had diabetes mellitus. The mean age was 51.6±10.2years. The ABPM readings were higher in men than in women (p<0.05).The prevalence of WCH was 26.4% overall, 39.3% in women and22.4% in men (p=0.01).In multivariable analysis, body mass index was the only significant determinant of WCH (Odds ratio= 1.15(95% confidence intervals: 1.00-1.43), p<0.05). Conclusion The prevalence of WCH was high in our study population and was correlated only with BMI. Accurate measurement of BP and appropriate diagnosis of hypertension using ABPM in this setting may help limiting the consequences of over estimating hypertension severity on individuals, families and health systems.
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Affiliation(s)
- Noah Takah
- Global Health Systems Solution, Limbe, Cameroon
| | - Anastase Dzudie
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Buea, Cameroon ; Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, South Africa ; Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Jules Ndjebet
- Douala cardiovascular centre of Bonapriso, Douala, Cameroon
| | - Guela Wawo
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Félicité Kamdem
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Yves Monkam
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Henry Luma
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Kathleen Blackett Ngu
- Department of Internal Medicine, Yaoundé University Teaching Hospital Yaoundé, Cameroon
| | - André Pascal Kengne
- Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, South Africa ; South African Medical Research Council of South Africa, Cape Town South Africa Department of Medicine, University of Cape Town, Cape Town, South Africa ; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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15
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Is white-coat hypertension a harbinger of increased risk? Hypertens Res 2014; 37:791-5. [DOI: 10.1038/hr.2014.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/15/2013] [Accepted: 01/01/2014] [Indexed: 11/09/2022]
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Abstract
Men have higher blood pressure than women through much of life regardless of race and ethnicity. This is a robust and highly conserved sex difference that it is also observed across species including dogs, rats, mice and chickens and it is found in induced, genetic and transgenic animal models of hypertension. Not only do the differences between the ovarian and testicular hormonal milieu contribute to this sexual dimorphism in blood pressure, the sex chromosomes also play a role in and of themselves. This review primarily focuses on epidemiological studies of blood pressure in men and women and experimental models of hypertension in both sexes. Gaps in current knowledge regarding what underlie male-female differences in blood pressure control are discussed. Elucidating the mechanisms underlying sex differences in hypertension may lead to the development of anti-hypertensives tailored to one's sex and ultimately to improved therapeutic strategies for treating this disease and preventing its devastating consequences.
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Affiliation(s)
- Kathryn Sandberg
- Center for the Study of Sex Differences in Health, Disease and Aging Georgetown University, Washington, DC 20057
| | - Hong Ji
- Center for the Study of Sex Differences in Health, Disease and Aging Georgetown University, Washington, DC 20057
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Kim SK, Bae JH, Nah DY, Lee DW, Hwang TY, Lee KS. Frequency and related factors of masked hypertension at a worksite in Korea. J Prev Med Public Health 2011; 44:131-9. [PMID: 21617339 PMCID: PMC3249249 DOI: 10.3961/jpmph.2011.44.3.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Masked hypertension is associated with metabolic risks and increased risk of cardiovascular disease. The purpose of this study was to identify the frequency of and risk factors of masked hypertension in Korean workers. Methods The study was conducted among 121 employees at a hotel in Gyeongju, Korea, from December 2008 to February 2009. We measured blood pressure (BP) both in the clinic and using 24-hour ambulatory BP monitors for all subjects. Hypertension was defined independently by both methods, and subjects were classified into four groups: true normotension, masked hypertension, white coat hypertension, and sustained hypertension. Results The frequency of masked hypertension in our study group was 25.6%. Compared with true normotension, the factors related to masked hypertension were male gender (odds ratio [OR], 10.7; 95% confidence interval [CI], 1.41 to 81.09), aging one year (OR, 0.88; 95% CI, 0.78 to 0.99), clinic BP 120-129/80-84 mmHg (OR, 8.42; 95% CI, 1.51 to 46.82), clinic BP 130-139 / 85-89 mmHg (OR, 12.14; 95% CI, 1.80 to 81.85), smoking (OR, 5.51; 95% CI, 1.15 to 26.54), and increase of total cholesterol 1 mg / dL (OR, 1.05; 95% CI, 1.02 to 1.08). In males only, these factors were clinic BP 120-129 / 80-84 mmHg (OR, 15.07; 95% CI, 1.55 to 146.19), clinic BP 130-139 / 85-89 mmHg (OR, 17.16; 95% CI, 1.56 to 189.45), smoking (OR, 11.61; 95% CI, 1.52 to 88.62), and increase of total cholesterol 1 mg/dL (OR, 1.05; 95% CI, 1.01 to 1.09). Conclusions The frequency of masked hypertension was high in our study sample. Detection and management of masked hypertension, a known strong predictor of cardiovascular risk, could improve prognosis for at-risk populations.
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Affiliation(s)
- Sang-Kyu Kim
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
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Abramson JL, Lewis C, Murrah NV. Relationship of self-reported alcohol consumption to ambulatory blood pressure in a sample of healthy adults. Am J Hypertens 2010; 23:994-9. [PMID: 20489685 DOI: 10.1038/ajh.2010.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Habitual alcohol consumption has shown positive associations with office blood pressure (BP). Less well established, however, is alcohol consumption's relationship to various measures of ambulatory BP (ABP) in healthy, normotensive persons. METHODS We investigated alcohol consumption's relationship to mean ABP, ABP variability, and the ABP arterial stiffness index in a sample of nonsmoking adults who were free of hypertension and cardiovascular disease (CVD; n = 157). Total alcohol consumption, intake of specific alcoholic beverages, and binge drinking were assessed by self-report. ABP was measured every 30 min for 24 h. RESULTS In multivariable-adjusted linear regression models, higher levels of total weekly alcohol consumption were associated with higher ABP. For those consuming 0, 1-2, and 3 or more alcoholic drinks per week, mean 24-h systolic ABP values were 112.2, 115.2, and 116.6 mm Hg, respectively (P = 0.05), and mean 24-h diastolic ABP values were 70.6, 71.9, and 74.2 mm Hg, respectively (P = 0.02). Beer and liquor consumption showed stronger positive associations with ABP than did wine consumption. Among nonbinge drinkers and binge drinkers, mean 24-h systolic ABP values were 113.3 and 118.6 mm Hg, respectively (P = 0.04) and mean 24-h diastolic ABP values were 71.3 and 75.0 mm Hg, respectively (P = 0.04). Alcohol consumption was not significantly related to ABP variability or the ABP arterial stiffness index. CONCLUSION Total habitual alcohol consumption, consumption of specific alcoholic drinks, and binge drinking are associated with higher mean ABP in healthy, normotensive adults.
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Sabater-Hernández D, Fikri-Benbrahim O, Faus MJ. Utilidad de la monitorización ambulatoria de la presión arterial en la toma de decisiones clínicas. Med Clin (Barc) 2010; 135:23-9. [DOI: 10.1016/j.medcli.2009.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
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Ben-Dov IZ, Bursztyn M. Ambulatory blood pressure monitoring in childhood and adult obesity. Curr Hypertens Rep 2009; 11:133-42. [DOI: 10.1007/s11906-009-0024-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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