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Yeo JJP, Yeo LS, Tan SSN, Delailah DDRA, Lee SWH, Hu ATH, Foo DHP, Sahiran F, Yap IKS, Fong AYY. Prevalence of true resistant hypertension in those referred for uncontrolled hypertension in Malaysia: A comparison using different definitions. Hypertens Res 2024; 47:352-357. [PMID: 37673957 DOI: 10.1038/s41440-023-01418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
Resistant hypertension is a well-recognised clinical challenge. However, the definition and epidemiology of true resistant hypertension (RH) are less understood, especially in Asia. This cross-sectional study examined the prevalence of RH referred from primary care clinics based on various guidelines. RH was defined as blood pressure (BP) being above the threshold using ambulatory blood pressure monitoring despite adequate lifestyle measures and optimal treatment with ≥3 medications at maximally tolerated doses. Between one in four (n = 94, 24.0% using Malaysian guidelines) and up to two-thirds (n = 249, 63.7% using 2018 American guidelines) of adults referred for uncontrolled hypertension met the criteria of true RH. Of those with RH, a further one-quarter (n = 26, 26.6%) were deemed to have refractory hypertension (elevated BP despite treatment with at least 5 antihypertensive medications). Adults with RH were generally younger, more likely to be male, had a higher BMI and were more likely to have gout, CKD, and angina compared to those with controlled hypertension. The prevalence of RH amongst Asian adults with poor hypertension control is high. A concerted effort is needed to reduce the high burden of RH, especially among this population.
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Affiliation(s)
- John Jui Ping Yeo
- Clinical Research Center, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia
| | - Leh Siang Yeo
- Clinical Research Center, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia
| | - Shirley Siang Ning Tan
- Clinical Research Center, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia
| | | | | | - Anna Ting Huey Hu
- Clinical Research Center, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia
| | - Diana Hui Ping Foo
- Clinical Research Center, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia
| | - Faiz Sahiran
- Klinik Kesihatan Petra Jaya, Ministry of Health Malaysia, Sarawak, Malaysia
| | | | - Alan Yean Yip Fong
- Clinical Research Center, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia.
- Department of Cardiology, Sarawak Heart Center, Kota Samarahan, Malaysia.
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Foo DHP, Law WC, Wong SC, Tay JS, Ng BHS, Chunggat J, Yeo JJP, Jong RHC, Sulaiman MNA, Igo M, Gan KX, Then LYY, Ho KH, Koh KT, Fong AYY. Comparison of adhesive single-lead cardiac ECG patch device with Holter monitoring for detecting atrial fibrillation after an acute cerebral ischemic event: An interim analysis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Malaysia
Background
Stroke secondary to atrial fibrillation (AF) is common and often associated with higher risk of stroke recurrence. Detection of AF is challenging due to brief unpredictable episodes of AF runs, especially in patients whose admission electrocardiogram (ECG) demonstrates a sinus rhythm. Probability of AF detection may be higher with early initiation of prolonged ECG monitoring.
Purpose
To compare diagnostic yield of 7-day cardiac ECG patch versus 24-hour Holter monitoring for detecting AF≥30 seconds; to identify predictors of AF in stroke patients; to determine if 7-day cardiac ECG patch results in a change in clinical practice.
Methods
In this investigator-initiated prospective study with pairwise comparison of 24-hour Holter and 7-day cardiac ECG patch monitoring, 150 patients who were admitted to a tertiary referral centre with acute ischemic stroke (AIS) or transient ischemic attack (TIA) within 1 week, without known AF, and had sinus rhythm in the admission 12-lead ECG were enrolled. Each patient underwent simultaneous 24-hour Holter and 7-day cardiac ECG patch monitoring. Routine transthoracic echocardiography was performed on each patient to assess cardiac function and exclude intracardiac thrombus.
Results
There were 102 (68.0%) male patients. 12 (8.0%) patients had underlying history of coronary artery disease; 26 (17.3%) had recurrent stroke or TIA. On admission, median NIH Stroke scale was 4; 18 (12.0%) patients had thrombolysis with alteplase. On transthoracic echocardiography, none had intracardiac thrombus.
Both Holter and cardiac ECG patch monitoring were initiated simultaneously at median 2 days after index stroke event. Of 150 patients, 17 (11.3%) detected AF ≥30 seconds. Of these 17 patients, 7 (4.7%) had AF detected within the first 24 hours on both Holter and cardiac ECG patch; 10 (6.7%) were detected after 24 hours on cardiac ECG patch only. Number needed to screen to detect one AF was 6. Compliance to 7-day cardiac ECG patch monitoring was 81.3%.
There was no significant difference in age among patients with and without AF. Although left atrium (LA) was not found to be dilated in patients with AF, LA volume index was significantly higher (28.3±15.9 vs 21.8±8.5, p=0.018) and LA emptying fraction (LAEF) was significantly lower (38.0%±30.2 vs 52.6%±16.7, p=0.007). The prolonged 7-day cardiac ECG monitoring patch resulted in 1.5-fold increase in prescription of anticoagulation therapy.
Conclusions
A 7-day cardiac ECG patch monitoring detected more patients with AF ≥30 seconds than 24-hour Holter monitoring and resulted in increase in prescription of anticoagulation therapy. Higher LA volume index and lower LA emptying fraction were predictors of AF in patients with a recent stroke.
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Affiliation(s)
- D H P Foo
- Sarawak General Hospital, Clinical Research Centre , Kuching , Malaysia
| | - W C Law
- Sarawak General Hospital, Neurology Unit , Kuching , Malaysia
| | - S C Wong
- Sarawak General Hospital, Neurology Unit , Kuching , Malaysia
| | - J S Tay
- Sarawak General Hospital, Neurology Unit , Kuching , Malaysia
| | - B H S Ng
- Sarawak General Hospital, Neurology Unit , Kuching , Malaysia
| | - J Chunggat
- Sarawak General Hospital, Clinical Research Centre , Kuching , Malaysia
| | - J J P Yeo
- Sarawak General Hospital, Clinical Research Centre , Kuching , Malaysia
| | - R H C Jong
- Sarawak General Hospital, Clinical Research Centre , Kuching , Malaysia
| | - M N A Sulaiman
- Sarawak General Hospital, Clinical Research Centre , Kuching , Malaysia
| | - M Igo
- Sarawak General Hospital, Clinical Research Centre , Kuching , Malaysia
| | - K X Gan
- Sarawak General Hospital, Neurology Unit , Kuching , Malaysia
| | - L Y Y Then
- Sarawak General Hospital, Neurology Unit , Kuching , Malaysia
| | - K H Ho
- Sarawak Heart Center, Department of Cardiology , Kuching , Malaysia
| | - K T Koh
- Sarawak Heart Center, Department of Cardiology , Kuching , Malaysia
| | - A Y Y Fong
- Sarawak General Hospital, Clinical Research Centre , Kuching , Malaysia
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