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Guo CY, Wu MY, Cheng HM. The Comprehensive Machine Learning Analytics for Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094943. [PMID: 34066464 PMCID: PMC8124765 DOI: 10.3390/ijerph18094943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Background: Early detection of heart failure is the basis for better medical treatment and prognosis. Over the last decades, both prevalence and incidence rates of heart failure have increased worldwide, resulting in a significant global public health issue. However, an early diagnosis is not an easy task because symptoms of heart failure are usually non-specific. Therefore, this study aims to develop a risk prediction model for incident heart failure through a machine learning-based predictive model. Although African Americans have a higher risk of incident heart failure among all populations, few studies have developed a heart failure risk prediction model for African Americans. Methods: This research implemented the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression, support vector machine, random forest, and Extreme Gradient Boosting (XGBoost) to establish the Jackson Heart Study's predictive model. In the analysis of real data, missing data are problematic when building a predictive model. Here, we evaluate predictors' inclusion with various missing rates and different missing imputation strategies to discover the optimal analytics. Results: According to hundreds of models that we examined, the best predictive model was the XGBoost that included variables with a missing rate of less than 30 percent, and we imputed missing values by non-parametric random forest imputation. The optimal XGBoost machine demonstrated an Area Under Curve (AUC) of 0.8409 to predict heart failure for the Jackson Heart Study. Conclusion: This research identifies variations of diabetes medication as the most crucial risk factor for heart failure compared to the complete cases approach that failed to discover this phenomenon.
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Wu HK, Chang MY, Cheng HM, Hsu PC, Lo LC, Chen LC, Lin KP, Chang HH. Low central blood pressure and sympathetic activity predispose for the development of intradialytic hypotension. Medicine (Baltimore) 2021; 100:e25299. [PMID: 33832099 PMCID: PMC8036036 DOI: 10.1097/md.0000000000025299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
Intradialytic hypotension (IDH) may lead to a poor life quality and was associated with cardiovascular mortality in patients under hemodialysis. This study investigated the autonomic nerve and cardiovascular function in the IDH episodes.In this case-control study, 70 end stage renal disease patients (198 visits) were recruited. Pulse wave analysis and heart rate variability were evaluated before hemodialysis. Two definitions of IDH were confirmed by medical records. IDH-f indicated a drop of systolic blood pressure or mean arterial pressure, accompanied with symptoms; IDH-n indicated a low nadir systolic pressure during the hemodialysis. All parameters were evaluated for the possible predisposing factors under each definition.A total of 24 IDH-f and 37 IDH-n were noted in 177 visits. For both definitions, central pulse pressure seemed to be a consistent predisposing factor. Furthermore, lower sympathetic activity (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.35-0.87), lower pulse pressure (OR 0.95; 95% CI 0.92-0.98), and higher augmentation index (OR 17.36; 95% CI 1.48-204.10) were the possible predisposing factors for IDH-f. On the contrary, lower mean arterial pressure (OR 0.87; 95% CI 0.78-0.98) was identified as the possible factor for IDH-n.It was suggested that the lower central pulse pressure and sympathetic activity might be involved in the development of IDH.
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Verma N, Rastogi S, Chia YC, Siddique S, Turana Y, Cheng HM, Sogunuru GP, Tay JC, Teo BW, Wang TD, Tsoi KKF, Kario K. Non-pharmacological management of hypertension. J Clin Hypertens (Greenwich) 2021; 23:1275-1283. [PMID: 33738923 PMCID: PMC8678745 DOI: 10.1111/jch.14236] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/01/2021] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
Hypertension is an insidious disease which predisposes to cardiovascular complications and if not treated properly can lead to various serious complications. Economic limitations, having additional benefits with few or almost no side effects have made non-pharmacological management of hypertension an attractive approach for dealing with hypertension, in developed and developing countries alike. A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials, and meta-analyses for this review paper. Lifestyle modifications including changes in the dietary pattern, adopting special diets with low sodium, saturated fat and high calcium, magnesium and potassium and trying the new methods like time restricted meal intake which work in tandem with the circadian rhythm are opening new vistas in the field of non-pharmacological management of hypertension. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, relaxation techniques of Yoga, Acupuncture, Tai chi, mindfulness-based stress-reduction program, and Transcendental Meditation. Air pollution of the surrounding air is linked with poor health outcomes and is a major contributor to the global burden of disease. Fine particulate matter <2.5 μm in diameter (PM2.5) is strongly associated with cardiovascular morbidity and mortality. Short-term PM exposure (hours to weeks) increases the likelihood of adverse cardiovascular events including myocardial infarction, stroke, and heart failure, and longer-term exposure multiplies that risk. Non-pharmacological methods should be initiated early phase of disease and should be continued with medication.
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Hoshide S, Kario K, Chia YC, Siddique S, Buranakitjaroen P, Tsoi K, Tay JC, Turana Y, Chen CH, Cheng HM, Huynh VM, Park S, Soenarta AA, Sogunuru GP, Wang TD, Wang JG. Characteristics of hypertension in obstructive sleep apnea: An Asian experience. J Clin Hypertens (Greenwich) 2021; 23:489-495. [PMID: 33705599 PMCID: PMC8029541 DOI: 10.1111/jch.14184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 12/02/2022]
Abstract
Obstructive sleep apnea (OSA) is a risk of hypertension and is associated with cardiovascular disease (CVD) incidence. In Asian countries, the prevalence of OSA is high, as in Western countries. When blood pressure (BP) is evaluated in OSA individuals using ambulatory BP monitoring (ABPM), the BP phenotype often indicates abnormal BP variability, such as increased nighttime BP or abnormal diurnal BP variation, that is, non‐dipper pattern, riser pattern, and morning BP surge, and all these conditions have been associated with increased CVD events. Asians have a higher prevalence of increased nighttime BP or morning BP surge than Westerners. Therefore, this review paper focused on OSA and hypertension from an Asian perspective to investigate the importance of the association between OSA and hypertension in the Asian population. Such abnormal BP variability has been shown to be associated with progression of arterial stiffness, and this association could provoke a vicious cycle between abnormal BP phenotypes and arterial stiffness, a phenomenon recognized as systemic hemodynamic atherothrombotic syndrome (SHATS). OSA may be one of the background factors that augment SHATS. An oxygen‐triggered nocturnal oscillometric BP measurement device combined with a pulse oximeter for continuous SpO2 monitoring could detect BP variability caused by OSA. In addition to treating the OSA, accurate and reliable detection and treatment of any residual BP elevation and BP variability caused by OSA would be necessary to prevent CVD events. However, more detailed detection of BP variability, such as beat‐by‐beat BP monitoring, would further help to reduce CV events.
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Tsoi K, Yiu K, Lee H, Cheng HM, Wang TD, Tay JC, Teo BW, Turana Y, Soenarta AA, Sogunuru GP, Siddique S, Chia YC, Shin J, Chen CH, Wang JG, Kario K. Applications of artificial intelligence for hypertension management. J Clin Hypertens (Greenwich) 2021; 23:568-574. [PMID: 33533536 PMCID: PMC8029548 DOI: 10.1111/jch.14180] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 01/13/2023]
Abstract
The prevalence of hypertension is increasing along with an aging population, causing millions of premature deaths annually worldwide. Low awareness of blood pressure (BP) elevation and suboptimal hypertension diagnosis serve as the major hurdles in effective hypertension management. The advent of artificial intelligence (AI), however, sheds the light of new strategies for hypertension management, such as remote supports from telemedicine and big data-derived prediction. There is considerable evidence demonstrating the feasibility of AI applications in hypertension management. A foreseeable trend was observed in integrating BP measurements with various wearable sensors and smartphones, so as to permit continuous and convenient monitoring. In the meantime, further investigations are advised to validate the novel prediction and prognostic tools. These revolutionary developments have made a stride toward the future model for digital management of chronic diseases.
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Chia YC, Turana Y, Sukonthasarn A, Zhang Y, Shin J, Cheng HM, Tay JC, Tsoi K, Siddique S, Verma N, Buranakitjaroen P, Sogunuru GP, Nailes J, Van Minh H, Park S, Teo BW, Chen CH, Wang TD, Soenarta AA, Hoshide S, Wang JG, Kario K. Comparison of guidelines for the management of hypertension: Similarities and differences between international and Asian countries; perspectives from HOPE-Asia Network. J Clin Hypertens (Greenwich) 2021; 23:422-434. [PMID: 33634570 PMCID: PMC8029511 DOI: 10.1111/jch.14226] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 12/14/2022]
Abstract
Guidelines on the management of hypertension have been developed by various professional bodies and institutions to primarily address the issues of diagnosis, treatment, and control in order to rationalize and improve the management of hypertension. Hypertension guidelines across the world have recently been updated following the new and controversial lower blood pressure threshold of ≥130/80 mmHg for the diagnosis of hypertension adopted by the Americans. While there are differences between the major as well as between the Asian national guidelines, there were also many similarities. This paper discusses and highlights the differences and similarities between the major international guidelines of the American College of Cardiology/American Heart Association, of the European Society of Cardiology/European Society of Hypertension, and of the International Society of Hypertension and also compares them with the Asian guidelines.
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Huang JF, Li Y, Shin J, Chia YC, Sukonthasarn A, Turana Y, Chen CH, Cheng HM, Ann Soenarta A, Tay JC, Wang TD, Kario K, Wang JG. Characteristics and control of the 24-hour ambulatory blood pressure in patients with metabolic syndrome. J Clin Hypertens (Greenwich) 2021; 23:450-456. [PMID: 33629806 PMCID: PMC8029521 DOI: 10.1111/jch.14229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 11/30/2022]
Abstract
Asian countries are facing an increasing prevalence of metabolic syndrome (MetS), which may aggravate the burden of cardiovascular diseases in this region. MetS is closely associated with ambulatory blood pressure (BP). Patients with MetS, compared to those without, had a twofold higher risk of new-onset office, home, or ambulatory hypertension. Furthermore, the risk of new-onset MetS in patients with white-coat, masked and sustained hypertension was also doubled compared to normotensives. High-risk masked hypertension and blunted nighttime BP dipping are common in patients with MetS, suggesting perfect 24-hour BP control with long-acting antihypertensive drugs and early initiation of combination therapy might be especially important for patients with MetS.
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Narita K, Hoshide S, Tsoi K, Siddique S, Shin J, Chia YC, Tay JC, Teo BW, Turana Y, Chen CH, Cheng HM, Sogunuru GP, Wang TD, Wang JG, Kario K. Disaster hypertension and cardiovascular events in disaster and COVID-19 pandemic. J Clin Hypertens (Greenwich) 2021; 23:575-583. [PMID: 33527663 PMCID: PMC8014319 DOI: 10.1111/jch.14192] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 01/18/2023]
Abstract
The incidence of large disasters has been increasing worldwide. This has led to a growing interest in disaster medicine. In this review, we report current evidence related to disasters and coronavirus disease‐2019 (COVID‐19) pandemic, such as cardiovascular diseases during disasters, management of disaster hypertension, and cardiovascular diseases associated with COVID‐19. This review summarizes the time course and mechanisms of disaster‐related diseases. It also discusses the use of information and communication technology (ICT) as a cardiovascular risk management strategy to prevent cardiovascular events. During the 2011 Great East Japan Earthquake, we used the “Disaster Cardiovascular Prevention” system that was employed for blood pressure (BP) monitoring and risk management using ICT. We introduced an ICT‐based BP monitoring device at evacuation centers and shared patients’ BP values in the database to support BP management by remote monitoring, which led to improved BP control. Effective use of telemedicine using ICT is important for risk management of cardiovascular diseases during disasters and pandemics in the future.
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Wang JG, Li Y, Chia YC, Cheng HM, Minh HV, Siddique S, Sogunuru GP, Tay JC, Teo BW, Tsoi K, Turana Y, Wang TD, Zhang YQ, Kario K. Telemedicine in the management of hypertension: Evolving technological platforms for blood pressure telemonitoring. J Clin Hypertens (Greenwich) 2021; 23:435-439. [PMID: 33484617 PMCID: PMC8029526 DOI: 10.1111/jch.14194] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/10/2021] [Indexed: 01/16/2023]
Abstract
The prevalence of hypertension is high and still increasing in almost all communities regardless of high, middle, or low income. The control rate remains low in most countries. Telemedicine offers possibilities to improve blood pressure control. The past two decades witnessed the fast evolving telecommunication from telephone transmission to smart mobile phone technology for telemedicine. There is some evidence from randomized controlled trials that telemonitoring improves blood pressure control. However, it requires co‐interventions. The emerging new technology may offer even more possibilities in telemonitoring and co‐interventions, for instance, an interactive platform between patients and health professionals for the management of hypertension. Telemedicine might ultimately change the situation of the unsatisfactory management of hypertension in many communities. It helps fully utilize antihypertensive treatment, the most effective cardiovascular prevention, to achieve the goal of ending atherosclerosis and arteriosclerosis in humans.
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Siddique S, Hameed Khan A, Shahab H, Zhang YQ, Chin Tay J, Buranakitjaroen P, Turana Y, Verma N, Chen CH, Cheng HM, Wang TD, Van Minh H, Chia YC, Kario K. Office blood pressure measurement: A comprehensive review. J Clin Hypertens (Greenwich) 2021; 23:440-449. [PMID: 33420745 PMCID: PMC8029522 DOI: 10.1111/jch.14169] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 01/05/2023]
Abstract
The conventional auscultatory methods for measuring blood pressure have been used to screen, diagnose, and manage hypertension since long. However, these have been found to be prone to errors especially the white coat phenomena which cause falsely high blood pressure readings. The Mercury sphygmomanometer and the Aneroid variety are no longer recommended by WHO for varying reasons. The Oscillometric devices are now recommended with preference for the Automated Office Blood Pressure measurement device which was found to have readings nearest to the Awake Ambulatory Blood Pressure readings. The downside for this device is the cost barrier. The alternative is to use the simple oscillometric device, which is much cheaper, with the rest and isolation criteria of the SPRINT study. This too may be difficult due to space constraints and the post‐clinic blood measurement is a new concept worth further exploration.
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Picone DS, Schultz MG, Armstrong MK, Black JA, Bos WJW, Chen CH, Cheng HM, Cremer A, Dwyer N, Hughes AD, Kim HL, Lacy PS, Laugesen E, Liang F, Ohte N, Okada S, Omboni S, Ott C, Pereira T, Pucci G, Schmieder RE, Sinha MD, Stouffer GA, Takazawa K, Roberts-Thomson P, Wang JG, Weber T, Westerhof BE, Williams B, Sharman JE. Identifying Isolated Systolic Hypertension From Upper-Arm Cuff Blood Pressure Compared With Invasive Measurements. Hypertension 2021; 77:632-639. [PMID: 33390047 DOI: 10.1161/hypertensionaha.120.16109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated systolic hypertension (ISH) is the most common form of hypertension and is highly prevalent in older people. We recently showed differences between upper-arm cuff and invasive blood pressure (BP) become greater with increasing age, which could influence correct identification of ISH. This study sought to determine the difference between identification of ISH by cuff BP compared with invasive BP. Cuff BP and invasive aortic BP were measured in 1695 subjects (median 64 years, interquartile range [55-72], 68% male) from the INSPECT (Invasive Blood Pressure Consortium) database. Data were recorded during coronary angiography among 29 studies, using 21 different cuff BP devices. ISH was defined as ≥130/<80 mm Hg using cuff BP compared with invasive aortic BP as the reference. The prevalence of ISH was 24% (n=407) according to cuff BP but 38% (n=642) according to invasive aortic BP. There was fair agreement (Cohen κ, 0.36) and 72% concordance between cuff and invasive aortic BP for identifying ISH. Among the 28% of subjects (n=471) with misclassification of ISH status by cuff BP, 20% (n=96) of the difference was due to lower cuff systolic BP compared with invasive aortic systolic BP (mean, -16.4 mm Hg [95% CI, -18.7 to -14.1]), whereas 49% (n=231) was from higher cuff diastolic BP compared with invasive aortic diastolic BP (+14.2 mm Hg [95% CI, 11.5-16.9]). In conclusion, compared with invasive BP, cuff BP fails to identify ISH in a sizeable portion of older people and demonstrates the need to improve cuff BP measurements.
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Chang SL, Kuo MJ, Lin YJ, Chen SA, Yang YY, Cheng HM, Yang LY, Kao SY, Lee FY. Virtual reality informative aids increase residents' atrial fibrillation ablation procedures-related knowledge and patients' satisfaction. J Chin Med Assoc 2021; 84:25-32. [PMID: 33230060 DOI: 10.1097/jcma.0000000000000464] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia, and increasing numbers of patients receive AF ablation nowadays. Therefore, in the cardiology division, residents need to be familiar with the AF ablation procedure-related knowledge for primary care. This study evaluated the baseline residents and patients' self-efficacy to the AF ablation procedure-related knowledge, developed the specific virtual reality (VR) informative aids, and evaluated the effects of VR training and resident-led VR aids-based patient education on their self-efficacy, in the aspects of familiarity, confidence and anxiety, and satisfaction. METHODS From 2019, April to 2020, April, this 1-year prospective prestudy and poststudy was undergone in the cardiology division. Between 2019, April and 2019, December, the experienced physicians were invited to develop VR informative aids for AF ablation procedure-related knowledge. Between January 2020 and April 2020, newly developed VR informative aids were implemented in the educational program of training rotated residents for giving patient education. RESULT A total of 20 residents and 32 patients were enrolled. The baseline self-reported self-efficacy and knowledge scores were relatively low among rotated residents and their patients. In addition to the high level of satisfaction, self-efficacy and knowledge scores of residents and their patients were increased after VR aids-based training and resident-led patient education. Higher degree of improvement in self-efficacy was noted among patients with depression/anxiety history than those without history. The follow-up assessments among residents showed that the positive effects of VR aids were sustained until 2 weeks later. CONCLUSION Overall, residents and patients reported that the VR aids increase the effectiveness of patient education, achieve the purpose of a paperless environment, and motivate them to recommend it to others. The implementation of resident-to-patient education has a positive impact on trainees and patients understanding about AF ablation procedures-related knowledge.
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Lin HF, Wang SC, Cheng HM, Sugawara J. Homebased Standing Core Exercise Training Improves Femoral Blood Flow but not Arterial Stiffness in Middle-Aged to Older Adults. Artery Res 2021. [DOI: 10.2991/artres.k.201222.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Matsubayashi H, Nagai M, Dote K, Turana Y, Siddique S, Chia YC, Chen CH, Cheng HM, Van Minh H, Verma N, Chin Tay J, Wee Teo B, Kario K. Long sleep duration and cardiovascular disease: Associations with arterial stiffness and blood pressure variability. J Clin Hypertens (Greenwich) 2020; 23:496-503. [PMID: 33377597 PMCID: PMC8029549 DOI: 10.1111/jch.14163] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/13/2020] [Accepted: 12/18/2020] [Indexed: 01/23/2023]
Abstract
Although short and long sleep duration are both risk factors of cardiovascular disease (CVD), the recent meta‐analyses have been shown that long sleep duration was closely associated with CVD mortality. While the specific mechanism underlying the association between long sleep duration and CVD remains unclear, long sleep duration was shown to be associated with arterial stiffness and blood pressure variability (BPV) in many Asian populations. This review article will focus on the pathophysiology of long sleep duration, arterial stiffness, BPV and their effects on CVD. To set the stage for this review, we first summarize the current insights for the relationship between long sleep duration and CVD in relation to arterial stiffness and BPV.
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Chuang SY, Chang HY, Tsai TY, Cheng HM, Pan WH, Chen CH. Isolated systolic hypertension and central blood pressure: Implications from the national nutrition and health survey in Taiwan. J Clin Hypertens (Greenwich) 2020; 23:656-664. [PMID: 33351260 PMCID: PMC8029537 DOI: 10.1111/jch.14105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022]
Abstract
We aimed to investigate the association between isolated systolic hypertension (ISH) and central blood pressure (BP) in a nationally representative population, with a focus on the young and middle‐aged adults (<50 years old). A total of 2029 adults without taking antihypertensive medications, aged ≥ 19 years old, participated in the 2013–2016 National Nutrition and Health Survey in Taiwan. Central and brachial BP were simultaneously measured using a cuff‐based stand‐alone central blood pressure monitor purporting to measure invasive central BP (type II device). Central hypertension was defined by central systolic (SBP)/diastolic BP (DBP) ≥130 or 90 mm Hg, and ISH was defined by brachial SBP ≥ 140 and DBP < 90 mm Hg. Overall, the prevalence rates of ISH, isolated diastolic hypertension (IDH, brachial SBP < 140 and DBP ≥ 90 mmHg), and systolic/diastolic hypertension (SDH, brachial SBP ≥ 140 and DBP ≥ 90 mmHg) were 6.51%, 1.92%, and 4.34%, respectively. ISH subjects had significantly higher central pulse pressure (PP) (62.8 ± 9.7 mm Hg for age < 50 years and 72.4 ± 13.5 mmHg for age ≥ 50 years) than those subjects with either IDH (44.7 ± 10.7 and 44.9 ± 10.6 mmHg) or SDH (55.2 ± 14.0 and 62.6 ± 17.1 mmHg). All ISH adults had central hypertension, and a higher prevalence of central obesity than the normotensives (80.95% vs. 26.15%, for age < 50 years; and 63.96% vs. 43.37% for age ≥ 50 years). All untreated subjects with ISH, whether younger or older, had central hypertension and had significantly higher central PP than those with IDH or SDH. Central obesity was one of the major characteristics of ISH, especially in the young‐ and middle‐aged adults.
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Wang TD, Lee CK, Chia YC, Tsoi K, Buranakitjaroen P, Chen CH, Cheng HM, Tay JC, Teo BW, Turana Y, Sogunuru GP, Wang JG, Kario K. Hypertension and erectile dysfunction: The role of endovascular therapy in Asia. J Clin Hypertens (Greenwich) 2020; 23:481-488. [PMID: 33314715 PMCID: PMC8029574 DOI: 10.1111/jch.14123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
The prevalence of erectile dysfunction (ED) is above 40% in both Asian and non-Asian male populations after the age of 40 years. The prevalence of ED among hypertensive patients is approximately double than that in normotensive population. Pelvic arterial insufficiency is the predominant cause of ED in men aged over 50 years. Stenosis in any segment of the iliac-pudendal-penile arterial system, which is considered an erectile-related arterial axis, could lead to ED. Pharmacotherapy with lifestyle modification is effective in alleviating sexual dysfunction, yet a substantial number of patients still develop ED. Given the established applicability of angioplasty for the entire iliac-pudendal-penile arterial system, penile duplex ultrasound, and pelvic computed tomography angiography could be considered as the routine screening tools in ED patients with poor response to phosphodiesterase-5 inhibitors. Endovascular therapy for pelvic arterial insufficiency-related ED has been shown to be a safe and effective treatment option in patients who have anatomically suitable vessels and functionally significant stenoses. Clinical improvement was achieved in over 60% of patients at one year following pelvic angioplasty in the PERFECT registry from Taiwan. A 30%-40% restenosis rate in distal internal pudendal and penile arteries remains a hurdle. Angioplasty for pelvic arterial occlusive disease could be considered as a viable approach to arteriogenic ED.
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Chang HC, Cheng HM, Chen CH, Wang TD, Soenarta AA, Turana Y, Teo BW, Tay JC, Tsoi K, Wang JG, Kario K. Dietary intervention for the management of hypertension in Asia. J Clin Hypertens (Greenwich) 2020; 23:538-544. [PMID: 33274585 PMCID: PMC8029518 DOI: 10.1111/jch.14116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
Hypertension is among the leading global risks for premature death. As the risks substantially increase along with the elevated blood pressure, a small reduction of blood pressure could have prevented numerous cardiovascular events in general population. Evidence has shown that dietary intervention is a cost-effective strategy that has been broadly advocated in the published guidelines. However, the implementation could be limited by different food cultures. This review details the mechanisms of each dietary intervention approach, evidence, and the implications in Asian populations, and the perspective of future research.
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Tsai TY, Cheng HM, Chuang SY, Chia YC, Soenarta AA, Minh HV, Siddique S, Turana Y, Tay JC, Kario K, Chen CH. Isolated systolic hypertension in Asia. J Clin Hypertens (Greenwich) 2020; 23:467-474. [PMID: 33249701 PMCID: PMC8029528 DOI: 10.1111/jch.14111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 11/04/2020] [Indexed: 01/09/2023]
Abstract
Isolated systolic hypertension (ISH) is the most common type of essential hypertension in the elderly and young adults. With rapid industrialization and population aging, the prevalence of ISH in Asia will rise substantially. Asian populations have distinct epidemiological features, risk factors and are especially vulnerable to ISH. There is a pressing need for Asian countries to formulate their unique strategies for control of ISH. In this review, we focus on the (1) epidemiology and pathophysiology, (2) risk factors and impact on outcomes, and (3) treatment goal and strategy for ISH in Asia.
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Guo CY, Chan CH, Chou YC, Sung SH, Cheng HM. A statistical predictive model consistent within a 5-year follow-up period for patients with acute heart failure. J Chin Med Assoc 2020; 83:1008-1013. [PMID: 32773590 PMCID: PMC7647426 DOI: 10.1097/jcma.0000000000000403] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute heart failure (AHF) is a major and rapidly growing health problem responsible for millions of hospitalizations annually. Due to a high proportion of in-hospital mortality and postdischarge rehospitalization and mortality, a prompt strategy for risk stratification and subsequently tailored therapy is desirable to help improve clinical outcomes. The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) and AHEAD-U (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus, U: uric acid) are popular prognostic scoring systems. However, only a specific follow-up period is considered in these systems, and whether their predictive capability is still accurate in a significantly shorter or longer follow-up period is not known. METHODS In this research, we adapted extensive statistical approaches based on the Cox model to explore consistent risk factors in various follow-up durations. Results showed that six factors, namely, hemoglobin level, age, sodium level, blood urea nitrogen level, atrial fibrillation, and high-density lipoprotein level could be used to establish a new prognostic model, which was referred to as HANBAH. For a simple clinical application, the HANBAH scoring system, with scores from 0 to 6, was developed using several statistical models. RESULTS Based on an evaluation using the conventional statistical approaches, such as the Akaike information criterion, concordance statistic, and Cox area under the curve, the HANBAH scoring system consistently outperformed other strategies in predicting short- and long-term mortality. Notably, an independent replication study also revealed similar results. In addition, a modern machine learning technique using the support vector machine confirmed its superior performance. CONCLUSION The use of the HANBAH scoring system, which is a clinically friendly tool, was proposed, and its efficacy in predicting the mortality rates of patients with AHF regardless of the follow-up duration was independently validated.
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Cheng HM, Chen CH. Measuring arterial stiffness in clinical practice: Moving one step forward. J Clin Hypertens (Greenwich) 2020; 22:1824-1826. [PMID: 32969585 DOI: 10.1111/jch.13965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022]
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Lee HY, Chen HL, Teoh JYC, Chen TC, Hao SY, Tsai HY, Huang WH, Juan YS, Cheng HM, Chang HM. Abiraterone and enzalutamide had different adverse effects on the cardiovascular system: a systematic review with pairwise and network meta-analyses. Prostate Cancer Prostatic Dis 2020; 24:244-252. [PMID: 32860011 DOI: 10.1038/s41391-020-00275-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Abiraterone and enzalutamide may increase the risk of cardiovascular events in patients with castration-resistant prostate cancer (CRPC). METHODS A comprehensive literature search was performed using a combination of keywords related to "abiraterone," "enzalutamide," "prostate cancer," and "adverse events." Phase II-IV randomized controlled trials (RCTs) on abiraterone or enzalutamide for patients with nonmetastatic or metastatic CRPC were included. Outcome measures included (1) any grade cardiac disorder, (2) severe grade cardiac disorder, (3) any grade hypertension, and (4) severe grade hypertension, as defined by the Common Terminology Criteria for Adverse Events. Pairwise meta-analysis and Bayesian network meta-analyses were performed to investigate the risk ratios (RRs) of abiraterone and enzalutamide. Surface under cumulative ranking curves (SUCRAs) and cumulative ranking probability plots based on the probability of developing cardiac disorders or hypertension were presented. RESULTS A total of 7103 patients from seven RCTs were included. Upon pairwise meta-analysis, abiraterone was associated with increased risks of any grade (RR = 1.34, 95% confidence interval (CI) = 1.05-1.73) and severe grade cardiac disorders (RR = 1.71, 95% CI = 1.16-2.53); enzalutamide was associated with increased risks of any grade (RR = 2.66, 95% CI = 1.93-3.66) and severe grade hypertension (RR = 2.79, 95% CI = 1.86-4.18). Based on the SUCRA rankings, abiraterone had a higher probability of cardiac disorders (84.84% for any grade and 85.12% for severe grade) than enzalutamide (62.83% for any grade and 50.76% for severe grade); whereas enzalutamide had a higher probability of hypertension (99.43% for any grade and 89.71% for severe grade) than abiraterone (49.08% for any grade and 49.37% for severe grade). CONCLUSIONS Abiraterone and enzalutamide had different adverse effects on the cardiovascular system. We should take this into consideration when we are deciding on the choice of novel hormonal agents for patients with CRPC.
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Chang HC, Huang CJ, Cheng HM, Yu WC, Chiang CE, Sung SH, Chen CH. Nocturnal thoracic volume overload and post-discharge outcomes in patients hospitalized for acute heart failure. ESC Heart Fail 2020; 7:2807-2817. [PMID: 32681759 PMCID: PMC7524107 DOI: 10.1002/ehf2.12881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 01/11/2023] Open
Abstract
Aims Volume overload and perturbations of pulsatile haemodynamics may precipitate acute heart failure (AHF). Nocturnal thoracic volume overload due to rostral fluid shift during recumbency undetected by daytime measures may impact nighttime haemodynamics and post‐discharge outcomes. Methods and results A total of 63 patients (median 60 years, 79.4% men, and left ventricular ejection fraction 29.4%) hospitalized for AHF were enrolled. Once clinical euvolaemia was achieved, noninvasive pulsatile haemodynamics were assessed during daytime followed by circadian monitoring (6 p.m. to 5 a.m.) of thoracic fluid content and thoracic fluid content index (TFCi) using impedance cardiography, normalized electromechanical activation time ratio (EMAT%) using acoustic cardiography, and mean blood pressure using ambulatory blood pressure monitoring before discharge. The primary endpoints were composited of the first hospitalization for heart failure and death from any cause. Patients were also followed for the repeated heart failure hospitalizations. During a median follow‐up duration of 16 months, 33 patients encountered primary composite endpoints (52.4%), and there were 42 hospitalizations developed among 25 patients. An overnight increase in TFCi along with persistently prolonged EMAT% and low mean blood pressure was observed in the eventful group. Overnight increase in TFCi (ΔTFCi, the difference between the measures at 4 a.m. and 6 p.m.) was an independent predictor of primary composite events (hazard ratio and 95% confidence interval: 1.58, 1.07–2.33; P = 0.022) and recurrent composite events (2.22, 1.51–3.26; P < 0.001), after adjusting for potential confounding factors. A high ΔTFCi (≥0.5/kΩ/m2) significantly correlated with higher post‐discharge events (hazard ratio 6.25; 95% confidence interval 2.30–16.96; P < 0.001) in comparison with a low ΔTFCi (<0.5/kΩ/m2). ΔTFCi was significantly associated with EMAT%, estimated glomerular filtration rate, and left ventricular ejection fraction, but not with parameters of pulsatile haemodynamics. Conclusions Nocturnal thoracic volume overload in AHF before discharge, indicating the presence of residual volume overload unidentified by daytime measures, may predict post‐discharge outcomes.
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Chiang CE, Ueng KC, Chao TH, Lin TH, Wu YJ, Wang KL, Sung SH, Yeh HI, Li YH, Liu PY, Chang KC, Shyu KG, Huang JL, Tsai CD, Hung HF, Liu ME, Chao TF, Cheng SM, Cheng HM, Chu PH, Yin WH, Wu YW, Chen WJ, Lai WT, Lin SJ, Yeh SJ, Hwang JJ. 2020 Consensus of Taiwan Society of Cardiology on the pharmacological management of patients with type 2 diabetes and cardiovascular diseases. J Chin Med Assoc 2020; 83:587-621. [PMID: 32628427 DOI: 10.1097/jcma.0000000000000359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The global incidence and prevalence of type 2 diabetes have been escalating in recent decades. The total diabetic population is expected to increase from 415 million in 2015 to 642 million by 2040. Patients with type 2 diabetes have an increased risk of atherosclerotic cardiovascular disease (ASCVD). About two-thirds of patients with type 2 diabetes died of ASCVD. The association between hyperglycemia and elevated cardiovascular (CV) risk has been demonstrated in multiple cohort studies. However, clinical trials of intensive glucose reduction by conventional antidiabetic agents did not significantly reduce macrovascular outcomes.In December 2008, U.S. Food and Drug Administration issued a mandate that every new antidiabetic agent requires rigorous assessments of its CV safety. Thereafter, more than 200,000 patients have been enrolled in a number of randomized controlled trials (RCTs). These trials were initially designed to prove noninferiority. It turned out that some of these trials demonstrated superiority of some new antidiabetic agents versus placebo in reducing CV endpoints, including macrovascular events, renal events, and heart failure. These results are important in clinical practice and also provide an opportunity for academic society to formulate treatment guidelines or consensus to provide specific recommendations for glucose control in various CV diseases.In 2018, the Taiwan Society of Cardiology (TSOC) and the Diabetes Association of Republic of China (DAROC) published the first joint consensus on the "Pharmacological Management of Patients with Type 2 Diabetes and Cardiovascular Diseases." In 2020, TSOC appointed a new consensus group to revise the previous version. The updated 2020 consensus was comprised of 5 major parts: (1) treatment of diabetes in patients with multiple risk factors, (2) treatment of diabetes in patients with coronary heart disease, (3) treatment of diabetes in patients with stage 3 chronic kidney disease, (4) treatment of diabetes in patients with a history of stroke, and (5) treatment of diabetes in patients with heart failure. The members of the consensus group thoroughly reviewed all the evidence, mainly RCTs, and also included meta-analyses and real-world evidence. The treatment targets of HbA1c were finalized. The antidiabetic agents were ranked according to their clinical evidence. The consensus is not mandatory. The final decision may need to be individualized and based on clinicians' discretion.
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Wang YC, Lin LS, Cheng HM, Lin HF. Hemodynamics Between Post-exercise Hypotension Responders And Non-responders After Maximal Exercise. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000682864.20820.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Huang WM, Cheng HM, Yu WC, Guo CY, Chiang CE, Chen CH, Sung SH. The ventilatory abnormalities and prognostic values of H 2 FPEF score in dyspnoeic patients with preserved left ventricle systolic function. ESC Heart Fail 2020; 7:1872-1879. [PMID: 32488965 PMCID: PMC7373923 DOI: 10.1002/ehf2.12754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is one of the major diagnoses in dyspnoeic subjects, and H2 FPEF score enables robust differentiation of HFpEF. Given ventilatory abnormalities prevail in subjects with HFpEF, the associations between H2 FPEF score and pulmonary function remain to be elucidated. METHODS AND RESULTS Subjects who presented with exertional dyspnoea and had left ventricular ejection fraction of >50% were eligible for this study. Total lung capacity, forced expiratory volume in the 1 s, and forced vital capacity (FVC) were obtained by pulmonary function tests. Pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM) were measured by echocardiogram. Among a total of 5849 participants (65.6 ± 6.4 years, 54% men), 2453 (41.9%) had low H2 FPEF score (0 ~ 1) and 160 (2.7%) had high H2 FPEF score,6~9 respectively. Subjects with high H2 FPEF score were older and had higher proportion of restrictive and obstructive defect, more morbidities, poorer renal function, lower haemoglobin, higher LVM, E/e' ratio, and PASP. During a mean follow-up duration of 30.0 ± 20.5 months, the H2 FPEF score was significantly associated with mortality [hazard ratio and 95% confidence intervals, 1.063(1.010-1.18)], independent of sex, haemoglobin, renal function, LVM, and comorbidities. CONCLUSIONS Either obstructive or restrictive ventilation defects prevail in subjects with high H2 FPEF score, indicating chronic obstructive pulmonary disease (COPD) is commonly associated with HFpEF. In addition, H2 FPEF score was correlated with long-term survival in dyspnoeic subjects with or without concomitant diseases of HFpEF and COPD.
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