Prevalence of prehypertension and hypertension in a Korean population: Korean National Health and Nutrition Survey 2001

Etiological distribution of isolated oculomotor nerve palsy: analysis of 633 patients and literature review

BACKGROUND AND PURPOSE

The etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of isolated oculomotor nerve palsy by recruiting patients from all departments in a referral-based university hospital.

METHODS

The medical records of 672 patients who had a confirmed diagnosis of isolated oculomotor nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020 were reviewed. A proportion of the etiology of isolated oculomotor nerve palsy was also compared with that of patients pooled from the previous studies that were searched on PubMed in May 2022.

RESULTS

The most common etiology was microvascular (n = 168, 26.5%), followed by vascular anomalies (n = 110, 17.4%), neoplastic (n = 86, 13.6%), inflammatory (n = 79, 12.5%), idiopathic (n = 60, 9.5%) and traumatic (n = 53, 8.4%). Neurologists were mainly involved in the management of microvascular and inflammatory oculomotor nerve palsies whilst ophthalmologists mainly participated in the care of idiopathic, neoplastic and traumatic palsies. Neurosurgeons mostly took care of oculomotor nerve palsy due to vascular anomalies.

CONCLUSIONS

The proportion of etiologies of isolated oculomotor nerve palsy may differ according to the specialties involved in the management. The results of previous studies on the etiological distribution of isolated oculomotor nerve palsy should be interpreted with this consideration.

Effectiveness of multi-component modular intervention among adults with prehypertension in a village of Dakshina Kannada district - a community-based interventional study - protocol

INTRODUCTION

The Joint National Committee (JNC 7) report on Prevention, Detection, Evaluation, and Treatment of Hypertension, defined "prehypertension," as individuals with a Systolic Blood Pressure (SBP) in the range of 120-139 mmHg and a (diastolic blood pressure) DBP of 80-89 mmHg. Prehypertension is directly linked with hypertension which is a precursor of CVDs. Owing to its high conversion rate to hypertension, it is important to identify individuals with blood pressures in this category and bring about lifestyle modifications in them that can prevent them from being hypertensive and from developing cardiovascular diseases later in life.

METHODS

This randomized controlled trial will be done among the selected pre-hypertensive adults of all genders residing in Kateel Gram panchayat, Dakshina Kannada district, Karnataka. A baseline survey will be done initially to assess the level of prehypertension among the study population. To study the effectiveness of the intervention, 142 individuals will be randomly allocated using block randomization technique to intervention and control groups. A multi-component module (educational intervention) will be developed, validated, and administered to participants in the intervention group, while the control group receives standard care. Each participant will then be followed up once in four months till the end of the study period of one year to assess for changes in SBP, DBP, WHR, BMI, stress levels, and usage of tobacco and alcohol.

ETHICS AND DISSEMINATION

Institutional Ethics Committee approval was obtained from Kasturba Medical College in Mangalore, India. The plans for dissemination of findings include presenting at scientific conferences and publishing in scholarly journals.

Etiologic Distribution of Isolated Trochlear Palsy: Analysis of 1,020 Patients and Literature Review

BACKGROUND AND PURPOSE

Trochlear palsy is the most common cause of vertical diplopia. The etiologies of trochlear palsy have shown a large discrepancy among the studies. This study aimed to establish the clinical features and underlying etiologies of isolated trochlear palsy by recruiting the patients from all departments in a referral-based university hospital.

METHODS

We reviewed the medical records of 1,258 patients who had a confirmed diagnosis of isolated trochlear palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020. We also compared the proportion of etiology with that of the patients pooled from the previous studies.

RESULTS

The most common etiology was congenital (n = 330, 32.4%), followed by idiopathic (n = 256, 25.1%), microvascular (n = 212, 20.8%), and traumatic (n = 145, 14.2%). These four etiologies explained 92.5% of isolated trochlear palsy. Patients were mostly managed by ophthalmologists (n = 841, 82.5%), followed by neurologists (n = 380, 37.3%), emergency physicians (n = 197, 19.3%), neurosurgeons (n = 75, 7.4%), and others (n = 18, 1.8%). The etiologic distribution of isolated trochlear palsy in the current study did not differ from that of 2,664 patients pooled from the previous studies.

CONCLUSIONS

The proportion of etiologies of isolated trochlear palsy differs according to the age ranges of the patients and specialties involved in the management. The etiologic distribution of isolated trochlear palsy in the current study was comparable to the pooled result of previous reports.

The Association between Blood Pressure Trajectories and Risk of Cardiovascular Diseases among Non-Hypertensive Chinese Population: A Population-Based Cohort Study

Although previous studies have discussed the association between trajectories of blood pressure (BP) and risk of cardiovascular diseases (CVDs), the association among the non-hypertensive general population of youth and middle age has not been elucidated. We used the growth mixture model to explore the trajectories of BP among the non-hypertensive Chinese population and applied Cox regression to evaluate the association between trajectories of BP and the risk of stroke or myocardial infarction (MI). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were categorized into three classes, respectively. Statistically significant associations were observed between SBP trajectories and stroke (range of adjusted hazard ratios (aHR): 1.369-3.837) or MI (rang of aHR = 6.047-13.017). Association between DBP trajectories and stroke (aHR: 3.685) or MI (range of aHR = 1.312-2.821) were also observed, although they did not reach statistical significance. Trajectories of SBP were more important risk factors than that of DBP in stroke and MI in our study population. BP management is important among pre-hypertensive adults to prevent stroke and MI when they age. Well-designed research with a larger sample size is required to confirm our findings and develop efficient methods to prevent CVDs.

The incidence and presumed aetiologies of fourth cranial nerve palsy in Korea: a 10-year nationwide cohort study

AIMS

To investigate the incidence and presumed aetiologies of fourth cranial nerve (CN4) palsy in Korea METHODS: Using the nationally representative dataset of the Korea National Health Insurance Service-National Sample Cohort from 2006 to 2015, newly developed CN4 palsy cases confirmed by a preceding disease-free period of ≥4 years were identified. The presumed aetiology of CN4 palsy was evaluated based on comorbidities around the CN4 palsy diagnosis.

RESULTS

Among the 1,108,292 cohort subjects, CN4 palsy newly developed in 390 patients during 10-year follow-up, and the overall incidence of CN4 palsy was 3.74 per 100,000 person-years (95% confidence interval, 3.38-4.12). The incidence of CN4 palsy showed a male preponderance in nearly all age groups, and the overall male-to-female ratio was 2.30. A bimodality by age-group was observed, with two peaks at 0-4 years and at 75-79 years. The most common presumed aetiologies were vascular (51.3%), congenital (20.0%), and idiopathic (18.5%). The incidence rate of a first peak for 0-4 years of age was 6.17 per 100,000 person-years, and cases in this group were congenital. The second peak incidence rate for 75-79 years of age was 11.81 per 100,000 person-years, and the main cause was vascular disease. Strabismus surgery was performed in 48 (12.3%) patients, most of whom (72.9%) were younger than 20 years.

CONCLUSION

The incidence of CN4 palsy has a male predominance in Koreans and shows bimodal peaks by age. The aetiology of CN4 palsy varies according to age-groups.

Incidence of hypertension among Asian Indians: 10 year follow up of the Chennai Urban Rural Epidemiology Study (CURES-153)

AIMS

There are very few studies on incidence of hypertension from developing countries. We report on the incidence of hypertension and its risk factors in Chennai city in southern India.

METHODS

Participants were 1691 individuals from the Chennai Urban Rural Epidemiology Study (CURES) cohorts who did not have hypertension (normotensive n = 878, prehypertension n = 813) at baseline and who were followed for a median of 9.0 years. During the follow-up, 41 with missing blood pressure values were excluded, leaving 1650 individuals for the present analysis. Incidence rates of hypertension and predictors of progression to prehypertension and/or hypertension were estimated using Cox proportional hazards model.

RESULTS

During the follow-up period, 426 out of 1650 individuals developed hypertension, giving an overall incidence of hypertension of 28.7(95%CI 26.1-31.5) per 1000 person-years. Individuals with dysglycemia at baseline had higher incident rates of hypertension. Collectively, four modifiable risk factors [pre-hypertension, dysglycemia, central obesity and physical inactivity] accounted for 87.2% of the population attributable risk of incident hypertension.

CONCLUSIONS

Higher body weight, BMI, age and dysglycemia were associated with an increased risk of incident hypertension. Prehypertension, dysglycemia, central obesity and physical inactivity accounted for 87% of incident hypertension.

Can Active Aerobic Exercise Reduce the Risk of Cardiovascular Disease in Prehypertensive Elderly Women by Improving HDL Cholesterol and Inflammatory Markers?

This study aims to verify the efficacy of exercise programs designed to prevent and treat hypertension-induced cardiovascular disease (CVD) by analyzing the effects of a 6-month active aerobic exercise program, administered to prehypertensive elderly women, on reducing the risk of developing CVD by enhancing their physical fitness level and improving the detailed markers of high-density lipoprotein cholesterol (HDL-C) and inflammatory markers. We assigned the elderly women (≥65 years) recruited into normal blood pressure (120–129/80–84; NBP, n = 18) and high-normal blood pressure (130–139/85–89; HNBP, n = 12) groups according to the European guidelines for the management of arterial hypertension. The exercise program was made up of combined workouts of elastic band resistance exercise and aerobics with dance music. The program took place three times a week for six months, with each session lasting 60 min. We measured pre- and post-intervention body composition, blood pressure, physical fitness level, blood lipids profile, HDL-C, SAA, TNF-α, IL-6, IL-4, IL-15, CRP, and HSP70 and calculated the Framingham risk scores for comparison. A significant post-intervention reduction in the mean systolic blood pressure (SBP) was observed in the HNBP group (p < 0.001), with significant increase in HDL-C (p < 0.01) and significant decrease in serum amyloid A (SAA) concentration (p < 0.01). A significant improvement in physical fitness factors such as physical efficiency index (PEI) was also observed in the HNBP group (p < 0.05). The post-intervention TNF-α, IL-6, and SAA concentrations were more significantly lower in the HNBP than in the NBP group (p < 0.05). Compared to the baseline values, a significant decrease in SAA concentration (p < 0.01) and significant increase in HSP70 concentration (p < 0.001) were observed in the HNBP group. The HNBP group’s 10-year CVD risk was also significantly reduced (p < 0.05). The pre–post differences in SBP and DBP were significantly correlated with those in the anti-inflammatory markers IL-4 and IL-15 (p < 0.01). In conclusion, the 6-month active aerobic exercise program of moderate intensity administered to prehypertensive elderly women (≥65 years) had the effect of reducing the 10-year CVD risk through a substantial reduction in SBP, overall physical fitness improvement, increase in HDL-C, decrease in SAA concentration, and substantial decrease in inflammatory biomarkers. It was also confirmed that an increase in anti-inflammatory markers, which showed a small range of increase with respect to the decrease in blood pressure, may have a major effect.

The Incidence and Etiologies of Third Cranial Nerve Palsy in Koreans: A 10-year Nationwide Cohort Study

PURPOSE

This study aimed to determine the incidence, prevalence, and etiologies of third cranial nerve (CN3) palsy in Koreans.

METHODS

Data were collected from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database of South Korea and analyzed. Incident CN3 palsy subjects in the cohort population were defined as cases occurring after the initial 4-year or longer washout period. The incidence and prevalence were analyzed by sex, age group, and year. The etiologies of CN3 palsy were evaluated using comorbidities.

RESULTS

Of 1,108,253 subjects, 387 patients were newly diagnosed with CN3 palsy between 2006 and 2015. The incidence of CN3 palsy was 3.71 per 100,000 person-years (95% confidence interval, 3.35-4.09). The incidence of CN3 palsy increased with age and accelerated after the age of 60 years. The mean male-to-female incidence ratio was 1.16. The main cause was presumed to be vascular disease (52.7%), followed by idiopathic causes (25.8%), intracranial neoplasm (7.8%), unruptured cerebral aneurysm (5.4%), and trauma (5.2%).

CONCLUSIONS

The incidence of CN3 palsy in Koreans increased with age and peaked between 75 and 79 years. The main cause of CN3 palsy was vascular disease.

Burden of prehypertension among adults in Kenya: a retrospective analysis of findings from the Healthy Heart Africa (HHA) Programme

Background

Hypertension is the leading risk factor for mortality globally. African countries, including Kenya, have a high and rising prevalence of hypertension. Prehypertension is associated with an increased risk of progression to overt hypertension and a higher risk of cardiovascular disease and mortality. Despite this, little is documented on the prevalence and distribution of prehypertension in sub-Saharan Africa. This study sought to estimate the overall burden of prehypertension in Kenyan adults enrolled in a large hypertension control programme, Healthy Heart Africa. The distribution and determinants of prehypertension in the sample were explored as secondary objectives.

Methods

This was a post hoc analysis of cross-sectional data obtained from population-level blood pressure (BP) screening of adults aged ≥18 years in the community and ambulatory care facilities in 17/47 sub-national administrative units in Kenya. All participants with a complete record for systolic and diastolic BP were included. Descriptive analyses were performed for sociodemographic characteristics. Pearson’s chi-square test was used to assess differences in categorical variables. Multivariate logistic regression analysis was performed to identify factors independently associated with prehypertension.

Results

Of 5,985,185 participant records that were included in the analysis, 34% were men (mean age: 45 [SD 2.9] years). The majority (63%) lived in rural Kenya. The prevalence of prehypertension was 54.5% and that of hypertension was 20.8%. Characteristics that were independently associated with prehypertension (adjusted odds ratio [95% CI]) included male sex (1.23 [±0.0023], p <  0.001 for all age groups > 25 years) and rural residence (1.60 [±0.023], p <  0.001).

Conclusions

Approximately one in every two Kenyan adults has prehypertension. This calls for urgent development and roll-out of a national BP screening and control programme. It also provides a strong basis for the formulation of multisectoral national policies that will ensure implementation of evidence-based, low-cost public health interventions geared towards primary prevention of hypertension, especially in population groups that are traditionally considered at low risk, such as young adults and rural residents.

The incidence and etiology of sixth cranial nerve palsy in Koreans: A 10-year nationwide cohort study

We aimed to investigate the incidence, prevalence, and etiology of sixth cranial nerve (CN6) palsy in the general Korean population. The nationally representative dataset of the Korea National Health Insurance Service–National Sample Cohort from 2006 through 2015 was analyzed. The incidence and prevalence of CN6 palsy were estimated in the cohort population, confirming that incident cases of CN6 palsy involved a preceding disease-free period of ≥4 years. The etiologies of CN6 palsy were presumed using comorbidity conditions. Among the 1,108,256 cohort subjects, CN6 palsy developed in 486 patients during the 10-year follow-up. The overall incidence of CN6 palsy was estimated to be 4.66 per 100,000 person-years (95% confidence interval [CI], 4.26–5.08) in the general population. This incidence increased with age, accelerating after 60 years of age and peaking at 70–74 years of age. The mean male-to-female incidence ratio was estimated as 1.41 in the whole population, and the incidence and prevalence of CN6 palsy showed an increasing trend over time in the study period. Surgical incidence for CN6 palsy was only 0.19 per 100,000 person-years (95% CI, 0.12–0.29). The etiologies were presumed to be vascular (56.6%), idiopathic (27.2%), neoplastic (5.6%), and traumatic (4.9%). In conclusion, the incidence of CN6 palsy increases with age, peaking at around 70 years, and shows a mild male predominance in Koreans.

Time Trends for Prostate Cancer Incidence from 2003 to 2013 in South Korea: An Age-Period-Cohort Analysis

PURPOSE

Prostate cancer (PCa) incidence is affected by aging phenomenon and performance of screening test. In United States, PCa incidence is affected by period effect of U.S. Preventive Services Task Force (USPSTF) recommendation. However, no study has reported the effect of USPSTF recommendation or aging phenomenon on PCa incidence in South Korea. Thus, the objective of this study was to investigate effects of age, period, and birth cohort on PCa incidence using age-period-cohort analysis.

Materials and Methods

Annual report of cancer statistics between 2003 and 2013 from National Health Insurance Service (NHIS) in South Korea for the number of PCa patients and Korean Statistical Information Service (KOSIS) data between 2003 and 2013 from national statistics in South Korea for the number of Korean male population were used. Age-period-cohort models were used to investigate effects of age, period, and birth cohort on PCa incidence.

RESULTS

Overall PCa incidence in South Korea was increased 8.8% in annual percentage (95% confidential interval, 6.5 to 11.2; p < 0.001). It showed an increasing pattern from 2003 to 2011 but a decreasing pattern from 2011 to 2013. Age increased the risk of PCa incidence. However, the speed of increase was slower with increasing age. PCa incidence was increased 1.4 times in 2008 compared to that in 2003 or 2013. Regarding cohort effect, the risk of PCa incidence started to increase from 1958 cohort.

CONCLUSION

PCa incidence was affected by period of specific year. There was a positive cohort effect on PCa incidence associated with age structural change.

Songling Xuemaikang capsules for patients with low-to-medium risk hypertension: study protocol for a randomized controlled trial

BACKGROUND

Hypertension is a major risk factor for cardio-cerebrovascular disease. Songling Xuemaikang capsules (SXC), a formulation of Chinese herbal patent medicine, has been used as a complementary medicine with conventional western medicine to treat patients with hypertension since 1994 in mainland China. However, the efficacy of treatment with SXC alone against hypertension remains unclear.

METHODS/DESIGN

This is a multicenter, placebo-controlled, double-blinded, randomized controlled clinical trial. A total of 570 patients with low-to-medium risk hypertension are randomized in a 1:1 ratio to receive SXC or placebo three times daily for eight weeks. The primary outcomes are 24-h average systolic blood pressure and average diastolic blood pressure. The secondary outcomes are daytime average blood pressure, night-time average blood pressure, fluctuation of blood pressure, hypertension control rate, traditional Chinese medicine (TCM) syndrome scores, and quality-of-life scores.

DISCUSSION

This is the first multicenter trial conducted to evaluate the efficacy and safety of TCM in patients with low-to-medium risk hypertension. Our study will provide evidence-based results of a complementary preventive measure for hypertension.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-IPR-17011383 . Registered on 12 May 2017.

Hypertension and Pre-Hypertension Among Iranian Adults Population: a Meta-Analysis of Prevalence, Awareness, Treatment, and Control

PURPOSE OF REVIEW

This meta-analysis and systematic review was conducted to evaluate hypertension and prehypertension prevalence, awareness, treatment, and control in Iranian adults population.

RECENT FINDINGS

In this study, six international and national databases were searched from inception until August 30, 2018. Forty-eight studies performed on 417,392 participants were included in the meta-analysis. Based on the results of random effect method (95% CI), the overall prevalence of pre-hypertension, hypertension, awareness, treatment, and control were 31.6% (95% CI 24.9, 38.3; I2 = 99.7%), 20.4% (95% CI 16.5, 24.4; I2 = 99.9%), 49.3% (95% CI 44.8, 53.8; I2 = 98.5%), 44.8% (95% CI 28.3, 61.2; I2 = 99.9%), 37.4% (95% CI 29.0, 45.8; I2 = 99.3%), respectively. Considering the increasing prevalence of pre-hypertension, hypertension, as well as more than half of the participants were unaware of their disease and were not treated, the results of the present study can help policy-makers to increase hypertension awareness, control, and treatment, especially in high-risk individuals.

Moxibustion for prehypertension and stage I hypertension: a pilot randomized controlled trial

BACKGROUND

Prehypertension and hypertension are associated with cardiovascular disease, ischemic heart disease, and stroke morbidity. The purpose of this study is to evaluate the effectiveness and safety of moxibustion in patients with prehypertension or hypertension.

METHODS

Forty-five subjects with prehypertension or stage I hypertension were randomized into three groups: moxibustion treatment group A (2 sessions/week for 4 weeks), moxibustion treatment group B (3 sessions/week for 4 weeks), and control group (nontreated group). The primary outcome measure was the change in blood pressure after 4 weeks of treatment. Safety was assessed at every visit.

RESULTS

There were no significant differences in systolic blood pressure (SBP) or diastolic blood pressure (DBP) among three groups after 4 weeks of treatment (p = 0.4798 and p = 0.3252, respectively). In treatment group B, there was a significant decrease in SBP and DBP from baseline to 4 weeks of treatment (mean difference (MD) -9.55; p = 0.0225, MD -7.55; p = 0.0098, respectively). There were no significant differences among groups in secondary outcome measures after 4 weeks of treatment. Six adverse events (AEs) in the treatment group A and 12 AEs in the treatment group B occurred related to the moxibustion treatment.

CONCLUSION

In conclusion, the results of this study show that moxibustion (3 sessions/week for 4 weeks) might lower blood pressure in patients with prehypertension or stage I hypertension and treatment frequency might affect effectiveness of moxibustion in BP regulation. Further randomized controlled trials with a large sample size on prehypertension and hypertension should be conducted.

TRIAL REGISTRATION

This study was registered with the 'Clinical Research Information Service (CRIS)', Republic of Korea (KCT0000469), and the protocol for this study was presented orally at the 15th International Council of Medical Acupuncture and Related Techniques (ICMART) in Athens, 25-27 May 2012.

A retrospective analysis of outpatient anesthesia management for dental treatment of patients with severe Alzheimer's disease

Background

The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders.

Methods

This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012–2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation.

Results

Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ≥ 6. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications.

Conclusion

With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.

Status of hypertension screening in the Korea National General Health Screening Program: a questionnaire survey on 210 screening centers in two metropolitan areas

BACKGROUND

The purpose of this survey was to evaluate the performance of hypertension screening in medical institutions conducting the national general health screening program of the Republic of Korea.

METHODS

We contacted 700 medical institutions of Seoul and Incheon areas which performed the national general health screening program in 2016, and 210 of them completed telephone survey. The questions asked in the survey include equipment, environment, personnel and quality control procedures for blood pressure (BP) measurement, and interpretation of the measurements.

RESULTS

A majority of the responding screening centers used oscilloscope sphygmomanometers (51.9%), had only one-sized cuff (65.2%), and measured BP in open space (54.3%). BP levels were measured mainly by nurses (62.0%) and doctors (25.0%), after a 1 to10 minutes (84.9%) of resting period. A 75.2% of screening centers regularly calibrated sphygmomanometers, 81.4% had a manual for BP measurement, and 59.0% had a training program. A 80.0% of respondents answered that they used averages of multiple BP measurements to determine an individual's BP level, and 82.9% answered that criteria for hypertension was systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg. If a screening finds an individual with hypertension, 82.9% of centers recommend revisiting for a second BP measurement rather than start medication immediately.

CONCLUSION

In most medical institutions performing general health screening program, certified medical personnel measure BP and interpret the results according to established protocols. However, there is room for improvement in the equipment, environment and quality control procedures for BP measurement.

Should Pre-hypertension Be Treated?

Hypertension is an important preventable risk factor for disease and death worldwide. In light of the world's population growth and aging, hypertension is a global public health issue. Many studies have shown associations between pre-hypertension and a higher risk of the future development of hypertension and cardiovascular disease in general populations. However, pre-hypertension per se is not a disease with an immediate high risk, and the clinical value of the identification of pre-hypertension is the potential detection of the early stage of the risk of hypertension and/or cardiovascular disease over an individual's lifespan. We recently assessed the impacts of age-related differences in risk factors on new-onset hypertension among normotensive individuals. As risk factors of the new onset of hypertension, the impact of diastolic blood pressure compared with systolic blood pressure (SBP), men compared with women, and higher body mass index were greater in the younger adults, whereas in the older adults, the impact of SBP and female sex were greater. Proteinuria was a risk factor for hypertension in both younger and older adults. Non-pharmacological approaches such as body weight reduction, low-salt diet, physical exercise, and good sleep hygiene should be first-line treatments for pre-hypertension. In addition, careful observation to detect the new onset of hypertension and the identification of the appropriate timing of pharmacologic treatment should be conducted, especially in adults with pre-hypertension and the risk factors mentioned above.

Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update

OBJECTIVES

The study was conducted to investigate the prevalence, awareness, treatment, control, and risk factors of hypertension in Chongqing Province in Southwest China.

METHODS

Multistage, stratified, random cluster sampling scheme was adopted to recruit representative samples. All of the selected study participants completed a questionnaire and physical examinations. Multivariable logistic regression models were used to identify the associated factors.

RESULTS

Overall, 14 420 study participants (men = 7186) above 18 years were enrolled. The overall hypertension prevalence was 23.9%, with rural residents having a higher prevalence than urban residents (26.0 vs. 21.6%, P < 0.001). The awareness, treatment, control, and control among treated patients were 44.1, 36.6, 8.5, and 23.3%, respectively. Elderly women inhabiting urban areas had better awareness and treatment. The urban and rural areas differed in control (12.9 vs. 5.1%, P < 0.001). Age, sex, alcohol consumption, family history of hypertension, overweight/obesity, visceral adipose index, and body fat percentage were identified as risk factors for hypertension in both areas. Education levels, smoking, and daily salt intake were correlated with hypertension only among rural residents, and central obesity was correlated with hypertension only among urban residents. Sex, rurality, age, education level, alcohol consumption, overweight/obesity, central obesity, visceral adipose index, and body fat percentage were identified as associated factors of awareness, treatment, and control.

CONCLUSION

During the past decade, there is an increasing prevalence of hypertension in the general population in Chongqing Province. The levels of awareness, treatment, and control have improved, but remain extremely low. More aggressive strategies should thus be adopted.

Which blood pressure measurement, systolic or diastolic, better predicts future hypertension in normotensive young adults?

The impact of age-related differences in blood pressure (BP) components on new-onset hypertension is not known. A follow-up examination of 93 303 normotensive individuals (mean age 41.1 years) who underwent a health checkup in 2005 was conducted every year for 8 years. The primary end point was new-onset hypertension (systolic BP [SBP]/diastolic BP [DBP] ≥140/90 mm Hg and/or the initiation of antihypertensive medications with self-reported hypertension). During the mean 4.9 years of follow-up, 14 590 subjects developed hypertension. The impact of DBP on the risk of developing hypertension compared with optimal BP (SBP <120 mm Hg and DBP <80 mm Hg) was significantly greater than that of SBP in subjects younger than 50 years (hazard ratios, 17.5 for isolated diastolic high-normal vs 10.5 for isolated systolic high-normal [P<.001]; 8.0 for isolated diastolic normal vs 4.1 for isolated systolic normal [P<.001]). Among the subjects 50 years and older, the corresponding effects of DBP and SBP were similar. Regarding the risk of new-onset hypertension, high DBP is more important than SBP in younger adults (<50 years) with normal or high-normal BP.

Urban and rural differences in hypertension risk factors in Turkey

Objective:

Existing literature shows considerable regional differences in terms of hypertension (HT) prevalence in Turkey. The purpose of this study was to analyze some of the known HT risk factors contributing to the variations between urban and rural areas of Turkey in HT development.

Methods:

We used data from the 2011 Chronic Diseases and Risk Factors Survey that was conducted by the Turkish Ministry of Health on a representative sample of the Turkish adult population aged 20 years or more (n=16.227). HT was defined as having at least one of the following: a mean systolic/diastolic blood pressure of at least 140/90 mm Hg, a previously diagnosed disease, or use of antihypertensive medication. Stepwise multiple logistic regression analysis was used to estimate HT risk factors in urban and rural settings.

Results:

Although the HT prevalence was higher in rural areas (28.4%) than in urban areas (23.9%), in this study, urbanization was found to be a contributing factor in multivariate regression analysis. Furthermore, separate regressions for urban and rural settings revealed that age, obesity, diabetes, hyperlipidemia, and smoking were independently and positively associated (p<0.05) with HT in both settings, while marital status, employment type, mental health, and lifestyle patterns; nutritional habits; and amount of physical activity and sedentary time (p<0.05) were risk indicators in urban areas only.

Conclusion:

The findings of our study demonstrate that contributory factors show some variations between urban and rural settings, and on gender within each setting. Taking into account the variations between urban and rural areas in HT development may provide greater insight into the design of prevention strategies.

Socioeconomic Disparities in the Prevalence, Diagnosis, and Control of Hypertension in the Context of a Universal Health Insurance System

A lower use of preventive intervention in low socioeconomic populations has been described in countries with universal coverage health care systems, but little is known about the possible socioeconomic inequalities in secondary prevention in a universal health insurance system. Data from the 2010-2013 Korea National Health and Nutrition Examination Survey, a nationwide survey, were analyzed. A total of 20,044 subjects older than 30 years of age were included after excluding subjects with missing data. Prevalence ratios were calculated using Poisson regression models with robust variance to explore factors associated with the prevalence, unawareness, and inappropriate control of hypertension. Hypertension prevalence decreased with increasing education and income level. We observed an inverse association between education level and undiagnosed hypertension among women, but not men. Socioeconomic level was not associated with inadequate control of hypertension among men or women. Future interventions should include primary prevention efforts targeted at lower socioeconomic populations to reduce disparities. There is substantial room for improvement in secondary prevention efforts. Monitoring strategies may highlight gaps in the preventive and care services offered to the most vulnerable individuals and encourage governments and practitioners to address these gaps.

Excessive Exercise Habits in Marathoners as Novel Indicators of Masked Hypertension

Background. Excessive exercise such as marathon running increases the risk of cardiovascular events that may be related to myocardial infarction and sudden death. We aimed to investigate that the exercise characteristics can be used as a novel indicator of masked hypertension. Methods. A total of 571 middle-aged recreational male marathoners were assigned to a high blood pressure group (HBPG; n = 214) or a normal blood pressure group (NBPG; n = 357). A graded exercise test was used to examine the hemodynamic response and cardiac events, and the personal exercise characteristics were recorded. Results. Systolic blood pressure and diastolic blood pressure were higher in the HBPG than in the NBPG (p < 0.05, all). The marathon history, exercise intensity, and time were longer and higher, whereas the marathon completion duration was shorter in the HBPG than in NBPG (p < 0.05, all). HBPG showed a higher frequency of alcohol consumption than NBPG (p < 0.05). Conclusion. More excessive exercise characteristics than the normative individuals. If the individuals exhibit high blood pressure during rest as well as exercise, the exercise characteristics could be used as a novel indicator for masked hypertension.

Serum uric acid level as a determinant of the metabolic syndrome: A case control study

AIMS

To determine whether elevations of uric acid levels are associated with the cluster of disorders described in metabolic syndrome and to evaluate whether hyperuricemia may be considered a component of this syndrome.

METHODS

One year case-control study was conducted in Bikaner, Rajasthan, India from January to December 2013. The study population consisted of 200 subjects, 100 with metabolic syndrome (case) and 100 without metabolic syndrome (control) aged between 18 and 80 years, attending OPD at PBM Hospital were studied. Controls were age and sex matched to the cases. Blood tests and all physical variables were examined using standard methods. Subjects were divided into 6 groups according to their possession of 0, 1, 2, 3, 4 or 5 components of the metabolic syndrome. Statistical analysis was done using ANOVA, linear regression analysis and multivariate linear regression model.

RESULTS

Mean serum UA level was significantly associated with all components of metabolic syndrome (p<0.001) and had strong positive correlation (r=+0.66 to +0.77, p<0.0001) with all of them except serum HDL with which it showed strong negative correlation(r=-0.71, p<0.0001). It increased as the number of metabolic factors increased showing a highly significant trend (p<0.0001). On multivariate regression analysis UA contributed to 66.84% variance of metabolic syndrome.

CONCLUSION

The current multivariate regression analysis clearly infers that uric acid can be considered as a marker and potential modifier of metabolic syndrome.

Pre-hypertension, pre-diabetes or both: which is best at predicting cardiovascular events in the long term?

The present study aimed to assess the value of pre-diabetes and pre-hypertension in predicting cardiovascular events. A population-based, cross-sectional survey was conducted, representing a large sample of the general Iranian population aged 35 years and older from the Isfahan Province and determined using a random, multistage cluster-sampling 10-year cohort. The five end points considered as study outcome were unstable angina (UA), acute occurrence of myocardial infarction (MI), sudden cardiac death (SCD), brain stroke and cardiovascular disease (CVD). Of the 6323 subjects scheduled for assessment of diabetes state 617 were diabetics and 712 were pre-diabetic. In addition, of these subjects, 1754 had hypertension and 2500 had pre-hypertension. Analysing only pre-hypertension, pre-diabetes and its combination and adjusted for gender and age variables, pre-hypertension and pre-diabetes status together, could only effectively predict occurrence of MI (hazard ratio (HR)=3.21, 95% confidence interval (CI): 1.06-9.76, P=0.04). In the same COX regression models, pre-hypertension status could predict UA and CVD occurrence (HR=2.94, 95% CI: 1.68-5.14, P<0.001 and HR=1.74, 95% CI: 1.23-2.47, P=0.002, respectively). However, pre-diabetes status could not predict any of these events after adjustment for gender and age. Our data provide valuable evidence of the triggering role of pre-hypertension and pre-diabetes together, on appearance and progression of MI even in healthy individuals and the significant predicting value of pre-hypertension on the occurrence of UA and CVD. In this regard, the value of pre-hypertension and pre-diabetes together, and the pre-hypertension state alone, are clearly superior to pre-diabetes state alone in predicting cardiovascular events.

The prevalence and heterogeneity of prehypertension: a meta-analysis and meta-regression of published literature worldwide

Objective

Prehypertension appears to be a precursor of hypertension and has been recognised as a major risk factor for cardiovascular disease (CVD). Recognition of prehypertension provides important opportunities for preventing hypertension and CVD. We aimed to investigate the world-wide prevalence and heterogeneity of prehypertension.

Methods

We performed a meta-analysis of cross-sectional studies worldwide that reported the prevalence of prehypertension. We searched for publications between January 1966 and November 2010, using PubMed, Ovid and the Cochrane Library, with the keyword ‘prehypertension’, supplemented by a manual search of references from recent reviews and relevant published original studies. Pooled prevalence of prehypertension was calculated using random-effects models. Heterogeneity was investigated by subgroup analysis and meta-regression. Twenty-two articles met our inclusion criteria, with a total sample of 242 322 individuals.

Results

The overall pooled prevalence of prehypertension was 38%. Significant heterogeneity across estimates of prevalence was observed (p = 0.000, I² = 99.9%). The prevalence rose as the sample size increased, and was higher among men than women (41 vs 34%). The non-Asian population was more likely to be prehypertensive than Asian individuals (42 vs 36%). A high prevalence of 47% was observed among the black African population in the non-Asian subgroup. The inception year of the surveys was the only source of heterogeneity we found by meta-regressional analysis (p = 0.06).

Conclusion

These results indicate that the prevalence of prehypertension was relatively high, particularly among males. Although more attention has been paid to this segment of the population since 2003, additional practical and reasonable steps should be taken to prevent and treat prehypertension.

Socioeconomic status and hypertension: a meta-analysis

BACKGROUND

The relationship between socioeconomic status (SES) and hypertension has been studied in a number of reviews. However, the impact of SES on hypertension has been reported in several studies with conflicting results.

METHODS

A systematic search was performed in PubMed, Proquest and Cochrane databases for observational studies on hypertension prevalence and SES, published in English, until March 2014. Hypertension was defined as a mean SBP of at least 140 mmHg or a DBP of at least 90 mmHg, or use of antihypertensive medication. The inverse variance method with a random-effects model was used to pool the risk estimates from the individual studies. Data abstraction was conducted independently by two authors.

RESULTS

Among the 2404 references, 51 studies fulfilled the inclusion criteria. An overall increased risk of hypertension among the lowest SES was found for all three indicators: income [pooled odds ratio (OR) 1.19, 95% confidence interval (CI) 0.96-1.48], occupation (pooled OR 1.31, 95% CI 1.04-1.64) and education (pooled OR 2.02, 95% CI 1.55-2.63). The associations were significant in high-income countries, and the increased risk of hypertension for the lowest categories of all SES indicators was most evident for women, whereas men revealed less consistent associations.

CONCLUSION

Low SES is associated with higher blood pressure, and this association is particularly evident in the level of education. It is important to identify and monitor hypertension to reduce the risk of this disease among the most vulnerable groups in different countries and among different societies.

Secondary Data Analysis of National Surveys in Japan Toward Improving Population Health

Secondary data analysis of national health surveys of the general population is a standard methodology for health metrics and evaluation; it is used to monitor trends in population health over time and benchmark the performance of health systems. In Japan, the government has established electronic databases of individual records from national surveys of the population’s health. However, the number of publications based on these datasets is small considering the scale and coverage of the surveys. There appear to be two major obstacles to the secondary use of Japanese national health survey data: strict data access control under the Statistics Act and an inadequate interdisciplinary research environment for resolving methodological difficulties encountered when dealing with secondary data. The usefulness of secondary analysis of survey data is evident with examples from the author’s previous studies based on vital records and the National Health and Nutrition Surveys, which showed that (i) tobacco smoking and high blood pressure are the major risk factors for adult mortality from non-communicable diseases in Japan; (ii) the decrease in mean blood pressure in Japan from the late 1980s to the early 2000s was partly attributable to the increased use of antihypertensive medication and reduced dietary salt intake; and (iii) progress in treatment coverage and control of high blood pressure is slower in Japan than in the United States and Britain. National health surveys in Japan are an invaluable asset, and findings from secondary analyses of these surveys would provide important suggestions for improving health in people around the world.

Beta-adrenergic receptor mediated inflammation control by monocytes is associated with blood pressure and risk factors for cardiovascular disease

Overwhelming data indicate that individuals with even mildly elevated blood pressure (BP) are at great risk for developing clinical hypertension and future cardiovascular disease (CVD). There remains a lack of consensus regarding treatment strategies for mildly elevated BP, termed prehypertension, and the knowledge of pathophysiology and mechanisms of its clinical outcomes remains limited. Our primary aim was to investigate βAR-mediated inflammation control (BARIC) responses of blood monocytes to isoproterenol (Iso) in relation to BP and CVD risk factors, including obesity, depressive mood, fasting glucose, triglycerides, and cholesterol levels in the 64 prehypertensive compared to 84 individuals with normal BP. BARIC was determined by measuring the degree of inhibition in lipopolysaccharides-stimulated monocytic intracellular TNF production by ex vivo Iso treatment (10(-8)M). Depressive mood was assessed by Beck Depression Inventory (BDI). Fasting metabolic and lipid panels were assessed, and plasma levels of inflammatory cytokines TNF, IL-1β, IL-6 were measured in a subset to confirm proinflammatory state of prehypertensive participants. Prehypertensive participants were older, heavier, included more men, and presented higher levels of fasting glucose, triglycerides, cholesterol, and plasma TNF compared to normotensive participants (p's<.05). BARIC was significantly attenuated in the prehypertensive compared to normotensive group (p<.05). BARIC was negatively associated with systolic BP, diastolic BP, age, BMI, fasting glucose, triglycerides, total and low density cholesterol levels, and somatic depressive symptoms in all participants (p's<.0001 to .05). However, among the prehypertensive individuals BARIC was positively associated with SBP even after controlling for the covariates (age, gender, race, BMI, glucose and lipid panel, somatic BDI scores) (p<.05). This differing nature of the BARIC-SBP relationship between the two BP groups may be attributed to moderating factors such as cardiorespiratory fitness or depressive symptoms that could not be clearly deciphered in this current study. Nonetheless, our findings indicate the associations between inflammation dysregulation mediated by sympathoadrenal activation and BP that is observable even among individuals with normal to mildly elevated BP. BARIC may be a useful and sensitive indicator of elevated risk for vascular inflammatory disease that can be detected even at lower BP levels, especially given its associations with traditional CVD risk factors and the critical role of monocytes in atherogenic processes.

Prehypertension Tsunami: A Decade Follow-Up of an Iranian Adult Population

OBJECTIVE

Prehypertension is associated with cardiovascular disease (CVD). There is no study to examine the incidence and risk factors of prehypertension in a sex stratified setting. The aim of this study was to examine the effect modification of sex for different risk factors which predicts the progression from normotension to prehypertension in a Middle East population-based cohort, during a median follow-up of 9.2 years.

METHODS

A multivariate Cox analysis was performed among 1466 and 2131 Iranian men and women, respectively, who were free of prehypertension, hypertension, CVD and diabetes at baseline and free of incident hypertension without preceding prehypertension at follow-up. Incident prehypertension at follow-up was defined as systolic blood pressure (SBP) of 120-139 mmHg and/or diastolic blood pressure (DBP) of 80-89 mmHg.

RESULTS

Overall, 1440 new cases of prehypertension were identified resulting in an incidence rate of 593/10000 person-years; the corresponding values for women and men were 489/10000 and 764/10000person-years, respectively. There were significant interactions between gender with age, DBP, waist-to-hip-ratio (WHpR) and estimated glomerular filtration rate (eGFR) (all P-values <0.05) in multivariate analysis. Strong associations were found between age, body mass index (BMI) and SBP with incident prehypertension in both genders. However, the effect of DBP and WHpR was significant among women and 2-hour post challenge plasma glucose (2h-PCPG)was an independent risk factor for men. In the sex-adjusted analysis, glomerular hyperfiltration [Hazard ratio (HR) and 95%CI: 1.01 (1.00-1.01), P-value = 0.02], age, BMI, WHpR, SBP and DBP had higher risks while being female [HR (95%CI): 0.81(0.69-0.94), P-value = 0.01] had a lower risk for incident prehypertension.

CONCLUSION

According to this study results, among Iranian population with high incidence of prehypertension, general adiposity and glomerular hyperfiltration in total, 2h-PCPG in men and central adiposity in women should be emphasized as risk factors for prehypertension.

A randomized trial on the effects of 2010 Dietary Guidelines for Americans and Korean diet patterns on cardiovascular risk factors in overweight and obese adults

BACKGROUND

Dietary patterns that are considered healthy (eg, the Dietary Approaches to Stop Hypertension diet and Mediterranean diet) may be more successful in reducing typical cardiovascular disease risks compared to dietary patterns considered unhealthy (eg, energy-dense diets such as the typical American diet).

OBJECTIVE

This study assessed the effects of a Korean diet, the 2010 Dietary Guidelines for Americans (DGA), and a typical American diet on cardiometabolic risk factors, including lipid levels and blood pressure, in overweight, non-Asian individuals in the United States with elevated low-density lipoprotein cholesterol.

DESIGN/INTERVENTION

The study was a three-period crossover, controlled-feeding study from January 2012 to May 2012. Thirty-one subjects were randomly allocated to one of six possible sequential orders for consuming the three diets for 4 weeks, each separated by a 10-day break. Data analysis included 27 subjects on the Korean diet periods and 29 in the DGA and typical American diet periods. Subjects remained weight stable.

MAIN OUTCOME MEASURES

Lipid profile, blood pressure, insulin, glucose, and 24-hour urinary sodium were determined at baseline and at the end of each diet period.

STATISTICAL ANALYSES PERFORMED

The additive main effects multiplicative interactions model was used to test for a subject by diet interaction. Differences among diets were determined using a mixed-models procedure (PROC MIXED) with random intercept for each subject.

RESULTS

Total cholesterol and low-density lipoprotein cholesterol significantly decreased on Korean (P<0.0001 and P<0.01, respectively) and DGA (P<0.01 and P<0.05, respectively) diets, but not on the typical American diet. Although an unfavorable outcome, high-density lipoprotein cholesterol significantly decreased on all three diets (Korean: P<0.0001; DGA: P<0.0001; typical American: P<0.05). No diet had a significant effect on serum triglycerides, but a slight increase in triglycerides in the Korean and decrease in the DGA resulted in a significant difference between these two diets (P<0.01). All three diets caused modest decreases in systolic and diastolic blood pressure, which reached statistical significance for DGA only (P<0.05 and P<0.01, respectively). No diet had significant effect on fasting insulin, whereas fasting glucose decreased significantly on the Korean (P<0.01) and typical American (P<0.05) diets only. Urinary sodium output decreased significantly on DGA (P<0.0001).

CONCLUSIONS

After a 4-week feeding period, Korean and DGA diet patterns resulted in positive changes in cardiovascular disease risk factors.

Gender differences in the association between socioeconomic status and hypertension incidence: the Korean Genome and Epidemiology Study (KoGES)

Background

Hypertension is a leading cause of cardiovascular events. We examined whether there was a gender difference in the association between SES, measured by education and income, and hypertension incidence.

Methods

Data for 2596 men and 2686 women aged 40–69 years without hypertension at baseline from the Korean Genome and Epidemiology Study (KoGES) were analyzed. Participants had two follow-up examinations during 4 years, and were classified into three categories by self-reported educational attainment: ≥ 10 years, 7–9 years, and 0–6 years, and monthly household income (×10,000 Korean Won): ≥ 200, 100–199, and <100. The association between SES and incidence hypertension was examined by Cox’s proportional hazard regression analyses.

Results

Adjusting for conventional risk factors, compared with the high education group (reference), the hazard ratios (95 % confidence interval) for incident hypertension across the education categories were 1.54 (1.16–2.06) and 1.80 (1.36–2.38) in women and 1.15 (0.92–1.43), and 1.08 (0.84–1.38) in men. Women with the low household income were more likely to have hypertension than those with the high household income and incident hypertension had an inverse association with household income level in women: multivariate adjusted hazard ratios were 1.00 (reference), 1.10 (0.83–1.45), and 1.63 (0.75–2.16). Men with medium income were less likely to have hypertension compared with those with high income (0.76, 0.61–0.90).

Conclusions

Educational level and economic status had stronger impacts on hypertension in Korean women than men. Thus, a stratified approach for women of low socioeconomic status, especially those with low educational attainment, is needed for the prevention of hypertension.

Prevalence of Prehypertension in Mexico and Its Association With Hypomagnesemia

BACKGROUND

Prehypertension (preHTN) increases the risk of developing hypertension. The objectives of this study were to estimate the prevalence of preHTN in the Mexican adult population and evaluate the association between hypomagnesemia and preHTN.

METHODS

This study was a 2-phase, population-based study. In the first phase, 4,272 Mexican adults (aged 20-65 years) were enrolled to determine the prevalence of preHTN. In the second phase, a cross-sectional analysis was performed to evaluate the association between hypomagnesemia and preHTN. The exclusion criteria were chronic diarrhea, malignancy, hepatic and renal diseases, chronic inflammatory disease, and the intake of magnesium supplements. PreHTN was defined as a systolic blood pressure (BP) of 120-139 mm Hg and/or diastolic BP of 80-89 mm Hg, and hypomagnesemia was defined as a serum magnesium concentration <1.8 mg/dl.

RESULTS

The prevalence of preHTN was 37.5% (95% confidence interval (CI): 36.0-39.0): 46.7% were men (95% CI: 44.1-49.4) and 33.2% (95% CI: 31.5-5.0) were women. The serum magnesium data were available for 921 participants. Hypomagnesemia was identified in 276 (30.0%; 95% CI: 27.1-33.0) subjects; of them, 176 (63.8%; 95% CI: 58.3-69.6) had preHTN. Individuals with preHTN exhibited lower magnesium levels than individuals without preHTN (1.78±0.36 vs. 1.95±0.37, P < 0.0005). A multiple logistic regression analysis (adjusted for age, sex, smoking, body mass index, waist circumference, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, and triglycerides levels) indicated a significant association between hypomagnesemia and preHTN (odds ratio = 1.78; 95% CI: 1.5-4.0, P < 0.0005).

CONCLUSIONS

The prevalence of preHTN in the Mexican population is 37.5%, and hypomagnesemia is strongly associated with preHTN.

Sasang constitution may act as a risk factor for prehypertension

Background

Prehypertension (pre-HTN), similar to hypertension, has been associated with an elevated risk of cardiovascular disease. The aim of this study was to determine whether the Sasang constitution (SC) types could also be independent risk factors for pre-HTN.

Methods

A total of 2,806 eligible subjects, older than 20 years old from 25 medical clinics, participated. Clinical data, including the blood pressure, age, height, weight, and data from blood tests, were collected. One-way ANOVA with Scheffé’s post-hoc analysis and the chi-square test were used, according to the SC and sex. Logistic regression was used to generate the odds ratios (ORs) and 95 % confidence interval (CI) for pre-HTN.

Results

The pre-HTN prevalence rates of the Soeumin type, Soyangin type and Tae-eumin type were 59.4 %, 60.1 % and 74.9 %, respectively, in men (p < 0.001) and 41.7 %, 44.4 % and 58.3 % in women (p < 0.001). The Soyangin type was not more associated with increased ORs than the Soeumin type in any of the subjects with pre-HTN. Even after adjusting for sex, BMI, FBG, TC, TGs, HDL, and LDL, the Tae-eumin type in men was associated with increased ORs of pre-HTN compared with the Soeumin type (OR 1.57, 95 % CI 1.03–2.39), but the Tae-eumin type in women was not associated with pre-HTN.

Conclusions

This study suggested that the Tae-eumin type combined with sex might be significantly and independently associated with pre-HTN, especially high pre-HTN.

The management of pre-hypertension in primary care: Is it adequate?

BACKGROUND

Pre-hypertension (pHT) is frequently diagnosed in the primary care setting, but its management by primary care physicians (PCPs) is not well characterized.

METHODS

All individuals aged 30-45 years who were insured by Clalit Health services in the Tel Aviv district and had their blood pressure (BP) measured from January 2006 to December 2010 were evaluated. Individuals were divided into three groups based on their initial BP value: optimal (< 120/80 mmHg), normal (systolic BP 120-129 or diastolic 80-84 mmHg) and borderline (130-139/85-89 mmHg). Groups were compared regarding clinical and laboratory follow-up performed by their PCP.

RESULTS

Of the 20,214 individuals included in the study, 6576 (32.5%) had values in the pHT range. Of these, 2126 (32.3% of those with pHT) had BP values defined as "borderline" and 4450 (67.6% of those with pHT) had BP values defined as "normal". The number of follow-up visits by the PCP and repeat BP measurement were similar in those with "optimal" BP and pHT. A third and fourth BP measurement were recorded more frequently in those with pHT. In those with pHT, there were more recorded BP measurements than in those with borderline BP (3.35 ± 3 vs. 3.23 ± 2.6), but the time from the initial to the second measurement and a record of a third and fourth measurement were the same in the two groups.

CONCLUSION

Identification of pHT does not lead to a significant change in follow-up by PCPs, irrespective of BP values in the pHT range.

Prehypertension--prevalence, health risks, and management strategies

Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident hypertension. The relative risk of incident hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single antihypertensive medications. To prevent one case of incident hypertension in adults with prehypertension and a 50% 5-year risk of hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with antihypertensive medication. The relative risk of incident cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg) prehypertension; only stage 2 prehypertension increases cardiovascular mortality. Among individuals with prehypertension, the 10-year absolute CVD risk for middle-aged adults without diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities. Antihypertensive medications reduce the relative risk of CVD and death by ~15% in secondary-prevention studies of prehypertension. Data on primary prevention of CVD with pharmacotherapy in prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident hypertension and CVD.

National prevalence and associated risk factors of hypertension and prehypertension among Vietnamese adults

BACKGROUND

Hypertension has recently been identified as the leading risk factor for global mortality. This study aims to present the national prevalence of hypertension and prehypertension and, their determinants in Vietnamese adults.

METHODS

Nationally representative data were obtained from the National Adult Overweight Survey 2005. This one visit survey included 17,199 subjects aged 25-64 years, with a mean body mass index (BMI) of 20.7 kg/m(2).

RESULTS

The overall census-weighted JNC7 (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) defined prevalence of hypertension was 20.7% (95% confidence interval (CI) = 19.4-22.1); the prevalence of prehypertension was 41.8% (95% CI = 40.4-43.1). Hypertension and prehypertension were more prevalent in men. Higher age, overweight, alcohol use (among men), and living in rural areas (among women) were independently associated with a higher prevalence of hypertension, whereas higher physical activity and education level were inversely associated. Age, BMI, and living in rural areas were independently associated with an increased prevalence of prehypertension. Among the hypertensives, 25.9% were aware of their hypertension, 12.2% were being treated, and 2.8% had their blood pressure under control; among the treated hypertensives, 32.4% had their blood pressure controlled.

CONCLUSIONS

Hypertension and prehypertension are prevalent in Vietnam, but awareness, treatment, and control are low. The findings suggest that lifestyle modifications, including the prevention of overweight, the promotion of physical activity particularly in urban areas, and the reduction of high alcohol consumption, may help to prevent hypertension in Vietnam. Furthermore, increased efforts regarding education, detection, and treatment could be important in management of hypertension and cardiovascular disease risk prevention.

Effect of health insurance type on health care utilization in patients with hypertension: a national health insurance database study in Korea

Background

Higher utilization of healthcare services has been observed among individuals who receive public aid compared to individuals who do not receive public aid in many countries. However, no systematic investigations have explored whether this pattern of higher utilization persists after correcting for a number of factors in Korea. In this study, we sought to examine whether the type of health insurance, wage-based contributory insurance (Health Insurance, HI) or government-subsidized public assistance (Medical Aid, MA), affects the utilization of inpatient services after controlling for baseline patient and institutional characteristics among patients with hypertension in Korea.

Methods

The Korean National Health Insurance claims database from 2006 and 2007 was used for analysis. To avoid biased estimates, we determined the most appropriate type of multivariate model for each outcome variable: a logistic regression model for the likelihood of hospitalization, a zero-inflated negative binomial model for the length of stay (LOS), and a generalized linear model with a log-link function for hospitalization costs.

Results

Adjusted odds ratio (OR) and factor changes showed that MA patients (n = 21,539) had a significantly higher likelihood of hospitalization (OR: 1.41-1.71), average LOS per patient (factor change: 1.31-1.42), and hospitalization costs per patient (factor change: 1.10-1.41) compared to HI patients (n = 304,027).

Conclusions

The pattern of higher healthcare utilization among MA patients persists even after controlling for baseline health conditions. This finding confirms that the type of health insurance affects the utilization of healthcare resources, and suggests that effective strategies are necessary to prevent the potential overutilization of inpatient care by MA patients with hypertension in Korea.

Early adulthood: an overlooked age group in national sodium reduction initiatives in South Korea

BACKGROUND/OBJECTIVES

South Korean's sodium consumption level is more than twice the upper limit level suggested by the WHO. Steep increases in the prevalence of hypertension and cardiovascular disease in Korea necessitate more effective sodium reduction programs. This study was conducted in order to compare sodium intake-related eating behaviors and key psychosocial factors according to age group and gender.

SUBJECTS/METHODS

Using an online survey, a total of 1,564 adults (20-59 years old) considered to be geographically representative of South Korea were recruited and surveyed. The major outcomes were perceived behaviors, knowledge, intentions, and self-efficacy related to sodium intake.

RESULTS

The results show that perceived behavior and level of self-efficacy related to low sodium consumption differed by age and gender. Female participants showed better behavior and intention towards low sodium intake than male counterparts. Young participants in their 20s showed the lowest intention to change their current sodium intake as well as lowest self-efficacy measures.

CONCLUSIONS

Future sodium reduction interventions should be developed with tailored messages targeting different age and gender groups. Specifically, interventions can be planned and implemented at the college level or for workers in their early career to increase their intention and self-efficacy as a means of preventing future health complications associated with high sodium intake.

Effect of renal function on the pharmacokinetics of fimasartan: a single-dose, open-label, Phase I study

Background

Fimasartan is a novel angiotensin II receptor blocker. Fimasartan is mainly eliminated via biliary excretion, and its urinary elimination is less than 3%.

Objective

Based on guidance from the United States Food and Drug Administration, a reduced pharmacokinetic (PK) study was conducted to evaluate the effect of renal function on the PK of fimasartan in patients with renal impairment and healthy volunteers.

Methods

A single centre, single-dose, open-label, healthy volunteer controlled trial was conducted in patients with renal impairment (RI) (estimated glomerular filtration rate lower than 30 mL/min/1.73 m²) and age-, weight- and sex-matched healthy volunteers (estimated glomerular filtration rate higher than 90 mL/min/1.73 m²). All participants received a single oral dose of fimasartan 120 mg, after which serial blood sampling for PK evaluation was conducted. Noncompartmental PK analysis of fimasartan was performed. A mixed-effects model approach was used to identify significant covariates and PK parameters.

Results

Sixteen subjects were enrolled (8 healthy volunteers and 8 RI patients). The maximum plasma concentrations and areas under the plasma concentration curves of the RI patients were higher than those of the healthy volunteers, with geometric mean ratios of 1.87 and 1.73, respectively. The relative bioavailability of fimasartan from the population PK analysis was 77% higher in the RI patients than in the healthy volunteers.

Conclusion

The increased drug exposure of fimasartan in RI patients was explained by the increased relative bioavailability. This result can be explained from our knowledge concerning alterations in PK related to renal function.

Analysis on associated factors of uncontrolled hypertension among elderly hypertensive patients in Southern China: a community-based, cross-sectional survey

Background

The prevalence of hypertension in China has risen dramatically in recent decades, but it is not well understood if hypertension is adequately controlled in the elderly population in Southern China. A provincial survey was performed in order to estimate the prevalence of hypertension control and the associated factors in the elderly population.

Methods

A cross-sectional survey was conducted in 6 community health service centers across 12 counties in Southern China from October 2010 to April 2011. Recruitment included a total of 10644 hypertensive subjects aged 60 or older. Basic lab tests and physical examinations were administrated on each subject. In addition, each subject completed a standardized questionnaire.

Results

The 10644 participants (mean age of 70.3 years) included 5527 women (51.9%), 5117 men (48.1%), 3148 overweight subjects (29.57%), 846 (7.95%) obese subjects, 1654 smokers (15.54%) and 1750 consumers of alcohol (16.44%). The control, treatment and awareness of hypertension were 44.6%, 50.3% and 46.3%, respectively. Most treated hypertensives (68.57%) used combination therapy of antihypertensive medications, and those using long-acting antihypertensive medications had a higher rate of adequately controlled hypertension. Results showed that elderly, living in rural and suburban areas, low education level, family history of hypertension, smoking, excessive salt consumption, lack of physical activity, overweight, obese and diabetes were associated with uncontrolled hypertension.

Conclusions

Lack of adequate hypertension control is relatively high among the elderly in Southern China. Hypertension awareness and early treatment are needed in this population, especially among suburban population, as well as adopting appropriate antihypertensive medication therapy and healthy lifestyles.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-903) contains supplementary material, which is available to authorized users.

A multicentre cohort study of acute heart failure syndromes in Korea: rationale, design, and interim observations of the Korean Acute Heart Failure (KorAHF) registry

AIMS

The Korean Acute Heart Failure registry (KorAHF) aims to evaluate the clinical characteristics, management, hospital course, and long-term outcomes of patients hospitalized for acute heart failure syndrome (AHFS) in Korea.

METHODS AND RESULTS

This is a prospective observational multicentre cohort study funded by the Korea National Institute of Health. Patients hospitalized for AHFS in 10 tertiary university hospitals across the country have been consecutively enrolled since March 2011. The study is expected to complete the scheduled enrolment of 5000 patients some time in 2014, and follow-up is planned through 2016. As of April 2012, the interim analysis of 2066 consecutive subjects was performed to understand the baseline characteristics of the population. The mean age was 69 ± 14 years; 55% were male; and 50% were de novo heart failure. The mean left ventricular ejection fraction (LVEF) was 40 ± 18%. Ischaemia was both the leading cause (38%) and the most frequent aggravating factor (26%) of AHFS. ACE inhibitors/ARBs and beta-blockers were prescribed at discharge in 65% and 51% of the patients, respectively. In-hospital mortality was 5.2%, and 0.9% of patients received urgent heart transplantation. Low blood pressure and azotaemia were the most important predictors of in-hospital mortality. The post-discharge 30-day and 180-day all-cause mortality were 1.2% and 9.2%, respectively.

CONCLUSIONS

Our analysis reveals that the prognosis of AHFS in Korea is poor and that there are specific features, including lower blood pressures at admission and lower rates of heart failure related to hypertension, compared with other registries. Adherence to current guidelines should be improved.