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Advani R, Chandrasekaran S. Chronic hypertension diagnosed by the American Heart Association and American College of Cardiology criteria is associated with increased risk of developing hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2024; 6:101269. [PMID: 38145820 DOI: 10.1016/j.ajogmf.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND ACOG uses a systolic blood pressure (SBP) ≥140 or diastolic blood pressure (DBP) ≥90 documented at <20 weeks of gestation to define chronic hypertension. In the nonpregnant state, the American Heart Association (AHA) and the American College of Cardiology (ACC) define chronic hypertension using lower diagnostic thresholds of SBP ≥130 or DBP ≥80. It remains unclear whether using more conservative guidelines in pregnancy improves identification of those at risk for gestational hypertension (GHTN) or preeclampsia (PRE). OBJECTIVE We sought to investigate whether subjects with chronic hypertension based on the American Heart Association and American College of Cardiology criteria had an increased risk for gestational hypertension and preeclampsia than those without chronic hypertension. STUDY DESIGN We conducted a retrospective cohort study utilizing a clinical database at a diverse, large urban, safety-net hospital. Subjects aged 18 to 40 years with singleton gestations and first trimester prenatal care were included. We defined subjects that met the criteria for stage 1 chronic hypertension based on first trimester systolic blood pressure and diastolic blood pressure cutoffs satisfying the American Heart Association and American College of Cardiology criteria (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg). Those who did not meet these criteria had a systolic blood pressure <130 mm Hg and a diastolic blood pressure <90 mm Hg. We did not include those with chronic hypertension based on the American College of Obstetricians and Gynecologists criteria in this cohort (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg at <20 weeks); therefore, those who met the American Heart Association and American College of Cardiology criteria solely consisted of subjects with systolic blood pressure of 130 to 139 mm Hg and diastolic blood pressure of 80 of 89 mm Hg. By doing this, we were able to specifically investigate the increased risk for this specific population, which remains unclear. Diagnoses of gestational hypertension and preeclampsia were based on the established American College of Obstetricians and Gynecologists criteria. Preeclampsia included those with and without severe features. Tests for normality were performed. Student t-tests or rank sum tests were performed as appropriate for continuous variables; chi-square or Fisher's exact tests were performed for categorical variables. Generalized linear models were performed to calculate risk ratios while controlling for appropriate confounders. RESULTS Of N=3354 subjects, 18% (n=629) were diagnosed with stage 1 chronic hypertension based on American Heart Association and American College of Cardiology criteria. Those with American Heart Association and American College of Cardiology stage 1 chronic hypertension had increased rates of gestational hypertension (35.4% vs 20%; P<.001) and preeclampsia (22.3% vs 10%; P<.001) than those without Stage 1 chronic hypertension based on these criteria. When controlling for maternal age, race, first trimester body mass index, pregestational diabetes, and substance use, those with the American Heart Association and American College of Cardiology stage 1 chronic hypertension had an almost 1.5-fold higher adjusted risk ratio of experiencing gestational hypertension (adjusted risk ratio, 1.49±0.10; P<.001) and almost 2-fold increased adjusted risk ratio of experiencing preeclampsia (adjusted risk ratio, 1.98±0.19; P<.001). CONCLUSION Our data suggest an increased risk for developing gestational hypertension and preeclampsia for subjects satisfying the American Heart Association and American College of Cardiology cutoff for stage 1 chronic hypertension. Future studies need to consider whether diagnosis of chronic hypertension in pregnancy should conform with American Heart Association and American College of Cardiology criteria, and if those with stage 1 chronic hypertension based on American Heart Association and American College of Cardiology criteria require the same preventative measures and interventions utilized by those diagnosed by American College of Obstetricians and Gynecologists criteria.
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Affiliation(s)
- Raina Advani
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
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Lee CJ, Hwang J, Kang CY, Kang D, Kim DH, Park HJ, Kim HC, Ihm SH, Kim YJ, Shin JH, Pyun WB, Park S. Asthma and increased risk of myocardial infarction and mortality among hypertensive Korean patients. Hypertens Res 2023; 46:1694-1704. [PMID: 36991063 DOI: 10.1038/s41440-023-01257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
This study aimed to evaluate the effects of asthma on cardiovascular disease incidence in patients with hypertension. A total of 639,784 patients with hypertension from the Korea National Health Insurance Service database were included, of whom 62,517 had history of asthma after propensity score matching. The risks of all-cause mortality, myocardial infarction (MI), stroke, and end-stage renal disease (ESRD) were assessed according to the presence of asthma, long-acting β2-agonist (LABA) inhaler usage, and/or systemic corticosteroid usage for up to 11 years. In addition, whether these risks were modified by average blood pressure (BP) levels during the follow-up period was examined. Asthma was associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.203; 95% confidence interval [CI], 1.165-1.241) and MI (HR, 1.244; 95% CI, 1.182-1.310) but not the risk of stroke or ESRD. LABA inhaler usage was associated with a higher risk of all-cause mortality and MI, and systemic corticosteroids usage showed a higher risk of ESRD as well as all-cause mortality and MI among hypertensive patients with asthma. Compared to patients without asthma, there was a graded increase in the risk of all-cause mortality and MI in those with asthma without LABA inhaler/systemic corticosteroid usage and in those with asthma with LABA inhaler/systemic corticosteroid usage. These associations were not significantly modified by BP levels. This nationwide population-based study supports that asthma may be a clinical factor that increases the risk of poor outcomes in patients with hypertension.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Chae Young Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Dayoung Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Do Hyang Kim
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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3
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Lee CJ, Lee JY, Han K, Kim DH, Cho H, Kim KJ, Kang ES, Cha BS, Lee YH, Park S. Blood Pressure Levels and Risks of Dementia: a Nationwide Study of 4.5 Million People. Hypertension 2021; 79:218-229. [PMID: 34775786 DOI: 10.1161/hypertensionaha.121.17283] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There are inconsistent results on the impacts of controlling blood pressure (BP) on the risk of dementia. We investigated the association between BP and risk of dementia subtypes by antihypertensive treatment and comorbidities. Using the Korean National Health Insurance Service-Health Screening Database from 2009 to 2012, a total of 4 522 447 adults aged 60+ years without a history of dementia were analyzed and followed up for a mean of 5.4 years. Individuals were classified according to their baseline systolic BP (SBP) and diastolic BP; SBP 130 to <140 mm Hg and diastolic BP 80 to <90 mm Hg were used as reference groups. The risk of overall dementia and probable Alzheimer disease was significantly higher in the SBP≥160 and lower SBP groups. These U-shaped associations were consistent regardless of antihypertensive use or comorbidities. The risk of probable vascular dementia (VaD) was not higher among lower SBP groups and increased gradually as SBP increased. Although there was a linear association between SBP and the risk of probable VaD in individuals not taking antihypertensives or without comorbidities, there was a U-shaped association in individuals taking antihypertensives or with comorbidities. Patterns of association between diastolic BP and risk of probable Alzheimer disease or probable VaD were similar to those with SBP, except for the risk of probable VaD in individuals taking antihypertensives. In conclusion, risks of probable Alzheimer disease and probable VaD were different among lower BP groups. Although the risk of dementia appears higher in people with lower BP receiving antihypertensives, this finding may be affected by comorbidities.
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Affiliation(s)
- Chan Joo Lee
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Lee
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (K.H.)
| | - Da Hye Kim
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (D.H.K.)
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital (H.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Division of Geriatrics (K.J.K.), Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
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O'Brien T, Tan A, Rose K, Focht B, Daloul R. Maintenance phase of a physical activity intervention in older kidney transplant recipients: A 12-month follow-up. Geriatr Nurs 2021; 42:1541-1546. [PMID: 34741827 DOI: 10.1016/j.gerinurse.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
Daily walking activities are associated with improving cardiovascular outcomes in older kidney transplant recipients. However, little is known regarding physical activity adherence outcomes in older kidney recipients. The purpose of this randomized controlled trial 12-month follow-up study was to evaluate the feasibility of the intervention (SystemCHANGE™ + activity tracker) during the maintenance period (7-12 months), compared to an attention-control group (activity tracker only) in older kidney recipients (age 60 and older). The sample included 60 participants (n = 30 IG; n = 30 ACG). Adherence rates for wearing the activity tracker daily were 96.5% in the IG and 80.8% in the ACG. The IG demonstrated within-group improvements for blood pressure at 12 months. Overall, there was a decrease in the average daily steps observed in both groups. These data suggest this intervention is feasible and additional boosters should be considered during the maintenance period to encourage physical activity.
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Affiliation(s)
- Tara O'Brien
- The Ohio State University College of Nursing, Columbus, OH Columbus, OH, Newton Hall,1585 Neil Ave, Columbus, OH 43210, USA.
| | - Alai Tan
- The Ohio State University College of Nursing Newton Hall, 1585 Neil Ave, Columbus, OH, USA 43210
| | - Karen Rose
- The Ohio State University College of Nursing Newton Hall, 1585 Neil Ave, Columbus, OH, USA 43210
| | - Brian Focht
- The Ohio State University College of Education and Human Ecology, 152 PAES, 305 Annie and John Glenn Ave, Columbus, OH, USA, 43210
| | - Reem Daloul
- The Ohio State University College of Medicine, 300 West 10th Avenue Suite 1150, Columbus, USA, OH 43210
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Vakil D, Zinonos S, Kostis JB, Dobrzynski JM, Cosgrove NM, Moreyra AE, Kostis WJ. Monotherapy treatment with chlorthalidone or amlodipine in the systolic blood pressure intervention trial (SPRINT). J Clin Hypertens (Greenwich) 2021; 23:1335-1343. [PMID: 34076333 PMCID: PMC8678684 DOI: 10.1111/jch.14296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
This post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) examined the performance of chlorthalidone (C) versus amlodipine (A) monotherapies. ANOVA was used to analyze the differences in systolic blood pressure (SBP) response between C and A. Logistic regression was used to examine monotherapy failure (adding a second antihypertensive agent or switching to a different antihypertensive agent) rates. Four hundred ninety-one participants were treated with C monotherapy (n = 210, mean dose = 22 mg/day) or A monotherapy (n = 281, mean dose = 7 mg/day). There was a significant difference in mean SBP reduction between the C and A monotherapies at the third visit (higher reduction with A, adjusted p = .018). Unadjusted analysis showed a higher failure with C in the standard treatment group. Although the average SBP at failure was higher and above the 140 mm Hg cutoff that indicated monotherapy failure with A (142.60) compared with C (138.40), more participants on C failed despite having SBP below the 140 cutoff. This was probably due to decisions made by the investigative teams to change the antihypertensive regimen, because, in their opinion, the clinical picture required it. After adjusting for baseline characteristics, C had higher failure than A only in the standard treatment group (1.64 odds ratio [OR], 95% CI 1.06-2.56, p = .028). A sub-analysis including participants who had never used antihypertensive treatment before randomization had similar results (2.57 OR, 95% CI 1.34-5.02, p = .004). Overall, in SPRINT chlorthalidone was associated with higher monotherapy failure than amlodipine in the standard treatment group because of decisions of the investigative teams.
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Affiliation(s)
- Deep Vakil
- Cardiovascular InstituteRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJUSA
| | - Stavros Zinonos
- Cardiovascular InstituteRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJUSA
| | - John B. Kostis
- Cardiovascular InstituteRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJUSA
| | - Jeanne M. Dobrzynski
- Cardiovascular InstituteRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJUSA
| | - Nora M. Cosgrove
- Cardiovascular InstituteRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJUSA
| | - Abel E. Moreyra
- Cardiovascular InstituteRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJUSA
| | - William J. Kostis
- Cardiovascular InstituteRutgers Robert Wood Johnson Medical SchoolNew BrunswickNJUSA
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Arafa A, Lee HH, Eshak ES, Shirai K, Liu K, Li J, Anni NS, Shim SY, Kim HC, Iso H. Modifiable Risk Factors for Cardiovascular Disease in Korea and Japan. Korean Circ J 2021; 51:643-655. [PMID: 34227266 PMCID: PMC8326218 DOI: 10.4070/kcj.2021.0121] [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: 04/12/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death and a major contributor to disability worldwide. Since the majority of cardiovascular events are preventable, identification of modifiable CVD risk factors and implementation of primordial prevention strategies should be a public health priority. In this aspect, the American Heart Association declared a strategic goal to reduce total CVD mortality in the US by 20% within 10 years via eliminating 7 major CVD risk factors (hypertension, diabetes, dyslipidemia, cigarette smoking, physical inactivity, obesity, and poor-quality diet) in 2010, and their strategy has been achieving. However, the applicability of similar metrics to prevent CVD among East Asians requires an in-depth investigation of the modifiable CVD risk factors based on national and regional evidence-based findings. Herein, this review article aims to discuss several modifiable risk factors for CVDs, using epidemiological evidence from cohort studies and nationally representative data of 2 East Asian countries: Korea and Japan.
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Affiliation(s)
- Ahmed Arafa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Hyeok Hee Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ehab S Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Public Health, Faculty of Medicine, Minia University, Minya, Egypt
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jiaqi Li
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Sun Young Shim
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
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Kim KI, Ji E, Choi JY, Kim SW, Ahn S, Kim CH. Ten-year trends of hypertension treatment and control rate in Korea. Sci Rep 2021; 11:6966. [PMID: 33772056 PMCID: PMC7997987 DOI: 10.1038/s41598-021-86199-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/11/2021] [Indexed: 11/20/2022] Open
Abstract
We analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trends of hypertension treatment and control rate in Korea over the past 10 years. In addition, we tried to investigate the effect of chronic medical conditions on hypertension management. We investigated the hypertension prevalence, awareness, treatment, and control rate from 2008 to 2017. KNHANES, which uses a stratified multistage sampling design, is a cross-sectional, nationally representative survey conducted by the Korean government. A total of 59,282 adults (≥ 20 years) were included, which was representative of the total population of around 40 million Koreans per year. The mean age was 50.7 ± 16.4 years and 42.6% were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity significantly increased over the 10 years. During this period, the hypertension treatment and control rate significantly improved. Hypertension treatment rate was significantly lower in the younger age group compared to the older age group, but the control rate among the treated patients was not significantly different between age groups. The treatment and control rates of hypertension were higher in patients with multimorbidity, which implies that it has a favorable effect on the treatment and control of hypertension. Hypertension treatment and control rate have improved over the past 10 years. The higher treatment and control rate in patients with multimorbidity suggest that the more aggressive surveillance might be associated with the improvement of hypertension treatment and control rate in Korea.
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Affiliation(s)
- Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Kyeongi, 463-707, Republic of Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Kyeongi, 463-707, Republic of Korea
| | - Sun-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Kyeongi, 463-707, Republic of Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Kyeongi, 463-707, Republic of Korea.
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8
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Protective effect of controlled blood pressure on risk of dementia in low-risk, grade 1 hypertension. J Hypertens 2021; 39:1662-1669. [PMID: 33710170 DOI: 10.1097/hjh.0000000000002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE High blood pressure (BP) increases the risk of dementia; however, few studies have reported on the risk of dementia in patients with low-risk, early-grade hypertension. We investigated the protective effect of controlled BP on risk of dementia in treated, low-risk, grade 1 hypertensive patients from the entire National Health Insurance Service National Health Examinee cohort. METHODS We selected grade 1 hypertension (140-159/90-99 mmHg) patients with low risk, diagnosed in 2005-2006. All patients (N = 128 665) were classified into controlled (average BP < 140/90 mmHg during the follow-up) and uncontrolled (average BP ≥ 140/90 mmHg) BP groups and followed up until 2015. The risk of dementia was estimated using Cox proportional hazard model after adjustments for propensity score. RESULTS Average BP was 131/81 mmHg in the controlled group (N = 49 408) and 144/87 mmHg in the uncontrolled group (N = 99 257). Overall dementia incidence rates in controlled and uncontrolled groups were 4.9 and 8.1 per 1000 person-year, respectively. The controlled group showed lower risk of overall dementia, Alzheimer's disease, and vascular dementia than the uncontrolled group. The controlled group had a low risk of vascular dementia at all ages, especially in the younger group (age <60). The optimal BP level associated with the lowest risk of dementia was 130 to less than 140 mmHg for SBP and 70 to less than 80 mmHg for DBP. CONCLUSION We concluded that among even low-risk and grade 1 hypertension patients, controlled BP significantly reduced the risk of dementia, including Alzheimer's disease and vascular dementia.
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Luo D, Cheng Y, Zhang H, Ba M, Chen P, Li H, Chen K, Sha W, Zhang C, Chen H. Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis. BMJ 2020; 370:m3222. [PMID: 32907799 PMCID: PMC7478061 DOI: 10.1136/bmj.m3222] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate and quantify the future risk of cardiovascular events in young adults with high blood pressure. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, and Web of Science were searched from inception to 6 March 2020. Relative risks were pooled using a random effects model and expressed with 95% confidence intervals. Absolute risk difference was calculated. Dose-response relations between blood pressure and individual outcomes were assessed by a restricted cubic spline model. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were selected that investigated the adverse outcomes of adults aged 18-45 with raised blood pressure. The primary study outcome was a composite of total cardiovascular events. Coronary heart disease, stroke, and all cause mortality were examined as secondary outcomes. RESULTS Seventeen observational cohorts consisting of approximately 4.5 million young adults were included in the analysis. The average follow-up was 14.7 years. Young adults with normal blood pressure had increased risk of cardiovascular events compared with those with optimal blood pressure (relative risk 1.19, 95% confidence interval 1.08 to 1.31; risk difference 0.37, 95% confidence interval 0.16 to 0.61 per 1000 person years). A graded, progressive association was found between blood pressure categories and increased risk of cardiovascular events (high normal blood pressure: relative risk 1.35, 95% confidence interval 1.22 to 1.49; risk difference 0.69, 95% confidence interval 0.43 to 0.97 per 1000 person years; grade 1 hypertension: 1.92, 1.68 to 2.19; 1.81, 1.34 to 2.34; grade 2 hypertension: 3.15, 2.31 to 4.29; 4.24, 2.58 to 6.48). Similar results were observed for coronary heart disease and stroke. Generally, the population attributable fraction for cardiovascular events associated with raised blood pressure was 23.8% (95% confidence interval 17.9% to 28.8%). The number needed to treat for one year to prevent one cardiovascular event was estimated at 2672 (95% confidence interval 1639 to 6250) for participants with normal blood pressure, 1450 (1031 to 2326) for those with high normal blood pressure, 552 (427 to 746) for those with grade 1 hypertension, and 236 (154 to 388) for those with grade 2 hypertension. CONCLUSIONS Young adults with raised blood pressure might have a slightly increased risk of cardiovascular events in later life. Because the evidence for blood pressure lowering is limited, active interventions should be cautious and warrant further investigation.
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Affiliation(s)
- Dongling Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunjiu Cheng
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haifeng Zhang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mingchuan Ba
- Department of Cardiology, Guangdong General Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, China
| | - Pengyuan Chen
- Department of Cardiology, Guangdong General Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, China
| | - Hezhi Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kequan Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weihong Sha
- Department of Gastroenterology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Caojin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hao Chen
- Department of Gastroenterology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
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Porcelli BA, Diveley E, Meyenburg K, Woolfolk C, Rosenbloom JI, Raghuraman N, Stout MJ, Sabol BA. A new definition of gestational hypertension? New-onset blood pressures of 130 to 139/80 to 89 mm Hg after 20 weeks of gestation. Am J Obstet Gynecol 2020; 223:442.e1-442.e7. [PMID: 32553915 DOI: 10.1016/j.ajog.2020.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/24/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Diagnostic criteria for hypertensive disorders in pregnancy have historically been based on the American Heart Association and American College of Cardiology's definition of hypertension, previously defined as a blood pressure of ≥140/90 mm Hg. With the recent redefinition of hypertension, blood pressures of 130 to 139/80 to 89 mm Hg are now considered abnormal. OBJECTIVE In this study, we aimed to test whether the new-onset blood pressure elevations of 130 to 139/80 to 89 mm Hg after 20 weeks of gestation in previously normotensive women are associated with increased risk for adverse pregnancy outcomes, specifically the development of hypertensive disorders in pregnancy. STUDY DESIGN We performed a retrospective cohort study at a single tertiary care center of all women who delivered singleton gestations after 20 weeks of gestation from January 01, 2014, to June 08, 2016. Normotensive patients were defined as having maximum blood pressure of <130/80 mm Hg before 20 weeks of gestation and no previous diagnosis of chronic hypertension. Patients who remained normotensive for the remainder of pregnancy were then compared with patients who developed new-onset blood pressure elevations of 130 to 139/80 to 89 mm Hg after 20 weeks of gestation before delivery admission. The primary outcome was the development of a hypertensive disorder in pregnancy at hospital admission or during delivery. Clinical outcomes were assessed using χ2 test and multivariable logistic regression. RESULTS Of the 2090 normotensive women from our cohort who were analyzed, 1318 (63.0%) remained normotensive for their entire antenatal course before delivery admission and 772 (37.0%) had new-onset blood pressure elevations between 130 and 139/80 and 89 mm Hg. Women with new-onset blood pressure elevations between 130 and 139/80 and 89 mm Hg after 20 weeks of gestation have a significantly increased risk for developing a hypertensive disorder in pregnancy at admission or during delivery (adjusted relative risk, 2.41; 95% confidence interval, 2.02-2.85) including an almost 3-fold increased risk for preeclampsia with severe features, even after adjusting for confounders. There were no differences in other secondary obstetrical outcomes. CONCLUSION Normotensive women with new-onset blood pressures elevations between 130 and 139/80 and 89 mm Hg after 20 weeks of gestation are more likely to experience hypertensive disorders in pregnancy and preeclampsia with severe features at or during their delivery hospitalization. These more modest blood pressure elevations may be an early indicator of disease and call into question our current blood pressure threshold for diagnosis of hypertensive disorders in pregnancy.
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Choi EK. Cardiovascular Research Using the Korean National Health Information Database. Korean Circ J 2020; 50:754-772. [PMID: 32725984 PMCID: PMC7441000 DOI: 10.4070/kcj.2020.0171] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
The Korean National Health Information Database (NHID) contains nationwide claims data, including sociodemographic data, health care utilization, health screening data, and healthcare provider information. To compensate for the limitations of randomized clinical trials, real-world observational studies using claims data have emerged as a novel research tool. We summarized the structure of the Korean NHID and the recent researches conducted in the field of cardiovascular science. Epidemiological studies, prescription patterns, temporal trends, comparison of effectiveness and safety of treatments, variability index using laboratory data, and rare intractable disease constitute interesting topics of research in cardiovascular science using the NHID. The operational definition of covariates and clinical outcomes is important for researchers interested in using the NHID data as new tools to prove their hypothesis. A step-by-step approach adopted by a team of data scientists, epidemiologists, statisticians, and clinical researchers may be most effective while designing research studies. The ultimate direction of research using the NHID should aim to improve the welfare of the public by promoting public health, reducing medical costs, and guiding healthcare policies.
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Affiliation(s)
- Eue Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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12
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Schiffrin EL. New blood pressure cut-offs, prevalence of hypertension and control, and mood disorders: are patients benefitting from lower cut-offs for defining hypertension? Eur Heart J 2020; 40:739-742. [PMID: 30624628 DOI: 10.1093/eurheartj/ehy891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ernesto L Schiffrin
- Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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13
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Belyavskiy E, Pieske‐Kraigher E, Tadic M. Blood pressure control in heart failure: Is everything black and white? J Clin Hypertens (Greenwich) 2019; 21:1132-1134. [PMID: 31282593 PMCID: PMC8030320 DOI: 10.1111/jch.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Evgeny Belyavskiy
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow‐Klinikum (CVK)BerlinGermany
| | - Elisabeth Pieske‐Kraigher
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow‐Klinikum (CVK)BerlinGermany
| | - Marijana Tadic
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow‐Klinikum (CVK)BerlinGermany
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Cho SMJ, Lee H, Pyun WB, Kim HC. Differential Control Rate of Systolic and Diastolic Blood Pressure among Korean Adults with Hypertension: the Sixth Korean National Health and Nutrition Examination Survey, 2013-2015 (KNHANES VI). Korean Circ J 2019; 49:1035-1048. [PMID: 31190479 PMCID: PMC6813160 DOI: 10.4070/kcj.2019.0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/27/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives Discrepancy in blood pressure (BP) control rate may be owed to different risk factors associated with elevated systolic and diastolic BP (SBP and DBP). Methods In a nationally representative survey of Korean population with BP measurements, a total of 5,100 participants with hypertension was included in the analyses. Three separate types of control rates were calculated: SBP, DBP, and (combined) S&DBP among all participants with hypertension and participants with treated hypertension, separately. Control rates were compared across sex and age groups. Multivariable logistic regression was used to identify demographic factors associated with SBP, DBP, and S&DBP control rates, separately. Results In total, SBP, DBP, and S&DBP control rates were 63.0%, 63.7%, and 42.5% among all hypertension patients, and 77.5%, 87.4%, and 71.6% among treated hypertension patients. Men aged 40–49 years with hypertension and 30–39 years treated for hypertension had the highest SBP control rate (74.6% and 96.2%), which decreased by older age. Inversely, DBP control rate progressively increased with older age. SBP control rate among women with hypertension was the highest in 40–49 years (67.0%) but without linear trend by age group. Interestingly, both combined and DBP control rates were noticeably low among women aged 50–59 years. Women with body mass index ≥25 were at higher odds of having controlled SBP. Lower DBP control rate was observed in men with lower education level, higher household income, and heavy drinkers. Conclusions Separate examination of control rates demonstrated different sex- and age-differential trends, which would have been overlooked in combined control rates.
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Affiliation(s)
- So Mi Jemma Cho
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.
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Zidek W. [Not Available]. MMW Fortschr Med 2019; 161:35. [PMID: 30887334 DOI: 10.1007/s15006-019-0267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Park S. Ideal Target Blood Pressure in Hypertension. Korean Circ J 2019; 49:1002-1009. [PMID: 31646769 PMCID: PMC6813156 DOI: 10.4070/kcj.2019.0261] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 01/02/2023] Open
Abstract
In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure (BP) lowering was associated with significant reduction in composite cardiovascular (CV) outcomes in hypertension. Subsequently, several meta-analyses have corroborated the findings from SPRINT and these benefits were more prominent in subjects with higher cardiovascular risk at baseline. As such, the recent American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline and the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guideline recommended the lowering of target BP to less than 130/80 mmHg in most hypertensive subjects. However, one should keep in mind the potential harm of too much BP lowering. Post hoc analysis of clinical trials have demonstrated increased cardiovascular mortality and events with too much BP lowering. Therefore, although intensive BP lowering may be beneficial in further reducing CV outcomes, too much reduction below 120/70 mmHg may actually harmful. In conclusion, although intensive BP lowering to achieve target BP below 130/80 mmHg is beneficial in reducing CV outcomes, one should do so cautiously as to avoid adverse events. As such, the first target of anti-hypertensive treatment should be to achieve BP lowering below 140/90 mmHg. Once that target is achieved, one could target BP below 130/80 mmHg keeping in mind to avoid signs of organ hypoperfusion such as orthostatic hypotension, orthostatic dizziness, weakness and serum creatinine elevation.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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