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Bakris G, Chen C, Campbell AK, Ashton V, Haskell L, Singhal M. Real-World Impact of Blood Pressure Control in Patients With Apparent Treatment-Resistant or Difficult-to-Control Hypertension and Stages 3 and 4 Chronic Kidney Disease. Am J Hypertens 2024; 37:438-446. [PMID: 38436491 PMCID: PMC11094384 DOI: 10.1093/ajh/hpae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common comorbidity in patients with apparent treatment-resistant hypertension (aTRH). We assessed clinical outcomes, healthcare resource utilization events, and costs in patients with aTRH or difficult-to-control hypertension and stage 3-4 CKD with uncontrolled vs. controlled BP. METHODS This retrospective cohort study used linked IQVIA Ambulatory EMR-US and IQVIA PharMetrics Plus claims databases. Adult patients had claims for ≥3 antihypertensive medication classes within 30 days between 01/01/2015 and 06/30/2021, 2 office BP measures recorded 1-90 days apart, ≥1 claim with ICD-9/10-CM diagnosis codes for CKD 3/4, and ≥1 year of continuous enrollment. Baseline BP was defined as uncontrolled (≥130/80 mm Hg) or controlled (<130/80 mm Hg) BP. Outcomes included risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure hospitalization), end-stage renal disease (ESRD), healthcare resource utilization events, and costs during follow-up. RESULTS Of 3,966 patients with stage 3-4 CKD using ≥3 antihypertensive medications, 2,479 had uncontrolled BP and 1,487 had controlled BP. After adjusting for baseline differences, patients with uncontrolled vs. controlled BP had a higher risk of MACE+ (HR [95% CI]: 1.18 [1.03-1.36]), ESRD (1.85 [1.44-2.39]), inpatient hospitalization (rate ratio [95% CI]: 1.35 [1.28-1.43]), and outpatient visits (1.12 [1.11-1.12]) and incurred higher total medical and pharmacy costs (mean difference [95% CI]: $10,055 [$6,741-$13,646] per patient per year). CONCLUSIONS Patients with aTRH and stage 3-4 CKD and uncontrolled BP despite treatment with ≥3 antihypertensive classes had an increased risk of MACE+ and ESRD and incurred greater healthcare resource utilization and medical expenditures compared with patients taking ≥3 antihypertensive classes with controlled BP.
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Affiliation(s)
- George Bakris
- University of Chicago Medicine, Chicago, Illinois, USA
| | - Cindy Chen
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | | | - Veronica Ashton
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Lloyd Haskell
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
| | - Mukul Singhal
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
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2
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Azzam O, Nejad SH, Carnagarin R, Nolde JM, Galindo-Kiuchi M, Schlaich MP. Taming resistant hypertension: The promise of novel pharmacologic approaches and renal denervation. Br J Pharmacol 2024; 181:319-339. [PMID: 37715452 DOI: 10.1111/bph.16247] [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: 04/08/2023] [Revised: 08/11/2023] [Accepted: 09/02/2023] [Indexed: 09/17/2023] Open
Abstract
Resistant hypertension is associated with an exceedingly high cardiovascular risk and there remains an unmet therapeutic need driven by pathophysiologic pathways unaddressed by guideline-recommended therapy. While spironolactone is widely considered as the preferable fourth-line drug, its broad application is limited by its side effect profile, especially off-target steroid receptor-mediated effects and hyperkalaemia in at-risk subpopulations. Recent landmark trials have reported promising safety and efficacy results for a number of novel compounds targeting relevant pathophysiologic pathways that remain unopposed by contemporary drugs. These include the dual endothelin receptor antagonist, aprocitentan, the aldosterone synthase inhibitor, baxdrostat and the nonsteroidal mineralocorticoid receptor antagonist finerenone. Furthermore, the evidence base for consideration of catheter-based renal denervation as a safe and effective adjunct therapeutic approach across the clinical spectrum of hypertension has been further substantiated. This review will summarise the recently published evidence on novel antihypertensive drugs and renal denervation in the context of resistant hypertension.
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Affiliation(s)
- Omar Azzam
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, Royal Perth Hospital Medical Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sayeh Heidari Nejad
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, Royal Perth Hospital Medical Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, Royal Perth Hospital Medical Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, Royal Perth Hospital Medical Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
| | - Marcio Galindo-Kiuchi
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, Royal Perth Hospital Medical Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, Royal Perth Hospital Medical Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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3
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Bakris G, Chen C, Campbell AK, Ashton V, Haskell L, Singhal M. Association of uncontrolled blood pressure in apparent treatment-resistant hypertension with increased risk of major adverse cardiovascular events plus. J Clin Hypertens (Greenwich) 2023; 25:737-747. [PMID: 37461262 PMCID: PMC10423765 DOI: 10.1111/jch.14701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
Patients with apparent treatment-resistant hypertension (aTRH) are at increased risk of end-organ damage and cardiovascular events. Little is known about the effects of blood pressure (BP) control in this population. Using a national claims database integrated with electronic medical records, the authors evaluated the relationships between uncontrolled BP (UBP; ≥130/80 mmHg) or controlled BP (CBP; <130/80 mmHg) and risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure requiring hospitalization) and end-stage renal disease (ESRD) in adult patients with aTRH (taking ≥3 antihypertensive medication classes concurrently within 30 days between January 1, 2015 and June 30, 2021). MACE+ components were also evaluated separately. Multivariable regression models were used to adjust for baseline differences in demographic and clinical characteristics, and sensitivity analyses using CBP <140/90 mmHg were conducted. Patients with UBP (n = 22 333) were younger and had fewer comorbidities at baseline than those with CBP (n = 11 427). In the primary analysis, which adjusted for these baseline differences, UBP versus CBP patients were at an 8% increased risk of MACE+ (driven by a 31% increased risk of stroke) and a 53% increased risk of ESRD after 2.7 years of follow-up. Greater MACE+ (22%) and ESRD (98%) risk increases with UBP versus CBP were seen in the sensitivity analysis. These real-world data showed an association between suboptimal BP control in patients with aTRH and higher incidence of MACE+ and ESRD linked with UBP despite the use of multidrug regimens. Thus, there remains a need for improved aTRH management.
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Affiliation(s)
| | - Cindy Chen
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | | | | | - Lloyd Haskell
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Mukul Singhal
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
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4
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Lim Y, Kim BC, Yoon SS, Kim HJ, Lee SJ, Lee MH, Kim JH, Park SJ, Jeong S, Han HW. Inverse association between changes in systolic and diastolic blood pressure and risk of depression: A nationally representative cohort study. J Affect Disord 2023; 335:49-56. [PMID: 37137410 DOI: 10.1016/j.jad.2023.04.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Depression is one of complex mental disorders with diverse etiological factors but the association between blood pressure (BP) and depression is unknown. We aimed to investigate the association between changes in BP (systolic and diastolic) and incident depression. METHODS From the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), 224,192 participants who underwent biennial health screenings from period I (2004-05) and II (2006-07) were included in the study. Systolic BP (SBP) and diastolic BP (DBP) categories were defined as follows: SBP into 5 categories (<90 mmHg, 90 mmHg -119 mmHg, 120 mmHg -129 mmHg, 130 mmHg -139 mmHg, ≥140 mmHg) and DBP into 4 categories (<60 mmHg, 60 mmHg -79 mmHg, 80 mmHg -89 mmHg, ≥90 mmHg). Also, BP levels were classified into 5 groups: normal, elevated BP, stage 1 BP, stage 2 BP, hypotension. Using the Cox proportional hazards regression, changes in SBP and DBP between two screening periods and the risk of depression were calculated by adjusted hazard ratio (aHR) and 95 % confidence interval (CI). RESULTS There were 17,780 depression events during 1.5 million person-year of follow-up. Compared to the participants with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg from both periods, those who decreased SBP from ≥140 mmHg to 120 mmHg-129 mmHg (aHR 1.13; 95 % CI 1.04-1.24; P = 0.001) and those who decreased DBP from ≥90 mmHg to 60 mmHg-79 mmHg (aHR 1.10; 95 % CI 1.02-1.20; P = 0.020) showed a higher risk of depression, respectively. CONCLUSIONS Changes in SBP and DBP showed an inverse relationship with depression risk.
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Affiliation(s)
- Yohwan Lim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Bo Chang Kim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Sung Soo Yoon
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Hye Jun Kim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Sang Jun Lee
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Myeong Hoon Lee
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Ju Hee Kim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea.
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea; Institute of Biomedical Informatics, CHA University School of Medicine, CHA University, 335 Pangyo-ro, Seongnam 13448, Republic of Korea.
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5
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Choi HE, Kim C, Lee DJ, Joo JE, Kim HS. Participation and Prognostic Impact of Cardiac Rehabilitation After Acute Coronary Syndrome: Big-Data Study of the Korean National Health Insurance Service. J Korean Med Sci 2023; 38:e119. [PMID: 37069813 PMCID: PMC10111042 DOI: 10.3346/jkms.2023.38.e119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/03/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND To investigate the actual rate and quality of cardiac rehabilitation (CR) participation in South Korea and its short-term impact on clinical outcomes after acute coronary syndrome (ACS). METHODS Data, including confirmed ACS diagnosis, socio-demographics, comorbidities, clinical outcomes, and CR claim codes, were collected from the Korean National Health Insurance Service claims database and compared between the CR and non-CR groups. RESULTS Overall, 102,544 patients were included in the study, of which only 5.8% attended CR. Regarding testing, 83.6% of CR patients performed the cardiopulmonary exercise test, but follow-up testing was infrequently performed; in addition, 53.1% of them participated in an electrocardiogram monitoring exercise, but over half participated in only one session. After 1:1 propensity score matching, post-ACS cardiovascular events were significantly lower in the CR group than in the non-CR group. The cumulative 3-year hazard ratio for all-cause death was 0.612 (95% confidence interval [CI], 0.495-0.756), recurrent ACS was 0.92 (95% CI, 0.853-0.993), CR readmission was 0.817 (95% CI, 0.768-0.868), and major adverse cardiovascular events (MACE) was 0.827 (95% CI, 0.781-0.874) in the CR group. CR was associated with a significant dose-response effect on MACE, with a reduction in incidence from 0.854 to 0.711. CONCLUSION The actual rate of CR participation in South Korea remains low, and participation quality was not outstanding despite National Health Insurance coverage. Nevertheless, the impact of CR on cardiovascular outcomes after ACS was significantly superior. Efforts to increase CR participation should be increased by establishing new CR facilities and strategies to resolve associated barriers.
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Affiliation(s)
- Hee-Eun Choi
- Department of Rehabilitation Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
| | - Da-Jung Lee
- Department of Rehabilitation Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae-Eun Joo
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Ho-Seob Kim
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
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Figueroa A, Maharaj A, Kang Y, Dillon KN, Martinez MA, Morita M, Nogimura D, Fischer SM. Combined Citrulline and Glutathione Supplementation Improves Endothelial Function and Blood Pressure Reactivity in Postmenopausal Women. Nutrients 2023; 15:nu15071557. [PMID: 37049398 PMCID: PMC10097312 DOI: 10.3390/nu15071557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Postmenopausal women (PMW) may experience endothelial dysfunction associated with arginine (ARG) deficiency relative to asymmetric dimethylarginine (ADMA) caused by oxidative stress. Endothelial dysfunction contributes to increased blood pressure (BP) responsiveness to sympathoexcitation induced by the cold pressor test (CPT). We investigated the effects of citrulline alone (CIT) and combined with the antioxidant glutathione (CIT+GSH) on vascular function. Forty-four healthy PMW were randomized to CIT (6 g), CIT+GSH (2 g + 200 mg: Setria®) or placebo (PL) for 4 weeks. Brachial artery flow-mediated dilation (FMD), aortic stiffness (pulse wave velocity, PWV), brachial and aortic BP reactivity to CPT, and serum fasting blood glucose (FBG), ARG, and ARG/ADMA ratio were measured. Baseline FBG was higher in CIT+GSH vs. PL. FMD increased after CIT+GSH vs. PL (p < 0.05). CIT and CIT+GSH increased ARG/ADMA (p < 0.05), but did not affect aortic PWV. CIT+GSH attenuated the brachial and aortic systolic BP and mean arterial pressure (MAP) responses to CPT vs. PL and CIT (p < 0.05). The improvements in FMD were related to baseline FMD (r = -0.39, p < 0.05) and aortic MAP response to CPT (r = -0.33, p < 0.05). This study showed that CIT+GSH improved FMD and attenuated systolic BP and MAP reactivity in PMW. Although CIT increased ARG/ADMA, it did not improve FMD in healthy PMW.
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Affiliation(s)
- Arturo Figueroa
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA
| | - Arun Maharaj
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yejin Kang
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA
| | - Katherine N Dillon
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA
| | - Mauricio A Martinez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA
| | - Masahiko Morita
- Research & Development Division, KIRIN Central Research Institute, Kirin Holdings Co., Ltd., 2-26-1, Muraoka-Higashi, Fujisawa 251-8555, Kanagawa, Japan
| | - Dai Nogimura
- Research & Development Division, KIRIN Central Research Institute, Kirin Holdings Co., Ltd., 2-26-1, Muraoka-Higashi, Fujisawa 251-8555, Kanagawa, Japan
| | - Stephen M Fischer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA
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7
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Kwon CH, Lee HY, Lee JH, Kim M, Sung KC. Optimal office blood pressure levels in younger (<50 years old) Korean hypertensive patients: a nationwide cohort study in South Korea. J Hypertens 2022; 40:2449-2458. [PMID: 35983871 DOI: 10.1097/hjh.0000000000003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is unclear what thresholds and targets of office blood pressure (BP) for treatment are appropriate in younger (<50 years old) hypertensive patients. Thus, the aim of this study was to evaluate associations of office BP levels with major cardiovascular events (MACEs) in these patients. METHODS Using the Korean National Health Insurance Service database, data of 98 192 younger (<50 years old) hypertensive patients having BP measurements available without any history of cardiovascular events from 2002 to 2011 were extracted. This cohort study evaluated associations of BP levels (<120/<70, 120-129/70-79, 130-139/80-89, 140-149/90-99, and ≥150/≥100 mmHg) with MACEs. The study outcome was MACE, a composite of cardiovascular death, myocardial infarction, stroke, and heart failure. RESULTS In all patients, those treated with antihypertensive medication accounted for 34.7% and those who achieved BP less than 130/80 mmHg accounted for 35.5%. During a mean follow-up of 9.5 ± 2.8 years, 4918 (5%) MACEs were documented in our cohort. The risk of MACE was the lowest [adjusted hazard ratio: 0.77, 95% confidence interval (CI) 0.66-0.89] for those with BP level of less than 120/less than 70 mmHg. It was the highest (hazard ratio 2.0, 95% CI 1.83-2.19) for those with BP level of at least 150/at least 100 mmHg in comparison with those with BP level of 130-139/80-89 mmHg. These results were consistent for all age groups (20-29, 30-39, and 40-49 years) and both sexes. CONCLUSION Elevated BP level from less than 120 mmHg/less than 70 mmHg is significantly correlated with an increased risk of MACE in younger (<50 years old) Korean hypertensive patients. Lowering BP to less than 120 mmHg/less than 70 mmHg is needed for these patients.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Jun Hyeok Lee
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju
| | - Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kwon CH, Kim W, Shin JH, Lee CJ, Kim HC, Kang SH, Jung MH, Kim DH, Lee JH, Kim HL, Kim HM, Cho IJ, Cho I, Kang DR, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Park S, Shin J, Ryu SK, Kang SM, Cho MC, Kim JH, Lee JH, Kim JY, Pyun WB, Sung KC. Office Blood Pressure Range and Cardiovascular Events in Patients With Hypertension: A Nationwide Cohort Study in South Korea. J Am Heart Assoc 2021; 10:e017890. [PMID: 33739126 PMCID: PMC8174356 DOI: 10.1161/jaha.120.017890] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background It is unclear what office blood pressure (BP) is the optimal treatment target range in patients with hypertension. Methods and Results Using the Korean National Health Insurance Service database, we extracted the data on 479 359 patients with hypertension with available BP measurements and no history of cardiovascular events from 2002 to 2011. The study end point was major cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. This cohort study evaluated the association of BP levels (<120/<70, 120–129/70–79, 130–139/80–89, 140–149/90–99, and ≥150/≥100 mm Hg) with MACE. During a median follow‐up of 9 years, 55 401 MACE were documented in our cohort. The risk of MACE was the lowest (adjusted hazard ratio [HR], 0.79; 95% CI, 0.76–0.84) at BP level of <120/<70 mm Hg, and was the highest (HR, 1.32; 95% CI, 1.29–1.36) at ≥150/≥100 mm Hg in comparison with 130 to 139/80 to 89 mm Hg. These results were consistent in all age groups and both sexes. Among patients treated with antihypertensive medication (n=237 592, 49.5%), in comparison with a BP level of 130 to 139/80 to 89 mm Hg, the risk of MACE was significantly higher in patients with elevated BP (≥140/≥90 mm Hg), but not significantly lower in patients with BP of <130/<80 mm Hg. Low BP <120/70 mm Hg was associated with increased risk of all‐cause or cardiovascular death in all age groups. Conclusions BP level is significantly correlated with the risk of MACE in all Korean patients with hypertension. However, there were no additional benefits for MACE amongst those treated for hypertension with BP <120/70 mm Hg.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology Department of Internal Medicine Konkuk University Medical Center Konkuk University School of Medicine Seoul Republic of Korea
| | - Woohyeun Kim
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Hyeon-Chang Kim
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Si-Hyuck Kang
- Cardiovascular Centre Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Mi-Hyang Jung
- Cardiovascular Center Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Hack Lyoung Kim
- Department of Internal Medicine Seoul National University College of MedicineBoramae Medical Center Seoul Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology Department of Internal Medicine Chung-Ang University HospitalChung-Ang University Seoul Republic of Korea
| | - In Jeong Cho
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Iksung Cho
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Dae Ryong Kang
- Department of Precision Medicine Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology Department of Internal Medicine Gil Hospital Gachon University Incheon Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology Department of Internal Medicine Bucheon St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology Department of Internal Medicine Yeouido St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology Department of Internal Medicine Kyung Hee University at Gangdong Seoul Republic of Korea
| | - Sungha Park
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Jinho Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology Department of Internal Medicine Eulji Medical School of Medicine Seoul Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Ju Han Kim
- Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Jun Hyeok Lee
- Department of Biostatistics Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Jang-Young Kim
- Department of Cardiology Yonsei University Wonju College of Medicine Wonju Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
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