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Kim IS, Kim S, Yoo TH, Kim JK. Diagnosis and treatment of hypertension in dialysis patients: a systematic review. Clin Hypertens 2023; 29:24. [PMID: 37653470 PMCID: PMC10472689 DOI: 10.1186/s40885-023-00240-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/24/2023] [Indexed: 09/02/2023] Open
Abstract
In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies widely among studies because of differences in the definition of hypertension and the methods of used to measure blood pressure (BP), i.e., peri-dialysis or ambulatory BP monitoring (ABPM). Recently, ABPM has become the gold standard for diagnosing hypertension in dialysis patients. Home BP monitoring can also be a good alternative to ABPM, emphasizing BP measurement outside the hemodialysis (HD) unit. One thing for sure is pre- and post-dialysis BP measurements should not be used alone to diagnose and manage hypertension in dialysis patients. The exact target of BP and the relationship between BP and all-cause mortality or cause-specific mortality are unclear in this population. Many observational studies with HD cohorts have almost universally reported a U-shaped or even an L-shaped association between BP and all-cause mortality, but most of these data are based on the BP measured in HD units. Some data with ABPM have shown a linear association between BP and mortality even in HD patients, similar to the general population. Supporting this, the results of meta-analysis have shown a clear benefit of BP reduction in HD patients. Therefore, further research is needed to determine the optimal target BP in the dialysis population, and for now, an individualized approach is appropriate, with particular emphasis on avoiding excessively low BP. Maintaining euvolemia is of paramount importance for BP control in dialysis patients. Patient heterogeneity and the lack of comparative evidence preclude the recommendation of one class of medication over another for all patients. Recently, however, β-blockers could be considered as a first-line therapy in dialysis patients, as they can reduce sympathetic overactivity and left ventricular hypertrophy, which contribute to the high incidence of arrhythmias and sudden cardiac death. Several studies with mineralocorticoid receptor antagonists have also reported promising results in reducing mortality in dialysis patients. However, safety issues such as hyperkalemia or hypotension should be further evaluated before their use.
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Affiliation(s)
- In Soo Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Pyungan-dong, Dongan-gu, Anyang, 431-070, Korea
| | - Sungmin Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Pyungan-dong, Dongan-gu, Anyang, 431-070, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea
| | - Jwa-Kyung Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Pyungan-dong, Dongan-gu, Anyang, 431-070, Korea.
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Song SH, Kim YJ, Choi HS, Kim CS, Bae EH, Ahn C, Oh KH, Park SK, Lee KB, Sung S, Han SH, Ma SK, Kim SW. Persistent Resistant Hypertension Has Worse Renal Outcomes in Chronic Kidney Disease than that Resolved in Two Years: Results from the KNOW-CKD Study. J Clin Med 2021; 10:jcm10173998. [PMID: 34501446 PMCID: PMC8432533 DOI: 10.3390/jcm10173998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023] Open
Abstract
Apparent treatment-resistant hypertension (ATRH) is closely related to chronic kidney disease (CKD); however, the long-term outcomes and the effects of improvement in ATRH in patients with CKD are not well understood. We evaluated the relationship between the persistence of ATRH and the progression of CKD. This cohort study enrolled 1921 patients with CKD. ATRH was defined as blood pressure above 140/90 mmHg and intake of three different types of antihypertensive agents, including diuretics, or intake of four or more different types of antihypertensive agents, regardless of blood pressure. We defined ATRH subgroups according to the ATRH status at the index year and two years later. The prevalence of ATRH at baseline was 14.0%. The presence of ATRH at both time points was an independent risk factor for end-point renal outcome (HR, 1.41; 95% CI, 1.04–1.92; p = 0.027). On the other hand, the presence of ATRH at any one of the time points was not statistically significant. In conclusion, persistent ATRH is more important for the prognosis of renal disease than the initial ATRH status. Continuous follow-up and appropriate treatment are important to improve the renal outcomes.
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Affiliation(s)
- Su-Hyun Song
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.-H.S.); (Y.-J.K.); (H.-S.C.); (C.-S.K.); (E.-H.B.)
- Chonnam National Universitiy Hospital, Gwangju 61469, Korea
| | - Young-Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.-H.S.); (Y.-J.K.); (H.-S.C.); (C.-S.K.); (E.-H.B.)
- Chonnam National Universitiy Hospital, Gwangju 61469, Korea
| | - Hong-Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.-H.S.); (Y.-J.K.); (H.-S.C.); (C.-S.K.); (E.-H.B.)
- Chonnam National Universitiy Hospital, Gwangju 61469, Korea
| | - Chang-Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.-H.S.); (Y.-J.K.); (H.-S.C.); (C.-S.K.); (E.-H.B.)
- Chonnam National Universitiy Hospital, Gwangju 61469, Korea
| | - Eun-Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.-H.S.); (Y.-J.K.); (H.-S.C.); (C.-S.K.); (E.-H.B.)
- Chonnam National Universitiy Hospital, Gwangju 61469, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.A.); (K.-H.O.)
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.A.); (K.-H.O.)
| | - Sue-Kyung Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Kyu-Beck Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul 03181, Korea;
| | - Suah Sung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea;
| | - Seung-Hyeok Han
- Department of Internal Medicine, College of medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Korea;
| | - Seong-Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.-H.S.); (Y.-J.K.); (H.-S.C.); (C.-S.K.); (E.-H.B.)
- Chonnam National Universitiy Hospital, Gwangju 61469, Korea
- Correspondence: (S.-K.M.); (S.-W.K.); Tel.: +82-62-220-6271 (S.-W.K.); +82-62-220-6579 (S.-K.M.); Fax: +82-62-225-8578 (S.-W.K. & S.-K.M.)
| | - Soo-Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.-H.S.); (Y.-J.K.); (H.-S.C.); (C.-S.K.); (E.-H.B.)
- Chonnam National Universitiy Hospital, Gwangju 61469, Korea
- Correspondence: (S.-K.M.); (S.-W.K.); Tel.: +82-62-220-6271 (S.-W.K.); +82-62-220-6579 (S.-K.M.); Fax: +82-62-225-8578 (S.-W.K. & S.-K.M.)
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3
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Kim S, Park JJ, Shin MS, Kwak CH, Lee BR, Park SJ, Lee HY, Kim SH, Kang SM, Yoo BS, Chung JW, Choi SW, Jo SH, Shin J, Choi DJ. Apparent treatment-resistant hypertension among ambulatory hypertensive patients: a cross-sectional study from 13 general hospitals. Korean J Intern Med 2021; 36:888-897. [PMID: 34092048 PMCID: PMC8273811 DOI: 10.3904/kjim.2019.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/17/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. METHODS We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. RESULTS Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m2 vs. 24.9 kg/m2, p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. CONCLUSION Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.
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Affiliation(s)
- Sehun Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul,
Korea
| | - Jin Joo Park
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Mi-Seung Shin
- Department of Cardiology, Gachon University Gil Medical Center, Incheon,
Korea
| | - Choong Hwan Kwak
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon,
Korea
| | - Bong-Ryeol Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu,
Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joong-Wha Chung
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju,
Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon,
Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Seoul,
Korea
| | - Dong-Ju Choi
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam,
Korea
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Smith TO, Sillito JA, Goh CH, Abdel-Fattah AR, Einarsson A, Soiza RL, Mamas MA, Tan MP, Potter JF, Loke YK, Myint PK. Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality: a systematic review. Age Ageing 2020; 49:184-192. [PMID: 31985773 DOI: 10.1093/ageing/afz178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality. METHODS Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised. RESULTS Sixty-one studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, "day-by-day" and "week-to-week" variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed). CONCLUSION An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes were not possible.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Norwich Medical School, University of East Anglia, Norwich, UEA Norwich, UK
| | - Julia Ann Sillito
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Choon-Hian Goh
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdel-Rahman Abdel-Fattah
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alice Einarsson
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
- Academic Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
| | - Roy L Soiza
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
- Academic Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Keele, UK
- Farr Institute, University of Manchester, Manchester, UK
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UEA Norwich, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UEA Norwich, UK
| | - Phyo K Myint
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
- Academic Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
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Chia R, Pandey A, Vongpatanasin W. Resistant hypertension-defining the scope of the problem. Prog Cardiovasc Dis 2019; 63:46-50. [PMID: 31863785 DOI: 10.1016/j.pcad.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 01/28/2023]
Abstract
The updated scientific statement by the American Heart Association has defined resistant hypertension (HTN;RH) as uncontrolled blood pressure (BP) ≥ 130/80 mmHg, despite concurrent use of 3 anti-HTN drug classes comprising a calcium channel blocker, a blocker of renin-angiotensin system, and a thiazide diuretic, preferably chlorthalidone. Using the updated BP criteria, the prevalence of RH in the United States is found to be modestly increased by approximately 3-4% among treated population. Meta-analysis of observational studies have demonstrated that pseudo-RH from white coat HTN or medication nonadherence is as much common as the truly RH. Thus, screening for pseudo-resistance in the evaluation of all apparent RH is of utmost importance as diagnosis of white-coat HTN requires no treatment, while medication nonadherence would benefit from identifying and targeting barriers to adherence.
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Affiliation(s)
- Richard Chia
- Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX; Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ambarish Pandey
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX
| | - Wanpen Vongpatanasin
- Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX; Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX.
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Yang ZQ, Zhao Q, Jiang P, Zheng SB, Xu B. Prevalence and control of hypertension among a Community of Elderly Population in Changning District of shanghai: a cross-sectional study. BMC Geriatr 2017; 17:296. [PMID: 29281978 PMCID: PMC5745978 DOI: 10.1186/s12877-017-0686-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is considered a major public health challenge. It is the most important risk factor for cardiovascular disease and is a prominent risk for China's elderly population. However, few studies have addressed the effect of blood pressure control on elderly hypertension patients in China. In response, this study aimed to investigate the prevalence and control of hypertension in the elderly population in Shanghai's communities. METHODS A secondary data analysis based on a government-financed health check-up program for an elderly population aged 65 and older from 2012 to 2014 was conducted in a central district of Shanghai. RESULTS Of the 44,978 study participants, 20,305 (45.1%) were males and 24,673 (54.9%) were females. The participants' median age was 72. Half of the participants were overweight or obese (BMI ≥ 24.0 kg/m2). The prevalence of hypertension was 59.9%. In the 18,032 participants without prior diagnosis of hypertension, 5530 (30.7%) had increased blood pressure. Among the 26,946 confirmed hypertension patients, the proportions of treatment and blood pressure control were 32.8% and 43.4% respectively. Multivariate analysis showed that the uncontrolled hypertension was significantly associated with older age, being overweight or obese, a lower level of education, an unbalanced dietary pattern, regular drinking and non-comorbidities. CONCLUSIONS The prevalence of hypertension was high in China's elderly population. The proportion of individuals who received treatment remained low, and blood pressure control was poor among hypertension patients. These results indicate that improvement of the ability to manage and control hypertension among urban elderly residents is urgently needed.
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Affiliation(s)
- Zhi-Qi Yang
- School of Public Health, Fudan University, Shanghai, China
| | - Qi Zhao
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Ping Jiang
- Changning District Health and Family Planning Commission, Changning District, Shanghai, China
| | - Song-Bai Zheng
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
- Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, School of Public Health, Fudan University, No.130 Dong-An Road, Shanghai, China
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Ali ER, Mohamad AM. Evaluation of the efficiency of anthropometric parameters and submental ultrasonographic indices as predictors for screening of obstructive sleep apnea and its severity. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_17_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Choi SI, Kim SK, Park S, Kim JH, Ihm SH, Kim GI, Kim WS, Pyun WB, Kim YM, Shin J. Erratum to: Prevalence of resistant hypertension and associated factors for blood pressure control status using Korean ambulatory blood pressure monitoring registry data. Clin Hypertens 2016; 22:14. [PMID: 26933509 PMCID: PMC4772461 DOI: 10.1186/s40885-016-0048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 11/25/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s40885-016-0045-x.].
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Affiliation(s)
- Sung Il Choi
- />Cardiology division, Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-Ku, Seoul, #133-792 South Korea
| | - Soon Kil Kim
- />Cardiology division, Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-Ku, Seoul, #133-792 South Korea
| | - Sungha Park
- />Department of Internal Medicine, Yonsei University, School of Medicine, Seoul, Korea
| | - Ju Han Kim
- />Department of Internal Medicine, Chonnam University, School of Medicine, GwangJu, Korea
| | - Sang Hyun Ihm
- />Department of Internal Medicine, Catholic University, College of Medicine, Bucheon, Korea
| | - Gwang-il Kim
- />Department of Internal Medicine, Seoul National University, School of Medicine, Bundang, Korea
| | - Woo Shik Kim
- />Department of Internal Medicine, Kyung Hee University, School of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- />Department of Internal Medicine, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Yu-Mi Kim
- />Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jinho Shin
- />Cardiology division, Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro Sungdong-Ku, Seoul, #133-792 South Korea
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