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Kang HK, Sung NJ. Correlation between Usual Source of Care and Medication Adherence in Patients with Hypertension. Korean J Fam Med 2024; 45:82-88. [PMID: 38008710 DOI: 10.4082/kjfm.23.0125] [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: 08/03/2023] [Accepted: 09/13/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Maintaining a usual source of care (USC), which is crucial for primary healthcare, encompasses initial contact, comprehensive services, coordinated care, and ongoing support. However, limited research exists on the relationship between USC and medication adherence in patients with hypertension. This study aimed to investigate the association between USC and medication adherence among patients with hypertension. METHODS Data from the 2nd Korea Health Panel Survey 2020 were analyzed. The final sample consisted of 3,318 participants aged 19 years or older diagnosed with hypertension. USC was categorized into three groups: no USC, place only (without a regular doctor), and regular doctor. Medication adherence was assessed using detailed items (dose, frequency, time, no stop) and a 4-point Likert scale. A logistic regression analysis was conducted with control for relevant variables. RESULTS Compared to the no USC group, the regular doctor group had significantly higher odds ratios (ORs) for overall perfect/high medication adherence rates: 1.70 (95% confidence interval [CI], 1.42-2.03) and 1.59 (95% CI, 1.14-2.20). Similar results were observed for each adherence item, including prefect dose (OR, 2.14; 95% CI, 1.73- 2.63), frequency (OR, 1.87; 95% CI, 1.53-2.28), time (OR, 1.72; 95% CI, 1.43-2.07), and no stop (OR, 1.56; 95% CI, 1.09-2.23)/high frequency (OR, 2.47; 95% CI, 1.21-5.01), time (OR, 2.30; 95% CI, 1.19-4.44). However, the place only group showed no significant differences in medication adherence except for perfect adherence to dose (OR, 1.35; 95% CI, 1.06-1.71). CONCLUSION These findings provide evidence supporting the need for healthcare policies that encourage having a regular doctor in South Korea, which has a healthcare system with limited primary care.
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Affiliation(s)
- Han-Kil Kang
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Nak-Jin Sung
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Department of Family Medicine, Dongguk University College of Medicine, Goyang, Korea
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2
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An S. The Moderated Mediation Effect of Age and Relaxation on the Relationship between the Type A Behavior Pattern and Blood Pressure in South Korea. Healthcare (Basel) 2023; 11:2264. [PMID: 37628462 PMCID: PMC10454317 DOI: 10.3390/healthcare11162264] [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: 07/18/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Although it is generally known that the type A behavior pattern (TABP) is associated with high blood pressure, recent studies have not consistently supported this association. Therefore, it is important to determine which factors moderate and mediate this relationship. The purpose of this study was to verify the moderated mediation effect of age and relaxation in the relationship between TABP and high blood pressure among middle-aged adults in South Korea. This study utilized data from the Korea Health and Genome Study (KHGS) supported by the Korea National Institute of Health. The participants in the present study were 10,022 Korean adults aged 40 to 69. To identify the conditional indirect effect of TABP on blood pressure through relaxation, with a consideration of age, a moderated mediation model using SPSS PROCESS macro 3.10 was applied. As is generally known, TABP was associated with high blood pressure, but its relevance was reversed through relaxation. Moreover, this relationship was moderated by age, which is known to be the most powerful predictor of high blood pressure. The lower age group with TABP exhibited a higher relaxation, whereas the higher age group with TABP demonstrated a lower relaxation. The findings demonstrate the need for relaxation education, stress management, or counseling to help individuals recognize their behavior patterns and strengthen the willingness and motivation for relaxation, especially among elderly people with TABP, in order to manage their blood pressure effectively.
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Affiliation(s)
- Sunghee An
- Graduate School of Education, Hongik University, 94 Wausan-ro, Seoul 04066, Republic of Korea
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3
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Lee JY, Bak JK, Kim M, Shin HG, Park KI, Lee SP, Lee HS, Lee JY, Kim KI, Kang SH, Lee JH, Jang SY, Lee JH, Kim KH, Cho JY, Park JH, Park SK, Lee HY. Long-term cardiovascular events in hypertensive patients: full report of the Korean Hypertension Cohort. Korean J Intern Med 2023; 38:56-67. [PMID: 36514267 PMCID: PMC9816676 DOI: 10.3904/kjim.2022.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS This study evaluated the long-term cardiovascular complications among Korean patients with hypertension and compared them with that of controls without hypertension. METHODS The Korean Hypertension Cohort (KHC) enrolled 11,043 patients with hypertension and followed them for more than 10 years. Age- and sex-matched controls without hypertension were enrolled at a 1:10 ratio. We compared the incidence of cardiovascular events and death among patients and controls without hypertension. RESULTS The mean age was 59 years, and 34.8% and 16.5% of the patients belonged to the high and moderate cardiovascular risk groups, respectively. During the 10-year follow-up, 1,591 cardiovascular events (14.4%) with 588 deaths (5.3%) occurred among patients with hypertension and 7,635 cardiovascular events (6.9%) with 4,826 deaths (4.4%) occurred among controls. Even the low-risk population with hypertension showed a higher cardiovascular event rate than the population without hypertension. Although blood pressure measurements in the clinic showed remarkable inaccuracy compared with those measured in the national health examinations, systolic blood pressure (SBP) ≥ 150 mmHg was significantly associated with a higher risk of cardiovascular events. CONCLUSION This long-term follow-up study confirmed the cardiovascular event rates among Korean hypertensive patients were substantial, reaching 15% in 10 years. SBP levels ≥ 150 mmHg were highly associated with occurrence of cardiovascular event rates.
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Affiliation(s)
- Jin Young Lee
- Department of Applied Statistics, Chung-Ang University, Seoul,
Korea
| | - Jean Kyung Bak
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul,
Korea
| | - Mina Kim
- Department of Applied Statistics, Chung-Ang University, Seoul,
Korea
| | - Ho-Gyun Shin
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul,
Korea
| | - Kyun-Ik Park
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul,
Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hee-Sun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Seoul National University, Seoul,
Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju,
Korea
| | - Jae Yeong Cho
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Jae-Hyeong Park
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Sue K. Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
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Sung KC, Sung JH, Cho EJ, Ahn JC, Han SH, Kim W, Kim KH, Sohn IS, Shin J, Kim SY, Kim KI, Kang SM, Park SJ, Kim YJ, Shin JH, Park SM, Park CG. Efficacy and safety of low-dose antihypertensive combination of amlodipine, telmisartan, and chlorthalidone: A randomized, double-blind, parallel, phase II trial. J Clin Hypertens (Greenwich) 2022; 24:1298-1309. [PMID: 36094783 PMCID: PMC9581102 DOI: 10.1111/jch.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
The aim of this clinical trial was to assess the efficacy and safety of low‐dose triple combinations of amlodipine, telmisartan, and chlorthalidone in patients with essential hypertension. After a 2‐week placebo run‐in period, 176 patients were randomized to seven treatment groups (placebo, quarter‐dose combination, third‐dose combination, half‐dose combination, amlodipine 5 mg, amlodipine 10 mg, and telmisartan 80 mg) and administered the assigned study drug orally for 8 weeks. The primary efficacy endpoint was the change in the mean sitting systolic blood pressure (BP) (MSSBP) at Week 8. The MSSBP and mean sitting diastolic BP in the quarter‐dose and half‐dose groups were significantly lower compared to the placebo and amlodipine 5 mg groups, with similar BP‐lowering effects observed compared to the amlodipine 10 mg and telmisartan 80 mg groups. However, the third‐dose group showed significant BP improvement only compared to the placebo group. A similar pattern was observed for the control rate of hypertension and response rates. Additional analysis was conducted after correcting for gender and age effects, and, as a result, the third‐dose group showed similar results with regard to the BP‐lowering effect as the quarter‐dose and half‐dose groups. In terms of safety, no special adverse events and clinically significant results were noted, and all dose groups of the triple combination are considered safe for use in essential hypertension patients. The current findings indicated that low‐dose triple combination of amlodipine, telmisartan, and chlorthalidone over 8 weeks effectively improved the BP‐lowering effect in patients with essential hypertension without any safety concerns.
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Affiliation(s)
- Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hoon Sung
- Division of Cardiology, Bundang CHA Medical Center, Sungnam, Korea
| | - Eun Joo Cho
- Division of Cardiology, Yeouido St. Mary's Hospital Catholic University, Seoul, Korea
| | - Jeong Cheon Ahn
- Department of Cardiology, Korea University Ansan Hospital, Ansan, Korea
| | - Seung Hwan Han
- Division of Cardiology, Gachon University Gil Hospital, Incheon, Korea
| | - Weon Kim
- Division of Cardiology and Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, KwangJu, Korea
| | - Il Suk Sohn
- Department of Cardiology, College of Medicine Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Seok Yeon Kim
- Division of Cardiology, Seoul Medical Center, Seoul, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Korea
| | - Seok Min Kang
- Division of Cardiology, Yonsei Cardiovascular Hospital, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Samsung Medical Center, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Chang-Gyu Park
- Division of Cardiology, Korea University Guro Hospital, Seoul, Korea
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5
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Koch S, Esch T, Werdecker L. Effects of a Yoga-Based Stress Intervention Program on the Blood Pressure of Young Police Officers: A Randomized Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:234-240. [PMID: 35294298 DOI: 10.1089/jicm.2021.0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: Despite improvements in health education and treatment, arterial hypertension remains a major health problem of increasing epidemiological importance. The purpose of this randomized controlled trial was to determine the impact of regular yoga breathing exercises on blood pressure, work-related stress, and the prevalence of arterial hypertension in young police academy trainees with no existing comorbidities. Design: A single-center, prospective, randomized controlled trial. Subjects: The study included 120 healthy trainees aged between 18 and 39 years who practiced weekly yoga exercises with an emphasis on breathing (prāṇāyāma) over an observation period of 6 months. Results: These regular exercises lowered the blood pressure of the participants by 1.34 mmHg (right arm, p = 0.007), increased their regenerative capacity (Recovery Experience Questionnaire [REQ] scale +2.77, p < 0.001) and resilience (Resilience Scale [RS] +4.6, p = 0.001), and concomitantly reduced the level of perceived stress (Perceived Stress Scale [PSS] -0.9, p < 0.001). In contrast, blood pressure in the control group had slightly increased over the study period by 0.1 mmHg (right arm, p < 0.001) and 1.0 mmHg (left arm, p = 0.03), and subjective scores had significantly worsened (REQ scale -3.4, p < 0.001; RS -2.29, p = 0.001; PSS +0.88, p < 0.001). Conclusions: The results point to a significant correlation between blood pressure and both regenerative capacity and stress level. Thus, the study confirms the hypothesis that yoga exercises reduce perceived stress and exert positive effects on blood pressure. Clinical Trial Registration Number: DRKS00025921.
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Affiliation(s)
- Steven Koch
- Department of Training and Sport, Educational Institutions of the Police of Thuringia, Meiningen, Germany.,Faculty of Health, School of Medicine, Institute for Integrative Health Care and Health Promotion, Witten/Herdecke University, Witten, Germany
| | - Tobias Esch
- Faculty of Health, School of Medicine, Institute for Integrative Health Care and Health Promotion, Witten/Herdecke University, Witten, Germany.,Faculty of Health, School of Medicine, University Clinic for Integrative Health Care, Institute for Integrative Health Care and Health Promotion, Witten/Herdecke University, Witten, Germany
| | - Lena Werdecker
- Faculty of Health, School of Medicine, Institute for Integrative Health Care and Health Promotion, Witten/Herdecke University, Witten, Germany
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6
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Lee HY, Oh GC, Sohn IS, Park S, Shin J, Pyun WB, Cho MC. Suboptimal Management Status of Younger Hypertensive Population in Korea. Korean Circ J 2021; 51:598-606. [PMID: 34085433 PMCID: PMC8263293 DOI: 10.4070/kcj.2020.0542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/13/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertension (HTN) is the most contributable risk factor for cardiovascular disease. May Measurement Month (MMM) is a global initiative to raise awareness of HTN and act as a temporary solution to the lack of screening programs worldwide. METHODS An opportunistic cross-sectional survey of participants aged ≥18 was carried out in May 2019. Over 10,000 participants were recruited in the MMM 2019 Korea, with a slogan of "A simple measure to save lives - #checkyourpressure." RESULTS A total of 9,950 participants with valid clinical blood pressure (BP) data were used for analysis. All participants were Korean in ethnicity. The mean age was 57.2±21.2 years, 57.8% were females, and the mean body mass index was 23.4±3.3 kg/m². Among the enrolled population, 20.1% were less than 30 years old, and 5.0% were 30-39 years old. 37.0% of the participants reported a previous diagnosis of HTN, and 91.3% of those diagnosed were on antihypertensive medications. Notably, more than 20% of the participants had not measured their BP during the last 12 months, and the awareness rate in the young hypertensive participants (aged <40) was less than 10%. Among hypertensive participants, the treatment rate was 69.3%, and the control rate among those taking medications was 61.2%. CONCLUSION MMM 2019 Korea campaign reported high BP control rates in individuals with HTN, reaching 60%. However, the awareness rate in young hypertensive participants was less than 10% along with suboptimal management status. The MMM 2019 Korea again raised the importance of regular BP measurement in the younger population.
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Affiliation(s)
- Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyu Chul Oh
- Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Il Suk Sohn
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
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7
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Kim HC, Ihm SH, Kim GH, Kim JH, Kim KI, Lee HY, Lee JH, Park JM, Park S, Pyun WB, Shin J, Chae SC. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension. Clin Hypertens 2019; 25:16. [PMID: 31388451 PMCID: PMC6670210 DOI: 10.1186/s40885-019-0121-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/03/2019] [Indexed: 02/08/2023] Open
Abstract
The Korean Society of Hypertension guideline defines hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, where the effectiveness of pharmacological treatment has been established. It is confirmed that higher blood pressure levels are associated with increased risk of cardiovascular disease and mortality also in the Korean population. About one third of Korean adults aged 30 years or older are estimated to have hypertension, and the prevalence of hypertension gradually increases as the age increases. The awareness, treatment, and control rates of hypertension are generally improving in Korea, but more efforts are required to increase awareness and treatment among younger patients with hypertension and to improve lifestyle modification compliance at all ages. More studies are required to determine the magnitude and impact of white coat hypertension and masked hypertension in the Korean population.
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Affiliation(s)
- Hyeon Chang Kim
- 1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Hyun Ihm
- 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gheun-Ho Kim
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Ju Han Kim
- 4Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, South Korea
| | - Kwang-Il Kim
- 5Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hae-Young Lee
- 6Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jang Hoon Lee
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 South Korea
| | - Jong-Moo Park
- 8Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Sungha Park
- 9Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wook Bum Pyun
- 10Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jinho Shin
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Shung Chull Chae
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 South Korea
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Lee HY, Park JB. The Korean Society of Hypertension Guidelines for the Management of Hypertension in 2013: Its Essentials and Key Points. Pulse (Basel) 2015; 3:21-8. [PMID: 26587454 DOI: 10.1159/000381994] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The Korean Society of Hypertension published new guidelines for the management of hypertension in 2013 which fully revised the first Korean hypertension treatment guideline published in 2004. Due to shortage of Korean data, the Committee decided to establish the guideline in the form of an 'adaptation' of the recently released guidelines. The prevalence of hypertension was 28.5% in the recent Korean National Health and Nutrition Examination Survey in 2011, and the awareness, treatment, and control rates are generally improving. However, the risks for cerebrovascular disease and coronary artery disease which are attributable to hypertension were the highest in Korea. The classification of hypertension is the same as in other guidelines. The remarkable difference is that prehypertension is further classified as stage 1 and 2 prehypertension because the cardiovascular risk is significantly different within the prehypertensive range. Although the decision-making was based on office blood pressure (BP) measured by the auscultation method using a stethoscope, the importance of home BP measurement and ambulatory BP monitoring is also stressed. The Korean guideline does not recommend a drug therapy in patients within the prehypertensive range, even in patients with prediabetes, diabetes mellitus, stroke, or coronary artery disease. In an elderly population over 65 years old, drug therapy can be initiated when the systolic BP (SBP) is ≥160 mm Hg. The target BP is generally an SBP of <140 mm Hg and a diastolic BP (DBP) of <90 mm Hg regardless of previous cardiovascular events. However, in patients with hypertension and diabetes, the lower DBP control <85 mm Hg is recommended. Also, in patients with hypertension with prominent albuminuria, a more strict SBP control <130 mm Hg can be recommended. In lifestyle modification, sodium reduction is the most important factor in Korea. Five classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, β-blockers, calcium antagonists, and diuretics, are equally recommended as a first-line treatment, whereas a combination therapy chosen from renin-angiotensin system inhibitors, calcium antagonists, and diuretics is preferentially recommended.
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Affiliation(s)
- Hae-Young Lee
- Seoul National University Hospital, Seoul, South Korea
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9
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Shin J, Park JB, Kim KI, Kim JH, Yang DH, Pyun WB, Kim YG, Kim GH, Chae SC. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology and diagnosis of hypertension. Clin Hypertens 2015; 21:1. [PMID: 26893915 PMCID: PMC4745140 DOI: 10.1186/s40885-014-0012-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023] Open
Abstract
The standardized techniques of blood pressure measurement in the clinic are emphasized and the indications for ambulatory and/or home blood pressure monitoring are specified more broadly. The epidemiologic findings specific to Korean population related to blood pressure are reviewed. Cardiovascular risk of hypertensive patients are stratified based upon the data of a Korean population cohort study.
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Affiliation(s)
- Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Bae Park
- Division of Cardiology, Department of Medicine, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, School of Medicine, Seoul National University, Bundang, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Wook Bum Pyun
- Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Gweon Kim
- Division of Cardiology, Department of Internal Medicine, Dongkuk University College of Medicine, Ilsan, Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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10
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Kang M, Kim J, Bae SS, Choi YJ, Shin DS. Older adults' perception of chronic illness management in South Korea. J Prev Med Public Health 2014; 47:236-43. [PMID: 25139170 PMCID: PMC4162119 DOI: 10.3961/jpmph.2014.47.4.236] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/16/2014] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. METHODS We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. RESULTS Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants' compliance with treatment. CONCLUSIONS For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established. OBJECTIVES Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. METHODS We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. RESULTS Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants’ compliance with treatment. CONCLUSIONS For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.
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Affiliation(s)
- Minah Kang
- Department of Public Administration, College of Social Sciences, Ewha Womans University, Seoul, Korea
| | - Jaiyong Kim
- Health Services Research Center, Hallym University, Seoul, Korea
| | - Sang-Soo Bae
- Health Services Research Center, Hallym University, Seoul, Korea ; Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Jun Choi
- Health Services Research Center, Hallym University, Seoul, Korea ; Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Soo Shin
- Division of Nursing, Hallym University, Chuncheon, Korea
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Djoussé L, Gaziano JM, Kase CS, Kurth T. Nut consumption and risk of stroke in US male physicians. Clin Nutr 2010; 29:605-9. [PMID: 20381933 PMCID: PMC2919604 DOI: 10.1016/j.clnu.2010.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 02/03/2010] [Accepted: 03/11/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS While nut consumption has been shown to lower the risk of hypertension and coronary disease, it is not known whether nut consumption is associated with the risk of stroke. We sought to examine whether nut consumption is associated with total and subtypes of stroke. METHODS Prospective cohort of 21,078 participants from the Physicians' Health Study (1982-2008) who were free of stroke at baseline. Nut consumption was assessed using a simple 19-item food questionnaire and stroke cases were confirmed after reviewing medical records. We used Cox's proportional hazards regression to estimate relative risks of total, ischemic, and hemorrhagic stroke according to consumption of any nuts. RESULTS During a mean follow up of 21.1 years, 1424 incident cases of stroke occurred (219 hemorrhagic, 1189 ischemic, and 16 of undetermined cause). There was no statistically significant association between nut consumption and total or ischemic stroke. In contrast, there was a suggestive non-linear relation between nut intake and hemorrhagic stroke: compared to subjects who did not consume nuts, multivariable-adjusted hazard ratios (95% CI) for hemorrhagic stroke for subjects consuming nuts <1, 1, 2-4, 5-6, and ≥7 times/week were 1.13 (0.78-1.62), 1.05 (0.70-1.58), 0.49 (0.27-0.89), 1.50 (0.79-2.84), and 1.84 (0.95-3.57), respectively (p for quadratic trend 0.12). CONCLUSIONS Our data showed no association between nuts and ischemic stroke and suggested a J-shaped relation between nut consumption and hemorrhagic stroke. Replication of our findings in the general population is warranted.
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Affiliation(s)
- Luc Djoussé
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Djoussé L, Rudich T, Gaziano JM. Nut consumption and risk of hypertension in US male physicians. Clin Nutr 2008; 28:10-4. [PMID: 18834651 DOI: 10.1016/j.clnu.2008.08.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 07/22/2008] [Accepted: 08/15/2008] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Hypertension is a risk factor for cardiovascular disease and dietary factors may play an important role in its prevention. We sought to examine the association between nut consumption and incident hypertension. METHODS Prospective cohort of 15,966 participants from the Physicians' Health Study I who were free of hypertension at baseline. Nut consumption was assessed using a simple abbreviated food questionnaire and hypertension was self-reported. We used Cox regression to estimate relative risks of hypertension according to nut consumption. RESULTS During 237,585 person-years of follow up, 8,423 new cases of hypertension occurred. Compared to subjects who did not consume nuts, multivariable adjusted hazard ratios (95% CI) for hypertension were 0.97 (0.91-1.03), 0.98 (0.92-1.05), 0.96 (0.89-1.03), and 0.82 (0.71-0.94) for nut consumption of 1-2 times per month and 1, 2-6, and > or = 7 times/week, respectively. In a secondary analysis stratified by body mass index, there was an inverse relation between nut intake and hypertension in lean subjects (p for trend 0.0019) but not in overweight or obese subjects (p for interaction 0.0037). CONCLUSION Our data suggest that nut consumption is associated with a lower risk of hypertension in US male physicians and that such relation may be influenced by adiposity.
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Affiliation(s)
- Luc Djoussé
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Strand M, Söderström I, Wiklund PG, Hallmans G, Weinehall L, Söderberg S, Olsson T. Estrogen receptor alpha gene polymorphisms and first-ever intracerebral hemorrhage. Cerebrovasc Dis 2007; 24:500-8. [PMID: 17971628 DOI: 10.1159/000110419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 06/21/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Signaling through estrogen receptor alpha (ER alpha) regulates vasodilatation and atherogenesis. Since hypertension and atherosclerosis are major mechanisms in stroke development, we hypothesized that genetic variants of the ER alpha gene (ESR1) are determinants of future ischemic stroke or intracerebral hemorrhage (ICH). METHODS In a population-based prospective nested case-control study, the relationships between ESR1 polymorphisms (c.454-397T>C and c.454-351A>G) and ischemic stroke and ICH were examined in univariate and multivariate models using conditional logistic regression, which included established risk factors.Definitive first-ever stroke events (n = 388), including ischemic stroke (n = 320), ICH (n = 61), and unspecified stroke (n = 7) cases, and controls without cardiovascular disease (n = 773), matched for age, sex, and geographical region were included. RESULTS Carriers of the c.454-397T/T genotype had a significantly (p = 0.017) increased risk of ICH (OR 2.31, 95% CI 1.16-4.60) in a univariate analysis. This association persisted (OR 3.94, 95% CI 1.54-10.03), after adjustment for stroke risk determinants. Carriers of c.454-397T/T or c.454-397T/C genotypes had significantly (p = 0.002 and p = 0.004, respectively) higher mean systolic blood pressure (SBP), than carriers of c.454-397C/C, and a similar relationship was observed for diastolic blood pressure (DBP). The combinations of c.454-397T/T genotype and hypertension (OR 21.46, 95% CI 5.20-88.51), or high SBP (OR 18.17, 95% CI 4.91-67.31) or DBP (OR 11.94, 95% CI 3.75-38.03), were strongly associated with increased risk of ICH. CONCLUSIONS In this population,the c.454-397T/T genotype associates with first-ever ICH, particularly in combination with hypertension. This implies that alterations in ER alpha-mediated signaling may be involved in the pathophysiology of this disease, with a putative impact on primary prevention.
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Affiliation(s)
- Magnus Strand
- Department of Public Health and Clinical Medicine, Medicine, University, Umeå, Sweden
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Wong ND. Hypertension in East Asians and Pacific Islanders. Hypertension 2007. [DOI: 10.1016/b978-1-4160-3053-9.50047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Choi KM, Park HS, Han JH, Lee JS, Lee J, Ryu OH, Lee KW, Cho KH, Yoon D, Baik SH, Choi DS, Kim SM. Prevalence of prehypertension and hypertension in a Korean population: Korean National Health and Nutrition Survey 2001. J Hypertens 2006; 24:1515-21. [PMID: 16877953 DOI: 10.1097/01.hjh.0000239286.02389.0f] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study aimed to determine the prevalence of prehypertension and hypertension, and their association with the risk factors in a Korean population. DESIGN The Korean Nation Health and Nutrition Survey 2001, a cross-sectional survey, was a nationally representative survey in which a stratified multistage sampling design was used. METHODS Data from a comprehensive questionnaire, together with a physical examination and blood sample, were obtained from 6074 Korean adults (2620 men and 3454 women) aged > or = 20 years, and analysed. RESULTS The estimated age-adjusted prevalence of hypertension and prehypertension was 22.9% (26.9% in men, 20.5% in women) and 31.6% (41.9% in men, 25.9% in women), respectively, in the Korean population according to Joint National Committee 7 criteria. Multivariate analysis revealed that age, gender, body mass index, fasting plasma glucose, total-cholesterol and alcohol consumption were significantly associated with hypertension. Overall, only 30.2% of the hypertensive individuals had been previously diagnosed. Furthermore, 22.9% of the hypertensive individuals were being treated with antihypertensive medication, but only 10.7% had their blood pressure adequately controlled. The rates of awareness, treatment and control were higher for the women than for the men, and these rates increased with age. CONCLUSION Hypertension and prehypertension are common in Korea, and more than one-half of the hypertensive patients have not been diagnosed. These results place great emphasis on the urgent need for a public health program to improve the detection, prevention and treatment of hypertension and prehypertension.
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Affiliation(s)
- Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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