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Xie H, Fan XF, Shuai WH, Zhong GY. The association between serum folate and elderly diastolic hypertension: results from the NHANES (2007-2018). Blood Press 2024; 33:2380002. [PMID: 39018205 DOI: 10.1080/08037051.2024.2380002] [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: 05/09/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
AIM To explore the association between serum folate concentration and the prevalence of elderly diastolic hypertension. This study aims to identify potential relationships that could inform further research into the mechanisms underlying hypertension management. METHODS Data from six NHANES cycles (2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016, and 2017-2018) were analysed for individuals aged over 60. Weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and restricted cubic spline (RCS) regression explored the serum folate concentration and elderly diastolic hypertension relationship. RESULTS This study included 9,419 participants (4,734 females and 4,685 males) with a mean age of 70.0 ± 7.0 years. Among them, 360 were diagnosed with diastolic hypertension. In the fully adjusted model, there was a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (OR 0.65; 95% CI: 0.52-0.82). When serum folate concentration levels were divided into quartiles (in μg/dL), the ORs for diastolic hypertension corresponding to Q2 (1.29-1.98), Q3 (1.99-3.08), and Q4 (3.09-5.56) levels compared to Q1 (0.18-1.28) were 1.41 (95% CI: 0.60-3.33), 0.48(95% CI: 0.20-1.16), and 0.35 (95% CI: 0.16-0.74), respectively, with a P for trend <.05. Restricted cubic spline plots showed a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (non-linearity: p = .495). Subgroup analysis indicated that the negative correlation between serum folate concentration and the prevalence of diastolic hypertension was more significant in female participants (interaction p = .009). CONCLUSION Higher serum folate concentration is associated with a lower prevalence of diastolic hypertension in the elderly.
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Affiliation(s)
- Hong Xie
- Department of General Medicine, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
| | - Xiao-Feng Fan
- Department of Cardiology, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
| | - Wen-Huan Shuai
- Department of Cardiology, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
| | - Gui-You Zhong
- Department of Cardiology, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
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Khalid N, Haider S, Hasnat M, Abdullah M, Asghar S, Shamoon Y, Elkattawy S, Vasudev R, Fayez SE. Trends and Disparities in Prevalence of Diagnosed Hypertension Among U.S. Adults from 2019 to 2022. Curr Probl Cardiol 2024:102750. [PMID: 39009252 DOI: 10.1016/j.cpcardiol.2024.102750] [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: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Hypertension (HTN) stands as a significant risk factor for cardiovascular diseases. Identifying trends and disparities in HTN prevalence is vital for developing public health policies. OBJECTIVE Investigate the trends and disparities in HTN prevalence among U.S. adults from 2019 to 2022. METHODS Data from the CDC's National Health Interview Survey were utilized, with regression analysis including Joinpoint and ARIMA models performed by ChatGPT-4 to predict future trends. RESULTS The study observed fluctuations in the overall prevalence of diagnosed HTN starting at 27.0% (95% CI: 26.4-27.7, 2019), and reaching 27.2% (95% CI: 26.5-27.8, 2022). Males consistently showed higher HTN rates than females throughout the study period, with male prevalence increasing from 27.2% (95% CI: 26.3-28.1, 2019) to 27.9% (95% CI: 27.0-28.8, 2022), while females experienced decline from 26.9% (95% CI: 26.1-27.8, 2019) to 26.5% (95% CI: 25.7-27.3, 2022). Southern U.S. exhibited the highest prevalence at 30.1% (95% CI: 29.1-31.2, 2022), compared to the lowest in the West at 22.5% (95% CI: 21.4-23.8). Black adults showed a higher prevalence of 34.4% (95% CI: 32.4-36.4, 2022) compared to White adults at 27.4% (95% CI: 26.7-28.2), and significantly lower rates were observed in Asian adults at 14.5% (95% CI: 7.4-24.5). CONCLUSION This study highlights stable trends in HTN prevalence among U.S. adults from 2019 to 2022, with significant disparities by gender, region, and race, underscoring the need for targeted public health interventions to address these inequalities.
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Affiliation(s)
- Noman Khalid
- Department of Internal Medicine, St. Joseph's University Medical Center, Paterson, New Jersey, USA.
| | - Safeeullah Haider
- Department of Community Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | - Mahnoor Hasnat
- Department of Community Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | - Muhammad Abdullah
- Department of Community Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | - Saad Asghar
- Department of Clinical Trials, Northwestern University, Chicago, IL, USA
| | - Yezin Shamoon
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Sherif Elkattawy
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Rahul Vasudev
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Shamoon E Fayez
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
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Choi JY, Kim H, Chun S, Jung YI, Yoo S, Oh IH, Kim GS, Ko JY, Lim JY, Lee M, Lee J, Kim KI. Information technology-supported integrated health service for older adults in long-term care settings. BMC Med 2024; 22:212. [PMID: 38807210 PMCID: PMC11134747 DOI: 10.1186/s12916-024-03427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. METHODS We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. RESULTS We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups. CONCLUSIONS The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization. TRIAL REGISTRATION Clinical Research Information Service, KCT0004360. Registered on 21 October 2019.
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Affiliation(s)
- Jung-Yeon Choi
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Young-Il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Gi-Soo Kim
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minho Lee
- Healthcare Convergence R&D Center, ezCaretech Co. Ltd, Seoul, Republic of Korea
| | - Jongseon Lee
- Healthcare Convergence R&D Center, Healthconnect Co. Ltd, Seoul, Republic of Korea
| | - Kwang-Il Kim
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Departments of Internal Medicine, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Kyeongi-do, 13620, Republic of Korea.
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Xu L, Gao Z, He M, Yang M. Effectiveness of the knowledge, attitude, practice intervention model in the management of hypertension in the elderly. J Clin Hypertens (Greenwich) 2024; 26:465-473. [PMID: 38468407 PMCID: PMC11088428 DOI: 10.1111/jch.14770] [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: 09/16/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 03/13/2024]
Abstract
This study illustrated the effectiveness of the knowledge, attitude, practice (KAP) intervention model for community hypertension in the elderly by the community physician-led, describing the study design and baseline data. The aim of the study was to compare the changes in the elderly hypertensive population before and after the KAP intervention model by managing the elderly hypertensive patients for a period of 1 year. Basic information and risk factors affecting blood pressure control based on baseline data of recruited elderly hypertensive patients. The management approach consists of two parts: (1) the unified management of the community physician to whom the patient belongs; and (2) the management of the contracted patient by the community physician. The aim was to demonstrate the anti-hypertensive effectiveness (control rate, blood pressure reduction, and pulse pressure), the distribution of blood pressure types, and the change of the KAP in elderly hypertensive patients before and after the intervention. The KAP intervention model was administered to 2660 elderly hypertensive patients in a 1-year period. The blood pressure control rate improved by 54.03%. Mean values of overall systolic and diastolic blood pressure decreased by 16.00 and 5.31 mmHg, respectively. The proportion of isolated systolic hypertension (ISH) and systolic-diastolic hypertension (SDH) decreased by 29.14% and 24.81%, respectively. The KAP compliance improved significantly. These results suggest that the community physician-led KAP intervention model is effective in the management of hypertension in the elderly.
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Affiliation(s)
- Li‐Shuang Xu
- Department of CardiologySchool of China Medical UniversityLiaoningChina
| | - Zhi‐Guang Gao
- Department of General PracticeChaoyang Central HospitalLiaoningChina
| | - Mei He
- Department of CardiologySchool of China Medical UniversityLiaoningChina
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Rosendo-Silva B, Prazeres F, Santiago LM, Rosendo I. Adherence to pharmacological therapy in patients with hypertension: protocol of a qualitative study by focus groups. BMJ Open 2024; 14:e076416. [PMID: 38594183 PMCID: PMC11015205 DOI: 10.1136/bmjopen-2023-076416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/22/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Non-adherence to antihypertensive medication significantly contributes to inadequate blood pressure control. Regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy.Understanding the complementary perspectives of patients and healthcare professionals can be valuable for designing strategies to enhance medication adherence. Few studies explored the perspectives of patients and healthcare professionals regarding medication adherence. None of them focused specifically on adherence to pharmacological therapy for hypertension in Portugal.Considering the high prevalence of non-adherence and its location-specific aspects, the priority should be identifying its barriers and developing tactics to address them.This study aims to gather the perspectives of patients with hypertension and healthcare professionals such as family doctors, nurses and community pharmacists from Portugal, regarding the most effective strategies to enhance antihypertensive medication adherence and to understand the factors contributing to non-adherence. METHODS AND ANALYSES We will conduct qualitative research through synchronous online focus groups of 6-10 participants. Some groups will involve patients with hypertension, while others will include family doctors, nurses and community pharmacists. The number of focus groups will depend on the achievement of theoretical saturation. A purposive sample will be used. Healthcare participants will be recruited via email, while patients will be recruited through their family doctors.The moderator will maintain neutrality while ensuring interactive contributions from every participant. Participants will be encouraged to express their opinions on the meeting summary. Meetings will be recorded and transcribed.Two researchers will perform content analyses using MAXQDA V.12 through comparative analyses and subsequent consensus. A third researcher will review the analyses. The results will be presented narratively. ETHICS AND DISSEMINATION The Ethics Committee of the University of Coimbra has approved this study with the number: CE-026/2021. The results will be disseminated via peer-reviewed publications and national and international conferences.
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Affiliation(s)
- Beatriz Rosendo-Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CINTESIS - Center for Health Technology and Services Research; Faculty of Medicine, University of Porto, Porto, Portugal
- USF Figueira Sul, Coimbra, Portugal
| | - Filipe Prazeres
- CINTESIS - Center for Health Technology and Services Research; Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luiz Miguel Santiago
- Centre for Health Studies and Research of the University of Coimbra (CEISUC), University of Coimbra, Coimbra, Portugal
- FGM University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Inês Rosendo
- CINTESIS - Center for Health Technology and Services Research; Faculty of Medicine, University of Porto, Porto, Portugal
- Family Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Calderón-Moreno J, Delgado-Rodriguez MJ, Juárez-Vela R, Tejada-Garrido CI, de Viñaspre-Hernández RR, Burgos-Esteban A, Sánchez-Conde P, Andreu-Fernández V, Gea-Caballero V, Santos-Sanchez JA, Quintana-Diaz M, Andrés-Esteban EM. Approximation to the economic cost of healthcare for hypertensive patients diagnosed with COVID-19. Front Public Health 2024; 12:1333081. [PMID: 38566790 PMCID: PMC10986305 DOI: 10.3389/fpubh.2024.1333081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Many researchers have focused their studies on hypertension due to its over-representation among COVID-19 patients. Both retrospective and observational studies conducted close to the Wuhan area have reported that hypertension is the most common comorbidity observed in patients affected by COVID-19. Objective Our objective is that patients with arterial hypertension have a worse prognosis in terms of evolution leading to higher costs. Methods A retrospective cross-sectional study was conducted. A total of 3,581 patients from La Paz University Hospital (LPUH) during the period between 15 July 2020 and 31 July 2020 were included in this study. Results It should be noted that 40.71% of the patients were hypertensive. As expected, hypertension was associated with men, among whom we observed a higher prevalence and a higher age (median age of 77 years (IQI: 65-85) versus 52 years (IQI: 37-64), p-value < 0.001). Hypertensive patients had a higher prevalence of dyspnea (52.14% vs. 47.15%, p-value = 0.004) and altered awareness (14.89% vs. 4.30%, p-value <0.001). The non-parametric Kaplan-Meier curve estimates the survival of patients in the two study groups. We can see how patients with hypertension have a higher associated mortality, with the difference being statistically significant, p-value (log-rank) = 0.004. Only for the appearance of complications during hospitalization, the group of hypertensive patients reached the figure of €1,355,901.71 compared to the total of 421,403.48 € for normotensive patients. Conclusion Our study shows the worse clinical evolution of patients with COVID-19 in terms of associated morbidity and mortality. It also shows that the cost of managing patients with hypertension is greater than that of managing normotensive patients.
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Affiliation(s)
| | | | - Raúl Juárez-Vela
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
| | | | - Regina Ruiz de Viñaspre-Hernández
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
| | | | - Pilar Sánchez-Conde
- Faculty of Medicine, University of Salamanca, Salamanca, Spain
- Anesthesia and Resuscitation Service, University Healthcare Complex, Salamanca, Spain
| | | | | | | | - Manuel Quintana-Diaz
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Intensive Care Unit, Hospital La Paz, La Paz, Spain
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Lim HS, Han H, Won S, Ji S, Park Y, Lee HY. Sex differences in the applicability of Western cardiovascular disease risk prediction equations in the Asian population. PLoS One 2024; 19:e0292067. [PMID: 38295132 PMCID: PMC10830057 DOI: 10.1371/journal.pone.0292067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/12/2023] [Indexed: 02/02/2024] Open
Abstract
AIMS Cardiovascular diseases (CVDs) are the most common cause of death, but they can be effectively managed through appropriate prevention and treatment. An important aspect in preventing CVDs is assessing each individual's comprehensive risk profile, for which various risk engines have been developed. The important keys to CVD risk engines are high reliability and accuracy, which show differences in predictability depending on disease status or race. Framingham risk score (FRS) and the atherosclerotic cardiovascular disease risk equations (ASCVD) were applied to the Korean population to assess their suitability. METHODS A retrospective cohort study was conducted using National Health Insurance Corporation sample cohort from 2003 to 2015. The enrolled participants over 30 years of age and without CVD followed-up for 10 years. We compared the prediction performance of FRS and ASCVD and calculated the relative importance of each covariate. RESULTS The AUCs of FRS (men: 0.750; women: 0.748) were higher than those of ASCVD (men: 0.718; women: 0.727) for both sexes (Delong test P <0.01). Goodness of fits (GOF) were poor for all models (Chi-square P < 0.001), especially, underestimation of the risk was pronounced in women. When the men's coefficients were applied to women's data, AUC (0.748; Delong test P<0.01) and the GOF (chi-square P = 0.746) were notably improved in FRS. Hypertension was found to be the most influential variable for CVD, and this is one of the reasons why FRS, having the highest relative weight to blood pressure, showed better performance. CONCLUSION When applying existing tools to Korean women, there was a noticeable underestimation. To accurately predict the risk of CVD, it was more appropriate to use FRS with men's coefficient in women. Moreover, hypertension was found to be a main risk factor for CVD.
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Affiliation(s)
- Hee-Sook Lim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, Republic of Korea
| | - Hyein Han
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- RexSoft Corps, Seoul, Republic of Korea
| | - Sungin Ji
- Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yoonhyung Park
- Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Liu J, Lu N, Shen S, Zhang W. Effect of comprehensive nursing intervention on quality of life and treatment outcomes in elderly patients with Gout and Hyperuricemia complicated with hypertension. Pak J Med Sci 2024; 40:358-363. [PMID: 38356818 PMCID: PMC10862416 DOI: 10.12669/pjms.40.3.7535] [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: 01/10/2023] [Revised: 03/24/2023] [Accepted: 09/29/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To evaluate the effect of comprehensive nursing intervention on the quality of life and treatment outcomes of elderly patients with gout and hyperuricemia complicated with hypertension. Methods This is a clinical comparative study. One hundred and twenty elderly patients with gout and hyperuricemia complicated with hypertension who were hospitalized at Baoding No.1 Central Hospital were included from March 20, 2021 to March 20, 2022, and randomly divided into two groups. Patients in the control group were given conventional nursing care in the perioperative period, while those in the experimental group were given comprehensive nursing intervention on the basis of the control group. The differences between the two groups in terms of clinical effects, quality of life were compared and analyzed. Results The response rate of the experimental group was higher than control group,with a statistically significant difference. After the intervention, the above indicators improved significantly in the experimental group compared to the control group, with statistically significant differences. There was no significant difference in Self-Rating Anxiety Scale(SAS) and Self-rating depression scale(SDS) levels between the two groups before the intervention. After the intervention, SAS and SDS decreased significantly in the experimental group compared to the control group, with statistically significant differences . The patient satisfaction rate of the experimental group was also higher than control group, with a statistically significant difference. Conclusion Comprehensive nursing intervention is an effective treatment option for elderly patients with gout and hyperuricemia complicated with hypertension, resulting in obvious improvements in patient quality of life, improved mood, patient satisfaction and treatment outcomes.
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Affiliation(s)
- Jing Liu
- Jing Liu, Department of Rheumatology and Immunology. Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Na Lu
- Na Lu, Department of Internal Medicine-Neurology. Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Shilu Shen
- Shilu Shen, Department of Rheumatology and Immunology. Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Wen Zhang
- Wen Zhang, Department of Rheumatology and Immunology. Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
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Lu N, Liu J, Cai P. Analysis of clinical efficacy of comprehensive nursing intervention on elderly patients with hypertension combined with hyperuricemia. Pak J Med Sci 2023; 39:1720-1724. [PMID: 37936750 PMCID: PMC10626088 DOI: 10.12669/pjms.39.6.7233] [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: 10/10/2022] [Revised: 12/23/2022] [Accepted: 07/08/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To evaluate the clinical efficacy of the comprehensive nursing intervention on elderly patients with hypertension combined with hyperuricemia. Methods This was a retrospective study. One hundred elderly patients with hypertension combined with hyperuricemia admitted to the Baoding No.1 Central Hospital from May 2019 to May 2020 were included and randomly divided into two groups. Patients in the control group were treated with conventional nursing intervention, while those in the experimental group were treated with comprehensive nursing intervention based on the therapy in the control group. The improvement of compliance behavior, clinical efficacy, quality of life and satisfaction with hypertension combined with hyperuricemia before and after treatment were compared and analyzed between the two groups. The proportion of patients in both groups who developed gout or renal insufficiency was recorded, and their long-term treatment outcomes were compared and analyzed. Results After the comprehensive nursing intervention, the number of cases of compliance behaviors in the experimental group was significantly higher than that in the control group(p<0.05). The systolic and diastolic blood pressure and uric acid levels were significantly lower in the experimental group compared to the control group after the intervention(p=0.00). The scores of physical function, psychological function, social function and material life status improved significantly in the experimental group compared to the control group after the intervention(p=0.00). The satisfaction rate of the experimental group was significantly higher than the control group(p=0.02). The proportion of patients in the experimental group who developed gout was significantly lower than that in the control group(p=0.03). Conclusion Comprehensive nursing intervention plays a vital role in the treatment and prognosis of hypertension combined with hyperuricemia.
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Affiliation(s)
- Na Lu
- Na Lu, Department of Internal Medicine Neurology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Jing Liu
- Jing Liu, Department of Rheumatology and Immunology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Pan Cai
- Pan Cai, Department of Rheumatology and Immunology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
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Park S, Shin J, Ihm SH, Kim KI, Kim HL, Kim HC, Lee EM, Lee JH, Ahn SY, Cho EJ, Kim JH, Kang HT, Lee HY, Lee S, Kim W, Park JM. Resistant hypertension: consensus document from the Korean society of hypertension. Clin Hypertens 2023; 29:30. [PMID: 37908019 PMCID: PMC10619268 DOI: 10.1186/s40885-023-00255-4] [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: 07/20/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023] Open
Abstract
Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Sang Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital327 Sosa-Ro, Wonmi-guGyunggi-do, Bucheon-si, 14647, Republic of Korea.
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunki Lee
- Hallym University, Dongtan Hospital, Gyeonggi-do, Korea
| | - Woohyeun Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
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11
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Ji E, Ahn S, Choi JY, Kim CH, Kim KI. Effect of multimorbidity on hypertension management. Sci Rep 2023; 13:18764. [PMID: 37907571 PMCID: PMC10618203 DOI: 10.1038/s41598-023-44813-0] [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: 04/12/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
Multimorbidity, the coexistence of multiple health conditions, is associated with functional decline, disability, and mortality. We aimed to investigate the effects of multimorbidity on hypertension treatment and control rates by analyzing data from the Korean National Health and Nutrition Examination Survey database, which is a cross-sectional, nationally representative survey conducted by the Korean government. Multimorbidity, defined as having two or more chronic diseases, was evaluated by blood pressure measurements, blood chemistry examinations, and questionnaires. We classified the participants according to the number of multimorbidities from 0 to ≥ 6. Association analysis was performed to identify the patterns of multimorbidity related to hypertension control. From 2016 to 2020, 30,271 adults (≥ 20 years) were included in the analysis (age: 52.1 ± 16.8 years, male: 44.0%), and 14,278 (47.2%) had multimorbidity. The number of chronic conditions was significantly higher in older adults, women, and hypertensive patients. Multimorbidity was associated with hypertension treatment. The number of chronic conditions was significantly higher in controlled compared to uncontrolled patients (3.6 ± 1.7 vs 2.9 ± 1.6, p < 0.001). But the control rate of hypertension among treated patients was lower in patients with multimorbidity (75.6% in hypertension only group vs 71.8% in multimorbidity group, p = 0.009). Multimorbidity patterns showed distinct features in treated and controlled hypertensive patients. In conclusion, multimorbidity has a beneficial effect on the treatment of hypertension, but the control rate of systolic blood pressure was lower among the patients with multimorbidity. More attention should be paid to the hypertensive patients with multimorbidity to improve the control rate of hypertension.
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Affiliation(s)
- Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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12
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Li L, Cheng S, Xu G. Identification of risk factors for hypertension in overweight and obese people and analysis of risk factor interactions: an R-based analysis. Front Cardiovasc Med 2023; 10:1180698. [PMID: 38028476 PMCID: PMC10644319 DOI: 10.3389/fcvm.2023.1180698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study identified the independent risk factors for hypertension in overweight and obese people and also analyzed the interaction between the risk factors. Methods A total of 5,098 overweight and obese people were enrolled in this study. First, the clinical metabolic characteristics of hypertension and control groups were compared. The logistic regression (LR) and classification and regression trees (CRT)-based decision tree (DT) models were used to screen the independent risk factors for hypertension in overweight and obese people. The multiplicative and additive scale analyses were used to analyze the two risk factors with interaction from the perspective of statistics and biological interaction. Finally, the receiver operating characteristic (ROC) and calibration curves were used to analyze the accuracy and identification ability of the LR and DT models. Results Age, UA, FPG, SBP, Cr, AST, TG, and FPG were higher in the hypertension group than in the control group (P < 0.05). The results of LR revealed that NAFLD, FPG, age, TG, LDL-c, UA, and Cr were positively correlated with hypertension in overweight and obese people, and GFR was negatively correlated with hypertension in overweight and obese people (P < 0.05). The DT model suggested that the risk factors of age, FPG, and UA interacted with each other. The multiplicative single and multiple factor analysis for FPG + UA, age + UA, age + FPG revealed a positive multiplicative interaction (P < 0.05, B ≠ 0, OR > 1). The additive single and multiple factor analysis for age + UA indicated a positive additive interaction. The ROC and calibration curve analysis indicated that the CRT decision tree, FPG + UA, age + UA, and age + FPG have certain accuracy and discrimination ability. Conclusion The independent risk factors for hypertension in overweight and obese people included NAFLD, FPG, age, TG, LDL-c, UA, and Cr. Among these, age + UA exhibited synergistic interaction, thereby providing a reference for the prevention and control of hypertension in overweight and obese people.
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Affiliation(s)
- LuWei Li
- Department of Rheumatology and Immunology, The First People’s Hospital of Nanning, Nanning, China
- School of Clinical Medicine, Guilin Medical University, Guilin, China
| | - SiShuai Cheng
- School of Clinical Medicine, Guilin Medical University, Guilin, China
| | - GuoQuan Xu
- School of Clinical Medicine, Guilin Medical University, Guilin, China
- Department of Urology, The First People’s Hospital of Qinzhou, Qinzhou, China
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13
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Oshchepkov DY, Makovka YV, Ponomarenko MP, Redina OE, Markel AL. Age-Dependent Changes in the Relationships between Traits Associated with the Pathogenesis of Stress-Sensitive Hypertension in ISIAH Rats. Int J Mol Sci 2023; 24:10984. [PMID: 37446162 DOI: 10.3390/ijms241310984] [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: 05/22/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Hypertension is one of the most significant risk factors for many cardiovascular diseases. At different stages of hypertension development, various pathophysiological processes can play a key role in the manifestation of the hypertensive phenotype and of comorbid conditions. Accordingly, it is thought that when diagnosing and choosing a strategy for treating hypertension, it is necessary to take into account age, the stage of disorder development, comorbidities, and effects of emotional-psychosocial factors. Nonetheless, such an approach to choosing a treatment strategy is hampered by incomplete knowledge about details of age-related associations between the numerous features that may contribute to the manifestation of the hypertensive phenotype. Here, we used two groups of male F2(ISIAHxWAG) hybrids of different ages, obtained by crossing hypertensive ISIAH rats (simulating stress-sensitive arterial hypertension) and normotensive WAG rats. By principal component analysis, the relationships among 21 morphological, physiological, and behavioral traits were examined. It was shown that the development of stress-sensitive hypertension in ISIAH rats is accompanied not only by an age-dependent (FDR < 5%) persistent increase in basal blood pressure but also by a decrease in the response to stress and by an increase in anxiety. The plasma corticosterone concentration at rest and its increase during short-term restraint stress in a group of young rats did not have a straightforward relationship with the other analyzed traits. Nonetheless, in older animals, such associations were found. Thus, the study revealed age-dependent relationships between the key features that determine hypertension manifestation in ISIAH rats. Our results may be useful for designing therapeutic strategies against stress-sensitive hypertension, taking into account the patients' age.
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Affiliation(s)
- Dmitry Yu Oshchepkov
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (SB RAS), Novosibirsk 630090, Russia
| | - Yulia V Makovka
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (SB RAS), Novosibirsk 630090, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk 630090, Russia
| | - Mikhail P Ponomarenko
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (SB RAS), Novosibirsk 630090, Russia
| | - Olga E Redina
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (SB RAS), Novosibirsk 630090, Russia
| | - Arcady L Markel
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (SB RAS), Novosibirsk 630090, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk 630090, Russia
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14
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Wang C, Wang P, Qi G. A new use of transcutaneous electrical nerve stimulation: Role of bioelectric technology in resistant hypertension (Review). Biomed Rep 2023; 18:38. [PMID: 37168651 PMCID: PMC10165504 DOI: 10.3892/br.2023.1621] [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: 10/05/2022] [Accepted: 02/21/2023] [Indexed: 05/13/2023] Open
Abstract
Hypertension is an important risk factor for cardiovascular and cerebrovascular disease-associated death. Hypertension and its complications are the main problems that have an impact on public health at present. A portion of adults with hypertension fail to meet the recommended blood pressure (BP) treatment goals, despite strict clinical management. Those individuals requiring at least three types of antihypertensive drugs to achieve their BP goal may be classified as patients with resistant hypertension (RH). Bioelectric technology is an emerging method that functions with the help of the human body's own bioelectric system. It is widely used in auxiliary examination, pain relief and organ function rehabilitation. Bioelectrical technology, as an effective treatment for RH, has developed rapidly in recent years and mainly includes renal sympathetic denervation, carotid baroreflex activation therapy, Traditional Chinese Medicine electroacupuncture and transcutaneous electrical nerve stimulation (TENS). The present review describes the pathogenesis of hypertension and provides an understanding of bioelectrical technology as a treatment. In particular, the development of the application of TENS in RH is introduced. The aim is to provide a basis for the clinical treatment of RH and a new idea for further clinical trials in this field.
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Affiliation(s)
- Chenghua Wang
- The Third Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050030, P.R. China
| | - Pu Wang
- The Third Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050030, P.R. China
| | - Guoqing Qi
- The Third Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050030, P.R. China
- Correspondence to: Dr Guoqing Qi, The Third Department of Cardiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei 050030, P.R. China
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15
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Choi HY, Kim E. Factors Influencing the Control of Hypertension According to the Gender of Older Adults. Healthcare (Basel) 2023; 11:healthcare11111595. [PMID: 37297736 DOI: 10.3390/healthcare11111595] [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: 02/27/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: This study aimed to identify factors associated with hypertension control among older adults with hypertension based on their socio-demographic and health characteristics. (2) Methods: The sample consisted of a total of 1824 with hypertension and was obtained from the Eighth Korean National Health and Nutrition Examination Survey (VIII-1, VIII-2). (3) Results: As the factors associated with hypertension control among older men, 65-74 years old (OR = 1.76, CI = 1.04-2.96), a lower education level (OR = 2.23, CI = 1.17-4.28), with obesity (OR = 2.05, CI = 1.13-2.05), and under-treatment of hypertension (OR = 22.07, CI = 6.54-7.45) increased the likelihood of rating hypertension control. As the factors associated with hypertension control among older women, trying to weight maintain (OR = 1.70, CI = 1.01-2.85) and under-treatment of hypertension (OR = 12.16, CI = 3.65-40.46) increased the likelihood of rating hypertension control. (4) Conclusion: The factor affecting the control of hypertension differed between the two genders. To improve the control of hypertension, the guidelines for treatment interventions should be gender-specific for the early elderly. There is a need to increase control of hypertension by having health-related behavioral modifications such as reducing obesity for older men and trying weight maintenance for older women.
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Affiliation(s)
- Hye Young Choi
- Department of Nursing, Kangwon National University, Samcheok 25949, Republic of Korea
| | - Eunha Kim
- Department of Nursing, Catholic University of Pusan, Busan 46252, Republic of Korea
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16
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Chatzis DG, Magounaki K, Pantazopoulos I, Beltsios ET, Katsi V, Tsioufis KP. Current Management of Hypertension in Older Adults. Drugs Aging 2023; 40:407-416. [PMID: 36933178 DOI: 10.1007/s40266-023-01013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/19/2023]
Abstract
Hypertension is a major global health issue and it accounts for a big proportion of disability and mortality worldwide even in adults aged 65 years and above. Moreover, advanced age per se is an independent risk factor for adverse cardiovascular events and there is abundant scientific evidence supporting the beneficial effects of blood pressure lowering, within certain limits, in this subset of hypertensive patients. The aim of this review article is to summarize the available evidence regarding the appropriate management of hypertension in this specific subgroup, in an era of a constantly increasing aging population.
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Affiliation(s)
- Dimitrios G Chatzis
- Medical School, European University Cyprus, 76 Siggrou avenue, 11742, Athens, Greece.
| | - Kalliopi Magounaki
- Department of Internal Medicine, KAT General Hospital of Athens, Athens, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West Germany Heart Center, University Clinic Essen, Essen, Germany
| | - Vasiliki Katsi
- Department of Cardiology, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos P Tsioufis
- 1st Cardiology Clinic, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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17
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Agarkov NM, Osipova OA, Shurygin SN, Kolpina LV, Kolomiets VI. Activities of Daily Living Index in elderly patients with hypertension and frailty syndrome after non-ST segment elevation myocardial infarction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2023-3363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
Abstract
Aim. To analyze Barthel Index of Activities of Daily Living (ADL) in elderly patients with hypertension (HTN) and frailty 6 months after non-ST segment elevation myocardial infarction non-STEMI).Material and methods. ADL was studied in 114 elderly patients (60-74 years old) with non-STEMI, HN and frailty and 80 patients of the same age with non-STEMI and HTN, but without frailty. ADL was determined 6 months after suffering non-STEMI.Results. ADL in patients with frailty was reduced to a greater extent (55,8 [52,4-57,9]) than in non-frail patients (72,9 [70,3-78,6]) (p<0,01). According to factor analysis, ADL reduction in frail patients compared with non-frail patients was mainly due to bed-chair transfer — 6,4 [6,2- 6,8] vs 9,8 [8,1-11,5] (p<0,001), walking test — 8,1 [8,0-8,5] vs 10,6 [9,4-12,7] (p<0,001), stair climbing — 5,3 [5,1-5,7] vs 7,4 [6,8-8,9] (p<0,001). ADL in patients with frailty and blood pressure (BP) <160/100 mm Hg was 62,1 [60,3-69,9], which is significantly higher than in frail patients with BP ≥160/100 mm Hg (48,0 [36,3-53,2]) (p<0,01).Conclusion. In frail patients aged 60-74 years, compared with non- frail patients, 6 months after non-STEMI, ADL was significantly lower in such components as stair climbing, walking, and bed-chair transfer. In patients with frailty and BP <160/100 mm Hg, ADL is significantly higher than in patients with higher blood pressure.
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Affiliation(s)
- N. M. Agarkov
- Southwest State University;
Belgorod State National Research University
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18
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Geng H, Chen X, Liang W, Liu M. Associated factors and hemodynamic characteristics of resistant hypertension in the elderly. J Clin Hypertens (Greenwich) 2023; 25:259-265. [PMID: 36748961 PMCID: PMC9994165 DOI: 10.1111/jch.14640] [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: 11/22/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to explore the associated factors and hemodynamic characteristics of resistant hypertension (RHTN) in the elderly. A total of 283 patients aged ≥60 years with hypertension were evaluated by the CNAP™ monitor. Among them, 240 patients were non-RHTN (controlled hypertension with use of three or fewer antihypertensive medications) and 43 patients were RHTN (uncontrolled hypertension despite the concurrent use of ≥3 antihypertensive drugs at optimized doses, including a diuretic, or achieving target blood pressure with the use of ≥4 antihypertensive medications). RHTN was associated with higher body mass index (BMI), longer hypertension duration, and coronary heart disease (p = .004, p < .001, and p = .042, respectively). The mean number of antihypertensive medications was greater in patients with RHTN (p < .001). Hemodynamic analysis revealed higher cardiac output in the RHTN group than in the non-RHTN group, while no difference was observed in systemic vascular resistance. Screening for secondary etiology showed that, among the 43 patients with RHTN, 8 (18.6%) had chronic kidney disease, 8 (18.6%) had obstructive sleep apnea, 4 (9.3%) had primary aldosteronism, 2 (4.7%) had renovascular disease. No significant differences were observed in the cardiac output and systemic vascular resistance values between different causes of RHTN. These findings suggest that higher body mass index, longer hypertension duration, and coronary heart disease emerged as the associated factors of RHTN in the elderly. RHTN is characterized by higher cardiac output. Screening for the possible secondary etiology of RHTN in the elderly patients is necessary and important.
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Affiliation(s)
- Hui Geng
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Xiahuan Chen
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Wenyi Liang
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Meilin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing, China
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19
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Won MH, Son YJ. Combined influence of sedentary behaviours and chronic pain on depressive symptoms in older Korean adults with hypertension. Eur J Cardiovasc Nurs 2022; 21:791-800. [PMID: 35285897 DOI: 10.1093/eurjcn/zvac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/29/2021] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
AIMS Depressive symptoms in hypertensive patients are linked to poor adherence to treatment. Sedentary behaviours and chronic pain can increase blood pressure and depressive symptoms, respectively. However, the impact of their coexistence on depressive symptoms in older adults with hypertension has not yet been investigated. This study aimed to identify the combined influence of sedentary behaviours and chronic pain on depressive symptoms in older adults with hypertension in Korea. METHODS AND RESULTS This cross-sectional study used data from the sixth Korea National Health and Nutrition Examination Survey from January to December 2014. The survey adopted multistage stratified sampling by geographical region, gender, and age. For the data analysis, a total of 573 patients with hypertension aged 65 years or older were included. Approximately, 61.0% of depressed older patients had both sedentary behaviours and chronic pain compared with patients without depressive symptoms. In multivariate logistic regression analysis, compared with patients without either sedentary behaviours or chronic pain, older adults with hypertension who presented both sedentary behaviours, and chronic pain had the highest risk of depressive symptoms (odds ratio = 13.86, 95% confidence interval = 5.87-32.71; P < 0.001). CONCLUSION Coexistence of sedentary behaviours and chronic pain in older hypertensive patients may lead to depressive symptoms. Evaluating both sedentary behaviours and chronic pain when assessing depressive symptoms in patients with hypertension would be beneficial in planning a patient-centred approach for controlling blood pressure. More prospective cohort studies with larger samples are required to identify the causal relationships.
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Affiliation(s)
- Mi Hwa Won
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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20
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Ruan W, Zhai X, Guan L, Wei X, Zhang S. Expressions of serum adiponectin and visfatin in patients with hypertension in cerebrovascular accidents and analysis of risk factors. Am J Transl Res 2022; 14:7852-7859. [PMID: 36505296 PMCID: PMC9730094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the expressions of serum adiponectin and visfatin in patients with hypertension and cerebrovascular accidents and to analyze the risk factors. METHODS Data of 161 patients with hypertension treated in The Affiliated Hospital of Shandong University of Traditional Chinese Medicine from March 2019 to July 2021 were retrospectively analyzed. There were 72 patients with cerebrovascular accidents assigned to an occurrence group. The remaining 89 patients without cerebrovascular accidents were assigned to a non-occurrence group. The two groups were compared in terms of the coagulation function (activated partial thromboplastin time, prothrombin time, and fibrinogen), liver function (aspartate aminotransferase (AST), glutamic pyruvic transaminase (GPT), albumin and total bilirubin (TB)), blood lipid indexes (cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL)), serum adiponectin, and visfatin levels. Pearson's correlation coefficient was performed to analyze the correlation of serum adiponectin and visfatin with blood lipid indexes. Logistics regression was performed to analyze the risk factors of stroke in patients with hypertension. RESULTS The two groups were similar in terms of sex, age, education level, smoking, drinking, and diabetes histories (P>0.05). There were more patients ≥65 years old with body mass index ≥20 kg/m2 and with hyperlipidemia in the occurrence group than those in the non-occurrence group (P<0.05). The two groups were not notably different in activated partial thromboplastin time, prothrombin time, fibrinogen, AST, GPT, albumin, TB, total cholesterol, and HDL (P>0.05). The occurrence group showed significantly higher triglyceride, LDL and adiponectin levels, and a notably lower visfatin level than the non-occurrence group (P<0.05). Adiponectin showed a positive correlation with triglyceride and a negative association with LDL (P<0.05). Visfatin showed only a negative correlation with triglyceride (P<0.05), but no correlation with LDL (P>0.05). A multivariate logistics regression analysis reported that hyperlipidemia, triglyceride, LDL, adiponectin, and visfatin were independent risk factors for stroke in patients with hypertension (P<0.05). CONCLUSION Serum adiponectin and visfatin were differentially expressed in patients with both hypertension and stroke. Our regression analysis revealed that serum adiponectin and visfatin were independent risk factors for stroke in patients with hypertension.
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Affiliation(s)
- Wenting Ruan
- Special Inspection Section, Affiliated Hospital of Shandong University of Traditional Chinese MedicineJinan 250014, Shandong, China
| | - Xixi Zhai
- First College of Clinical Medicine, Shandong University of Traditional Chinese MedicineJinan 250014, Shandong, China
| | - Lin Guan
- Special Inspection Section, Affiliated Hospital of Shandong University of Traditional Chinese MedicineJinan 250014, Shandong, China
| | - Xijin Wei
- Special Inspection Section, Affiliated Hospital of Shandong University of Traditional Chinese MedicineJinan 250014, Shandong, China
| | - Sishuo Zhang
- First College of Clinical Medicine, Shandong University of Traditional Chinese MedicineJinan 250014, Shandong, China,Three Departments of Encephalopathy, Affiliated Hospital of Shandong University of Traditional Chinese MedicineJinan 250014, Shandong, China
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21
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Analysis of Clinical Characteristics and Influencing Factors for H-Type Hypertension Complicated with Other Chronic Diseases in a Community in Beijing. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6974065. [PMID: 36159579 PMCID: PMC9499743 DOI: 10.1155/2022/6974065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
Objective. The aim of the study is to analyze the clinical characteristics of patients with H-type hypertension complicated with other chronic diseases in a community in Beijing and to explore the influencing factors related to the occurrence of the disease by means of a case-control study. Methods. A questionnaire was designed. 362 residents with H-type hypertension in a community in Beijing were randomly enrolled from January 2020 to December 2021. The general data and clinical indexes of the patients were collected and their clinical characteristics were analyzed. According to the complications of other chronic diseases, they were divided into the simple hypertension group (n = 65) and the other chronic disease group (n = 297). Univariate and multivariate analyses were used to analyze the influencing factors for H-type hypertension patients with other chronic diseases. Results. Among the 362 H-type hypertension patients, 21 cases were aged 35–45 years, 35 cases were aged 45–55 years, and 127 cases were aged 55–65 years. The number of patients aged ≥65 years was 179, and the number of patients aged ≥55 years accounted for the highest proportion with a constituent ratio of 85.00%. Only 65 patients were patients with simple hypertension. The remaining 297 patients were complicated with different kinds of chronic diseases. The types of chronic diseases include malignant tumors, diabetes, rheumatoid arthritis, coronary heart disease, asthma, chronic obstructive pulmonary disease, systemic lupus erythematosus, and stroke. The proportion of H-type hypertension complicated with coronary heart disease, diabetes, and stroke is higher. Among the 297 patients, most of them were local, resident, and nonagricultural patients with a constituent ratio of 89.90%, 95.96%, and 98.98%, respectively. The prevalence rate of the male was 59.60% higher than that of the female at 40.40%. The blood types B and AB were more common. 90.57% of patients were married and the proportion of body mass index (BMI) was 45.79%. 60.61% of patients had a history of smoking, 55.56% had a history of drinking, 35.02% had a regular physical examination, 14.81% had regular exercise, and 37.71% had a light diet. There were significant differences in marital status, smoking, alcohol consumption, regular exercise, and light diet between the simple hypertension group and the chronic disease group (
). The results of the logistic regression analysis showed that smoking, drinking, little exercise, and not eating lightly were the independent risk factors for other chronic diseases (
). Conclusion. The incidence of H-type hypertension is higher in people ≥55 years old. Most of them are accompanied by three other chronic diseases: smoking, drinking, little exercise, and no light diet are also risk factors for chronic diseases.
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22
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Lee DH, Lee JH, Kim SY, Lee HY, Choi JY, Hong Y, Park SK, Ryu DR, Yang DH, Hwang SJ, Choi JH, Kim KH, Lee SH, Joo SJ, Park JH, Kim SH, Kim HL, Kim KI, Cho MC. Optimal blood pressure target in the elderly: rationale and design of the HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial. Korean J Intern Med 2022; 37:1070-1081. [PMID: 35859277 PMCID: PMC9449210 DOI: 10.3904/kjim.2022.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients. METHODS The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths. RESULTS As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group. CONCLUSION The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.
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Affiliation(s)
- Dong-Hwa Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju,
Korea
- Department of Cardiology and Cardiocerebrovascular Center, Chungbuk National University Hospital, Cheongju,
Korea
| | - So Young Kim
- Department of Cardiology and Cardiocerebrovascular Center, Chungbuk National University Hospital, Cheongju,
Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Youjin Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Cancer Research Institute, Seoul National University, Seoul,
Korea
| | - Sue K. Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon,
Korea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu,
Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju,
Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan,
Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju,
Korea
| | - Seung Jae Joo
- Department of Cardiology, Jeju National University Hospital, Jeju,
Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Hack-Lyong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 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
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju,
Korea
- Department of Cardiology and Cardiocerebrovascular Center, Chungbuk National University Hospital, Cheongju,
Korea
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Modifiable and Non-modifiable Factors Associated with Low Awareness of Hypertension Treatment in Indonesia: A Cross-Sectional Population-Based National Survey. Glob Heart 2022; 17:56. [PMID: 36051316 PMCID: PMC9389957 DOI: 10.5334/gh.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Low awareness about hypertension treatment is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors is essential for developing effective intervention strategies. This study aims to identify the modifiable and non-modifiable factors associated with low awareness about hypertension treatment. Method: This national, cross-sectional, population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among respondents with hypertension aged ≥15 years. Depression and insomnia, as modifiable factors, were assessed using the Centre for Epidemiologic Studies—Depression (CES-D) and the Patient-Recorded Outcomes Measurement Information System (PROMIS) questionnaire, respectively. Non-modifiable factors, such as sociodemographic information, were obtained from self-reported data. Logistic regression analysis was used to assess the association between these factors and low awareness about hypertension treatment. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Result: The study recruited 7,920 respondents, the majority of whom were female (53.8%) and aged <60 years (71.1%). The prevalence of low awareness of hypertension treatment was 87.1% (51.8% in women and 48.2% in men). Being an elderly (OR: 1.60, 95%CI 1.36–1.88), being irregularly blood pressure control (OR: 4.40, 95% CI 3.78–5.13), having depressive symptoms (OR: 1.35, 95% CI 1.12–1.62), having insomnia (OR: 1.31, 95% CI 1.11–1.53), and having low satisfaction with health care (OR: 1.28, 95% CI 1.08–1.51) were associated with low awareness of hypertension treatment. Surprisingly, respondents with strong religiosity (OR: 1.62; 95% CI 1.25–2.09) were more likely to display low awareness of hypertension treatment. Conclusion: The main factors associated with low awareness of hypertension treatment are modifiable. Thus, health care professionals should integrate more patient-specific factors when designing tailored interventions.
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24
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Camafort M, Chung WJ, Shin JH. Role of ambulatory blood pressure monitoring in elderly hypertensive patients. Clin Hypertens 2022; 28:22. [PMID: 35773739 PMCID: PMC9248111 DOI: 10.1186/s40885-022-00205-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/10/2022] [Indexed: 01/02/2023] Open
Abstract
Background Arterial hypertension is facing some changes in the last years. Its prevalence is increasing in elderly subjects. This growing prevalence is due to longer survival of the population worldwide, among other factors. On the other hand, recent guidelines have insisted in the relevance of out of office blood pressure measurements, to improve diagnostic and management of hypertension. Therefore, elderly subjects with hypertension could benefit from out of office blood pressure measurements, like ambulatory blood pressure measurements; nevertheless, there are very few or no specific recommendations regarding this. Aim In this review, we will gather the most important information about this subject. Results As hypertension in the elderly has some specific characteristics related to aging of the cardiovascular system, the most important aspect could be that these characteristics make ambulatory blood pressure measurement suitable for its use in elderly. Among those a higher prevalence of white coat hypertension, white coat phenomenon, and a higher nocturnal blood pressure and higher prevalence of nondipper and riser pattern, represent aspects that should be considered for better diagnostic and an improved management. Conclusion As the prevalence of hypertension will grow in the next years, more studies specifically directed to this subject are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00205-6.
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Affiliation(s)
- Miguel Camafort
- ESH Excellence Hypertension Center, Department of Internal Medicine, Geriatrics Section, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Research Group on Cardiovascular Risk, Nutrition and Aging, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Research Group CB06/03/0019, Biomedical Network Research Center in Obesity and Nutrition (CIBER-OBN), Institute of Health Carlos III (ISCIII), Ministry of Science, Innovation and Universities, Madrid, Spain.
| | - Wook-Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.,Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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25
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Shin J, Kim KI. A clinical algorithm to determine target blood pressure in the elderly: evidence and limitations from a clinical perspective. Clin Hypertens 2022; 28:17. [PMID: 35701854 PMCID: PMC9199158 DOI: 10.1186/s40885-022-00202-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/22/2022] [Indexed: 01/14/2023] Open
Abstract
As the elderly population is growing rapidly, management of hypertension in South Korea faces major challenges because the proportion of elderly hypertension patients is also increasing. The characteristics of this population are also much more complex than younger patients. Elderly hypertension is characterized by wide variations in (1) fitness or biological age, (2) white-coat effect, (3) poor functional status or frailty, (4) dependency in activities of daily living or institutionalization, (5) orthostatic hypotension, and (6) multiple comorbidities. All of these should be considered when choosing optimal target blood pressure in individual patients. Recent randomized clinical trials have shown that the benefits of intensive blood pressure control for elderly patients is greater than previously thought. For generalization of these results and implementation of the guidelines based on these studies, defining the clinician’s role for individualization is critically important. For individualized decisions for target blood pressure (BP) in the elderly with hypertension, four components should first be checked. These consist of (1) the minimum requirement of functional status and capability of activities of daily living, (2) lack of harmful evidence by the target BP, (3) absence of white-coat hypertension, and (4) standing systolic BP ≥ 110 mmHg without orthostatic symptoms. Risk of decreased organ perfusion by arterial stenosis should be screened before starting intensive BP control. When the target BP differs among comorbidities, the lowest target BP should be given preference. After starting intensive BP lowering therapy, tolerability should be monitored, and the titration should be based on the mean level of blood pressure by office supplemented by out-of-office BPs. Applications of the clinical algorithms will be useful to achieve more standardized and simplified applications of target BP in the elderly.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Internal Medicine, Geriatric Center, Seoul National University Bundang Hospital, 82 Gumi-ro, Bundang-gu, 13620, Seongnam, Korea.
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26
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Prevalence of pain in community-dwelling older adults with hypertension in the United States. Sci Rep 2022; 12:8387. [PMID: 35589916 PMCID: PMC9119929 DOI: 10.1038/s41598-022-12331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Hypertension and pain are both prevalent conditions in the older adult population. We aimed to report the prevalence of pain discomforts and investigated the association between hypertension and pain discomforts among older adults in the United States. Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7601 adults ages ≥ 65 years. Prevalence of bothersome pain, activity-limiting pain, locations of pain and usage of pain medicine were evaluated. Demographics, comorbidities, and other covariates were compared between older adults with hypertension and those without. Multivariate regression was further performed to yield adjusted odd ratios. Among 6825 older adults, 4533 of them had a history of hypertension while 2272 of them had not. Prevalence of bothersome pain (57.12% versus 44.81%, p < 0.001) and activity-limiting pain (56.21% versus 46.12%, p < 0.001) were significantly higher in the hypertension group. After adjusting for all covariates, hypertension demonstrated a significant association with activity-limiting pain (OR 1.63, 95% CI 1.06 to 2.52, p = 0.02). In conclusion, pain was more prevalent in older Americans with hypertension. The positive association between hypertension and pain suggested that routine pain assessment and proper treatment would be required to improve the function and quality of life among older adults especially with hypertension.
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27
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Kim KI. Hypertension in Older Women: The Biggest Challenge for Cardiovascular Health in an Aged Society. Korean Circ J 2022; 52:393-394. [PMID: 35388993 PMCID: PMC9064702 DOI: 10.4070/kcj.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
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28
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Choi JY, Chun S, Kim H, Jung YI, Yoo S, Kim KI. Analysis of blood pressure and blood pressure variability pattern among older patients in long-term care hospitals: an observational study analysing the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) dataset. Age Ageing 2022; 51:6540143. [PMID: 35253050 DOI: 10.1093/ageing/afac018] [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: 06/14/2021] [Revised: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES There are limited data regarding blood pressure (BP) variability among older adults living in long-term care hospitals (LTCHs). We aimed to collect data from LTCH and analyse BP characteristics and its variability among these patients using a novel platform. METHODS The Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) platform was used to construct a daily BP dataset using data of 394 older patients from 6 LTCHs. BP variability was expressed as coefficient of variation (CV = standard deviation/mean of BP × 100). Physical frailty and cognitive function were evaluated using the K-FRAIL questionnaire and the Cognitive Performance Scale of the interRAI Long-Term Care Facilities tool, respectively. RESULTS From September 2019 to September 2020, 151,092 BP measurements, 346.5 (IQR 290.8-486.3) measurements per patient, were included. The mean BP was 123.4 ± 10.8/71.3 ± 6.5 mmHg. BP was significantly lower in frail patients (122.2 ± 11.3/70.4 ± 6.8 mmHg) than in pre-frail/robust patients (124.4 ± 10.4/72.1 ± 6.1 mmHg, P < 0.05). However, CV of systolic (10.7 ± 2.3% versus 11.3 ± 2.3%, P = 0.005) and diastolic (11.6 ± 2.3% versus 12.4 ± 2.4%, P < 0.001) BP was higher in frail patients. The mean BP was lower, but BP variability was higher in patients with cognitive impairment. The mean BP, but not BP variability, was higher in treated hypertensive patients, as the number of antihypertensive medications increased. CONCLUSION Older patients with physical or cognitive frailty had lower BP but higher BP variability. Relationship among frailty, increased BP variability and adverse clinical outcomes should be investigated.
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Affiliation(s)
- Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Institute on Aging, Seoul National University, Seoul, Republic of Korea
| | - Young-il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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29
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Hassan D, Peeters LEJ, Koch BCP, Versmissen J. DiffErenCes in AntihypertenSive Drug Blood Levels in Patients with HypertensiON (DECISION): Protocol for a Prospective Observational Study Comparing Pharmacokinetics and Pharmacodynamics Between Young and Elderly Patients. High Blood Press Cardiovasc Prev 2022; 29:239-243. [PMID: 35175576 PMCID: PMC9050759 DOI: 10.1007/s40292-022-00505-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Adequate controlled blood pressure decreases the risk of cardiovascular events. However, the elderly are more vulnerable and thereby more prone to side effects of antihypertensive drugs. A lack of pharmacokinetic and pharmacodynamic (PK/PD) studies in older patients makes specific and tailored advices towards antihypertensive drug therapy difficult. The aim of our study, DiffErenCes In antihypertenSive drug levels In patients with hypertensiON (DECISION), is to fill in this PK/PD knowledge gap and move towards precision dosing. DECISION is a prospective observational PK/PD study set up to determine the difference in exposure to the antihypertensive drugs, losartan and perindopril, measured by drug levels in blood. The area under the curve (AUC; PK) and furthermore the association between the AUC and the effect on blood pressure (PD) will be compared between elderly and younger patients.
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Affiliation(s)
- Dimokrat Hassan
- Department Hospital Pharmacy, Erasmus University Medical Center, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Laura E J Peeters
- Department Hospital Pharmacy, Erasmus University Medical Center, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department Hospital Pharmacy, Erasmus University Medical Center, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jorie Versmissen
- Department Hospital Pharmacy, Erasmus University Medical Center, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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30
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Xu Z, Chen H, Zhou H, Sun X, Ren J, Sun H, Chen C, Chen G. Comparison of noninvasive continuous arterial blood pressure measured by NICAP with arterial line in elderly patients. BMC Geriatr 2022; 22:108. [PMID: 35130866 PMCID: PMC8822785 DOI: 10.1186/s12877-022-02803-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/31/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-Invasive Continuous Arterial Pressure system (NICAP) allows continuous monitoring, timely detection of hypotension, and avoiding risks from invasive procedures. A previous study showed good comparability of NICAP with arterial line in people with no evidence of cardiovascular disease. Therefore, the goal of this study was to investigate whether NICAP could be accurately applied to elderly patients. METHODS In this single-centered observational study, forty-one patients above 65 undergoing elective surgeries requiring artery catheterizations were enrolled from July 17, 2020, to June 25, 2021. Radial artery cannulation and NICAP monitoring were started before anesthesia. Blood pressure during the anesthesia induction and the whole surgery, trend of blood pressure changes, time needed for establishing continuous monitoring, and complications were recorded. RESULTS A total of 6751 valid pairs of blood pressure measurements were analyzed. In the Bland-Altman analysis, the arithmetic means for systolic, diastolic, and mean arterial pressure were 2.2, 3.3, and 2.8 mmHg, respectively. NICAP and arterial line correlation coefficients for systolic, diastolic, and mean arterial pressure were 0.49, 0.33, and 0.45, respectively. In the trending analysis, the polar concordance rates at 30 degrees were 70.9% for systolic, 67.7% for diastolic, and 69.3% for mean arterial blood pressure. During the anesthesia induction, the arithmetic means for systolic, diastolic, and mean arterial pressure in the Bland-Altman analysis were 1.7, -0.2, and 0.5 mmHg, respectively. NICAP and arterial line correlation coefficients for systolic, diastolic, and mean arterial pressure were 0.78, 0.61 and 0.75, respectively. No severe complications occurred. CONCLUSIONS NICAP has a poor correlation with the arterial line in elderly patients for the whole surgery or during anesthesia induction. Moreover, it showed poor comparability in the detection of blood pressure change trends with arterial lines. Our findings suggest that NICAP might not be sufficiently accurate to be applied clinically in elderly patients with comorbidities. More accurate calibration and iteration are needed.
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Affiliation(s)
- Zhao Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Hongyang Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Hongyu Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Xiaohui Sun
- Department of Anesthesiology, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Jun Ren
- Department of Anesthesiology, Xinjiang Production and Construction Corps Hospital, No. 232 Qingnian Road, 830002, Urumqi, China
| | - Hongxia Sun
- Department of Anesthesiology, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China.
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China.
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31
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Lee HY, Kim KI, Ihm SH, Rhee MY, Sohn IS, Park S, Jeon ES, Song JM, Pyun WB, Sung KC, Kim MH, Kim SH, Kim SY, Kim SJ, Kim EJ, Shin J, Lee SY, Chun KJ, Jeong JO, Chae SC, Yoo KD, Choi YJ, Park YH, Kim CH. A Randomized, Double-blind, Active-controlled, Two Parallel-Group, Optional Titration, Multicenter, Phase IIIb Study to Evaluate the Efficacy and Safety of Fimasartan Versus Perindopril Monotherapy With and Without a Diuretic Combination in Elderly Patients With Essential Hypertension. Clin Ther 2021; 43:1746-1756. [PMID: 34503866 DOI: 10.1016/j.clinthera.2021.08.003] [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: 02/16/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The efficacy and tolerability of fimasartan in elderly patients have not been fully evaluated. This study was therefore conducted to determine the efficacy and tolerability of fimasartan compared with perindopril in elderly Korean patients aged >70 years with essential hypertension (defined by a mean sitting systolic blood pressure [SBP] ≥140 mm Hg). METHODS This randomized, double-blind, active-controlled, 2 parallel-group, optional titration, multicenter, Phase IIIb trial (FITNESS [Fimasartan in the Senior Subjects]) enrolled 241 patients from 23 cardiac centers in the Republic of Korea between August 2017 and December 2019. After the placebo run-in period, treatment started with fimasartan 30 mg or perindopril arginine 2.5 mg once daily at a 1:1 ratio; if BP was not controlled at week 4, the dose was doubled. If BP was not controlled at week 8, a diuretic combination (fimasartan 60 mg/hydrochlorothiazide 12.5 mg or perindopril arginine 5 mg/indapamide 1.25 mg) was administered. After 16 weeks of the double-blind treatment, the patients with controlled BP participated in an 8-week open-label extension study, with the 2 groups unified by fimasartan 60 mg with or without hydrochlorothiazide 12.5 mg for 8 weeks. The primary outcome was a change in SBP for 8 weeks. The secondary outcomes included a change in sitting diastolic BP (DBP) for 8 weeks and changes in SBP and DBP for 4, 16, and 24 weeks. FINDINGS At week 8, mean SBP significantly decreased from baseline in both groups: -14.2 (14.4) mm Hg in the fimasartan group and -9.0 (16.1) mm Hg in the perindopril group. The difference between the 2 groups was 5.4 (2.1) mm Hg, indicating the noninferiority of fimasartan to perindopril. Moreover, fimasartan exhibited a higher BP-lowering effect than perindopril (P = 0.0108). In addition, reductions in SBP and DBP from baseline to weeks 4, 8, and 16 were significantly greater in the fimasartan group than in the perindopril group, although the SBP reduction was comparable at week 16. Both groups reported an excellent mean compliance rate of 97.4% (4.7%) through week 16. During the study period, 82 adverse events were reported in 52 patients, 40 in the fimasartan group and 42 in the perindopril group (P = 0.4647). Dizziness was the most commonly reported adverse event (7 cases). Remarkably, only 1 case of orthostatic hypotension was reported during the study period. IMPLICATIONS In elderly patients with essential hypertension, fimasartan 30 to 60 mg with a possible hydrochlorothiazide 12.5-mg combination was noninferior to perindopril 2.5 to 5 mg with a possible indapamide 1.25-mg combination. Furthermore, fimasartan exhibited higher BP-lowering efficacy than perindopril. There was no difference in tolerability between the 2 groups. Clinicaltrials.gov Identifier: NCT03246555.
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Affiliation(s)
- Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sang Hyun Ihm
- Department of Internal Medicine, The Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon-si, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University Health System, Severance Hospital, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Dong-A University Hospital, Busan, Republic of Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Seoul National University Borame Medical Center, Seoul, Republic of Korea
| | - Seok-Yeon Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Republic of Korea
| | - Shin-Jae Kim
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Eung Ju Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of Medicine, Kyungpuk National University, Daegu, Republic of Korea
| | - Ki Dong Yoo
- Department of Internal Medicine, The Catholic University of Korea, ST. Vincent's Hospital, Suwon-si, Republic of Korea
| | - Young Jin Choi
- Department of Internal Medicine, Sejong Hospital, Bucheon-si, Republic of Korea
| | - Yong Hwan Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-si, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
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Kańtoch A, Grodzicki T, Wójkowska-Mach J, Heczko P, Gryglewska B. Explanatory survival model for nursing home residents- a 9-year retrospective cohort study. Arch Gerontol Geriatr 2021; 97:104497. [PMID: 34411924 DOI: 10.1016/j.archger.2021.104497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a gap in the literature regarding the analysis of long-term survival and mortality risk factors among disabled and multimorbid institutionalized populations. The study aimed to analyze 9-year survival, investigate mortality factors, and develop an explanatory survival model for nursing home residents. MATERIALS AND METHODS A retrospective cohort study with a 9-year follow-up (2009-2018) was conducted among 96 residents of a nursing home with Barthel index ≤ 40. The study was based on baseline measurements performed in 2009, which included results obtained on geriatric scales: Mini Nutritional Assessment Short-Form (MNA-SF) and Abbreviated Mental Test Score (AMTS). Information on demographics, comorbidities, pharmacotherapy, transfers and deaths came from medical records. Kaplan-Meier curves were used to estimate and present survival data. Factors associated with mortality were determined using Cox proportional hazard models. RESULTS The median survival was 2.9 years. Mortality during the follow-up period was 83%. Kaplan-Meier curves showed that residents with normal nutritional status (p = 0.002) and taking aspirin (p = 0.005) had a better 9-year survival. The multivariable Cox regression model revealed that the risk of mortality (Hazard Ratio, HR) increased in older age (HR=1.04), male gender (HR=2.08), with risk of malnutrition (HR=3.91), malnutrition (HR=4.84), and presence of urinary incontinence (HR=2.14). The aspirin use was the strongest protective factor against death (HR=0.40). CONCLUSION The aspirin use was associated with better long-term survival for nursing home residents. Factors associated with higher mortality among residents include older age, male gender, poor nutritional status, and urinary incontinence. BRIEF SUMMARY We are the first to report the beneficial effects of a low-dose of aspirin on the long-term survival of disabled, institutionalized populations with multimorbidity. Furthermore, this study presents an explanatory model of survival for nursing home residents and identifies the long-term mortality risk factors among disabled residents with multimorbidity.
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Affiliation(s)
- Anna Kańtoch
- Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland
| | - Tomasz Grodzicki
- Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland
| | - Jadwiga Wójkowska-Mach
- Jagiellonian University Medical College, Faculty of Medicine, Department of Microbiology, 18 Czysta Str., 31-121 Kraków, Poland
| | - Piotr Heczko
- Jagiellonian University Medical College, Faculty of Medicine, Department of Microbiology, 18 Czysta Str., 31-121 Kraków, Poland
| | - Barbara Gryglewska
- Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland.
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Kim HS, Kang M, Kang G. Renin-angiotensin system modulators and other risk factors in COVID-19 patients with hypertension: a Korean perspective. BMC Infect Dis 2021; 21:175. [PMID: 33588797 PMCID: PMC7883762 DOI: 10.1186/s12879-021-05848-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND While hypertension is the most common comorbid condition in patients with coronavirus disease 2019 (COVID-19) in Korea, there is a lack of studies investigating risk factors in COVID-19 patients with hypertension in Korea. In this study, we aimed to examine the effects risk factors in hypertensive Korean COVID-19 patients. METHODS We selected patients from the database of the project #OpenData4Covid19. This information was linked to their 3-year historical healthcare data. The severity of the disease was classified into five levels. We also clustered the levels into two grades. RESULTS The risk factors associated with COVID-19 severity were old age, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), malignancy, and renal replacement therapy. The use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) both before and after a diagnosis of COVID-19 were not associated with COVID-19 severity. A multivariate analysis revealed that old age, male sex, diabetes mellitus, and renal replacement therapy were risk factors for severe COVID-19. CONCLUSION The results suggest that in hypertensive patients with COVID-19, older age, male sex, a diagnosis of diabetes mellitus, and renal replacement therapy were risk factors for a severe clinical course. In addition, the use of ARBs and ACEIs before or after COVID-19 infection did not affect a patient's risk of contracting COVID-19 nor did it contribute to a worse prognosis for the disease. These results highlighted that precautions should be considered for hypertensive patients with those risk factors and do not support discontinuation of ARBs and ACEIs during COVID-19 pandemic.
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Affiliation(s)
- Hee-Sung Kim
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Minseok Kang
- Department of Health Information and Management, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju, 28644, Republic of Korea
| | - Gilwon Kang
- Department of Health Information and Management, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju, 28644, Republic of Korea.
- Chungbuk Regional Cardiovascular Center, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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Suarez-Villar R, Martinez-Urbistondo D, Fernandez MA, Lopez-Cano M, Fernandez E, Dominguez A, Prosper L, Rodriguez-Cobo A, Tinoco MEC, Nadal P, Risco CR, Fernández PV, Martínez JA. Cross-sectional evaluation of the interaction between activity relative-time expenditure and comorbidity concerning physical quality of life. Medicine (Baltimore) 2020; 99:e22552. [PMID: 33235060 PMCID: PMC7710197 DOI: 10.1097/md.0000000000022552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Quality of life (QoL) is a matter of concern in both healthy and diseased individuals. Lifestyle factors such as physical activity and sleep have a direct impact on QoL. In this context, interactions between activity time expenditure and QoL might be different in comorbid and non comorbid patients. Besides, the quantification and evaluation of time expenditure is ordinarily measured as the absolute time devoted to each activity. The objective of this study is the evaluation of the influence and interactions of activity-relative time expenditure and co-morbidity in Physical QoL.The study involved 302 consecutive patients, from an Internal Medicine ambulatory evaluation. Validated questionnaires were used to collect demographic variables and time expenditure variables. QoL was gathered with de survey short form-36questionnaire. Comorbidity was compiled with de Charlson Comorbidity Index. SPSS v20.0 was used for statistical analysis.As hypothesized, healthy subjects had higher Physical QoL score than comorbid subjects (P < .05). Physical activity and sleep relative time expenditure were statistically significant and associated to a better QoL in comorbid patients (P < .05). Interestingly, sleep was found to have statistically significant interaction with a score of ≥2 in the Charlson Comorbidity Index. Age, gender, comorbidity, physical activity relative time expenditure, and the interaction between relative time dedicated to sleep and comorbidity were found statistically significant in a multivariate model on Physical QoL prediction.Activity-relative time expenditure could be an adequate measure of daily activity pattern in the evaluation of QoL. Relative time spent in physical activity and sleep might be positively associated to Physical QoL. Sleep and comorbidity could have a statistically significant interaction in the prediction of Physical QoL.
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Affiliation(s)
| | | | | | | | - Eva Fernandez
- Internal Medicine Department. HM Sanchinarro. HM Hospitales
| | | | - Laura Prosper
- Internal Medicine Department. HM Sanchinarro. HM Hospitales
| | | | | | - Paula Nadal
- Internal Medicine Department. HM Sanchinarro. HM Hospitales
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Epidemiological characteristics and related factors of frailty in older Chinese adults with hypertension: a population-based study. J Hypertens 2020; 38:2192-2197. [DOI: 10.1097/hjh.0000000000002650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Shin J, Cho MC. Updated Reasons and Clinical Implications of New Korean Hypertension Guidelines for Cardiologists. Korean Circ J 2020; 50:476-484. [PMID: 32281319 PMCID: PMC7234851 DOI: 10.4070/kcj.2019.0338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Abstract
Leaving behind substantial reflections or skepticisms on the shortage of evidences about blood pressure (BP) thresholds for antihypertensive drug therapy and target BPs, major hypertensive guidelines including Korean hypertension guidelines were recently updated for earlier and more intensive control of BP. Because hypertension is one of the major risk factors for death, stroke, cardiovascular (CV) disease, heart failure, and cognitive impairment, substantial improvement of hypertension management is necessary to reduce disease and socioeconomic burdens and to promote CV health. Theoretically, earlier intervention in terms of age and BP level and thorough control of BP into within normal range would prevent or delay major adverse CV events. Revised hypertension guidelines were developed by the American College of Cardiology/American Heart Association, Korean Society of Hypertension, European Society of Cardiology/European Society of Hypertension, and Japanese Society of Hypertension in order. In this article, recent updates and clinical significances of the Korean hypertension guidelines will be discussed with comparison of foreign hypertension guidelines and considerable changes in the management of hypertension will be introduced for cardiologists and general practitioners.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
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