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Lee HY, Min KW, Han KA, Kim JS, Ahn JC, Kim MH, Lee JB, Shin SH, Kim CJ, Kim KH, Cho DK, Choi J, Rhee MY, Her SH, Kim W, Na JO, Cho GY, Kim SY, Park GM, Lee BK, Jo SH, Lee BW, Sohn IS, Kim DI, Ihm SH, Lee SH, Chung JW, Cho EJ, Son JW, Oh SJ, Hwang JY, Jeong JO, Han KR, Yoon HJ, Seo SM, Chung WJ, Bae JW, Choi JH, Hyun BJ, Cha JE, Yoo SJ, Shin J. The Efficacy and Tolerability of Irbesartan/Amlodipine Combination Therapy in Patients With Essential Hypertension Whose Blood Pressure Were not Controlled by Irbesartan Monotherapy. Clin Ther 2024:S0149-2918(24)00084-5. [PMID: 38704294 DOI: 10.1016/j.clinthera.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE This study aimed to evaluate the efficacy and tolerability of irbesartan (IRB) and amlodipine (AML) combination therapy in patients with essential hypertension whose blood pressure (BP) was not controlled by IRB monotherapy. METHODS Two multicenter, randomized, double-blind, placebo-controlled, phase III studies were conducted in Korea (the I-DUO 301 study and the I-DUO 302 study). After a 4-week run-in period with either 150 mg IRB (I-DUO 301 study) or 300 mg IRB (I-DUO 302 study), patients with uncontrolled BP (ie, mean sitting systolic BP [MSSBP] ≥140 mmHg to <180 mmHg and mean sitting diastolic BP <110 mmHg) were randomized to the placebo, AML 5 mg, or AML 10 mg group. A total of 428 participants were enrolled in the 2 I-DUO studies. In the I-DUO 301 study, 271 participants were randomized in a 1:1:1 ratio to receive either IRB/AML 150/5 mg, IRB/AML 150/10 mg, or IRB 150 mg/placebo. In the I-DUO 302 study, 157 participants were randomized in a 1:1 ratio to receive IRB/AML 300/5 mg or IRB 300 mg/placebo. The primary endpoint was the change in MSSBP from baseline to week 8. Tolerability was assessed according to the development of treatment-emergent adverse events (TEAEs) and clinically significant changes in physical examination, laboratory tests, pulse, and 12-lead electrocardiography. FINDINGS In I-DUO 301, the mean (SD) changes of MSSBP at week 8 from baseline were -14.78 (12.35) mmHg, -21.47 (12.78) mmHg, and -8.61 (12.19) mmHg in the IRB/AML 150/5 mg, IRB/AML 150/10 mg, and IRB 150 mg/placebo groups, respectively. In I-DUO 302, the mean (SD) changes of MSSBP at week 8 from baseline were -13.30 (12.47) mmHg and -7.19 (15.37) mmHg in the IRB/AML 300/5 mg and IRB 300 mg/placebo groups, respectively. In both studies, all combination groups showed a significantly higher reduction in MSSBP than the IRB monotherapy groups (P < 0.001 for both). TEAEs occurred in 10.00%, 10.99%, and 12.22% of participants in the IRB/AML 150/5 mg, IRB/AML 150/10 mg, and IRB 150 mg/placebo groups, respectively, in I-DUO 301 and in 6.33% and 10.67% of participants in the IRB/AML 300/5 mg and IRB 300 mg/placebo groups, respectively, in I-DUO 302, with no significant between-group differences. Overall, there was one serious adverse event throughout I-DUO study. IMPLICATIONS The combination of IRB and AML has superior antihypertensive effects compared with IRB alone over an 8-week treatment period, with placebo-like tolerability. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05476354 (I-DUO 301), NCT05475665 (I-DUO 302).
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Affiliation(s)
- Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Wan Min
- Department of Endocrinology and Metabolism, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Kyung Ah Han
- Department of Endocrinology and Metabolism, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Jeong Su Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jeong Cheon Ahn
- Department of Cardiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Jin Bae Lee
- Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Sung-Hee Shin
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Chong-Jin Kim
- Department of Cardiology, CHA Gangnam Medical Center, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School /Hospital, Gwangju, Republic of Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Junghyun Choi
- Department of Cardiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Moo-Yong Rhee
- Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jin Oh Na
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Seok Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Sang-Ho Jo
- Department of Internal Medicine, Division of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Il-Suk Sohn
- Department of Cardiology, KyungHee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Joong-Wha Chung
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jang Won Son
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Seung-Jin Oh
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyoo-Rok Han
- Department of Cardiology, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Suk Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jin-Ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | | | | | | | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea..
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Kim MC, Ahn Y, Kim MH, Kim SY, Hong TJ, Rhee MY, Kim SH, Hong SJ, Kim H, Kim W, Chae IH, Kang DH, Kim BK, Kim HS. A Randomized, Multicenter, Double-blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of a Quadruple Combination of Amlodipine, Losartan, Rosuvastatin, and Ezetimibe in Patients with Concomitant Essential Hypertension and Dyslipidemia. Am J Cardiovasc Drugs 2023:10.1007/s40256-023-00590-9. [PMID: 37395974 DOI: 10.1007/s40256-023-00590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Few data are available regarding the efficacy and safety of a single-pill combination (SPC) consisting of four medications in patients with concomitant hypertension and dyslipidemia. OBJECTIVE We aimed to determine the efficacy and tolerability of a fixed-dose SPC consisting of 5 mg amlodipine, 100 mg losartan, 20 mg rosuvastatin, and 10 mg ezetimibe (A/L/R/E) in patients with concomitant hypertension and dyslipidemia. METHODS This was a 14-week, randomized, multicenter, double-blind, placebo-controlled, phase III clinical trial. In total, 145 patients were randomized to receive A/L/R/E, A/L, or L/R/E. The primary endpoints were the average change in the low-density lipoprotein cholesterol (LDL-C) level in the A/L/R/E and A/L groups and the sitting systolic blood pressure (sitSBP) in the A/L/R/E and L/R/E groups. The numbers of patients with adverse drug reactions (ADRs) were compared as safety variables. RESULTS The average percentage change in the LDL-C level as the least squares mean (LSM) from the baseline LDL-C level at the end of the 8-week treatment was - 59.0% in the A/L/R/E group and 0.2% in the A/L group (LSM difference - 59.2, 95% confidence interval [CI] - 68.1 to - 50.4; p < 0.0001). The average change in the sitSBP as the LSM was - 15.8 mmHg in the A/L/R/E group and -4.7 mmHg in the L/R/E group (LSM difference - 11.1, 95% CI - 16.8 to - 5.4; p = 0.0002). No ADRs occurred in the A/L/R/E group. CONCLUSIONS A/L/R/E as an SPC could be an effective treatment for patients with hypertension and dyslipidemia without significant safety issues. CLINICAL TRIALS REGISTRATION NCT04074551 (registered 30 August 2019).
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Affiliation(s)
- Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Medical School, Pusan, Republic of Korea
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University Medical School, Pusan, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Seoul Boramae Hospital, Seoul National University Medical School, Seoul, Republic of Korea
| | - Soon-Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Weon Kim
- Division of Cardiovascular, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University Medical School, Seoul, Republic of Korea
| | - In Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University Hospital, Seongnam, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University Medical School, 101, Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
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Sung KC, Hong SJ, Rhee MY, Jeong MH, Kim DH, Lim SW, Park K, Lee JB, Kim SY, Cho JM, Cho GY, Heo JH, Kim SH, Lee HY, Kim W, Cho DK, Park S, Shin J, Pyun WB, Kwon K, Rha SW, Jung JA. Comparison of efficacy and safety between third-dose triple and third-dose dual antihypertensive combination therapies in patients with hypertension. J Clin Hypertens (Greenwich) 2023; 25:429-439. [PMID: 37095689 PMCID: PMC10184484 DOI: 10.1111/jch.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 04/26/2023]
Abstract
We compared the efficacy and safety of third-standard-dose triple and third-standard-dose dual antihypertensive combination therapies in patients with mild to moderate hypertension. This was a phase II multicenter, randomized, double-blind, parallel-group trial. After a 4-week placebo run-in period, 245 participants were randomized to the third-dose triple combination (ALC group; amlodipine 1.67 mg + losartan potassium 16.67 mg + chlorthalidone 4.17 mg) or third-dose dual combination (AL group; amlodipine 1.67 mg + losartan potassium 16.67 mg, LC group; losartan potassium 16.67 mg + chlorthalidone 4.17 mg, AC group; amlodipine 1.67 mg + chlorthalidone 4.17 mg) therapy groups and followed up for 8 weeks. The mean systolic blood pressure (BP) reduction was -18.3 ± 13.2, -13.0 ± 13.3, -16.3 ± 12.4, and -13.8 ± 13.2 mmHg in the ALC, AL, LC, and AC groups, respectively. The ALC group showed significant systolic BP reduction compared to the AL and AC groups at weeks 4 (P = .010 and P = .018, respectively) and 8 (P = .017 and P = .036, respectively). At week 4, the proportion of systolic BP responders was significantly higher in the ALC group (42.6%) than in the AL (22.0%), LC (23.3%), and AC (27.1%) groups (P = .013, P = .021, and P = .045, respectively). At week 8, the proportion of systolic and diastolic BP responders was significantly higher in the ALC group (59.7%) than in the AL (39.3%) and AC (42.4%) groups (P = .022 and P = .049, respectively) at week 8. Third-standard-dose triple antihypertensive combination therapy demonstrated early effective BP control compared to third-standard-dose dual combination therapies, without increasing adverse drug reactions in patients with mild-to-moderate hypertension.
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Affiliation(s)
- Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi, Republic of Korea
| | - Myung-Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lim
- Cardiology Division, Cardiac center, CHA Bundang medical center, CHA University, Seongnam, Republic of Korea
| | - Kyungil Park
- Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jin Bae Lee
- Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Jin-Man Cho
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Ho Heo
- Division of Cardiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Sang-Hyun Kim
- Boramae Hospital, Seoul University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of internal medicine, Division of Cardiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Weon Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | - Deok-Kyu Cho
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Sungha Park
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Wook-Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Kihwan Kwon
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jin-A Jung
- Hanmi Pharm.Co.,Ltd., Songpa-gu, Seoul, Republic of Korea
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Song ZY, Kim MH, Lee HC, Park SJ, Rhee MY, Choi JI, Kim SH, Chae IH, Hong YJ, Lee NH, Hwang GS, Hur SH, Son JW, Chae JK, Kim HS. Efficacy and Safety of Coadministered Ezetimibe-Rosuvastatin plus Telmisartan in South Korean Patients with Dyslipidemia and Hypertension: A Multicenter, Randomized, Double-Blind, Active-Controlled, Phase III Trial. J Clin Med 2023; 12:jcm12062377. [PMID: 36983377 PMCID: PMC10053813 DOI: 10.3390/jcm12062377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The introduction of a fixed-dose combination (FDC) is expected to improve treatment compliance. METHODS There were 181 subjects who were randomized to three groups: ezetimibe-rosuvastatin 10/20 mg + telmisartan 80 mg, ezetimibe-rosuvastatin 10/20 mg, and telmisartan 80 mg. The primary outcomes were change in mean sitting systolic blood pressure (MSSBP) and percentage change in low-density-lipoprotein cholesterol (LDL-C) compared to baseline at week 8. RESULTS The least-square mean (SE) in MSSBP changes between the ezetimibe-rosuvastatin 10/20 mg + telmisartan 80 mg group and the ezetimibe-rosuvastatin 10/20 mg group were -25.81 (2.34) mmHg and -7.66 (2.45) mmHg. There was a significant difference between the two groups (-18.15 (2.83) mmHg, 95% CI -23.75 to -12.56, p < 0.0001). Changes in least-square mean (SE) in LDL-C between the ezetimibe-rosuvastatin 10/20 mg + telmisartan 80 mg group and the telmisartan 80 mg group were -63.82 (2.87)% and -2.48 (3.12)%. A significant difference was observed between the two groups (-61.34 (3.33)%, 95% CI -67.91 to -54.78, p < 0.0001). No serious adverse events were observed. CONCLUSIONS Ezetimibe-rosuvastatin plus telmisartan treatment is effective and safe when compared to either ezetimibe-rosuvastatin or telmisartan.
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Affiliation(s)
- Zhao-Yan Song
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Republic of Korea
| | - Moo-Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Republic of Korea
| | - Han-Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Young-Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju 61469, Republic of Korea
| | - Nam-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu 42601, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Seoul 26426, Republic of Korea
| | - Jei-Keon Chae
- Department of Cardiology, Chunbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul Naional University College of Medicine, Seoul 03080, Republic of Korea
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Won KB, Shin ES, Kang J, Yang HM, Park KW, Han KR, Moon KW, Oh SK, Kim U, Rhee MY, Kim DI, Kim SY, Lee SY, Han JK, Koo BK, Kim HS. Body Mass Index and Major Adverse Events During Chronic Antiplatelet Monotherapy After Percutaneous Coronary Intervention With Drug-Eluting Stents - Results From the HOST-EXAM Trial. Circ J 2023; 87:268-276. [PMID: 36123011 DOI: 10.1253/circj.cj-22-0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study evaluated the association of body mass index (BMI) with adverse clinical outcomes during chronic maintenance antiplatelet monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods and Results: Overall, 5,112 patients were stratified (in kg/m2) into underweight (BMI ≤18.4), normal weight (18.5-22.9), overweight (23.0-24.9), obesity (25.0-29.9) and severe obesity (≥30.0) categories with randomized antiplatelet monotherapy of aspirin 100 mg or clopidogrel 75 mg once daily for 24 months. The primary endpoint was the composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome and major bleeding of Bleeding Academic Research Consortium type ≥3. Compared with normal weight, the risk of primary composite outcomes was higher in the underweight (hazard ratio [HR] 2.183 [1.199-3.974]), but lower in the obesity (HR 0.730 [0.558-0.954]) and severe obesity (HR 0.518 [0.278-0.966]) categories, which is partly driven by the difference in all-cause death. The risk of major bleeding was significantly higher in the underweight (HR 4.140 [1.704-10.059]) than in the normal weight category. A decrease in categorical BMI was independently associated with the increased risk of primary composite outcomes. CONCLUSIONS Lower BMI is associated with a higher risk of primary composite outcomes, which is primarily related to the events of all-cause death or major bleeding during chronic maintenance antiplatelet monotherapy after PCI with DES.
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Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Jeehoon Kang
- Division of Cardiology, Seoul National University Hospital
| | - Han-Mo Yang
- Division of Cardiology, Seoul National University Hospital
| | - Kyung Woo Park
- Division of Cardiology, Seoul National University Hospital
| | - Kyoo-Rok Han
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, The Catholic University of Korea
| | - Seok Kyu Oh
- Division of Cardiology, Wonkwang University Hospital
| | - Ung Kim
- Division of Cardiology, Yeungnam University Hospital
| | - Moo-Yong Rhee
- Division of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine
| | - Doo-Il Kim
- Division of Cardiology, Haeundae Paik Hospital, Inje University
| | - Song-Yi Kim
- Division of Cardiology, College of Medicine, Jeju National University
| | - Sung-Yun Lee
- Division of Cardiology, Ilsan Paik Hospital, Inje University
| | - Jung-Kyu Han
- Division of Cardiology, Seoul National University Hospital
| | - Bon-Kwon Koo
- Division of Cardiology, Seoul National University Hospital
| | - Hyo-Soo Kim
- Division of Cardiology, Seoul National University Hospital
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Rhee MY, Munakata M, Nah DY, Kim JS, Kim HY. Home blood pressure measurement for hypertension management in the real world: Do not just measure, but share with your physician. Front Cardiovasc Med 2023; 10:1103216. [PMID: 36742078 PMCID: PMC9889357 DOI: 10.3389/fcvm.2023.1103216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Studies of the effectiveness of home blood pressure (BP) measurement on the treatment of hypertension in the real world are sparse, and the results are controversial. There is an efficacy-effectiveness gap in the treatment of hypertension using home BP measurements. We aimed to investigate the effect of reporting home BP to physicians on ambulatory BP control as a factor contributing to the efficacy-effectiveness gap in treating patients with hypertension. Methods We recruited patients ≥20 years of age taking antihypertensive drugs. Office and 24-h ambulatory BP were measured. A questionnaire to the measurement of home BP was conducted. Participants were divided into an HBPM(-) group, home BP was not measured (n = 467); HBPM(+)-R(-) group, home BP was measured but not reported (n = 81); and HBPM(+)-R(+) group, home BP was measured and reported (n = 125). Results The HBPM(+)-R(+) group had significantly lower office systolic BP (SBP, p = 0.035), 24-h SBP (p = 0.009), and daytime SBP (p = 0.016) than the HBPM(-) group, and lower nighttime SBP (p = 0.005) and diastolic BP (DBP, p = 0.008) than the HBPM(+)-R(-) group. In the multivariate analysis, the differences in 24-h SBP, daytime SBP, and nighttime DBP remained significant. There was a significant difference between groups in the target achievement rate of 24-h SBP (p = 0.046), nighttime SBP (p = 0.021), and nighttime DBP (p = 0.023). The nighttime SBP and DBP target achievement rates in the HBPM(+)-R(+) group were higher than those in the HBPM(+)-R(-) group (p = 0.006 and 0.010, respectively). Among patients measuring home BP, the adjusted odds ratio for 24-h and nighttime BP target achievement in the HBPM(+)-R(+) group were 2.233 and 3.658, respectively. Conclusion Home BP measurements should be reported to the treating physician to effectively manage hypertension. Clinical trial registration https://clinicaltrials.gov, identifier NCT03868384.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea,College of Medicine, Dongguk University, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea,*Correspondence: Moo-Yong Rhee,
| | - Masanori Munakata
- Division of Hypertension and Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan
| | - Deuk-Young Nah
- College of Medicine, Dongguk University, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea,Cardiovascular Center, Dongguk University Gyeongju Hospital, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea
| | - Je Sang Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea,College of Medicine, Dongguk University, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, College of Health Science and Department of Health Care Sciences, Graduate School and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
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Lee YJ, Rhee MY, Kim JS, Do U, Kim JH, Kim BK, Kim HY. Association of the magnitude of the difference in blood pressure between office and ambulatory measurements with blood pressure variability in untreated individuals. Clin Hypertens 2022; 28:36. [PMID: 36517899 PMCID: PMC9753313 DOI: 10.1186/s40885-022-00220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/19/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We evaluated the association between cardiovascular risk factors and the magnitude of the difference in systolic blood pressure (SBP) between office and ambulatory measurements (masked effect) in untreated individuals without apparent hypertension-mediated organ damage (HMOD). METHODS The inclusion criteria were 1) age ≥ 20 years, 2) blood pressure ≥ 140/90 mmHg at the outpatient clinic, and 3) not receiving antihypertensive medications. The difference between office and ambulatory SBP was calculated by subtracting the ambulatory daytime SBP from the office SBP. The association between the masked effect and SBP variability was analyzed in individuals without HMOD (no electrocardiographic left ventricular hypertrophy, spot urine albumin-to-creatinine ratio < 30 mg/g, and estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2, n = 296). RESULTS Among the cardiovascular risk factors, ambulatory BP variability was significantly correlated with the SBP difference. The standard deviation (SD) and coefficient of variation (cv) of 24-h SBP exhibited a significant negative linear association with the SBP difference in univariate and multivariate analyses adjusted for age, sex, presence of diabetes, and 24-h ambulatory SBP. A significant association was observed in patients with ambulatory daytime hypertension. In the multivariate analysis, individuals with a negative SBP difference > -5 mmHg exhibited a higher SD and cv of 24-h SBP than those with a negative SBP difference ≤ -5 mmHg or a positive SBP difference. CONCLUSIONS The results of our study suggest that the magnitude of the negative difference in office and ambulatory SBP may be a potential risk factor, even in individuals without apparent HMOD. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov ( NCT03855605 ).
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Affiliation(s)
- Yea Je Lee
- grid.470090.a0000 0004 1792 3864Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Moo-Yong Rhee
- grid.470090.a0000 0004 1792 3864Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong -gu, Goyang-si, Goyang, 10326 Gyeonggi-do Korea ,grid.255168.d0000 0001 0671 5021College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, Gyeongsangbuk-do 38066 Republic of Korea
| | - Je Sang Kim
- grid.470090.a0000 0004 1792 3864Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong -gu, Goyang-si, Goyang, 10326 Gyeonggi-do Korea
| | - Ungjeong Do
- grid.470090.a0000 0004 1792 3864Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong -gu, Goyang-si, Goyang, 10326 Gyeonggi-do Korea
| | - Ji-Hyun Kim
- grid.470090.a0000 0004 1792 3864Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong -gu, Goyang-si, Goyang, 10326 Gyeonggi-do Korea
| | - Byong-Kyu Kim
- grid.255168.d0000 0001 0671 5021Cardiology Division, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Hae-Young Kim
- grid.222754.40000 0001 0840 2678Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Korea
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Jeon ES, Lim SW, Kim SY, Yang HM, Kim MH, Rhee MY, Han SH, Shin J, Kim KI, Jeong JO, Sung KC, Hong GR, Kim HS, Kwon K, Kang TS, Lee HY, Han SE. A randomized, double-blind, multicenter, phase III study on the efficacy and safety of a combination treatment involving fimasartan, amlodipine, rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy. Clin Hypertens 2022; 28:40. [DOI: 10.1186/s40885-022-00223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Abstract
Background
To assess the efficacy and safety of a combination therapy involving fimasartan, amlodipine, and rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond to fimasartan monotherapy.
Methods
This phase III, randomized, double-blind, multicenter study was conducted in adults aged 19–70 years. Patients who voluntarily consented were screened for eligibility to enroll in the study. Patients who failed to respond to 4 weeks of fimasartan monotherapy were randomized with a 1:1:1 ratio to the fimasartan 60 mg/amlodipine 10 mg + rosuvastatin 20 mg (FMS/ALD + RSV) as study group, fimasartan 60 mg/amlodipine 10 mg (FMS/ALD) as control 1 group, and fimasartan 60 mg + rosuvastatin 20 mg (FMS + RSV) as control 2 group. The primary efficacy endpoints were the change in the sitting systolic blood pressure and the rate of change in the low-density lipoprotein cholesterol (LDL-C) level from baseline to 8 weeks. The adverse events, adverse drug reactions, physical examination findings, laboratory test results, electrocardiograms, and vital signs were evaluated to assess safety in the study.
Results
Of 138 randomized patients, 131 were conducted efficacy analysis, and 125 completed the study. For the change in LDL-C and sitting SBP (SiSBP) as primary efficacy assessments, the change in LDL-C at week 8 was significantly reduce in the FMS/ALD + RSV group than in the control 1 group (P < 0.001). The change in SiSBP at week 8 were greater reduce in the FMS/ALD + RSV group than in the FMS + RSV group (both P < 0.001). For the safety evaluation, there were no differences among the treatment groups in the incidence of adverse drug reactions.
Conclusions
The fimasartan/amlodipine + rosuvastatin combination therapy can effectively and safely lower blood pressure and improve lipid levels in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy.
Trial registration
NCT03156842, Registered 17 May 2017
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Hwang SY, Oh H, Rhee MY, Kang S, Kim HY. Association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension in middle-aged and older adults in Korea: A 10-year follow-up study. J Periodontol 2022; 93:1283-1293. [PMID: 35446990 DOI: 10.1002/jper.21-0706] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The relationship between periodontitis and hypertension remains controversial. This study aimed to investigate the association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension. METHODS A total of 104,349 participants were selected from the National Health Insurance System-Health Screening cohort. Incident hypertension and periodontitis were diagnosed based on the patients' clinical records and health examinations. A multivariable Cox proportional hazards regression analysis was performed after adjusting for socioeconomic factors, coexisting disease, and health behaviors. RESULTS The mean age of the participants was 51.1 years (range, 40-79 years) at baseline, and 55.1% were men. A total of 52,855 incident hypertension cases were identified during the median follow-up period of 9.6 years. Among the participants, periodontitis (hazard ratio [HR]: 1.02, 95% confidence interval [95% CI]: 1.00-1.04), number of missing teeth (for ≥15 group, HR: 1.40, 95% CI: 1.29-1.52), dental scaling (HR: 0.93, 95% CI: 0.91-0.95), and tooth brushing frequency (for ≥3 group, HR: 0.85, 95% CI: 0.83-0.88) were significantly associated with incident hypertension after full adjustments for covariates. While periodontitis was significantly associated with incident hypertension (HR: 1.04, 95% CI: 1.02-1.06) in the middle-aged group (40-64 years), the effect was insignificant in the older group (≥65 years). CONCLUSION Oral inflammation could contribute to the incidence of hypertension; thus, efforts to reduce oral inflammation should be encouraged. Future intervention studies are warranted to determine whether oral health care could be beneficial in the management of hypertension. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Su-Yeon Hwang
- Research Institute for Future Medical Science, Chungnam National University Sejong Hospital, Sejong, 30099, Korea.,Department of Public Health Sciences, Graduate School, and Transdisciplinary Major in Learning Health Systems, Korea University, Seoul, Korea
| | - Hannah Oh
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang, Korea
| | - Sangwook Kang
- Department of Applied Statistics, Department of Statistics and Data Science, Yonsei University, Seoul, Korea
| | - Hae-Young Kim
- Department of Public Health Sciences, Graduate School, and Transdisciplinary Major in Learning Health Systems, Korea University, Seoul, Korea.,Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Korea
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Rhee TM, Kang J, Woo (KW) Park K, Yang HM, Won KB, Rha SW, Bae JW, Lee NH, Hur SH, Yoon J, Park TH, Kim BS, Lim SW, Cho YH, Jeon DW, Kim SH, Han KR, Moon KW, Oh SK, Kim U, Rhee MY, Kim DI, Kim SY, Lee S, Lee SU, Kim SW, Kim SY, Jeon HK, Cha KS, Jo SH, Ryu JK, Suh IW, Choi HH, Woo SI, Chae IH, Shin WY, Kim DK, Oh JH, Jeong MH, Kim YH, Han JK, Shin ES, Koo BK, Kim HS. TCT-6 Impact of Diabetes Mellitus on the Effectiveness of Aspirin Versus Clopidogrel as a Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: Results From the HOST-EXAM Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim JS, Rhee MY, Kim CH, Kim YR, Do U, Kim JH, Kim YK, Lee HJ, Park JY, Namgung J, Lee SY, Cho DK, Choi TY, Kim SY. Algorithm for diagnosing hypertension using out-of-office blood pressure measurements. J Clin Hypertens (Greenwich) 2021; 23:1965-1974. [PMID: 34699680 PMCID: PMC8630611 DOI: 10.1111/jch.14382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
The authors developed and validated a diagnostic algorithm using the optimal upper and lower cut‐off values of office and home BP at which ambulatory BP measurements need to be applied. Patients presenting with high BP (≥140/90 mm Hg) at the outpatient clinic were referred to measure office, home, and ambulatory BP. Office and home BP were divided into hypertension, intermediate (requiring diagnosis using ambulatory BP), and normotension zones. The upper and lower BP cut‐off levels of intermediate zone were determined corresponding to a level of 95% specificity and 95% sensitivity for detecting daytime ambulatory hypertension by using the receiver operator characteristic curve. A diagnostic algorithm using three methods, OBP‐ABP: office BP measurement and subsequent ambulatory BP measurements if office BP is intermediate zone; OBP‐HBP‐ABP: office BP, subsequent home BP measurement if office BP is within intermediate zone and subsequent ambulatory BP measurement if home BP is within intermediate zone; and HBP‐ABP: home BP measurement and subsequent ambulatory BP measurements if home BP is within intermediate zone, were developed and validated. In the development population (n = 256), the developed algorithm yielded better diagnostic accuracies than 75.8% (95%CI 70.1–80.9) for office BP alone and 76.2% (95%CI 70.5–81.3) for home BP alone as follows: 96.5% (95%CI: 93.4–98.4) for OBP‐ABP, 93.4% (95%CI: 89.6–96.1) for OBP‐HBP‐ABP, and 94.9% (95%CI: 91.5–97.3%) for HBP‐ABP. In the validation population (n = 399), the developed algorithm showed similarly improved diagnostic accuracy. The developed algorithm applying ambulatory BP measurement to the intermediate zone of office and home BP improves the diagnostic accuracy for hypertension.
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Affiliation(s)
- Je Sang Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Chee Hae Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Yoo Ri Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Ungjeong Do
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Ji-Hyun Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Young Kwon Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Hyun Jung Lee
- Division of Hematology and Medical Oncology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Jee Yeon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - June Namgung
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Sung Yun Lee
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Tae-Young Choi
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea
| | - Seok Yeon Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rhee MY, Kim JS, Kim CH, Kim JH, Lee JH, Kim SW, Nah DY, Gu N, Cho EJ, Sung KC, Hong KS. Prevalence and characteristics of isolated nocturnal hypertension in the general population. Korean J Intern Med 2021; 36:1126-1133. [PMID: 34503319 PMCID: PMC8435498 DOI: 10.3904/kjim.2021.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Ascertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population. METHODS Of 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment. RESULTS The prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping. CONCLUSION The present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
- Correspondence to Moo-Yong Rhee, M.D. Cardiovascular Center, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea Tel: +82-31-961-5775 Fax: +82-31-961-7786 E-mail:
| | - Je Sang Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Chee Hae Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ji-Hyun Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jung-Ha Lee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sun-Woong Kim
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Deuk-Young Nah
- Cardiovascular Center, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Namyi Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Eun-Joo Cho
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Chul Sung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Soon Hong
- Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Lee SA, Kim W, Hong TJ, Ahn Y, Kim MH, Hong SJ, Kim BS, Kim SY, Chae IH, Kim BJ, Rhee MY, Shin JH, Kang TS, Cho JM, Kim JS, Lee CW. Effects of Fixed-dose Combination of Low-intensity Rosuvastatin and Ezetimibe Versus Moderate-intensity Rosuvastatin Monotherapy on Lipid Profiles in Patients With Hypercholesterolemia: A Randomized, Double-blind, Multicenter, Phase III Study. Clin Ther 2021; 43:1573-1589. [PMID: 34429197 DOI: 10.1016/j.clinthera.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We investigated whether the combination therapy of low-intensity rosuvastatin and ezetimibe is an useful alternative to moderate-intensity rosuvastatin monotherapy in patients requiring cholesterol-lowering therapy. METHODS This was a multicenter randomized, double-blind study to investigate the safety and efficacy of a fixed-dose combination of rosuvastatin 2.5 mg and ezetimibe 10 mg (R2.5+E10) compared to those of ezetimibe 10 mg monotherapy (E10), rosuvastatin 2.5 mg (R2.5), and rosuvastatin 5 mg monotherapy (R5) in patients with hypercholesterolemia. A total of 348 patients at 15 centers in Korea were screened, and 279 patients were randomized to different groups in the study. Clinical and laboratory examinations were performed at baseline and 4 and 8 weeks after intervention. The primary endpoint was the percentage change of low-density lipoprotein (LDL) cholesterol levels at the 8-week follow-up. FINDINGS Baseline characteristics were similar among the four groups. There were significant changes in lipid profiles at the 8-week follow-up. A greater decrease in the LDL cholesterol levels (primary endpoint) were found in the R2.5+E10 group (-45.7±18.6%) than in the E10 group (-16.7±14.7%, p<0.0001), R2.5 group (-32.6±15.1%, p<0.0001), and R5 group (-38.9±13.9%, p=0.0003). Similar outcomes were observed regarding the decrease in total cholesterol, non-high-density lipoprotein (HDL) cholesterol, and apolipoprotein B protein. In addition, changes in the triglyceride and HDL levels in the R2.5+E10 group were significantly different compared with those in the E10 group; however, the changes were similar to those in the other treatment groups. In patients with low and moderate risk, all patients achieved the target LDL cholesterol levels in the R2.5+E10 group (100%) compared to 13.0% in the E10 group, 47.6% in the R2.5 group, and 65.2% in the R5 group. Adverse effects were rare and similar in the four groups. IMPLICATIONS Fixed-dose combination of low-intensity rosuvastatin and ezetimibe was more effective in lowering LDL cholesterol and achieving LDL cholesterol goals than moderate-intensity rosuvastatin monotherapy. These findings suggest that the combination therapy of low-intensity rosuvastatin and ezetimibe is an useful alternative to moderate-intensity rosuvastatin monotherapy for cholesterol management, particularly in patients with low and moderate risk. ClinicalTrials.gov identifier: NCT04652349.
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Affiliation(s)
- Seung-Ah Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Weon Kim
- Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Moo Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Dong-A University Medical Center, Busan, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Bong Sik Kim
- Department of Internal Medicine, Hyundae General Hospital, Gyeonggi-do, Republic of Korea
| | - Seok Yeon Kim
- Department of Cardiovascular Center, Seoul Medical Center, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Joon Han Shin
- Division of Cardiology, Ajou University Medical Center, Gyeonggi-do, Republic of Korea
| | - Tae Soo Kang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University School of Medicine, Chungcheongnam-do, Republic of Korea
| | - Jin Man Cho
- Cardiovascular Center, Kyunghee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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15
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Jung MH, Lee JH, Lee CJ, Shin JH, Kang SH, Kwon CH, Kim DH, Kim WH, Kim HL, Kim HM, Cho IJ, Cho I, Hwang J, Ryu S, Kang C, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Park S, Shin J, Ryu SK, Rhee MY, Kang SM, Pyun WB, Cho MC, Sung KC. Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea. J Clin Hypertens (Greenwich) 2021; 23:879-887. [PMID: 33492766 PMCID: PMC8678844 DOI: 10.1111/jch.14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/18/2023]
Abstract
The potential cancer risk associated with long‐term exposure to angiotensin receptor blockers (ARBs) is still unclear. We assessed the risk of incident cancer among hypertensive patients who were treated with ARBs compared with patients exposed to angiotensin‐converting enzyme inhibitors (ACEIs), which are known to have a neutral effect on cancer development. Using the Korean National Health Insurance Service database, we analyzed the data of patients diagnosed with essential hypertension from January 2005 to December 2012 who were aged ≥40 years, initially free of cancer, and were prescribed either ACEI or ARB (n = 293,962). Cox proportional hazard model adjusted for covariates was used to evaluate the risk of incident cancer. During a mean follow‐up of 10 years, 24,610 incident cancers were observed. ARB use was associated with a decreased risk of overall cancer compared with ACEI use (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.72‐0.80). Similar results were obtained for lung (HR 0.73, 95% CI 0.64‐0.82), hepatic (HR 0.56, 95% CI 0.48‐0.65), and gastric cancers (HR 0.74, 95% CI 0.66‐0.83). Regardless of the subgroup, greater reduction of cancer risk was seen among patients treated with ARB than that among patients treated with ACEIs. Particularly, the decreased risk of cancer among ARB users was more prominent among males and heavy drinkers (interaction P < .005). Dose‐response analyses demonstrated a gradual decrease in risk with prolonged ARB therapy than that with ACEI use. In conclusion, ARB use was associated with a decreased risk of overall cancer and several site‐specific cancers.
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Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Si Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo-Hyeun Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hack Lyoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Heart Research Institute, ChungAng University Hospital, Seoul, Republic of Korea
| | - In Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea
| | - Soorack Ryu
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea
| | - Chaeyeong Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang Il Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji University Medical Center, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, 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
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Hong SJ, Sung KC, Lim SW, Kim SY, Kim W, Shin J, Park S, Kim HY, Rhee MY. Low-Dose Triple Antihypertensive Combination Therapy in Patients with Hypertension: A Randomized, Double-Blind, Phase II Study. Drug Des Devel Ther 2021; 14:5735-5746. [PMID: 33408462 PMCID: PMC7781016 DOI: 10.2147/dddt.s286586] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
Purpose We evaluated the dose-responsiveness, efficacy, and safety of low-dose triple antihypertensive combination therapies in patients with mild-to-moderate hypertension. Patients and Methods After a 1 to 2-week placebo run-in period, 248 patients were randomized to the half-dose triple combination (amlodipine 2.5 mg + losartan 25 mg + chlorthalidone 6.25 mg), third-dose triple combination (amlodipine 1.67 mg + losartan 16.67 mg + chlorthalidone 4.17 mg), quarter-dose triple combination (amlodipine 1.25 mg + losartan 12.5 mg + chlorthalidone 3.13mg), amlodipine 10mg, amlodipine 5mg, losartan 100mg, and placebo groups for 8 weeks. The primary outcome was the mean change in systolic blood pressure (SBP) from baseline to week 8. Results The placebo-corrected SBP reductions of the half-dose, third-dose, quarter-dose combination, amlodipine 10 mg, amlodipine 5 mg and losartan 100 mg treatments were −17.2, −19.5, −14.9, −18.5, −11.3 and −9.9 mmHg, respectively. The BP control and response rates were significantly higher in the half-dose, third-dose, and quarter-dose combination groups than in the placebo group (all p < 0.01). Despite no intergroup differences in study drug-related adverse events, ankle circumference increased significantly in the amlodipine group compared to those in the combination treatment groups. The quarter-dose combination, amlodipine 5 mg, and losartan 100 mg groups showed similar SBP reduction and BP response rates. The SBP reduction and BP response rate in the third-dose and half-dose combination groups were not significantly different from those in the amlodipine 10 mg group but superior to those in the losartan 100 mg group. Conclusion Low-dose triple combination therapies could be effective as antihypertensive therapies. Trial Registration ClinicalTrials.gov identifier NCT03897868.
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Affiliation(s)
- Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Department of Cardiology, Gangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lim
- Cardiology Division, Cardiac Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Weon Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, College of Health Science & Department of Health Care Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi, Republic of Korea.,College of Medicine, Dongguk University, Gyeongju-si, Gyeongbuk, Republic of Korea
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17
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Lee CJ, Ha JH, Kim JY, Kim IC, Ryu SK, Rhee MY, Lee JH, Lee JH, Lee HY, Ihm SH, Chung JW, Choi JH, Shin J, Park S, Kario K. Office blood pressure threshold of 130/80 mmHg better predicts uncontrolled out-of-office blood pressure in apparent treatment-resistant hypertension. J Clin Hypertens (Greenwich) 2020; 23:595-605. [PMID: 33280228 PMCID: PMC8029554 DOI: 10.1111/jch.14113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
The objective of this study was to compare the diagnostic accuracy of office blood pressure (BP) threshold of 140/90 and 130/80 mmHg for correctly identifying uncontrolled out‐of‐office BP in apparent treatment‐resistant hypertension (aTRH). We analyzed 468 subjects from a prospectively enrolled cohort of patients with resistant hypertension in South Korea (clinicaltrials.gov: NCT03540992). Resistant hypertension was defined as office BP ≥ 130/80 mmHg with three different classes of antihypertensive medications including thiazide‐type/like diuretics, or treated hypertension with four or more different classes of antihypertensive medications. We conducted different types of BP measurements including office BP, automated office BP (AOBP), home BP, and ambulatory BP. We defined uncontrolled out‐of‐office BP as daytime BP ≥ 135/85 mmHg and/or home BP ≥ 135/85 mmHg. Among subjects with office BP < 140/90 mmHg and subjects with office BP < 130/80 mmHg, 66% and 55% had uncontrolled out‐of‐office BP, respectively. The prevalence of controlled and masked uncontrolled hypertension was lower, and the prevalence of white‐coat and sustained uncontrolled hypertension was higher, with a threshold of 130/80 mmHg than of 140/90 mmHg, for both office BP and AOBP. The office BP threshold of 130/80 mmHg was better able to diagnose uncontrolled out‐of‐office BP than 140/90 mmHg, and the net reclassification improvement (NRI) was 0.255. The AOBP threshold of 130/80 mmHg also revealed better diagnostic accuracy than 140/90 mmHg, with NRI of 0.543. The office BP threshold of 130/80 mmHg showed better than 140/90 mmHg in terms of the correspondence to out‐of‐office BP in subjects with aTRH.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ha Ha
- Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jang Young Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, College of Medicine, Dongguk University Ilsan Hospital, Dongguk University, Goyang, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jung-Hee Lee
- Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong Wha Chung
- Department of Internal Medicine, Chosun University School of Medicine, Kwangju, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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18
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Rhee MY, Kim CH, Ahn Y, Shin JH, Han SH, Kang HJ, Hong SJ, Kim HY. Efficacy and Safety of Nebivolol and Rosuvastatin Combination Treatment in Patients with Concomitant Hypertension and Hyperlipidemia. Drug Des Devel Ther 2020; 14:5005-5017. [PMID: 33235439 PMCID: PMC7680129 DOI: 10.2147/dddt.s280055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We evaluated the efficacy and safety of nebivolol and rosuvastatin combination treatment in patients with hypertension and hyperlipidemia. PATIENTS AND METHODS Eligible patients, after more than 4 weeks of therapeutic lifestyle change, were randomly assigned to three groups: 5 mg nebivolol plus 20 mg rosuvastatin (NEBI/RSV), 20 mg rosuvastatin (RSV), or 5 mg nebivolol (NEBI). Treatments lasted 8 weeks. RESULTS Efficacy was analyzed using data from 276 patients. Sitting systolic and diastolic blood pressures differed between the NEBI/RSV and RSV groups (LSmean difference = -5.89 and -5.99 mmHg; 95% confidence interval [CI] = -9.88 to -1.90 mmHg and -8.13 to -3.84 mmHg, respectively). Reductions in the two pressures did not differ between the NEB/RSV and NEB groups. The percent reduction in low-density lipoprotein (LDL) cholesterol differed between the NEBI/RSV and NEBI groups (LSmean difference = -47.76%, 95% CI = -52.69 to -42.84%) but not between the NEBI/RSV and RSV groups. The blood pressure (BP) control rate was higher in the NEBI/RSV group than in the RVS group (51.09% vs 29.67%, p = 0.003). The LDL cholesterol goal achievement rate was higher in the NEBI/RSV group than in the NEBI group (85.87% vs 11.83%, p < 0.001). The incidence of adverse drug reactions in the NEBI/RSV, RSV, and NEBI groups was 8.51%, 7.45%, and 8.60%, respectively (p = 0.950). CONCLUSION Nebivolol plus rosuvastatin treatment is effective in reducing BP and LDL cholesterol levels and is safe in patients with hypertension and hypercholesterolemia without the loss of BP or the LDL cholesterol-lowering effect of each drug. TRIAL REGISTRATION CRIS registration number KCT0002148.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Cheol Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University Medical Center, Suwon, Republic of Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, College of Health Science & Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
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Lee YS, Rhee MY, Lee SY. Effect of nutrition education in reducing sodium intake and increasing potassium intake in hypertensive adults. Nutr Res Pract 2020; 14:540-552. [PMID: 33029293 PMCID: PMC7520557 DOI: 10.4162/nrp.2020.14.5.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/11/2020] [Accepted: 04/02/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/OBJECTIVES Hypertension is the major risk factor for cardiovascular disease, a leading cause of deaths in Korea. The objective of this study was to evaluate the effect of a nutrition education in reducing sodium intake and increasing potassium intake in hypertensive adults. SUBJECTS/METHODS Subjects who participated in this study were 88 adults (28 males and 60 females) who were pre-hypertension or untreated hypertensive patients aged ≥ 30 yrs in Gyeonggi Province, Korea. These subjects were divided into 2 groups: a low-sodium education (LS) group and a low-sodium high-potassium education (LSHP) group. Nutrition education of 3 sessions for 12 weeks was conducted. Blood pressure, blood and urine components, nutrient intake, and dietary behavior were compared between the two education groups. RESULT Blood pressure was decreased in both groups after the nutrition education (P < 0.05). In the LSHP group, levels of blood glucose (P < 0.05), total cholesterol (P < 0.01), and low-density lipoprotein-cholesterol (P < 0.05) were decreased after the program completion. Sodium intake was decreased in both groups after the nutrition education (P < 0.05). However, Na/K ratio was only decreased in the LS group (P < 0.05). Intake frequency of fish & shellfish was only significantly reduced in the LS group (P < 0.05), while intake frequencies of cooked rice, noodles & dumplings, breads & snacks, stew, kimchi, and fish & shellfish were reduced in the LSHP group (P < 0.05). Total score of dietary behavior appeared to be effectively decreased in both groups after the education program (P < 0.001). CONCLUSIONS This education for reducing sodium intake was effective in reducing blood pressure and sodium intake. The education for enhancing potassium intake resulted in positive changes in blood glucose and serum cholesterol levels.
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Affiliation(s)
- You-Sin Lee
- Department of Home Economics Education, Dongguk University, Seoul 04620, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Sim-Yeol Lee
- Department of Home Economics Education, Dongguk University, Seoul 04620, Korea
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20
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Jin X, Kim MH, Han KH, Hong SJ, Ahn JC, Sung JH, Cho JM, Lee HC, Choi SY, Lee K, Kim WS, Rhee MY, Kim JH, Hong SP, Yoo BS, Cho EJ, Lee JH, Kim PJ, Park CG, Hyon MS, Shin JH, Lee SH, Sung KC, Hwang J, Kwon K, Chae IH, Seo JS, Kim H, Lee H, Cho Y, Kim HS. Efficacy and safety of co-administered telmisartan/amlodipine and rosuvastatin in subjects with hypertension and dyslipidemia. J Clin Hypertens (Greenwich) 2020; 22:1835-1845. [PMID: 32937023 PMCID: PMC7692919 DOI: 10.1111/jch.13893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022]
Abstract
Single risk factors, such as hypertension and dyslipidemia, can combine to exacerbate the development and severity of cardiovascular disease. Treatment goals may be more effectively achieved if multiple disease factors are targeted with combination treatment. We enrolled 202 patients who were randomly divided into the following three groups: telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg, telmisartan 80 mg + rosuvastatin 20 mg, and telmisartan/amlodipine 80/5 mg. The primary efficacy variables were changes from baseline in mean sitting systolic blood pressure (MSSBP) between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg at 8 weeks, and the percent changes from baseline in low‐density lipoprotein (LDL) cholesterol between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg at 8 weeks. The secondary efficacy variables were changes in MSSBP, mean sitting diastolic blood pressure (MSDBP), LDL cholesterol and other lipid levels at 4 weeks and 8 weeks, as well as observed adverse events during follow‐up. There were no significant differences between the three groups in demographic characteristics and no significant difference among the three groups in terms of baseline characteristics for the validity evaluation variables. The mean overall treatment compliance in the three groups was, respectively, 98.42%, 96.68%, and 98.12%, indicating strong compliance for all patients. The Least‐Square (LS) mean (SE) for changes in MSSBP in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg) groups were −19.3 (2.68) mm Hg and −6.69 (2.76) mm Hg. The difference between the two groups was significant (−12.60 (2.77) mm Hg, 95% CI −18.06 to −7.14, P < .0001). The LS Mean for the percent changes from baseline in LDL cholesterol in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg) groups were −52.45 (3.23) % and 2.68 (3.15) %. The difference between the two groups was significant (−55.13 (3.20) %, 95% CI −61.45 to −48.81, P < .0001). There were no adverse events leading to discontinuation or death. Combined administration of telmisartan/amlodipine 80/5 mg and rosuvastatin 20 mg for the treatment of hypertensive patients with dyslipidemia significantly reduces blood pressure and improves lipid control. ClinicalTrials.gov identifier: NCT03067688.
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Affiliation(s)
- Xuan Jin
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Ki Hoon Han
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Soon Jun Hong
- Division of Cardiology, Department of Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Jeong-Cheon Ahn
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jin-Man Cho
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyounghoon Lee
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo-Shik Kim
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Pyo Hong
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pum-Joon Kim
- Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chang-Gyu Park
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Min Su Hyon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jin Ho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Jinyong Hwang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Kihwan Kwon
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Sook Seo
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hana Lee
- Yuhan Research Institute, Yuhan Corporation, Yongin, Korea
| | - Yoonhwa Cho
- Yuhan Research Institute, Yuhan Corporation, Yongin, Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Oh E, Kim Y, Park SY, Lim Y, Shin JY, Kim JY, Kim JH, Rhee MY, Kwon O. The fruit of Acanthopanax senticosus Harms improves arterial stiffness and blood pressure: a randomized, placebo-controlled trial. Nutr Res Pract 2020; 14:322-333. [PMID: 32765813 PMCID: PMC7390742 DOI: 10.4162/nrp.2020.14.4.322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/13/2020] [Accepted: 03/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/OBJECTIVES Arterial stiffness and endothelial dysfunction are 2 of the independent predictors for cardiovascular disease, while Acanthopanax senticosus Harms (ASH) is a traditional medicinal plant that can improve cardiovascular health. This study aimed to investigate the efficacy of the fruit of ASH on vascular function in apparently healthy subjects. SUBJECTS/METHODS A 12-week, randomized, double-blind, placebo-controlled design, consisting of healthy adults with at least 2 of the following 3 conditions: borderline high blood pressure (BP; 120 mmHg ≤ systolic BP ≤ 160 mmHg or 80 mmHg ≤ diastolic BP ≤ 100 mmHg), smoking (≥10 cigarettes/day), and borderline blood lipid levels (220 ≤ total cholesterol ≤ 240, 130 ≤ low density lipoprotein cholesterol ≤ 165, or 150 ≤ triglyceride ≤ 220 mg/dL). Randomly assigned 76 subjects who received a placebo or 2 doses of ASH fruit (low, 500 mg/day; high, 1,000 mg/day) completed the intervention. Brachial-ankle pulse wave velocity (baPWV), flow-mediated dilation, carotid intima-media thickness, and BP were measured both at baseline and following the 12-week intervention. Endothelial nitric oxide synthase (eNOS) phosphorylation was assessed by western blotting. RESULTS Compared with the placebo group, the low-dose group showed more significant changes after the 12-week intervention period in terms of systolic BP (0.1 vs. −7.7 mmHg; P = 0.044), baPWV (31.3 vs. −98.7 cm/s; P = 0.007), and the ratio of phospho-eNOS/eNOS (0.8 vs. 1.22; P = 0.037). CONCLUSIONS These results suggest that ASH fruit extract at 500 mg/day has the potential to improve BP and arterial stiffness via endothelial eNOS activation in healthy adults with smoking and the tendency of having elevated BP or blood lipid parameters. Trial Registration Clinical Research Information Service Identifier: KCT0001072
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Affiliation(s)
- Eunkyoung Oh
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Youjin Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Soo-Yeon Park
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Yeni Lim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Ji-Yoon Shin
- Ewha Graduate School of Converging Clinical & Public Health, Seoul 03760, Korea
| | - Ji Yeon Kim
- Department of Food Science and Technology, Seoul National University of Science and Technology, Seoul 01811, Korea
| | - Ji-Hyun Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Oran Kwon
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
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Kim BK, Rhee MY. Impact of 2018 ESC/ESH and 2017 ACC/AHA Hypertension Guidelines: Difference in Prevalence of White-Coat and Masked Hypertension. Healthcare (Basel) 2020; 8:healthcare8020122. [PMID: 32375221 PMCID: PMC7348809 DOI: 10.3390/healthcare8020122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 12/02/2022] Open
Abstract
Our study evaluated whether there were differences in the prevalence of white-coat hypertension (WH) and masked hypertension (MH) based on the 2018 ESC/ESH and 2017 ACC/AHA hypertension guidelines in Korea. The motivation was the lowering of the diagnostic threshold for hypertension in the 2017 ACC/AHA guidelines. Of 319 participants without antihypertensive drug history and with suspected hypertension based on outpatient clinic blood pressure (BP) measured by physicians, 263 participants (51.6 ± 9.6 years; 125 men) who had valid research-grade office BP and 24-h ambulatory BP measurements were enrolled. WH prevalence based on daytime ambulatory BP among normotensive individuals was lower with the ESC/ESH guidelines than the ACC/AHA guidelines (29.0% vs. 71.4%, p < 0.001). However, MH prevalence based on daytime ambulatory BP among hypertensive individuals was higher based on the ESC/ESH guidelines (21.6% vs. 1.8%, p < 0.001). Seventy percent of WH cases (2017 ACC/AHA guidelines) and 95.2% of MH cases (2018 ESC/ESH guidelines) occurred in individuals with systolic BP of 130–139 mmHg and/or diastolic BP of 80–89 mmHg. The diagnostic threshold of the 2017 ACC/AHA guidelines yielded a higher prevalence of WH compared to that of the 2018 ESC/ESH guidelines. However, the prevalence of MH was higher with the 2018 ESC/ESH guidelines than with the 2017 ACC/AHA guidelines. The high prevalence of WH and MH in people with a systolic BP of 130–139 mmHg or diastolic BP of 80–89 mmHg suggests the need for a more active out-of-office BP measurement in this patient group.
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Affiliation(s)
- Byong-Kyu Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju Hospital, Gyeongju 38067, Korea;
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi 10326, Korea
- Correspondence: ; Tel.: +82-31-961-5775; Fax: +82-31-961-7786
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, Korea
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Rhee MY, Kim JH, Namgung J, Lee SY, Cho DK, Choi TY, Kim SY. P800Proposal of an algorithm for the diagnosis of hypertension by using out-of-office blood pressure measurements. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Based on the data of patients who measured office BP (OBP) in controlled condition, home BP (HBP), and 24-hour ambulatory BP (24hABP) for diagnosis of hypertension, we developed and validated a diagnostic algorithm for hypertension.
Methods
Patients who have high BP (≥140/90 mmHg) at the outpatient clinic were referred to measure OBP in controlled condition, HBP and 24hABP. The OBP was measured three times at each visit for 3 days in controlled condition by using a validated oscillometric device. HBP was measured for 7 days in triplicates every morning and evening. The 24hABP was measured on the 8th day. Same study protocol was used for development and validation population.
Results
In the development of algorithm, 319 patients were recruited and data of 256 patients (51.8±9.7 years, 119 men) with valid HBP and 24hABP measurements were analyzed. In the validation of algorithm, 300 patients were recruited and data of 257 patients (52.4±9.8 years, 126 men) with valid HBP and 24hABP measurements were analyzed. In the development population, the prevalence of masked hypertension was 19.5% (n=50) and most of them (n=47, 94%) was in the range of 130–139/80–89 mmHg. The BP in the range of 130–144/80–94 mmHg was defined as the grey zone of OBP, because prevalence of white-coat hypertension was lowered to 1.6% from 4.3% with threshold of 145/95 mmHg. The diagnostic sensitivity, specificity, positive and negative predictive value of OBP was improved to 97.4%, 76.5, 96.5% and 81.3% after excluding the grey zone of OBP (n=125). The diagnostic agreement between 24hABP and HBP in the grey zone of OBP was 64%. The diagnostic sensitivity, specificity, positive and negative predictive value of HBP were 88.8%, 74.7, 93.5% and 61.5% after excluding the grey zone of HBP (130–134/80–84 mmHg, n=28). Based upon these results, we developed a diagnostic algorithm for hypertension by using on out-of-office BP measurements to improved diagnostic accuracy of hypertension (Figure). In the validation population, the developed algorithm showed similar diagnostic accuracy.
Diagnostic algorithm for hypertension
Conclusion
For accurate diagnosis of hypertension, OBP measurement according to guidelines and 24hABP measurement to grey zone of OBP is preferred. To improve diagnostic accuracy of HBP measurement, 24hABP measurement to grey zone of HBP is required.
Acknowledgement/Funding
Part of this study was supported by a grand from Dong-A ST Co. Ltd., Seoul, Korea.
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Affiliation(s)
- M Y Rhee
- Dongguk University Ilsan Hospital, Goyang-si, Korea (Republic of)
| | - J H Kim
- Dongguk University Ilsan Hospital, Goyang-si, Korea (Republic of)
| | - J Namgung
- Inje University Ilsan Paik Hospital, Goyang, Korea (Republic of)
| | - S Y Lee
- Inje University Ilsan Paik Hospital, Goyang, Korea (Republic of)
| | - D K Cho
- Hospital Myongji, Goyang, Korea (Republic of)
| | - T Y Choi
- Seoul Red Cross Hospital, Seoul, Korea (Republic of)
| | - S Y Kim
- Seoul Medical Center, Seoul, Korea (Republic of)
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Kang MG, Kim KI, Ihm SH, Rhee MY, Sohn IS, Lee HY, 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. Fimasartan versus perindopril with and without diuretics in the treatment of elderly patients with essential hypertension (Fimasartan in the Senior Subjects (FITNESS)): study protocol for a randomized controlled trial. Trials 2019; 20:389. [PMID: 31262348 PMCID: PMC6604456 DOI: 10.1186/s13063-019-3466-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/24/2019] [Indexed: 01/24/2023] Open
Abstract
Background Hypertension is an important risk factor for cardiovascular disease, even in the elderly. Fimasartan is a new non-peptide angiotensin II receptor blocker with a selective type I receptor blocking effect. The objective of this study is to confirm the safety and the non-inferiority of the blood pressure–lowering effect of fimasartan compared with those of perindopril, which has been proven safe and effective in elderly patients with hypertension. Methods This is a randomized, double-blind, active-controlled, two-parallel group, optional-titration, multicenter, phase 3 study comparing the efficacy and safety of fimasartan and perindopril arginine. The study population consists of individuals 70 years old or older with essential hypertension. The primary outcome will be a change in sitting systolic blood pressure from baseline after the administration of the investigational product for 8 weeks. The secondary outcomes will be a change in sitting diastolic blood pressure from baseline and changes in sitting systolic blood pressure and diastolic blood pressure from baseline after the administration of the investigational product for 4, 16, and 24 weeks. The sample size will be 119 subjects for each group to confer enough power to test for the primary outcome. Discussion Research to confirm the efficacy and safety of a new medicine compared with those of previously proven anti-hypertensive drugs is beneficial to guide physicians in the selection of therapeutic agents. If it is confirmed that the new drug is not inferior to the existing drug, the drug will be considered as an option in the treatment of hypertension in elderly patients. Trial registration ClinicalTrials.gov Identifier: NCT03246555, registered on July 25, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3466-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min-Gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwang-ju, 61748, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gumi-ro 166, Bundang-gu, Seongnam-si, Kyeongi-do, 463-707, Republic of Korea
| | - Sang Hyun Ihm
- Department of Internal Medicine, The Catholic University of Korea Bucheon ST. Mary's Hospital, 327, Sosa-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University Health System, Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan, University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, Republic of Korea
| | - Jong-Min Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, 260, Gonghangdae-ro, Gangseo-gu, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Dong-A University Hospital, 26, Daesingongwon-ro, Seo-gu, Busan, Republic of Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Seoul National University Borame Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, Republic of Korea
| | - Seok-Yeon Kim
- Department of Internal Medicine, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, Republic of Korea
| | - Shin-Jae Kim
- Department of Internal Medicine, Ulsan University Hospital, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, Republic of Korea
| | - Eung Ju Kim
- Department of Internal Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University Hospital, Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.,Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon, 34134, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, 130, Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Ki Dong Yoo
- Department of Internal Medicine, The Catholic University of Korea, ST. Vincent's Hospital, 93-1, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Young Jin Choi
- Department of Internal Medicine, Sejong Hospital, 28, Hohyeon-ro 489beon-gil, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Yong Hwan Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gumi-ro 166, Bundang-gu, Seongnam-si, Kyeongi-do, 463-707, Republic of Korea.
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26
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Hong SJ, Jeong HS, Ahn JC, Cha DH, Won KH, Kim W, Cho SK, Kim SY, Yoo BS, Sung KC, Rha SW, Shin JH, Han KR, Chung WS, Hyon MS, Lee HC, Bae JH, Rhee MY, Kwan J, Jeon DW, Yoo KD, Kim HS. A Phase III, Multicenter, Randomized, Double-blind, Active Comparator Clinical Trial to Compare the Efficacy and Safety of Combination Therapy With Ezetimibe and Rosuvastatin Versus Rosuvastatin Monotherapy in Patients With Hypercholesterolemia: I-ROSETTE (Ildong Rosuvastatin & Ezetimibe for Hypercholesterolemia) Randomized Controlled Trial. Clin Ther 2019; 40:226-241.e4. [PMID: 29402522 DOI: 10.1016/j.clinthera.2017.12.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/16/2017] [Accepted: 12/22/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Combination therapy with ezetimibe and statins is recommended in cases of statin intolerance or insufficiency. The objective of this study was to compare the efficacy and safety of combination therapy with ezetimibe and rosuvastatin versus those of rosuvastatin monotherapy in patients with hypercholesterolemia. METHODS I-ROSETTE (Ildong ROSuvastatin & ezETimibe for hypercholesTElolemia) was an 8-week, double-blind, multicenter, Phase III randomized controlled trial conducted at 20 hospitals in the Republic of Korea. Patients with hypercholesterolemia who required medical treatment according to National Cholesterol Education Program Adult Treatment Panel III guidelines were eligible for participation in the study. Patients were randomly assigned to receive ezetimibe 10 mg/rosuvastatin 20 mg, ezetimibe 10 mg/rosuvastatin 10 mg, ezetimibe 10 mg/rosuvastatin 5 mg, rosuvastatin 20 mg, rosuvastatin 10 mg, or rosuvastatin 5 mg in a 1:1:1:1:1:1 ratio. The primary end point was the difference in the mean percent change from baseline in LDL-C level after 8 weeks of treatment between the ezetimibe/rosuvastatin and rosuvastatin treatment groups. All patients were assessed for adverse events (AEs), clinical laboratory data, and vital signs. FINDINGS Of 396 patients, 389 with efficacy data were analyzed. Baseline characteristics among 6 groups were similar. After 8 weeks of double-blind treatment, the percent changes in adjusted mean LDL-C levels at week 8 compared with baseline values were -57.0% (2.1%) and -44.4% (2.1%) in the total ezetimibe/rosuvastatin and total rosuvastatin groups, respectively (P < 0.001). The LDL-C-lowering efficacy of each of the ezetimibe/rosuvastatin combinations was superior to that of each of the respective doses of rosuvastatin. The mean percent change in LDL-C level in all ezetimibe/rosuvastatin combination groups was >50%. The number of patients who achieved target LDL-C levels at week 8 was significantly greater in the ezetimibe/rosuvastatin group (180 [92.3%] of 195 patients) than in the rosuvastatin monotherapy group (155 [79.9%] of 194 patients) (P < 0.001). There were no significant differences in the incidence of overall AEs, adverse drug reactions, and serious AEs; laboratory findings, including liver function test results and creatinine kinase levels, were comparable between groups. IMPLICATIONS Fixed-dose combinations of ezetimibe/rosuvastatin significantly improved lipid profiles in patients with hypercholesterolemia compared with rosuvastatin monotherapy. All groups treated with rosuvastatin and ezetimibe reported a decrease in mean LDL-C level >50%. The safety and tolerability of ezetimibe/rosuvastatin therapy were comparable with those of rosuvastatin monotherapy. ClinicalTrials.gov identifier: NCT02749994.
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Affiliation(s)
- Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Han Saem Jeong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeong Cheon Ahn
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Dong-Hun Cha
- Division of Cardiology, Department of Internal Medicine, Bundang CHA Hospital, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Kyung Heon Won
- Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, Republic of Korea
| | - Weon Kim
- Cardiovascular Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sang Kyoon Cho
- Division of Cardiology, Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Republic of Korea
| | - Seok-Yeon Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, Republic of Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University Medical Center, Suwon, Republic of Korea
| | - Kyoo Rok Han
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Wook Sung Chung
- Division of Cardiology, Department of Internal Medicine, The Catholic University, Seoul, Republic of Korea
| | - Min Su Hyon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jang-Ho Bae
- Division of Cardiology Heart Center, Konyang University Hospital, Daejeon
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jun Kwan
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Dong Woon Jeon
- Division of Cardiology, Department of Internal Medicine, NHIS Ilsan Hospital, Goyang, Republic of Korea
| | - Ki Dong Yoo
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea St. Vincent's Hospital, Suwon, Republic of Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kyung Kim M, Kwon M, Rhee MY, Kim KI, Nah DY, Kim SW, Gu N, Sung KC, Hong KS, Cho EJ, Jo SH. Dose–response association of 24-hour urine sodium and sodium to potassium ratio with nighttime blood pressure at older ages. Eur J Prev Cardiol 2019; 26:952-960. [DOI: 10.1177/2047487318819528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims We investigated the dose–response association of 24-hour urine sodium and potassium with 24-hour ambulatory blood pressure. Design Cross-sectional community-based study. Methods Among the 1128 participants in the community-based cross-sectional survey, 740 participants (aged 20–70 years) with complete 24-hour urine collection and valid 24-hour ambulatory blood pressure monitoring were included in the study. Participants were grouped into younger (<55 years, n = 523) and older (≥55 years, n = 217). Results In the older population, nighttime blood pressure linearly increased with 24-hour urine sodium and the sodium to potassium ratio. For 24-hour urine sodium, adjusted β was 0.171 (95% confidence interval (CI) 0.036–0.305) for nighttime systolic blood pressure and 0.144 (95% CI 0.012–0.276) for nighttime diastolic blood pressure. For the 24-hour urine sodium to potassium ratio, adjusted β was 0.142 (95% CI 0.013–0.270) for nighttime systolic blood pressure and 0.144 (95% CI 0.018–0.270) for nighttime diastolic blood pressure. The 24-hour blood pressure linearly increased with the 24-hour urine sodium to potassium ratio and adjusted β was 0.133 (95% CI 0.003–0.262) for 24-hour systolic blood pressure and 0.123 (95% CI 0.003–0.244) for 24-hour diastolic blood pressure. Daytime blood pressure and 24-hour systolic blood pressure showed a significant but non-linear association with 24-hour urine sodium among the older population. In the younger population, 24-hour urine sodium, potassium and the sodium to potassium ratio were not associated with ambulatory blood pressure. Conclusion In the older population, 24-hour urine sodium and the sodium to potassium ratio showed a linear and positive association with nighttime blood pressure, and 24-hour urine sodium was associated with 24-hour systolic blood pressure and daytime blood pressure in a non-linear fashion.
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Affiliation(s)
- Mi Kyung Kim
- Cancer Epidemiology Branch, National Cancer Center, South Korea
| | - Minji Kwon
- Cancer Epidemiology Branch, National Cancer Center, South Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Deuk-Young Nah
- Division of Cardiology, Dongguk University Gyeongju Hospital, Republic of Korea
| | - Sun-Woong Kim
- Department of Statistics, Dongguk University, Republic of Korea
| | - Namyi Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Republic of Korea
| | - Ki-Chul Sung
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | | | - Eun-Joo Cho
- Division of Cardiology, St Paul’s Hospital, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Sacred Heart Hospital, South Korea
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Gu N, Kim KJ, Lim CY, Lee JK, Rhee MY, Shin KH, Lee SH, Ahn S. Survey on the undergraduate curriculum in clinical pharmacology and interns' prescribing ability in South Korea. Transl Clin Pharmacol 2018; 26:128-133. [PMID: 32055562 PMCID: PMC6989231 DOI: 10.12793/tcp.2018.26.3.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022] Open
Abstract
Appropriate prescription writing is one of the critical medical processes affecting the quality of public health care. However, this is a complex task for newly qualified intern doctors because of its complex characteristics requiring sufficient knowledge of medications and principles of clinical pharmacology, skills of diagnosis and communication, and critical judgment. This study aims to gather data on the current status of undergraduate prescribing education in South Korea. Two surveys were administered in this study: survey A to 26 medical schools in South Korea to gather information on the status of undergraduate education in clinical pharmacology; and survey B to 244 intern doctors in large hospitals to gather their opinions regarding prescribing education and ability. In survey A, half of the responding institutions provided prescribing education via various formats of classes over two curriculums including lecture, applied practice, group discussions, computer-utilized training, and workshops. In survey B, we found that intern doctors have the least confidence when prescribing drugs for special patient populations, especially pregnant women. These intern doctors believed that a case-based practical training or group discussion class would be an effective approach to supplement their prescribing education concurrently or after the clerkship in medical schools or right before starting intern training with a core drug list. The results of the present study may help instructors in charge of prescribing education when communicating and cooperating with each other to improve undergraduate prescribing education and the quality of national medical care.
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Affiliation(s)
- Namyi Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University College of Medicine and Ilsan Hospital, Goyang 10326, Korea
| | - Kyong-Jee Kim
- Department of Medical Education, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Chi-Yeon Lim
- Department of Biostatistics, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University College of Medicine and Ilsan Hospital, Goyang 10326, Korea
| | - Moo-Yong Rhee
- Department of Internal Medicine, Dongguk University College of Medicine and Ilsan Hospital, Goyang 10326, Korea
| | - Kwang-Hee Shin
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Korea
| | - Seung-Hwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Sangzin Ahn
- Department of Pharmacology, Inje University College of Medicine, Busan 47392, Korea
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Ahn Y, Kim Y, Chang K, Kim W, Rhee MY, Cha KS, Hyon MS, Shim CY, Lee SY, Kim DI, Kim SW, Lim SW, Han KR, Jo SH, Lee NH, Kwan J, Ahn T. A multicenter, randomized, and double-blind phase IV clinical trial to compare the efficacy and safety of fixed-dose combinations of amlodipine orotate/valsartan 5/160 mg versus valsartan/hydrochlorothiazide 160/12.5 mg in patients with essential hypertension uncontrolled by valsartan 160 mg monotherapy. Medicine (Baltimore) 2018; 97:e12329. [PMID: 30212981 PMCID: PMC6156014 DOI: 10.1097/md.0000000000012329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine whether the effectiveness and safety of fixed-dose combinations (FDCs) of amlodipine orotate/valsartan (AML/VAL) 5/160 mg are noninferior to those of valsartan/hydrochlorothiazide (VAL/HCTZ) 160/12.5 mg in hypertensive patients with inadequate response to valsartan 160 mg monotherapy. METHODS This 8-week, active-controlled, parallel-group, fixed-dose, multicenter, double-blind randomized controlled, and noninferiority trial was conducted at 17 cardiovascular centers in the Republic of Korea. Eligible patients had mean sitting diastolic blood pressure (msDBP) ≥90 mm Hg despite monotherapy with valsartan 160 mg for 4 weeks. Patients were randomly assigned to treatment with AML/VAL 5/160 mg FDC (AML/VAL) group or VAL/HCTZ 160/12.5 mg FDC (VAL/HCTZ) group once daily for 8 weeks. A total of 238 patients were enrolled (AML/VAL group, n = 121; VAL/HCTZ group, n = 117), of whom 228 completed the study. RESULTS At 8 weeks after randomization, msDBP was significantly decreased in both groups (-9.44 ± 0.69 mm Hg in the AML/VAL group and -7.47 ± 0.71 mm Hg in the VAL/HCTZ group, both P < .001 vs baseline). Between group difference was -1.96 ± 1.00 mm Hg, indicating that AML/VAL 5/160 mg FDC was not inferior to VAL/HCTZ 160/12.5 mg FDC at primary efficacy endpoint. Control rate of BP defined as the percentage of patients achieving mean sitting SBP (msSBP) <140 mm Hg or msDBP <90 mm Hg (target BP) from baseline to week 8 was significantly higher in the AML/VAL group than that in the VAL/HCTZ group (84.3% [n = 102] in the AML/VAL group vs 71.3% [n = 82] in the VAL/HCTZ group, P = .016). At 8 weeks after randomization, mean uric acid level was significantly increased in the VAL/HCTZ group compared to that at baseline (0.64 ± 0.08 mg/dL; P < .001). However, it was slightly decreased from baseline in the AML/VAL group (-0.12 ± 0.08 mg/dL; P = .085). The intergroup difference was significant (P < .001). CONCLUSION The effectiveness and safety AML/VAL 5/160 mg FDC are noninferior to those of VAL/HCTZ 160/12.5 mg FDC in patients with hypertension inadequately controlled by valsartan 160 mg monotherapy.
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Affiliation(s)
- Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju
| | - Yongcheol Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju
| | - Kiyuk Chang
- The Catholic University of Korea, Seoul St. Mary's Hospital
| | - Weon Kim
- Kyung Hee University Hospital, Seoul
| | | | | | - Min Su Hyon
- Soonchunhyang University Seoul Hospital, Seoul
| | - Chi Young Shim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul
| | | | - Doo Il Kim
- Inje University Haeundae Paik Hostpital, Busan
| | | | - Sang-Wook Lim
- CHA Bundang Medical Center, CHA University, Seongnam
| | - Kyoo-Rok Han
- Hallym University Kangdong Sacred Heart Hospital, Seoul
| | - Sang-Ho Jo
- Hanllym University Sacred Heart Hospital, Anyang
| | - Nae-Hee Lee
- Soonchunhyang University Bucheon Hospital, Bucheon
| | | | - Taehoon Ahn
- Heart Center, Gachon University Gil Hospital, Incheon, Republic of Korea
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Rhee MY, Nah DY, Kim JH, Roh SY, Gu N. P5719Association of serum uric acid level with subtype of hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Y Rhee
- Dongguk University Hospital, Goyang, Korea Republic of
| | - D Y Nah
- Dongguk University College of Medicine Gyeongju Hospital, Gyeongju, Korea Republic of
| | - J H Kim
- Dongguk University Ilsan Hospital, Cardiovascular Center, Goyang, Korea Republic of
| | - S Y Roh
- Dongguk University Ilsan Hospital, Cardiovascular Center, Goyang, Korea Republic of
| | - N Gu
- Dongguk University Hospital, Goyang, Korea Republic of
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Rhee MY, Kim JY, Kim JH, Namgung J, Lee SY, Cho DK, Choi TY, Kim SY. Optimal schedule of home blood-pressure measurements for the diagnosis of hypertension. Hypertens Res 2018; 41:738-747. [DOI: 10.1038/s41440-018-0069-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/30/2017] [Accepted: 01/16/2018] [Indexed: 12/15/2022]
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Kim W, Yoon YE, Shin SH, Bae JW, Hong BK, Hong SJ, Sung KC, Han SH, Kim W, Rhee MY, Kim SH, Lee SE, Hyon MS, Hwang GS, Son JW, Kim JY, Kim MK, Kim SW, Park JH, Shin JH, Park CG. Efficacy and Safety of Ezetimibe and Rosuvastatin Combination Therapy Versus Those of Rosuvastatin Monotherapy in Patients With Primary Hypercholesterolemia. Clin Ther 2018; 40:993-1013. [DOI: 10.1016/j.clinthera.2018.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 01/19/2023]
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Oh GC, Han JK, Han KH, Hyon MS, Doh JH, Kim MH, Jeong JO, Bae JH, Kim SH, Yoo BS, Baek SH, Rhee MY, Ihm SH, Sung JH, Choi YJ, Kim SJ, Hong KS, Lee BK, Cho J, Shin ES, Rhew JY, Kim H, Kim HS. Efficacy and Safety of Fixed-dose Combination Therapy With Telmisartan and Rosuvastatin in Korean Patients With Hypertension and Dyslipidemia: TELSTA-YU (TELmisartan-rosuvaSTAtin from YUhan), a Multicenter, Randomized, 4-arm, Double-blind, Placebo-controlled, Phase III Study. Clin Ther 2018; 40:676-691.e1. [DOI: 10.1016/j.clinthera.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/16/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
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Kong JS, Lee YK, Kim MK, Choi MK, Heo YR, Hyun T, Kim SM, Lyu ES, Oh SY, Park HR, Rhee MY, Ro HK, Song MK. Estimation model for habitual 24-hour urinary-sodium excretion using simple questionnaires from normotensive Koreans. PLoS One 2018; 13:e0192588. [PMID: 29447201 PMCID: PMC5813954 DOI: 10.1371/journal.pone.0192588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 01/27/2018] [Indexed: 11/19/2022] Open
Abstract
This study was conducted to develop an equation for estimation of 24-h urinary-sodium excretion that can serve as an alternative to 24-h dietary recall and 24-h urine collection for normotensive Korean adults. In total, data on 640 healthy Korean adults aged 19 to 69 years from 4 regions of the country were collected as a training set. In order to externally validate the equation developed from that training set, 200 subjects were recruited independently as a validation set. Due to heterogeneity by gender, we constructed a gender-specific equation for estimation of 24-h urinary-sodium excretion by using a multivariable linear regression model and assessed the performance of the developed equation in validation set. The best model consisted of age, body weight, dietary behavior (‘eating salty food’, ‘Kimchi consumption’, ‘Korean soup or stew consumption’, ‘soy sauce or red pepper paste consumption’), and smoking status in men, and age, body weight, dietary behavior (‘salt preference’, ‘eating salty food’, ‘checking sodium content for processed foods’, ‘nut consumption’), and smoking status in women, respectively. When this model was tested in the external validation set, the mean bias between the measured and estimated 24-h urinary-sodium excretion from Bland-Altman plots was -1.92 (95% CI: -113, 110) mmol/d for men and -1.51 (95% CI: -90.6, 87.6) mmol/d for women. The cut-points of sodium intake calculated based on the equations were ≥4,000 mg/d for men and ≥3,500 mg/d for women, with 89.8 and 76.6% sensitivity and 29.3 and 64.2% specificity, respectively. In this study, a habitual 24-hour urinary-sodium-excretion-estimation model of normotensive Korean adults based on anthropometric and lifestyle factors was developed and showed feasibility for an asymptomatic population.
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Affiliation(s)
- Ji-Sook Kong
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Goyang, Gyeonggi, South Korea
| | - Yeon-Kyung Lee
- Department of Food Science and Nutrition, Kyungpook National University, Daegu, South Korea
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Goyang, Gyeonggi, South Korea
- * E-mail:
| | - Mi-Kyeong Choi
- Division of Food Science, Kongju National University, Yesan, South Korea
| | - Young-Ran Heo
- Department of Food and Nutrition, Chonnam National University, Gwangju, South Korea
| | - Taisun Hyun
- Department of Food and Nutrition, Chungbuk National University, Cheongju, South Korea
| | - Sun Mee Kim
- Department of Family Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Eun-Soon Lyu
- Department of Food Science and Nutrition, Pukyong National University, Busan, South Korea
| | - Se-Young Oh
- Department of Food and Nutrition, Kyunghee University, Seoul, South Korea
| | - Hae-Ryun Park
- Department of Food and Nutrition, Myongji University, Yongin, South Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Gyeonggi, South Korea
| | - Hee-Kyong Ro
- Department of Food and Nutrition, Dongshin University, Naju, South Korea
| | - Mi Kyung Song
- Biometrics Research Branch and Biostatistics Collaboration Unit, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital, National Cancer Center, Goyang, Korea, National Cancer Center, Goyang, Gyeonggi, South Korea
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Oh J, Lee CJ, Kim DI, Rhee MY, Lee BK, Ahn Y, Cho BR, Woo JT, Hur SH, Jeong JO, Jang Y, Lee SH. Target achievement with maximal statin-based lipid-lowering therapy in Korean patients with familial hypercholesterolemia: A study supported by the Korean Society of Lipid and Atherosclerosis. Clin Cardiol 2017; 40:1291-1296. [PMID: 29243274 DOI: 10.1002/clc.22826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Data on treatment results of lipid-lowering therapy (LLT) in familial hypercholesterolemia (FH) are limited, particularly in Asian patients. HYPOTHESIS We sought to evaluate the target achievement rate and associated variables in Korean patients with FH after maximal statin-based LLT. METHODS We enrolled 146 patients with heterozygous FH, and 90 patients were finally analyzed. Patients were initially prescribed rosuvastatin 10 mg or atorvastatin 20 mg, and the regimen was adjusted to achieve the low-density lipoprotein cholesterol (LDL-C) target of 100 mg/dL. The primary evaluation point was the achievement rate of the LDL-C targets at 12 months: LDL-C < 100 mg/dL and ≥50% LDL-C reduction. The associations between clinical variables and target achievement were also analyzed. RESULTS At 12 months, 58% of patients were receiving high-intensity regimens, whereas 46% were receiving combination therapy. The mean pre- and post-treatment LDL-C levels were 229 and 118 mg/dL, respectively. Twenty-eight percent of patients achieved LDL-C < 100 mg/dL, and 47% achieved ≥50% LDL-C reduction. Pretreatment LDL-C and high-intensity regimens indicated a negative tendency toward the attainment of LDL-C < 100 mg/dL. Conversely, pretreatment LDL-C and diabetes mellitus were positively associated with a higher rate of ≥50% LDL-C reduction. CONCLUSIONS The target achievement of LDL-C < 100 mg/dL was low, and 50% LDL-C reduction was moderately achieved in Korean patients with FH receiving maximal statin-based LLT. Pretreatment LDL-C levels and diabetes mellitus were associated with target achievement. Our results provide rare and informative data on FH treatment in Asian patients.
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Affiliation(s)
- Jaewon Oh
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Doo Il Kim
- Cardiology Division, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Byoung-Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Youngkeun Ahn
- Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Byung Ryul Cho
- Cardiology Division, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chunchon, Korea
| | - Jeong-Taek Woo
- Endocrinology Division, Department of Internal Medicine, Kyunghee University School of Medicine, Seoul, Korea
| | - Seung-Ho Hur
- Cardiology Division, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jin-Ok Jeong
- Cardiology Division, Department of Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Lee HY, Kim SY, Choi KJ, Yoo BS, Cha DH, Jung HO, Ryu DR, Choi JH, Lee KJ, Park TH, Oh JH, Kim SM, Choi JY, Kim KH, Shim J, Kim WS, Choi SW, Park DG, Song PS, Hong TJ, Rhee MY, Rha SW, Park SW. A Randomized, Multicenter, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and the Tolerability of a Triple Combination of Amlodipine/Losartan/Rosuvastatin in Patients With Comorbid Essential Hypertension and Hyperlipidemia. Clin Ther 2017; 39:2366-2379. [DOI: 10.1016/j.clinthera.2017.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/06/2017] [Accepted: 10/14/2017] [Indexed: 01/01/2023]
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Park JS, Rhee MY, Namgung J, Lee SY, Cho DK, Choi TY, Kim SY, Kim JY, Park SM, Choi JH, Lee JH, Kim HY. Comparison of Optimal Diagnostic Thresholds of Hypertension With Home Blood Pressure Monitoring and 24-Hour Ambulatory Blood Pressure Monitoring. Am J Hypertens 2017; 30:1170-1176. [PMID: 28992112 DOI: 10.1093/ajh/hpx115] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Differences between the recently suggested outcome-driven diagnostic threshold of home blood pressure (HBP) measurements and the currently recommended diagnostic threshold of HBP measurements may cause a disagreement between 24-hour ambulatory blood pressure (ABP) and HBP measurements in the diagnosis of hypertension. We evaluated the agreement of various HBP diagnostic thresholds (135/85, 130/85, and 130/80 mm Hg) to ABP measurements, as a reference method. METHODS Patients who were confirmed to have high BP (≥140/90 mm Hg) at the outpatient clinic were referred. HBP measurement was performed for 7 days in triplicates every morning and evening. The 24-hour ABP measurement was performed on the 8th day. Using 24-hour ABP measurement as a reference method, we analyzed HBP diagnostic thresholds at 135/85, 130/85, and 130/80 mm Hg. RESULTS Among 319 patients, 256 patients (mean age, 51.8 ± 9.7 years; 119 men) with valid HBP measurements and 24-hour ABP measurements were enrolled. The threshold of 130/80 mm Hg showed the highest diagnostic sensitivity (P = 0.001) with diagnostic agreement by Kappa statistics. Using 130/80 mm Hg as a diagnostic threshold of hypertension, the prevalence of masked hypertension was significantly lower than 130/85 and 135/85 mm Hg (7.8, 15.2, and 18.4%, respectively, P = 0.002). CONCLUSIONS The present study suggests that lowering the diagnostic thresholds of HBP measurement from 135/85 mm Hg to 130/80 mm Hg may improve diagnostic accuracy for hypertension.
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Affiliation(s)
- Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - June Namgung
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Yun Lee
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Tae-Young Choi
- Division of Cardiology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Seok Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sang Min Park
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Hyuk Choi
- Division of Cardiology, College of Medicine, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jae Hang Lee
- Department of thoracic and cardiovascular surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, College of Health Science and Department of Public Health Sciences, Graduate School, Korea University, Seoul, Korea
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Nah DY, Kim BK, Bae JH, Chung JW, Rhee MY, Lee K, Jeong MH, Kim YJ. TCTAP A-016 Influence of Complete Atrioventricular Block on In-hospital and 12-month Cardiac Mortality in Patients with ST Elevation Myocardial Infarction. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rhee MY, Ahn T, Chang K, Chae SC, Yang TH, Shim WJ, Kang TS, Ryu JK, Nah DY, Park TH, Chae IH, Park SW, Lee HY, Tahk SJ, Yoon YW, Shim CY, Shin DG, Seo HS, Lee SY, Kim DI, Kwan J, Joo SJ, Jeong MH, Jeong JO, Sung KC, Kim SY, Kim SH, Chun KJ, Oh DJ. The efficacy and safety of co-administration of fimasartan and rosuvastatin to patients with hypertension and dyslipidemia. BMC Pharmacol Toxicol 2017; 18:2. [PMID: 28057081 PMCID: PMC5217661 DOI: 10.1186/s40360-016-0112-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hypertension and dyslipidemia are major risk factors of cardiovascular disease (CVD) events. The objective of this study was to evaluate the efficacy and safety of the co-administration of fimasartan and rosuvastatin in patients with hypertension and hypercholesterolemia. Methods We conducted a randomized double-blind and parallel-group trial. Patients who met eligible criteria after 4 weeks of therapeutic life change were randomly assigned to the following groups. 1) co-administration of fimasartan 120 mg/rosuvastatin 20 mg (FMS/RSV), 2) fimasartan 120 mg (FMS) alone 3) rosuvastatin 20 mg (RSV) alone. Drugs were administered once daily for 8 weeks. Results Of 140 randomized patients, 135 for whom efficacy data were available were analyzed. After 8 weeks of treatment, the FMS/RSV treatment group showed greater reductions in sitting systolic (siSBP) and diastolic (siDBP) blood pressures than those in the group receiving RSV alone (both p < 0.001). Reductions in siSBP and siDBP were not significantly different between the FMS/RSV and FMS alone groups (p = 0.500 and p = 0.734, respectively). After 8 weeks of treatment, FMS/RSV treatment showed greater efficacy in percentage reduction of low-density lipoprotein cholesterol (LDL-C) level from baseline than that shown by FMS alone treatment (p < 0.001). The response rates of siSBP with FMS/RSV, FMS alone, and RSV alone treatments were 65.22, 55.56, and 34.09%, respectively (FMS/RSV vs. RSV, p = 0.006). The LDL-C goal attainment rates with FMS/RSV, RSV alone, and FMS alone treatments were 80.43%, 81.82%, and 15.56%, respectively (FMS/RSV vs. FMS, p < 0.001). Incidence of adverse drug reactions with FMS/RSV treatment was 8.33%, which was similar to those associated with FMS and RSV alone treatments. Conclusion This study demonstrated that the co-administration of fimasartan and rosuvastatin to patients with both hypertension and hypercholesterolemia was efficacious and safe. Trial registration ClinicalTrials.gov Identifier: NCT02166814. 16 June 2014 Electronic supplementary material The online version of this article (doi:10.1186/s40360-016-0112-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Taehoon Ahn
- Division of Cardiology, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Wan Joo Shim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Tae Soo Kang
- Department of Cardiology, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jae-Kean Ryu
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Deuk-Young Nah
- Division of Cardiology, Dongguk University Gyeongju Hospital, Gyeongju, Republic of Korea
| | - Tae-Ho Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Woo Park
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Hospital, Suwon, Republic of Korea
| | - Young Won Yoon
- Division of Cardiology, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Dong-Gu Shin
- Department of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Hong Seog Seo
- Division of Cardiology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sung Yun Lee
- Cardiac and Vascular Center, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Doo Il Kim
- Department of Cardiology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jun Kwan
- Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Seung-Jae Joo
- Division of Cardiology, Jeju National University Hospital, Jeju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiovascular, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Seoul Metropolitan Government Seoul National University Hospital Boramae Medical Center, Seoul, Republic of Korea
| | - Kook-Jin Chun
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Joo Oh
- Division of Cardiology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Wang TD, Tan RS, Lee HY, Ihm SH, Rhee MY, Tomlinson B, Pal P, Yang F, Hirschhorn E, Prescott MF, Hinder M, Langenickel TH. Effects of Sacubitril/Valsartan (LCZ696) on Natriuresis, Diuresis, Blood Pressures, and NT-proBNP in Salt-Sensitive Hypertension. Hypertension 2017; 69:32-41. [DOI: 10.1161/hypertensionaha.116.08484] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 09/26/2016] [Accepted: 10/20/2016] [Indexed: 11/16/2022]
Abstract
Salt-sensitive hypertension (SSH) is characterized by impaired sodium excretion and subnormal vasodilatory response to salt loading. Sacubitril/valsartan (LCZ696) was hypothesized to increase natriuresis and diuresis and result in superior blood pressure control compared with valsartan in Asian patients with SSH. In this randomized, double-blind, crossover study, 72 patients with SSH received sacubitril/valsartan 400 mg and valsartan 320 mg once daily for 4 weeks each. SSH was diagnosed if the mean arterial pressure increased by ≥10% when patients switched from low (50 mmol/d) to high (320 mmol/d) sodium diet. The primary outcome was cumulative 6- and 24-hour sodium excretion after first dose administration. Compared with valsartan, sacubitril/valsartan was associated with a significant increase in natriuresis (adjusted treatment difference: 24.5 mmol/6 hours, 50.3 mmol/24 hours, both
P
<0.001) and diuresis (adjusted treatment difference: 291.2 mL/6 hours,
P
<0.001; 356.4 mL/24 hours,
P
=0.002) on day 1, but not on day 28, and greater reductions in office and ambulatory blood pressure on day 28. Despite morning dosing of both drugs, ambulatory blood pressure reductions were more pronounced at nighttime than at daytime or the 24-hour average. Compared with valsartan, sacubitril/valsartan significantly reduced N-terminal pro B-type natriuretic peptide levels on day 28 (adjusted treatment difference: −20%;
P
=0.001). Sacubitril/valsartan and valsartan were safe and well tolerated with no significant changes in body weight or serum sodium and potassium levels with either treatments. In conclusion, sacubitril/valsartan compared with valsartan was associated with short-term increases in natriuresis and diuresis, superior office and ambulatory blood pressure control, and significantly reduced N-terminal pro B-type natriuretic peptide levels in Asian patients with SSH.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01681576.
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Affiliation(s)
- Tzung-Dau Wang
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Ru-San Tan
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Hae-Young Lee
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Sang-Hyun Ihm
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Moo-Yong Rhee
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Brian Tomlinson
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Parasar Pal
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Fan Yang
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Elizabeth Hirschhorn
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Margaret F. Prescott
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Markus Hinder
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
| | - Thomas H. Langenickel
- From the Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (T.-D.W.); National Heart Centre, Department of Cardiology, Singapore (R.-S.T.); Seoul National University Hospital, Department of Internal Medicine, South Korea (H.-Y.L.); The Catholic University of Korea Bucheon, St Mary’s Hospital, Department of Cardiology, Bucheon-si, Gyeonggi-do, South Korea (S.-H.I.); Dongguk University Ilsan Hospital,
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Rhee MY, Kim JH, Shin SJ, Gu N, Nah DY, Park JH, Kim SW, Kim HJ, Oh KW, Kim JH, Lee SY. Estimating 24-Hour Urine Sodium From Multiple Spot Urine Samples. J Clin Hypertens (Greenwich) 2016; 19:431-438. [DOI: 10.1111/jch.12922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
- Clinical Trial Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Ji-Hyun Kim
- Cardiovascular Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Sung-Joon Shin
- Division of Nephrology; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Namyi Gu
- Clinical Trial Center; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
- Department of Clinical Pharmacology and Therapeutics; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Deuk-Young Nah
- Cardiovascular Center; Dongguk University Gyeongju Hospital; Gyeongju-si Gyeongsangbuk-do Korea
| | - Ju-Hyun Park
- Department of Statistics; Dongguk University; Jung-gu Seoul Korea
| | - Sun-Woong Kim
- Department of Statistics; Survey and Health Policy Research Center; Dongguk University; Jung-gu Seoul Korea
| | - Hyun Ja. Kim
- Department of Food and Nutrition; Gangneung-Wonju National University; Gangneung-si Gangwon-do Korea
| | - Kyung Won. Oh
- Division of Health and Nutrition Survey; Korea Centers for Disease Control and Prevention; Heungdeok-gu Cheongju-si Korea
| | - Ji-Hyeon Kim
- Department of Pediatrics; Dongguk University Ilsan Hospital; Goyang-si Gyeonggi-do Korea
| | - Sim-Yeol Lee
- Department of Home Economics Education; Dongguk University; Jung-gu Seoul Korea
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Kim KJ, Kim SH, Yoon YW, Rha SW, Hong SJ, Kwak CH, Kim W, Nam CW, Rhee MY, Park TH, Hong TJ, Park S, Ahn Y, Lee N, Jeon HK, Jeon DW, Han KR, Moon KW, Chae IH, Kim HS. Effect of fixed-dose combinations of ezetimibe plus rosuvastatin in patients with primary hypercholesterolemia: MRS-ROZE (Multicenter Randomized Study of ROsuvastatin and eZEtimibe). Cardiovasc Ther 2016; 34:371-82. [PMID: 27506635 PMCID: PMC5108468 DOI: 10.1111/1755-5922.12213] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM We aimed to compare the effects of fixed-dose combinations of ezetimibe plus rosuvastatin to rosuvastatin alone in patients with primary hypercholesterolemia, including a subgroup analysis of patients with diabetes mellitus (DM) or metabolic syndrome (MetS). METHOD This multicenter eight-week randomized double-blind phase III study evaluated the safety and efficacy of fixed-dose combinations of ezetimibe 10 mg plus rosuvastatin, compared with rosuvastatin alone in patients with primary hypercholesterolemia. Four hundred and seven patients with primary hypercholesterolemia who required lipid-lowering treatment according to the ATP III guideline were randomized to one of the following six treatments for 8 weeks: fixed-dose combinations with ezetimibe 10 mg daily plus rosuvastatin (5, 10, or 20 mg daily) or rosuvastatin alone (5, 10, or 20 mg daily). RESULTS Fixed-dose combination of ezetimibe plus rosuvastatin significantly reduced LDL cholesterol, total cholesterol, and triglyceride levels compared with rosuvastatin alone. Depending on the rosuvastatin dose, these fixed-dose combinations of ezetimibe plus rosuvastatin provided LDL cholesterol, total cholesterol, and triglyceride reductions of 56%-63%, 37%-43%, and 19%-24%, respectively. Moreover, the effect of combination treatment on cholesterol levels was more pronounced in patients with DM or MetS than in non-DM or non-MetS patients, respectively, whereas the effect of rosuvastatin alone did not differ between DM vs non-DM or MetS vs non-MetS patients. CONCLUSION Fixed-dose combinations of ezetimibe and rosuvastatin provided significantly superior efficacy to rosuvastatin alone in lowering LDL cholesterol, total cholesterol, and triglyceride levels. Moreover, the reduction rate was greater in patients with DM or MetS.
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Affiliation(s)
- Kyung-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Won Yoon
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Department of Internal Medicine, Medical College, Korea University, Seoul, Korea
| | - Soon-Jun Hong
- Division of Cardiology, Department of Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Choong-Hwan Kwak
- Division of Cardiology, Department of Cardiovascular Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Weon Kim
- Cardiovascular Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University, Gyeongju, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Tae-Ho Park
- Department of Internal Medicine, Cardiology Division, Dong-A University Hospital, Busan, Korea
| | | | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Namho Lee
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hui-Kyung Jeon
- Department of Cardiovascular, Uijeongbu, Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong-Woon Jeon
- Division of Cardiology, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Korea
| | - Kyoo-Rok Han
- Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Keon-Woong Moon
- Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Rhee MY, Kim SW, Choi EH, Kim JH, Nah DY, Shin SJ, Gu N. Prevalence of Masked Hypertension: a Population-Based Survey in a Large City by Using 24-Hour Ambulatory Blood Pressure Monitoring. Korean Circ J 2016; 46:681-687. [PMID: 27721860 PMCID: PMC5054181 DOI: 10.4070/kcj.2016.46.5.681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 01/19/2023] Open
Abstract
Background and Objectives We estimated the prevalence of hypertension and hypertension subtypes in a large semi-urban city in Korea, using 24-hour ambulatory blood pressure monitoring (ABPM) in a randomly selected sample population. Subjects and Methods A random sample (aged 20-65 years) from a city with an adult population of approximately 600000 was selected by using a list-assisted random digit dialing method. The 24-hour ABPM and conventional blood pressure measurement (CBPM) of these individuals were obtained. Results Among the 496 participants, valid 24-hour ABPM and CBPM were obtained from 462 (93%) individuals. The estimated prevalence of hypertension in Goyang was 17.54% by CBPM and 32.70% by 24-hour ABPM (p<0.01). In the age stratified analysis, both CBPM and 24-hour ABPM showed increased prevalence of hypertension with age. The estimated prevalence of masked hypertension was 16.22% and that of white-coat hypertension was 1.08%. Men had a higher prevalence of masked hypertension than women (20.79% vs. 11.86%, p=0.0295). The estimated prevalence of masked hypertension was 17.5%, 20.58%, 24.34%, and 13.29% in the age categories of 30s, 40s, 50s, and 60s, respectively. The estimated prevalence of masked uncontrolled hypertension was 26.79% in patients with hypertension who were taking antihypertensive medications. Conclusion The estimated prevalence of hypertension by 24-hour ABPM was higher than that by CBPM, revealing high prevalence of masked hypertension. The high prevalence of masked hypertension supports the adoption of ABPM in the national population survey and clinical practice to improve public health and reduce health care costs.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sun-Woong Kim
- Department of Statistics, Survey and Health Policy Research Center, Dongguk University, Seoul, Korea
| | - Eun-Hee Choi
- Department of Statistics, Survey and Health Policy Research Center, Dongguk University, Seoul, Korea
| | - Ji-Hyun Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Deuk-Young Nah
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Sung-Joon Shin
- Division of Nephrology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Namyi Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Goyang, Korea
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Lee JH, Rhee MY. PS 11-05 INTER-ARM BLOOD PRESSURE DIFFERENCE. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000500837.68408.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rhee MY, Kim JH, Shin SJ, Gu N, Nah DY, Kim SW, Park JH, Kim HJ, Oh KW. PS 18-11 ESTIMATION OF 24-HOUR URINE SODIUM FROM MULTIPLE SPOT URINE SAMPLES. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000501358.42012.de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Park CY, Gu N, Lim CY, Oh JH, Chang M, Kim M, Rhee MY. The effect of Vaccinium uliginosum extract on tablet computer-induced asthenopia: randomized placebo-controlled study. Altern Ther Health Med 2016; 16:296. [PMID: 27538497 PMCID: PMC4991001 DOI: 10.1186/s12906-016-1283-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 08/12/2016] [Indexed: 12/12/2022]
Abstract
Background To investigate the alleviation effect of Vaccinium uliginosum extract (DA9301) on tablet computer-induced asthenopia. Methods This was a randomized, placebo-controlled, double-blind and parallel study (Trial registration number: 2013–95). A total 60 volunteers were randomized into DA9301 (n = 30) and control (n = 30) groups. The DA9301 group received DA9301 oral pill (1000 mg/day) for 4 weeks and the control group received placebo. Asthenopia was evaluated by administering a questionnaire containing 10 questions (responses were scored on a scales of 0–6; total score: 60) regarding ocular symptoms before (baseline) and 4 weeks after receiving pills (DA9301 or placebo). The participants completed the questionnaire before and after tablet computer (iPad Air, Apple Inc.) watching at each visit. The change in total asthenopia score (TAS) was calculated and compared between the groups Results TAS increased significantly after tablet computer watching at baseline in DA9301 group. (from 20.35 to 23.88; p = 0.031) However, after receiving DA9301 for 4 weeks, TAS remained stable after tablet computer watching. In the control group, TAS changes induced by tablet computer watching were not significant both at baseline and at 4 weeks after receiving placebo. Further analysis revealed the scores for “tired eyes” (p = 0.001), “sore/aching eyes” (p = 0.038), “irritated eyes” (p = 0.010), “watery eyes” (p = 0.005), “dry eyes” (p = 0.003), “eye strain” (p = 0.006), “blurred vision” (p = 0.034), and “visual discomfort” (p = 0.018) significantly improved in the DA9301 group. Conclusions We found that oral intake of DA9301 (1000 mg/day for 4 weeks) was effective in alleviating asthenopia symptoms induced by tablet computer watching. Trial registration The study is registered at www.clinicaltrials.gov (registration number: NCT02641470, date of registration December 30, 2015).
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Kim KI, Shin MS, Ihm SH, Youn HJ, Sung KC, Chae SC, Nam CW, Seo HS, Park SM, Rhee MY, Kim MH, Cha KS, Kim YJ, Kim JJ, Chun KJ, Yoo BS, Park S, Shin ES, Kim DS, Il Kim D, Kim KH, Joo SJ, Jeong JO, Shin J, Kim CH. A Randomized, Double-blind, Multicenter, Phase III Study to Evaluate the Efficacy and Safety of Fimasartan/Amlodipine Combined Therapy Versus Fimasartan Monotherapy in Patients With Essential Hypertension Unresponsive to Fimasartan Monotherapy. Clin Ther 2016; 38:2159-2170. [PMID: 27502326 DOI: 10.1016/j.clinthera.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The goal of this study was to evaluate whether the blood pressure-lowering efficacy of fimasartan/amlodipine combination therapy was superior to that of fimasartan monotherapy after 8 weeks of treatment in patients with hypertension who had failed to respond adequately to fimasartan monotherapy. METHODS This trial was a randomized, double-blind, multicenter, Phase III clinical study. Patients who failed to respond after 4 weeks of treatment with 60 mg daily of fimasartan (sitting systolic blood pressure [SiSBP]) ≥140 mm Hg) were randomized to receive either daily fimasartan 60 mg or fimasartan/amlodipine 60 mg/10 mg. The primary efficacy end point was the change in SiSBP from baseline to week 8. Secondary end points included the change in SiSBP from baseline to week 4, the changes in sitting diastolic blood pressure from baseline to weeks 4 and 8, and the response rate (SiSBP <140 mm Hg or decrease in SiSBP ≥20 mm Hg) or control rate (SiSBP <140 mm Hg) at week 8. Treatment-emergent adverse events were also assessed. FINDINGS Of 143 patients randomized to treatment, 137 patients who had available efficacy data were analyzed. The mean age of patients was 59.1 (8.9) years, and 100 (73.0%) were male. Baseline SiSBP and sitting diastolic blood pressure were 150.6 (9.2) mm Hg and 91.7 (8.6) mm Hg, respectively. In the fimasartan/amlodipine combination group, a greater reduction in SiSBP from baseline to week 8 was observed compared with the fimasartan group (7.8 [13.3] mm Hg in the fimasartan group vs 20.5 [14.6] mm Hg in the fimasartan/amlodipine group; P < 0.0001). This reduction was observed after 4 weeks. The mean SiSBP changes from baseline to week 4 were 8.1 (15.8) mm Hg in the fimasartan group and 20.1 (14.7) mm Hg in the fimasartan/amlodipine group (P < 0.0001). At week 8, the response rate was significantly higher in the fimasartan/amlodipine (82.1%) group than in the fimasartan (32.9%) group (P < 0.0001). The control rate at week 8 was also higher in the fimasartan/amlodipine (79.1%) group than in the fimasartan (31.4%) group (P < 0.0001). Adverse drug reactions were observed in 9 patients (6.3%), with no significant differences between treatment groups. There were no serious adverse events associated with the study drugs. IMPLICATIONS Fimasartan/amlodipine combination therapy exhibited superior efficacy in reducing blood pressure, with no increase in adverse drug reactions, compared with fimasartan monotherapy. ClinicalTrials.gov identifier: NCT02152306.
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Affiliation(s)
- Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Mi-Seung Shin
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sang-Hyun Ihm
- Department of Internal Medicine, Bucheon St. Mary׳s Hospital, College of Medicine, The Catholic University of Koreau, Bucheon, Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chang-Wook Nam
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Republic of Korea
| | - Hong Seog Seo
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Kook Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Byung-Su Yoo
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei Health System, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine,Ulsan, Republic of Korea
| | - Dong-Soo Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Doo Il Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Cheol Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Gu N, Cho JY, Shin KH, Jang IJ, Rhee MY. The influence of dietary sodium content on the pharmacokinetics and pharmacodynamics of fimasartan. Drug Des Devel Ther 2016; 10:1525-31. [PMID: 27143858 PMCID: PMC4844258 DOI: 10.2147/dddt.s94694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A low sodium diet enhances the hemodynamic effect of renin–angiotensin system blockers. It was suggested that the substrates of P-glycoprotein or cytochrome P450 3A4 were reduced on a high sodium diet. This study aimed to investigate the influence of high sodium diet on the pharmacokinetics and pharmacodynamics of fimasartan, which is a substrate of cytochrome P450 3A4 but not P-glycoprotein. The study design was a two-diet, two-period, two-sequence, randomized, open-label, and crossover with 1-week washout for diet. Eligible subjects were fed with either low sodium (50 mEq/day) diet or high sodium diet (300 mEq/day) for 7 days in the first hospitalization period and the other diet in the second period. On the seventh morning of each period, subjects received a single dose of fimasartan 60 mg in a fasted state. The serial plasma concentrations of fimasartan, serum aldosterone concentration (SAC), and plasma renin activity (PRA) were measured for pharmacokinetic–pharmacodynamic analysis. Sixteen subjects completed the study satisfying the compliance test for diets. Although the mean systemic exposure of fimasartan is slightly (≈10%) decreased on a high sodium diet, the difference was not statistically or clinically significant (P>0.05). The SAC and PRA after fimasartan administration were highly dependent on their baseline levels. The dietary sodium content influenced the baseline of SAC and PRA, but did not influence the ratio change of SAC and PRA after fimasartan treatment. The ratio change of SAC after fimasartan treatment was correlated to the systemic exposure of fimasartan (P<0.05), while the correlation between the ratio change of PRA after fimasartan treatment and the individual systemic exposure of fimasartan was not significant (P>0.05). In conclusion, the pharmacokinetics of fimasartan and ratio changes of SAC and PRA after fimasartan treatment were not significantly influenced by dietary sodium content.
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Affiliation(s)
- Namyi Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University College of Medicine and Ilsan Hospital, Goyang, Republic of Korea; Clinical Trial Center, Dongguk University College of Medicine and Ilsan Hospital, Goyang, Republic of Korea
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Kwang-Hee Shin
- Pharmacotherapy & Translational Research Lab., College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Clinical Trial Center, Dongguk University College of Medicine and Ilsan Hospital, Goyang, Republic of Korea; Cardiovascular Center, Dongguk University College of Medicine and Ilsan Hospital, Goyang, Republic of Korea
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Rhee OJ, Rhee MY, Oh SW, Shin SJ, Gu N, Nah DY, Kim SW, Lee JH. Effect of sodium intake on renin level: Analysis of general population and meta-analysis of randomized controlled trials. Int J Cardiol 2016; 215:120-6. [PMID: 27111173 DOI: 10.1016/j.ijcard.2016.04.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND We evaluated the association between sodium intake and plasma renin levels in the cross sectional study and meta-analysis of randomized controlled trials, whether there is a persistent elevation of plasma renin by longer-term sodium intake restriction. METHODS Plasma renin activity (PRA) and 24-h urine sodium (24HUNa) excretion were measured from individuals randomly selected from a community. Simple and multiple linear regression analyses adjusted for age, 24-h systolic blood pressure, 24-h average heart rate, fasting blood glucose and gender were performed. For meta-analysis, 74 studies published from 1975 to mid-2014 were identified in a systematic literature search using EMBASE, CINAHL, and MEDLINE. Random effects meta-analyses and a meta-regression analysis were performed. RESULTS Among the 496 participants recruited, 210 normotensive and 87 untreated hypertensive subjects were included in the analysis. There was no significant association between PRA and 24HUNa in the total population, or hypertensive and normotensive individuals. In the meta-analysis, the standard mean difference (SMD) of renin level by sodium intake reduction was 1.26 (95% CI: 1.08 to 1.44, Z=12.80, P<0.001, I(2)=87%). In the meta-regression analysis, an increase in a day of intervention was associated with a fall in SMD by -0.04 (95% CI: -0.05 to -0.02, Z=-5.27, P<0.001, I(2)=86%), indicating that longer duration of reduced sodium intake would lead to lesser SMD of renin level. CONCLUSIONS The present population based cross-sectional study and meta-analysis suggests that prolonged reduction in sodium intake is very unlikely associated with elevation of plasma renin levels.
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Affiliation(s)
- O J Rhee
- Department of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | - M Y Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
| | - S W Oh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - S J Shin
- Division of Nephrology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - N Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - D Y Nah
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - S W Kim
- Department of Statistics, Survey and Health Policy Research Center, Dongguk University, Seoul, Republic of Korea
| | - J H Lee
- Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Rhee MY, Kim JH, Na SH, Chung JW, Bae JH, Nah DY, Gu N, Kim HY. Elevation of heart-femoral pulse wave velocity by short-term low sodium diet followed by high sodium diet in hypertensive patients with sodium sensitivity. Nutr Res Pract 2016; 10:288-93. [PMID: 27247725 PMCID: PMC4880728 DOI: 10.4162/nrp.2016.10.3.288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/17/2015] [Accepted: 12/04/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVES We compared changes in heart-femoral pulse wave velocity (hfPWV) in response to low sodium and high sodium diet between individuals with sodium sensitivity (SS) and resistance (SR) to evaluate the influence of sodium intake on arterial stiffness. SUBJECTS/METHODS Thirty-one hypertensive and 70 normotensive individuals were given 7 days of low sodium dietary approach to stop hypertension (DASH) diet (LSD, 100 mmol NaCl/day) followed by 7 days of high sodium DASH diet (HSD, 300 mmol NaCl/day) during 2 weeks of hospitalization. The hfPWV was measured and compared after the LSD and HSD. RESULTS The hfPWV was significantly elevated from LSD to HSD in individuals with SS (P = 0.001) independently of changes in mean arterial pressure (P = 0.037). Conversely, there was no significant elevation of hfPWV from LSD to HSD in individuals with SR. The percent change in hfPWV from the LSD to the HSD in individuals with SS was higher than that in individuals with SR. Subgroup analysis revealed that individuals with both SS and hypertension showed significant elevation of hfPWV from LSD to HSD upon adjusted analysis using changes of the means arterial pressure (P = 0.040). However, there was no significant elevation of hfPWV in individuals with SS and normotension. CONCLUSION High sodium intake elevated hfPWV in hypertensive individuals with SS, suggesting that high sodium intake increases aortic stiffness, and may contribute to enhanced cardiovascular risk in hypertensive individuals with SS.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea
| | - Ji-Hyun Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea
| | - Sang-Hoon Na
- Emergency Medicine and Cardiology, Emergency Medical Center, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin-Wook Chung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 38067, Korea
| | - Jun-Ho Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 38067, Korea
| | - Deuk-Young Nah
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 38067, Korea
| | - Namyi Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, College of Health Science & Department of Public Health Science, Graduate School, Korea University, Seoul 02841, Korea
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