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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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Jang J, Park S, Kim S, Kim SH, Oh YS, Sa YK, Hwang Y, Jang SW, Ihm SH, Choi Y. Clinical outcomes with the use of sodium-glucose cotransporter-2 inhibitors in patients with atrial fibrillation and type 2 diabetes mellitus: a multi-centre, real-world cohort study. Eur J Prev Cardiol 2024; 31:320-329. [PMID: 37798123 DOI: 10.1093/eurjpc/zwad322] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
AIMS Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to improve cardiovascular outcomes and reduce the incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). We investigated the clinical outcomes with and without the use of SGLT2is in patients with T2DM and concomitant AF. METHODS AND RESULTS We derived patient data from a clinical data warehouse constructed from the electronic medical records of seven medical centres. Data for 11 012 patients diagnosed with both AF and T2DM were analysed. New SGLT2i users were classified into the SGLT2i group and those who were not prescribed SGLT2is were classified into the control group. We performed a 1:2 propensity score (PS)-matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure (HF) events in 3 years. The PS-matched population consisted of 1115 patients in the SGLT2i group and 2050 patients in the control group. Incidence of the primary endpoint was significantly lower in the SGLT2i group [8.4 vs. 14.6%, hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.55-0.87]. Sodium-glucose cotransporter-2 inhibitors use was associated with significantly lower all-cause mortality (HR 0.43, 95% CI 0.29-0.67) and HF hospitalization (HR 0.77, 95% CI 0.59-0.99). Adverse renal events, defined as >50% increase in serum creatinine level or initiation of dialysis, occurred less often in the SGLT2i group (HR 0.50, 95% CI 0.38-0.66, P < 0.001). CONCLUSION Use of SGLT2is in patients with T2DM and concomitant AF was associated with reduced mortality or HF hospitalization events.
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Affiliation(s)
- Jaehyuk Jang
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonboro, Uijeongbu, Gyeonggido 11765, South Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Soyoon Park
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Soohyun Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Sung-Hwan Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Yong-Seog Oh
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Young Kyoung Sa
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Youmi Hwang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Sung-Won Jang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Hyun Ihm
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St.Mary's Hospital, The Catholic University of Korea, Bucheon, South Korea
| | - Young Choi
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
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Jung MH, Ihm SH. Correction to "Obesity-related hypertension and chronic kidney disease: from evaluation to management". Kidney Res Clin Pract 2024; 43:130. [PMID: 38311361 PMCID: PMC10846994 DOI: 10.23876/j.krcp.23.072.e1] [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] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kim HL, Park SM, Cho IJ, Kim YM, Kim DH, Kim SH, Kim KI, Sung KC, Ihm SH, Shin J, Kim Y, Oh K, Lee EM. Standardized protocol of blood pressure measurement and quality control program for the Korea National Health and Nutrition Examination Survey. Clin Hypertens 2023; 29:28. [PMID: 37821979 PMCID: PMC10568909 DOI: 10.1186/s40885-023-00252-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/21/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Accurate blood pressure (BP) measurement is crucial for hypertension detection and management. The Korea National Health and Nutrition Examination Survey (KNHANES) assesses the health of Koreans using representative cross-sectional data. BP measurements were historically done with mercury sphygmomanometers for participants aged ≥10 years. However, KNHANES transitioned to Greenlight 300TM (mercury-free auscultatory device) in 2020 for participants aged ≥6 years and used dual devices (Microlife WatchBP Office AFIB and Greenlight) in 2021-2022. To ensure consistency, KNHANES will adopt Microlife as the unified BP device with Greenlight for device validation from 2023. Under the new protocol, participants aged ≥6 years will have their BP measured three times at 30-second intervals after a 5-minute rest under ambient temperature (20-25℃) and noise ≤65 dB. The average of the 2nd and 3rd readings will be used as the representative BP value. The quality control (QC) program involves four trained examiners passing the "quality control and assurance of BP measurement program" three times annually, and undergoing "video monitoring of weekly calibration process" once a year. Additionally, the QC team will conduct "on-site evaluations of BP measurement" at mobile examination centers three times a year. A Five-Step QC process for BP devices was also developed. This document outlines the standardized BP measurement protocol and rigorous QC program in KNHANES, aiming to ensure accurate and reliable BP data for epidemiological research and public health policymaking in South Korea.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Park
- Divison of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - In Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Yu-Mi Kim
- Department of Preventive, College of Medicine, Hanyang University, Seoul, Republic of Korea
- Hanyang University School of Public Health, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hye Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, 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
| | - 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
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yoonjung Kim
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Kyungwon Oh
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, 15865, Republic of Korea.
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Park S, Ihm SH, Cho IJ, Kim DH, Park JH, Chung WB, Choi S, Lee HY, Kim HC, Sohn IS, Lee EM, Kim JH, Kim KI, Cho EJ, Sung KC, Shin J, Pyun WB. Statement on chronotherapy for the treatment of hypertension: consensus document from the Korean society of hypertension. Clin Hypertens 2023; 29:25. [PMID: 37653547 PMCID: PMC10472721 DOI: 10.1186/s40885-023-00249-2] [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: 05/16/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Nocturnal blood pressure (BP) has been shown to have a significant predictive value for cardiovascular disease. In some cases, it has a superior predictive value for future cardiovascular outcomes than daytime BP. As efficacy of BP medications wanes during nighttime and early morning, control of nocturnal hypertension and morning hypertension can be difficult. As such, chronotherapy, the dosing of BP medication in the evening, has been an ongoing topic of interest in the field of hypertension. Some studies have shown that chronotherapy is effective in reducing nocturnal BP, improving non dipping and rising patterns to dipping patterns, and improving cardiovascular prognosis. However, criticism and concerns have been raised regarding the design of these studies, such as the Hygia study, and the implausible clinical benefits in cardiovascular outcomes considering the degree of BP lowering from bedtime dosing. Studies have shown that there is no consistent evidence to suggest that routine administration of antihypertensive medications at bedtime can improve nocturnal BP and early morning BP control. However, in some cases of uncontrolled nocturnal hypertension and morning hypertension, such as in those with diabetes mellitus, chronic kidney disease, and obstructive sleep apnea, bedtime dosing has shown efficacy in reducing evening and early morning BP. The recently published the Treatment in Morning versus Evening (TIME) study failed to demonstrate benefit of bedtime dosing in reducing cardiovascular outcomes in patients with hypertension. With issues of the Hygia study and negative results from the TIME study, it is unclear at this time whether routine bedtime dosing is beneficial for reducing cardiovascular outcomes.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea & Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
| | - In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University, Seoul, South Korea
| | - Seonghoon Choi
- Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hae Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Director of Geriatric center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Wook Bum Pyun
- Division of cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea & Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Jung MH, Lee SY, Youn JC, Chung WB, Ihm SH, Kang D, Kyoung DS, Jung HO, Chang K, Youn HJ, Lee H, Kang D, Cho J, Kaneko H, Kim HC. Antihypertensive Medication Adherence and Cardiovascular Outcomes in Patients With Cancer: A Nationwide Population-Based Cohort Study. J Am Heart Assoc 2023:e029362. [PMID: 37421285 PMCID: PMC10382088 DOI: 10.1161/jaha.123.029362] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
Background Hypertension is an important cause of morbidity, which predisposes patients to major cardiovascular events and mortality. The aim of this study was to explore the association between adherence to antihypertensive medication and clinical outcomes in adult patients with cancer. Methods and Results Using the 2002 to 2013 Korean National Health Insurance Service-National Sample Cohort, we extracted adult patients with cancer treated with antihypertensive medications. Based on the medication possession ratio value, participants were divided into 3 groups: good (medication possession ratio ≥0.8), moderate (0.5≤ medication possession ratio <0.8), and poor (medication possession ratio <0.5) adherence groups. The primary outcomes were overall and cardiovascular mortality. The secondary outcome was cardiovascular events requiring hospitalization due to major cardiovascular diseases. Among 19 246 patients with cancer with concomitant hypertension, 66.4% were in the nonadherence group (26.3% were moderate and 40.0% were poor adherence group). Over a median of 8.4 years of follow-up, 2752 deaths and 6057 cardiovascular events occurred. Compared with the good adherence group, the moderate and poor adherence groups had a 1.85-fold and 2.19-fold increased risk for overall mortality, and 1.72-fold and 1.71-fold elevated risk for cardiovascular mortality, respectively, after adjustment for possible confounders. Furthermore, the moderate and poor adherence groups had a 1.33-fold and 1.34-fold elevated risk of new-onset cardiovascular events, respectively. These trends were consistent across cardiovascular event subtypes. Conclusions Nonadherence to antihypertensive medication was common in patients with cancer and was associated with worse clinical outcomes in adult patients with cancer with hypertension. More attention should be paid to improving adherence to antihypertensive medication among patients with cancer.
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Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - So-Young Lee
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Jong-Chan 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
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Sang-Hyun Ihm
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Division of Cardiology, Department of Internal Medicine Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Bucheon-si Republic of Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharmaceutical Co., Ltd Seoul Republic of Korea
| | - Dae-Sung Kyoung
- Data Science Team, Hanmi Pharmaceutical Co., Ltd Seoul Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul 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
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Hokyou Lee
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Republic of Korea
- Cardiovascular and Metabolic Disease Etiology Research Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Clinical Research Design and Evaluation SAIHST, Sungkyunkwan University Seoul Republic of Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Clinical Research Design and Evaluation SAIHST, Sungkyunkwan University Seoul Republic of Korea
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine Graduate School of Medicine The University of Tokyo Tokyo Japan
- Department of Advanced Cardiology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hyeon Chang Kim
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Republic of Korea
- Cardiovascular and Metabolic Disease Etiology Research Center Yonsei University College of Medicine Seoul Republic of Korea
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Jung MH, Ihm SH. Obesity-related hypertension and chronic kidney disease: from evaluation to management. Kidney Res Clin Pract 2023; 42:431-444. [PMID: 37551125 PMCID: PMC10407638 DOI: 10.23876/j.krcp.23.072] [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: 03/27/2023] [Revised: 05/14/2023] [Accepted: 06/15/2023] [Indexed: 08/09/2023] Open
Abstract
With the recent obesity pandemic, obesity-related hypertension and its complications (e.g., heart failure, coronary disease, and chronic kidney disease [CKD]) are gaining attention in clinical and research fields. Obesity-related hypertension frequently precedes the onset of CKD and aggravates its progression. In this review, we discuss the role of visceral fat in the pathophysiology of obesity-related hypertension and the potential therapeutic strategies for its prevention and management. Various factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and inflammatory pathways, are intricately involved in the pathogenesis of obesity-related hypertension. These factors individually and jointly contribute to the development of hypertension (usually sodium-sensitive or resistant hypertension) and, ultimately, to the progression of CKD. From a clinical standpoint, a decline in renal function in advanced CKD further makes blood pressure control challenging since only a few options are available for blood pressure-lowering medications. Proactive lifestyle modification, pharmacological treatment for obesity, and bariatric surgery can be considered for obesity control and management. Furthermore, intensive blood pressure control is required to prevent and halt the development and progression of CKD.
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Grants
- 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, 2016E330 0201, 2016E3300202,2019E320100, 2019E320101, 2019 E320102, 2022-11-007 Korea Disease Control and Prevention Agency
- NRF-2019R1A2C2086276 National Research Foundation of Korea
- BCRI22042, BCRI22079 Chonnam National University Hospital Biomedical Research Institute
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Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee CJ, Hwang J, Kang CY, Kang D, Kim DH, Park HJ, Kim HC, Ihm SH, Kim YJ, Shin JH, Pyun WB, Park S. Asthma and increased risk of myocardial infarction and mortality among hypertensive Korean patients. Hypertens Res 2023; 46:1694-1704. [PMID: 36991063 DOI: 10.1038/s41440-023-01257-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
This study aimed to evaluate the effects of asthma on cardiovascular disease incidence in patients with hypertension. A total of 639,784 patients with hypertension from the Korea National Health Insurance Service database were included, of whom 62,517 had history of asthma after propensity score matching. The risks of all-cause mortality, myocardial infarction (MI), stroke, and end-stage renal disease (ESRD) were assessed according to the presence of asthma, long-acting β2-agonist (LABA) inhaler usage, and/or systemic corticosteroid usage for up to 11 years. In addition, whether these risks were modified by average blood pressure (BP) levels during the follow-up period was examined. Asthma was associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.203; 95% confidence interval [CI], 1.165-1.241) and MI (HR, 1.244; 95% CI, 1.182-1.310) but not the risk of stroke or ESRD. LABA inhaler usage was associated with a higher risk of all-cause mortality and MI, and systemic corticosteroids usage showed a higher risk of ESRD as well as all-cause mortality and MI among hypertensive patients with asthma. Compared to patients without asthma, there was a graded increase in the risk of all-cause mortality and MI in those with asthma without LABA inhaler/systemic corticosteroid usage and in those with asthma with LABA inhaler/systemic corticosteroid usage. These associations were not significantly modified by BP levels. This nationwide population-based study supports that asthma may be a clinical factor that increases the risk of poor outcomes in patients with hypertension.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Chae Young Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Dayoung Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Do Hyang Kim
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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9
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Jang Y, Seo JM, Ihm SH, Lee HY. Feasibility, credence, and usefulness of out-of-office cuffless blood pressure monitoring using smartwatch: a population survey. Clin Hypertens 2023; 29:15. [PMID: 37259165 DOI: 10.1186/s40885-023-00242-9] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cuffless blood pressure (BP) measurement, enabled by recent advances in wearable devices, allows for BP monitoring in daily life. This study aims to evaluate the feasibility, cresdence, and usefulness of cuffless BP monitoring through a population survey. METHODS During the "Daily BP Measurement with Your Galaxy Watch" campaign held by the Korean Society of Hypertension, participants were asked to share their experiences with cuffless BP measurement using a smartwatch application through an online survey. The questionnaire included questions about age, underlying medical conditions, smartwatch utilization, experience with BP calibration, the reliability of BP values measured by a smartwatch, and willingness to use the BP monitoring function in the future. RESULTS A total of 1071 participants responded to the survey. The largest age group (decile) was 50-59 years old (33.3%), followed by 40-49 years old (29.9%). Although nearly half of the participants (47.5%) had no chronic diseases, 40.1% reported having hypertension. BP monitoring was the most frequently utilized smartwatch function (95.8%), followed by heart rate measurement (87.1%). 31.8% of participants reported that BP values measured by the smartphone application were "very accurate and helpful," while 63.5% rated them as "slightly lower (44.4%)" or "higher (19.1%)" compared to the standard home BP monitoring device. 93% of the participants reported utilizing the BP monitoring function at least once a week. Regarding the BP calibration process, most participants (93.9%) calibrated the BP measurement application themselves, and 50.8% rated the difficulty level as "very easy." CONCLUSION Cuffless BP measurement using a smartwatch application was feasible in the general population, including the self-calibration process. However, the satisfaction level in terms of accuracy is still modest, indicating a need for further development.
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Affiliation(s)
- Yongjun Jang
- Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Mo Seo
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
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10
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Han M, Lee YR, Park T, Ihm SH, Pyun WB, Burkard T, Cho MC, Camafort M, Yang E, Stergiou GS, Lee HY, Seo JM. Feasibility and measurement stability of smartwatch-based cuffless blood pressure monitoring: A real-world prospective observational study. Hypertens Res 2023; 46:922-931. [PMID: 36781979 DOI: 10.1038/s41440-023-01215-z] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
Cuffless wearable devices are currently being developed for long-term monitoring of blood pressure (BP) in patients with hypertension and in apparently healthy people. This study evaluated the feasibility and measurement stability of smartwatch-based cuffless BP monitoring in real-world conditions. Users of the first smartwatch-based cuffless BP monitor approved in Korea (Samsung Galaxy Watch) were invited to upload their data from using the device for 4 weeks post calibration. A total of 760 participants (mean age 43.7 ± 11.9, 80.3% men) provided 35,797 BP readings (average monitoring 22 ± 4 days [SD]; average readings 47 ± 42 per participant [median 36]). Each participant obtained 1.5 ± 1.3 readings/day and 19.7% of the participants obtained measurements every day. BP showed considerable variability, mainly depending on the day and time of the measurement. There was a trend towards higher BP levels on Mondays than on other days of the week and on workdays than in weekends. BP readings taken between 00:00 and 04:00 tended to be the lowest, whereas those between 12:00 and 16:00 the highest. The average pre-post calibration error for systolic BP (difference in 7-day BP before and after calibration), was 6.8 ± 5.6 mmHg, and was increased with higher systolic BP levels before calibration. Smartwatch-based cuffless BP monitoring is feasible for out-of-office monitoring in the real-world setting. The stability of BP measurement post calibration and the standardization and optimal time interval for recalibration need further investigation.
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Affiliation(s)
- Minju Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young-Ro Lee
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Taeyoung Park
- Department of Applied Statistics and Department of Statistics and Data Science, Yonsei University, 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, South Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Woman's University Seoul Hospital, Seoul, South Korea
| | - Thilo Burkard
- Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Miguel Camafort
- ESH Excellence Hypertension Center, Department of Internal Medicine, Geriatrics Section, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eugene Yang
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Jong-Mo Seo
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
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Kim YM, Ohn DW, Kim SH, Kim DH, Park SM, Cho IJ, Ihm SH, Sung KC, Oh KW, Shin J, Lee EM. Direct comparison of an automated oscillometric device with an electronic auscultatory device for epidemiologic survey to evaluate the prevalence of hypertension. Medicine (Baltimore) 2022; 101:e32299. [PMID: 36550921 PMCID: PMC9771199 DOI: 10.1097/md.0000000000032299] [Citation(s) in RCA: 2] [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] [Indexed: 12/24/2022] Open
Abstract
Mercury-free sphygmomanometers are gradually replacing the traditional sphygmomanometers in clinical settings and epidemiological surveys for measuring blood pressure (BP) due to mercury toxicity. No direct comparative studies have evaluated BP differences and statistical errors of automated oscillometric devices (ODs) against electronic auscultatory devices (ADs) for epidemiologic surveys. Herein, we evaluated the validity of ODs for the Korea National Health and Nutrition Examination Survey (KNHANES) using the Universal Standard for BP device validation through a direct comparison with ADs as the reference standard. Four trained observers performed validation on 278 volunteers aged ≥ 19 years with a standardized BP measurement protocol. Agreement between the BP measurements recorded with an OD against those recorded with an AD was assessed by Lin's concordance correlation coefficient (CCC) and Bland-Altman's limits of agreement. To evaluate the agreement for BP classification, weighted kappa values were estimated. To explore the factors associated with BP measurement differences between the 2 devices, multiple linear regression analysis was performed. The average BP differences (OD-AD) were 2.6 ± 6.2 mm Hg for systolic BP (SBP) and -5.1 ± 5.6 mm Hg for diastolic BP (DBP). Lin's CCCs were 0.927 and 0.768 for the overall SBP and DBP, respectively. The cumulative percentage of absolute errors ≤10 mm Hg was 88.1% for SBP and 81.3% for DBP. The weighted kappa value for the Joint National Committee 7 BP classification was 0.75 (95% confidence interval: 0.68-0.81). An OD overestimated the prevalence of SBP (0.3%, P = .0222) and underestimated the prevalence of DBP (1.8%, P < .0001). Multivariate analysis to identify the risk factors for BP difference revealed the arm circumference (AC) to be negatively associated with BP difference. Male sex was positively associated, while age was negatively associated with SBP difference. OD-DBP was positively associated with DBP difference and negatively associated for DBP absolute error. ODs met the accuracy requirements of the Universal Standard criteria against ADs for SBP but not for DBP. Thus, the DBP values may be underestimated by ODs in the KNHANES.
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Affiliation(s)
- Yu-Mi Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Hanyang University School of Public Health, Seoul, Republic of Korea
| | - Dae Woong Ohn
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gyeonggi-do, Republic of Korea
| | - Seong Heon Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Park
- Divison of Cardiology, Dept. Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - In Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, 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
| | - Kyung Won Oh
- Korea Disease Control and Prevention Agency, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gyeonggi-do, Republic of Korea
- * Correspondence: Eun Mi Lee, Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do 15865, Republic of Korea (e-mail: )
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12
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Ihm SH, Park JH, Kim JY, Kim JH, Kim KI, Lee EM, Lee HY, Park S, Shin J, Kim CH. Home blood pressure monitoring: a position statement from the Korean Society of Hypertension Home Blood Pressure Forum. Clin Hypertens 2022; 28:38. [PMID: 36180964 PMCID: PMC9526300 DOI: 10.1186/s40885-022-00218-1] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Home blood pressure measurement (HBPM) has the advantage of measuring blood pressure (BP) multiple times over a long period. HBPM effectively diagnoses stress-induced transient BP elevations (i.e., white coat hypertension), insufficient BP control throughout the day (i.e., masked hypertension), and even BP variability. In most cases, HBPM may increase self-awareness of BP, increasing the compliance of treatment. Cumulative evidence has reported better improved predictive values of HBPM in cardiovascular morbidity and mortality than office BP monitoring. In this position paper, the Korean Society of Hypertension Home Blood Pressure Forum provides comprehensive information and clinical importance on HBPM.
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Affiliation(s)
- Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine and Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ju-Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Ho Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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13
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Jung MH, Yi SW, An SJ, Yi JJ, Ihm SH, Han S, Ryu KH, Jung HO, Youn HJ. Associations between the triglyceride-glucose index and cardiovascular disease in over 150,000 cancer survivors: a population-based cohort study. Cardiovasc Diabetol 2022; 21:52. [PMID: 35429972 PMCID: PMC9013459 DOI: 10.1186/s12933-022-01490-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
Background The prevention of subsequent cardiovascular disease (CVD) is an essential part of cancer survivorship care. We conducted the present study to investigate the association between the TyG index (a surrogate marker of insulin resistance) and the risk of cardiovascular disease (CVD) events in cancer survivors. Methods Adult cancer patients, who underwent routine health examinations during 2009–2010 and were survived for more than 5 years as of January 1, 2011, were followed for hospitalization of CVD (either ischemic heart disease, stroke, or heart failure) until December 2020. Cox model was used to calculate hazard ratios associated with baseline TyG index (loge [fasting triglyceride (mg) × fasting glucose (mg)/2]) for the CVD hospitalization. Results A total of 155,167 cancer survivors (mean age 59.9 ± 12.0 years, female 59.1%) were included in this study. A graded positive association was observed between TyG and CVD hospitalization. An 8% elevated risk for CVD hospitalization was observed for a TyG index of 8-8.4 (aHR 1.08 [95% CI 1.01–1.14]); 10% elevated risk for a TyG index of 8.5–8.9 (aHR 1.10 [95% CI 1.03–1.17]); 23% elevated risk for a TyG index of 9.0-9.4 (aHR 1.23 [95% CI 1.15–1.31]); 34% elevated risk for a TyG index of 9.5–9.9 (aHR 1.34 [95% CI 1.23–1.47]); and 55% elevated risk for a TyG index ≥ 10 compared to the reference group (TyG index < 8). Per 1-unit increase in the TyG index, a 16% increase in CVD hospitalization and a 45% increase in acute myocardial infarction hospitalization were demonstrated. Graded positive associations were evident for atherosclerotic CVD subtypes, such as ischemic heart disease, acute myocardial infarction, and ischemic stroke, but not for hemorrhagic stroke or heart failure. Conclusions The TyG index may serve as a simple surrogate marker for the risk stratification of future CVD events, particularly atherosclerotic subtypes, in cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01490-z.
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Kim HL, Hwang D, Lee JH, Lee HY, Ihm SH, Kim KI, Shin J, Park S, Kim DH, Sung KC. Diuretics versus others for long-term clinical outcomes as first-line antihypertensive medications: analysis of national real-world database. Hypertens Res 2022; 45:758-768. [PMID: 35338336 DOI: 10.1038/s41440-022-00890-8] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023]
Abstract
Although several large trials that included African American patients with hypertension have demonstrated the superiority of diuretics as an initial monotherapy, its applicability to other ethnicities remains questionable. The purpose of this study was to investigate whether diuretics as first-line antihypertensive medications are superior to other classes of drugs in the Korean population. Using the Korean National Health Insurance Service database, we analyzed 95,201 Korean hypertensive patients without prior history of cardiovascular disease who started a single antihypertensive drug between January 2002 and December 2017. The primary endpoint was a composite of cardiovascular death, myocardial infarction and stroke. Each endpoint was compared among five classes of antihypertensive drugs [diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and beta-blockers (BBs)]. In multivariable Cox analysis, diuretics were superior to ACEIs (hazard ratio [HR], 1.58-2.01), inferior to ARBs (HR, 0.37-0.43) and similar to CCBs and BBs for the primary endpoint. Similar findings were obtained for all-cause and cardiovascular mortality and stroke. This result was consistently observed in the longer treatment group and in the propensity score-matched pairs. In Korean hypertensive patients without cardiovascular disease, initiation with diuretics could not be superior to other medications, but rather inferior to ARBs in preventing adverse cardiovascular outcomes. Randomized studies are needed to confirm our results.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Doyeon Hwang
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Hyeok Lee
- Center of Biomedical Data Science, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, 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
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 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.
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15
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Jung MH, Yi SW, An SJ, Youn KH, Yi JJ, Han S, Ihm SH, Jung HO, Youn HJ, Ryu KH. Association of Physical Activity and Lower Respiratory Tract Infection Outcomes in Patients With Cardiovascular Disease. J Am Heart Assoc 2022; 11:e023775. [PMID: 35132873 PMCID: PMC9075310 DOI: 10.1161/jaha.121.023775] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To investigate the dose-response association between physical activity and lower respiratory tract infection (LoRI) outcomes in patients with cardiovascular disease. Methods and Results Using the Korean National Health Insurance data, we identified individuals aged 18 to 99 years (mean age, 62.6±11.3 years; women, 49.6%) with cardiovascular disease who participated in health screening from January 1, 2009, to December 31, 2012 (n=1 048 502), and were followed up until 2018 for mortality and until 2019 for hospitalization. Amount of physical activity was assessed using self-reported questionnaires and categorized into 5 groups: 0 (completely sedentary), <500, 500 to 999, 1000 to 1499, and ≥1500 metabolic equivalents of task min/wk. After controlling for various confounders, adjusted hazard ratios (95% CIs) were 1.00 (reference), 0.74 (0.70-0.78), 0.66 (0.62-0.70), 0.52 (0.47-0.57), and 0.54 (0.49-0.60) for LoRI mortality, and 1.00 (reference), 0.84 (0.83-0.85), 0.77 (0.76-0.79), 0.72 (0.70-0.73), and 0.71 (0.69-0.73) for LoRI hospitalization among those engaging in physical activity of 0, <500, 500 to 999, 1000 to 1499, and ≥1500 metabolic equivalents of task min/wk, respectively. Assuming linear association between 0 and 2000 metabolic equivalents of task min/wk, each 500-metabolic equivalents of task min/wk increase of physical activity was associated with reduced LoRI mortality and hospitalization by 22% and 13%, respectively. The negative association was stronger in the older population than in the younger population (P for interaction <0.01). Conclusions In patients with cardiovascular disease, engaging in even a low level of physical activity was associated with a decreased risk of mortality and hospitalization from LoRI than being completely sedentary, and incremental risk reduction was observed with increased physical activity.
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Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, The Catholic University of Korea Seoul Republic of Korea
| | - Sang-Wook Yi
- Department of Preventive Medicine and Public Health Catholic Kwandong University College of Medicine Gangneung Republic of Korea
| | - Sang Joon An
- Department of Neurology International St. Mary's HospitalCatholic Kwandong University College of Medicine Incheon Republic of Korea
| | - Kwan-Hyun Youn
- Department of Biomedical Art Incheon Catholic University Graduate School Incheon Republic of Korea
| | - Jee-Jeon Yi
- Institute for Occupational and Environmental HealthCatholic Kwandong University Gangneung Republic of Korea
| | - Seongwoo Han
- Cardiovascular Center Dongtan Sacred Heart Hospital, Hallym University College of Medicine Hwaseong-si Republic of 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 Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, The Catholic University of Korea Seoul Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, The Catholic University of Korea Seoul Republic of Korea
| | - Kyu-Hyung Ryu
- Cardiovascular Center Dongtan Sacred Heart Hospital, Hallym University College of Medicine Hwaseong-si Republic of Korea
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Kim DH, Cho IJ, Kim W, Lee CJ, Kim HC, Shin JH, Kang SH, Jung MH, Kwon CH, Lee JH, Kim HL, Kim HM, Cho I, Kang DR, Lee HY, Chung WJ, Kim KI, Cho EJ, Sohn IS, Park S, Shin J, Ryu SK, Kang SM, Pyun WB, Cho MC, Kim JH, Lee JH, Ihm SH, Sung KC. Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets. Korean Circ J 2022; 52:460-474. [PMID: 35388992 PMCID: PMC9160643 DOI: 10.4070/kcj.2021.0330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022] Open
Abstract
From a nation-wide population-based cohort study comprised 237,592 patients with hypertension treated, we found that elevated on-treatment diastolic blood pressures (DBP) by the Seventh Report of Joint National Committee definition (systolic blood pressure [SBP] <140 mmHg with a DBP ≥90 mmHg) was associated a high risk of major cardiovascular events including mortality, while elevated DBP by the 2017 American College of Cardiology/American Heart Association definition (SBP <130, DBP ≥80 mmHg) was only associated with a higher risk of stroke. The results of this study provide evidence of the value of an DBP target in subjects who have achieved SBP goals. Background and Objectives This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated on-treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.
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Affiliation(s)
- Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon-Chang Kim
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hack Lyoung Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyue Mee Kim
- Heart Research Institute, ChungAng University Hospital, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Korea
| | - Kwang Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Il-Suk Sohn
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong, Seoul, Korea
| | - Sungha Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji Medical School of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Hyeok Lee
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ihm SH, Park SH, Lee JO, Kim OR, Park EH, Kim KR, Kim JH, Hwang BH, Youn HJ, Oak MH, Chang K. A Standardized Lindera obtusiloba Extract Improves Endothelial Dysfunction and Attenuates Plaque Development in Hyperlipidemic ApoE-Knockout Mice. Plants (Basel) 2021; 10:plants10112493. [PMID: 34834858 PMCID: PMC8618780 DOI: 10.3390/plants10112493] [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] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 06/01/2023]
Abstract
Lindera obtusiloba extract (LOE), a traditional herbal medicine used to enhance blood circulation and to reduce inflammation, induced NO-mediated endothelium-dependent relaxation, and reduced the formation of reactive oxygen species (ROS). The study investigated whether LOE improves endothelial dysfunction and reduces plaque inflammation and progression by inhibiting ROS generation in a mouse model of atherosclerosis. Eight-week-old apolipoprotein E-deficient (apoE-/-) mice fed with a western diet (WD) were randomized into different groups by administering vehicle (0.5% carboxymethylcellulose (CMC)), LOE (100 mg/kg/day), or losartan (30 mg/kg/day) by gavage until the age of 28 weeks. Fourteen male C57BL/6 mice that were fed normal chow and treated with CMC were used as negative controls. Similar to losartan treatment, LOE treatment induced the concentration-dependent relaxation of aorta rings in WD-fed apoE-/- mice. LOE treatment significantly reduced the vascular ROS formation and expression of NADPH oxidase subunits, including p22phox and p47phox. Compared with WD-fed apoE-/- mice, mice exposed to chronic LOE treatment exhibited reductions in plaque inflammation-related fluorescence signals and atherosclerotic lesions. These effects were greater than those of losartan treatment. In conclusion, LOE treatment improves endothelial dysfunction and reduces plaque inflammation as well as lesion areas by reducing vascular NADPH oxidase-induced ROS generation in a mouse model of atherosclerosis.
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Affiliation(s)
- Sang-Hyun Ihm
- College of Medicine, Cardiovascular Research Institute for Intractable Disease, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.I.); (S.-H.P.); (O.-R.K.); (E.-H.P.); (B.-H.H.); (H.-J.Y.)
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Sin-Hee Park
- College of Medicine, Cardiovascular Research Institute for Intractable Disease, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.I.); (S.-H.P.); (O.-R.K.); (E.-H.P.); (B.-H.H.); (H.-J.Y.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Jung-Ok Lee
- Research and Development Center, Han Wha Pharma, Co., Ltd., Chuncheon 24468, Korea; (J.-O.L.); (K.-R.K.)
| | - Ok-Ran Kim
- College of Medicine, Cardiovascular Research Institute for Intractable Disease, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.I.); (S.-H.P.); (O.-R.K.); (E.-H.P.); (B.-H.H.); (H.-J.Y.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Eun-Hye Park
- College of Medicine, Cardiovascular Research Institute for Intractable Disease, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.I.); (S.-H.P.); (O.-R.K.); (E.-H.P.); (B.-H.H.); (H.-J.Y.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Kyoung-Rak Kim
- Research and Development Center, Han Wha Pharma, Co., Ltd., Chuncheon 24468, Korea; (J.-O.L.); (K.-R.K.)
| | - Jong-Hoon Kim
- Research Center, YangJi Chemicals, Suwon 16229, Korea;
| | - Byung-Hee Hwang
- College of Medicine, Cardiovascular Research Institute for Intractable Disease, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.I.); (S.-H.P.); (O.-R.K.); (E.-H.P.); (B.-H.H.); (H.-J.Y.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Ho-Joong Youn
- College of Medicine, Cardiovascular Research Institute for Intractable Disease, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.I.); (S.-H.P.); (O.-R.K.); (E.-H.P.); (B.-H.H.); (H.-J.Y.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Min-Ho Oak
- College of Pharmacy, Mokpo National University, Muan-gun 58554, Korea
| | - Kiyuk Chang
- College of Medicine, Cardiovascular Research Institute for Intractable Disease, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.I.); (S.-H.P.); (O.-R.K.); (E.-H.P.); (B.-H.H.); (H.-J.Y.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
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Sohn IS, Ihm SH, Kim GH, Park SM, Hong BK, Lee CH, Lee SH, Chang DI, Joo SP, Lee SC, Lee YH, Jeon DW, Jung KT, Rhee SJ, Cho YJ, Kim CJ. Real-world evidence on the strategy of olmesartan-based triple single-pill combination in Korean hypertensive patients: a prospective, multicenter, observational study (RESOLVE-PRO). Clin Hypertens 2021; 27:21. [PMID: 34719392 PMCID: PMC8559412 DOI: 10.1186/s40885-021-00177-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/17/2021] [Accepted: 08/22/2021] [Indexed: 01/22/2023] Open
Abstract
Background In this prospective, multicenter, non-comparative observational study, the effectiveness and safety of the triple single-pill combination (SPC) of olmesartan/amlodipine/hydrochlorothiazide (OM/AML/HCTZ) were evaluated in a real clinical practice setting in Korean patients with essential hypertension. Methods A total of 3752 patients were enrolled and followed for 12 months after administration of OM/AML/HCTZ. Primary endpoint was change from baseline to month 6 in the mean systolic blood pressure (SBP). Secondary endpoints included changes from baseline in the mean SBP at month 3, 9, 12 and the mean diastolic blood pressure (DBP) at month 3, 6, 9, 12; changes in the mean SBP/DBP according to age and underlying risk factors; and blood pressure control rate (%) at different time points. Adherence to and satisfaction with OM/AML/HCTZ treatment among patients and physicians were assessed by medication possession ratio (MPR) and numeric rating scale, respectively, as exploratory endpoints. Safety was evaluated by the incidence and severity of adverse events (AEs) as well as the discontinuation rate due to AEs. Results OM/AML/HCTZ administration led to significant reductions in the mean SBP/DBP by 11.5/6.6, 12.3/7.0, 12.3/7.2, and 12.8/7.4 mmHg from baseline to month 3, 6, 9 and 12, respectively (P < 0.0001). The BP reductions were maintained throughout the 1-year observation period in all patients with different age groups and risk factors (diabetes mellitus, cardiovascular disease, and renal disease). The BP control rate (%) of < 140/90 mmHg was 65.9, 67.9, 68.9, and 70.6% at month 3, 6, 9, and 12, respectively. The mean MPR during the observation period was 0.96. The safety results were consistent with the previously reported safety profile of OM/AML/HCTZ. Conclusions Treatment with the triple SPC of OM/AML/HCTZ demonstrated significant effectiveness in reducing SBP/DBP and achieving target BP control with high adherence over the 1-year observation period in Korean hypertensive patients and was well-tolerated. Trial registration CRIS, KCT0002196, Registered 3 May 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00177-z.
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Affiliation(s)
- Il Suk Sohn
- Department of Internal Medicine, Division of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Department of Internal Medicine, Division of Cardiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Gee Hee Kim
- Department of Internal Medicine, Division of Cardiology, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Bum-Kee Hong
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Hoon Lee
- Department of Internal Medicine, Division of Cardiology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Sang Hyun Lee
- Department of Internal Medicine, Division of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sang-Chan Lee
- Department of Neurology, Dong-Eui Hospital, Busan, Republic of Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Woon Jeon
- Department of Internal Medicine, Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kyung Tae Jung
- Department of Internal Medicine, Division of Cardiology, Eulji University Hospital, Daejeon, Republic of Korea
| | - Si Jae Rhee
- Medical Affairs Department, Daiichi Sankyo Korea Co., Ltd., Seoul, Republic of Korea
| | - Yoon-Jin Cho
- Medical Affairs Department, Daiichi Sankyo Korea Co., Ltd., Seoul, Republic of Korea
| | - Chong-Jin Kim
- Department of Cardiology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea.
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Kim CW, Hwang BH, Moon H, Kang J, Park EH, Ihm SH, Chang K, Hong KS. In vivo MRI detection of intraplaque macrophages with biocompatible silica-coated iron oxide nanoparticles in murine atherosclerosis. J Appl Biomater Funct Mater 2021; 19:22808000211014751. [PMID: 34520279 DOI: 10.1177/22808000211014751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Identification of a vulnerable atherosclerotic plaque before rupture is an unmet clinical need. Integrating nanomedicine with multimodal imaging has the potential to precisely detect biological processes in atherosclerosis. We synthesized silica-coated iron oxide nanoparticles (SIONs) coated with rhodamine B isothiocyanate and polyethylene glycol and investigated their feasibility in the detection of macrophages in inflamed atherosclerotic plaques of apolipoprotein E-deficient (ApoE-/-) mice via magnetic resonance (MR) and fluorescence reflectance (FR) imaging. In vitro cellular uptake of SIONs was assessed in macrophages using confocal laser scanning microscopy (CLSM). In vivo MR imaging was performed 24 h after SION injection via the tail vein in 26-week-old ApoE-/- mice fed a high-cholesterol diet (HCD). We also performed FR imaging of the extracted aortas from four different mice: two normal-diet-fed C57BL/6 mice injected with saline or 10 mg/kg SIONs and two HCD-fed ApoE-/- mice injected with 5 or 10 mg/kg SIONs. The harvested aortas were cryosectioned and stained with immunohistochemical staining. The CLSM images at 24 h after incubation showed efficient uptake of SIONs by macrophages, with no evidence of cytotoxicity. The in vivo and ex vivo MR and FR images demonstrated SION deposition in the atheroma. Upon immunohistochemical staining of the aorta, CLSM images revealed colocalization of macrophages and SIONs in the atherosclerotic plaque. These results demonstrate that polyethylene glycosylated SIONs could be a highly effective method to identify macrophage activity in atherosclerotic plaques as a multimodal imaging agent.
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Affiliation(s)
- Chan Woo Kim
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Hee Hwang
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeyoung Moon
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea
| | - Jongeun Kang
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Graduate School of Analytical Science and Technology, Chungnam National University, Daejeon, Republic of Korea
| | - Eun-Hye Park
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Kiyuk Chang
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan Soo Hong
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Graduate School of Analytical Science and Technology, Chungnam National University, Daejeon, Republic of Korea
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Choi J, Sung KC, Ihm SH, Yoon CH, Park SW, Park SH, Kim JY, Kwon SU, Lee HY. Central blood pressure lowering effect of telmisartan-rosuvastatin single-pill combination in hypertensive patients combined with dyslipidemia: A pilot study. J Clin Hypertens (Greenwich) 2021; 23:1664-1674. [PMID: 34384001 PMCID: PMC8678791 DOI: 10.1111/jch.14345] [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: 05/25/2021] [Revised: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
This multicenter, phase 4, Prospective Randomized Open, Blinded End‐point (PROBE) study aimed to evaluate safety and efficacy of telmisartan/rosuvastatin single‐pill combination (SPC) therapy on lowering central blood pressure (BP) compared with telmisartan monotherapy in hypertensive patients with dyslipidemia in Korea. Study was terminated earlier than planned due to COVID‐19 pandemic, thus should be considered as a pilot study. Among 125 patients who met the inclusion criteria of hypertension and dyslipidemia (defined as 10‐year Atherosclerotic Cardiovascular Disease risk score over 5%), 80 patients went through 4‐week single‐group run‐in period with telmisartan 40–80 mg, then randomized to telmisartan 80 mg + rosuvastatin (10 or 20 mg) SPC group or telmisartan 80 mg monotherapy group. The central/brachial BP, brachial‐ankle pulse wave velocity (baPWV), and augmentation index (AIx) were assessed at baseline and 16 weeks later. Mean brachial SBP changed from 135.80 ± 14.22 mmHg to 130.69 ± 13.23 mmHg in telmisartan/rosuvastatin group and from 134.37 ± 12.50 mmHg to 133.75 ± 12.30 mmHg in telmisartan monotherapy group without significant difference (between‐group difference p = .149). Mean central SBP were reduced significantly in the telmisartan/rosuvastatin group with change from 126.72 ± 14.44 mmHg to 121.56 ± 14.56 mmHg while telmisartan monotherapy group showed no significant change (between‐group difference p = .028). BaPWV changed from 1672.57 ± 371.72 m/s to 1591.75 ± 272.16 m/s in telmisartan/rosuvastatin group and from 1542.85 ± 263.70 m/s to 1586.12 ± 297.45 m/s in telmisartan group with no significance (between‐group difference p = .078). Change of AIx had no significant difference (between‐group difference p = .314). Both groups showed excellent compliance rate of 96.9 ± 4.5% with no significant difference in adverse rate. Telmisartan/rosuvastatin SPC therapy was more effective in lowering central BP compared with the telmisartan monotherapy. The results of this study showed benefit of additive statin therapy in hypertensive patients combined with dyslipidemia.
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Affiliation(s)
- JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center & Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ha Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jang-Young Kim
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea.,Institute of Genomic Cohort, Yonsei University, Wonju, Republic of Korea
| | - Sung-Uk Kwon
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Hwang BH, Kim E, Park EH, Kim CW, Lee KY, Kim JJ, Choo EH, Lim S, Choi IJ, Kim CJ, Ihm SH, Chang K. AIMP3 induces laminopathy and senescence of vascular smooth muscle cells by reducing lamin A expression and leads to vascular aging in vivo. Exp Gerontol 2021; 153:111483. [PMID: 34274427 DOI: 10.1016/j.exger.2021.111483] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/26/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
Aminoacyl-tRNA synthetase-interacting multifunctional protein 3 (AIMP3), a tumor suppressor, mediates a progeroid phenotype in mice by downregulating lamin A. We investigated whether AIMP3 induces laminopathy and senescence of human aortic smooth muscle cells (HASMCs) and is associated with vascular aging in mice and humans in line with decreased lamin A expression. Cellular senescence was evaluated after transfecting HASMCs with AIMP3. Molecular analyses of genes encoding AIMP3, lamin A, chemokine (C-C motif) ligand 2 (CCL2), and C-C chemokine receptor type 2 (CCR2) and histological comparisons of aortas were performed with mice at various ages (7 weeks, 5 months, 12 months, 24 months, and 32 months), AIMP3-transgenic mice, and human femoral arteries of cadavers. AIMP3-transfected HASMCs exhibited increased AIMP3 and senescence marker p16 protein expression and decreased lamin A protein expression in accordance with their disrupted nuclear morphology in histological analyses. AIMP3-transgenic mice displayed increased AIMP3 protein expression and decreased lamin A protein expression in aortas together with typical aging pathologies. Similar changes were observed in wild-type aging (24-month-old) mice but not in wild-type young (7-week-old) mice. In humans, AIMP3 and lamin A protein expression was higher and lower, respectively, in femoral arteries of elderly individuals than in those of their younger counterparts. This study found that AIMP3 overexpression in vitro decreased lamin A expression and induced nuclear laminopathy and cellular senescence. Similar findings were made in the vasculature of aging mice and elderly humans.
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Affiliation(s)
- Byung Hee Hwang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunmin Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Hye Park
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Woo Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan-Yong Lee
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Jin Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ho Choo
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Lim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Ik Jun Choi
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Chan Joon Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Sang-Hyun Ihm
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Kiyuk Chang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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22
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Kwon CH, Kim W, Shin JH, Lee CJ, Kim HC, Kang SH, Jung MH, Kim DH, Lee JH, Kim HL, Kim HM, Cho IJ, Cho I, Kang DR, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Park S, Shin J, Ryu SK, Kang SM, Cho MC, Kim JH, Lee JH, Kim JY, Pyun WB, Sung KC. Office Blood Pressure Range and Cardiovascular Events in Patients With Hypertension: A Nationwide Cohort Study in South Korea. J Am Heart Assoc 2021; 10:e017890. [PMID: 33739126 PMCID: PMC8174356 DOI: 10.1161/jaha.120.017890] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background It is unclear what office blood pressure (BP) is the optimal treatment target range in patients with hypertension. Methods and Results Using the Korean National Health Insurance Service database, we extracted the data on 479 359 patients with hypertension with available BP measurements and no history of cardiovascular events from 2002 to 2011. The study end point was major cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. This cohort study evaluated the association of BP levels (<120/<70, 120–129/70–79, 130–139/80–89, 140–149/90–99, and ≥150/≥100 mm Hg) with MACE. During a median follow‐up of 9 years, 55 401 MACE were documented in our cohort. The risk of MACE was the lowest (adjusted hazard ratio [HR], 0.79; 95% CI, 0.76–0.84) at BP level of <120/<70 mm Hg, and was the highest (HR, 1.32; 95% CI, 1.29–1.36) at ≥150/≥100 mm Hg in comparison with 130 to 139/80 to 89 mm Hg. These results were consistent in all age groups and both sexes. Among patients treated with antihypertensive medication (n=237 592, 49.5%), in comparison with a BP level of 130 to 139/80 to 89 mm Hg, the risk of MACE was significantly higher in patients with elevated BP (≥140/≥90 mm Hg), but not significantly lower in patients with BP of <130/<80 mm Hg. Low BP <120/70 mm Hg was associated with increased risk of all‐cause or cardiovascular death in all age groups. Conclusions BP level is significantly correlated with the risk of MACE in all Korean patients with hypertension. However, there were no additional benefits for MACE amongst those treated for hypertension with BP <120/70 mm Hg.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology Department of Internal Medicine Konkuk University Medical Center Konkuk University School of Medicine Seoul Republic of Korea
| | - Woohyeun Kim
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Hyeon-Chang Kim
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Si-Hyuck Kang
- Cardiovascular Centre Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Mi-Hyang Jung
- Cardiovascular Center Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Hack Lyoung Kim
- Department of Internal Medicine Seoul National University College of MedicineBoramae Medical Center Seoul Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology Department of Internal Medicine Chung-Ang University HospitalChung-Ang University Seoul Republic of Korea
| | - In Jeong Cho
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Iksung Cho
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Dae Ryong Kang
- Department of Precision Medicine Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology Department of Internal Medicine Gil Hospital Gachon University Incheon Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology Department of Internal Medicine Bucheon St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology Department of Internal Medicine Yeouido St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology Department of Internal Medicine Kyung Hee University at Gangdong Seoul Republic of Korea
| | - Sungha Park
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Jinho Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology Department of Internal Medicine Eulji Medical School of Medicine Seoul Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Ju Han Kim
- Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Jun Hyeok Lee
- Department of Biostatistics Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Jang-Young Kim
- Department of Cardiology Yonsei University Wonju College of Medicine Wonju Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
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23
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Shin JH, Jung MH, Kwon CH, Lee CJ, Kim DH, Kim HL, Kim W, Kang SH, Lee JH, Kim HM, Cho IJ, Cho I, Lee JH, Kang DR, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Kim HC, Park S, Shin J, Kim JH, Ryu SK, Kang SM, Pyun WB, Cho MC, Sung KC. Disparities in Mortality and Cardiovascular Events by Income and Blood Pressure Levels Among Patients With Hypertension in South Korea. J Am Heart Assoc 2021; 10:e018446. [PMID: 33719521 PMCID: PMC8174369 DOI: 10.1161/jaha.120.018446] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Socioeconomic status is associated with differences in risk factors of cardiovascular disease and increased risks of cardiovascular disease and mortality. However, it is unclear whether an association exists between cardiovascular disease and income, a common measure of socioeconomic status, among patients with hypertension. Methods and Results This population‐based longitudinal study comprised 479 359 patients aged ≥19 years diagnosed with essential hypertension. Participants were categorized by income and blood pressure levels. Primary end point was all‐cause and cardiovascular mortality and secondary end points were cardiovascular events, a composite of cardiovascular death, myocardial infarction, and stroke. Low income was significantly associated with high all‐cause (hazard ratio [HR], 1.26; 95% CI, 1.23–1.29, lowest versus highest income) and cardiovascular mortality (HR, 1.31; 95% CI, 1.25–1.38) as well as cardiovascular events (HR, 1.07; 95% CI, 1.05–1.10) in patients with hypertension after adjusting for age, sex, systolic blood pressure, body mass index, smoking status, alcohol consumption, physical activity, fasting glucose, total cholesterol, and the use of aspirin or statins. In each blood pressure category, low‐income levels were associated with high all‐cause and cardiovascular mortality and cardiovascular events. The excess risks of all‐cause and cardiovascular mortality and cardiovascular events associated with uncontrolled blood pressure were more prominent in the lowest income group. Conclusions Low income and uncontrolled blood pressure are associated with increased all‐cause and cardiovascular mortality and cardiovascular events in patients with hypertension. These findings suggest that income is an important aspect of social determinants of health that has an impact on cardiovascular outcomes in the care of hypertension.
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Affiliation(s)
- Jeong-Hun Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Mi-Hyang Jung
- Cardiovascular Center Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine Konkuk University Medical Center Konkuk University School of Medicine Seoul Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology Department of Internal Medicine Yonsei University College 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
| | - Hack-Lyoung Kim
- Department of Internal Medicine Seoul National University College of MedicineBoramae Medical Center Seoul Republic of Korea
| | - Woohyeun Kim
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology Department of Internal Medicine Cardiovascular Center Mediplex Sejong Hospital Incheon 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 Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Jun Hyeok Lee
- Center of Biomedical Data Science Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology Department of Internal Medicine Gil Hospital Gachon University Incheon Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology Department of Internal Medicine Bucheon St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology Department of Internal Medicine Yeouido St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology Department of Internal Medicine KyungHee University at Gangdong Seoul Republic of Korea
| | - Hyeon-Chang Kim
- Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Sungha Park
- Division of Cardiology Department of Internal Medicine 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
| | - Ju Han Kim
- Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology Department of Internal Medicine Eulji Medical School of Medicine Seoul Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology Department of Internal Medicine 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 HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
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24
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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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25
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Jung MH, Ihm SH, Lee DH, Han S, Jung HO, Youn HJ, Ryu KH. Sex-specific associations of obesity with exercise capacity and diastolic function in Koreans. Nutr Metab Cardiovasc Dis 2021; 31:254-262. [PMID: 33097412 DOI: 10.1016/j.numecd.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Women with obesity are highly predominant among patients with heart failure with preserved ejection fraction (HFpEF). We aimed to elucidate sex-specific associations of obesity with exercise capacity and diastolic function. METHODS AND RESULTS Healthy individuals without known cardiovascular diseases undergoing cardiopulmonary exercise test and echocardiography (n = 736) were included and categorized into 4 groups according to their sex and obesity. Exercise capacity was lower in women than men. Obesity was associated with a lower exercise capacity in women (23.5 ± 7.3 vs. 21.3 ± 5.4 ml/kg/min, p < 0.05) but not in men (28.2 ± 7.8 vs. 28.0 ± 6.6 ml/kg/min, p > 0.10). Overall, women had a higher E/e' than men. Women without obesity had a similar E/e' to men with obesity (8.2 ± 1.8 vs. 8.4 ± 2.1, p > 0.10), and women with obesity had the highest E/e'. Among 5 risk factors (aging, obesity, elevated blood pressure, elevated heart rate, and elevated fasting glucose), obesity was a significant determinant of exercise intolerance in women but not men. Furthermore, obesity was associated with a greater risk of diastolic dysfunction in women than men (women, adjusted odds ratio 4.35 [95% confidence interval 2.44-7.74]; men, adjusted odds ratio 2.91 [95% confidence interval 1.42-5.95]). CONCLUSION Obesity had a more deleterious effect on exercise capacity and diastolic function in women than men, even in a healthy cohort. These subclinical changes might contribute to the development of a female predominance among HFpEF patients, particularly among individuals with obesity.
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Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaweong, Republic of 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, Republic of Korea.
| | - Dong-Hyeon Lee
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seongwoo Han
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaweong, Republic of Korea
| | - Hae Ok Jung
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho-Joong Youn
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu-Hyung Ryu
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaweong, Republic of Korea
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26
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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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Kim HL, Kim HM, Kwon CH, Shin JH, Jung MH, Lee CJ, Kim DH, Kim WH, Kang SH, Lee JH, Cho IJ, Cho I, Lee JH, Kang DR, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Kim HC, Shin J, Kim JH, Ryu SK, Kang SM, Pyun WB, Cho MC, Park S, Sung KC. Blood pressure levels and cardiovascular risk according to age in patients with diabetes mellitus: a nationwide population-based cohort study. Cardiovasc Diabetol 2020; 19:181. [PMID: 33076934 PMCID: PMC7574489 DOI: 10.1186/s12933-020-01156-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/10/2020] [Indexed: 02/08/2023] Open
Abstract
Background Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. Methods Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. Results Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130–139/80–89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130–139/80–89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130–139/80–89 mmHg and BP 120–129/70–79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130–139/80–89 mmHg at all ages. Conclusions In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130–139/80–89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130–139/80–89 mmHg at the age of ≥ 70.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School 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
| | - Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, 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
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, 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, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jun Hyeok Lee
- Center of Biomedical Data Science, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - 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, KyungHee University at Gangdong, Seoul, Republic of Korea
| | - Hyeon-Chang Kim
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji Medical School of Medicine, Seoul, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, 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 Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, 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, 03181, Republic of Korea.
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Ihm SH, Chung WB, Lee JM, Hwang BH, Yoo KD, Her SH, Song WH, Chae IH, Park TH, Kim JH, Jeon DW, Cho BR, Kang SH, Park SD, Lee JB, Woo JT, Lee BW, Han KA, Won KH, Kim HS, Yu JM, Chung CH, Kim HJ, Cho HC, Seung KB. Efficacy and Tolerability of Pitavastatin Versus Pitavastatin/Fenofibrate in High-risk Korean Patients with Mixed Dyslipidemia: A Multicenter, Randomized, Double-blinded, Parallel, Therapeutic Confirmatory Clinical Trial. Clin Ther 2020; 42:2021-2035.e3. [PMID: 32891418 DOI: 10.1016/j.clinthera.2020.08.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/20/2020] [Accepted: 08/05/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Dyslipidemia is an important risk factor for cardiovascular disease (CVD). Statins are known to effectively reduce not only low-density lipoprotein cholesterol (LDL-C) level but also death and nonfatal myocardial infarction due to coronary heart disease. The risk for CVD from atherogenic dyslipidemia persists when elevated triglyceride (TG) and reduced high-density lipoprotein cholesterol (HDL-C) levels are not controlled with statin therapy. Therefore, statin/fenofibrate combination therapy is more effective in reducing CVD risk. Here, we assessed the efficacy and tolerability of pitavastatin/fenofibrate combination therapy in patients with mixed dyslipidemia and a high risk for CVD. METHODS This multicenter, randomized, double-blind, parallel-group, therapeutic-confirmatory clinical trial evaluated the efficacy and tolerability of fixed-dose combination therapy with pitavastatin/fenofibrate 2/160 mg in Korean patients with a high risk for CVD and a controlled LDL-C level (<100 mg/dL) and a TG level of 150-500 mg/dL after a run-in period with pitavastatin 2 mg alone. In the 8-week main study, 347 eligible patients were randomly assigned to receive pitavastatin 2 mg with or without fenofibrate 160 mg after a run-in period. In the extension study, patients with controlled LDL-C and non-HDL-C (<130 mg/dL) levels were included after the completion of the main study. All participants in the extension study received the pitavastatin/fenofibrate combination therapy for 16 weeks for the assessment of the tolerability of long-term treatment. FINDINGS The difference in the mean percentage change in non-HDL-C from baseline to week 8 between the combination therapy and monotherapy groups was -12.45% (95% CI, -17.18 to -7.72), and the combination therapy was associated with a greater reduction in non-HDL-C. The changes in lipid profile, including apolipoproteins, fibrinogen, and high-sensitivity C-reactive protein from baseline to weeks 4 and 8 were statistically significant with combination therapy compared to monotherapy at all time points. Furthermore, the rates of achievement of non-HDL-C and apolipoprotein B targets at week 8 in the combination therapy and monotherapy groups were 88.30% versus 77.98% (P = 0.0110) and 78.94% versus 68.45% (P = 0.0021), respectively. The combination therapy was well tolerated, with a safety profile similar to that of statin monotherapy. IMPLICATIONS In these Korean patients with mixed dyslipidemia and a high risk for CVD, combination therapy with pitavastatin/fenofibrate was associated with a greater reduction in non-HDL-C compared with that with pitavastatin monotherapy, and a significantly improvement in other lipid levels. Moreover, the combination therapy was well tolerated, with a safety profile similar to that of statin monotherapy. Therefore, pitavastatin/fenofibrate combination therapy could be effective and well tolerated in patients with mixed dyslipidemia. ClinicalTrials.gov identifier: NCT03618797.
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Affiliation(s)
- Sang-Hyun Ihm
- Department of Internal Medicine, Bucheon St. Mary's Hospital, Bucheon, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo-Baek Chung
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong-Min Lee
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung-Hee Hwang
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki-Dong Yoo
- Department of Internal Medicine, St. Vincent's Hospital, Suwon, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Ho Her
- Department of Internal Medicine, St. Vincent's Hospital, Suwon, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo-Hyuk Song
- Department of Internal Medicine, Ansan Hospital, Korea University, Ansan, South Korea
| | - In-Ho Chae
- Department of Internal Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam, South Korea
| | - Tae-Ho Park
- Department of Internal Medicine, Dong-A University Hospital, Busan, South Korea
| | - Ju-Han Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Dong Woon Jeon
- Department of Internal Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea
| | - Byung-Ryul Cho
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Seung-Ho Kang
- Department of Internal Medicine, Cheju Halla General Hospital, Jeju, South Korea
| | - Sang-Don Park
- Department of Internal Medicine, Inha University Hospital, Incheon, South Korea
| | - Jin-Bae Lee
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Jeong-Taek Woo
- Department of Internal Medicine, Kyunghee University Medical Center, Seoul, South Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea
| | - Kyung-Ah Han
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Kyung-Heon Won
- Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jae-Myung Yu
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, South Korea
| | - Choon Hee Chung
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Hae-Jin Kim
- Department of Internal Medicine, Ajou University Hospital, Suwon, South Korea
| | - Ho-Chan Cho
- Department of Internal Medicine, Dongsan Hospital, Keimyung University, Daegu, South Korea
| | - Ki-Bae Seung
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Kim TY, Ihm SH, Roh JW, Lim S, Park CS, Kim HY. Massive pulmonary thromboembolism combined with transient thyrotoxicosis in an 18 year old girl. Clin Hypertens 2020; 26:17. [PMID: 32884835 PMCID: PMC7461343 DOI: 10.1186/s40885-020-00150-2] [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: 03/04/2020] [Accepted: 07/20/2020] [Indexed: 12/05/2022] Open
Abstract
Background Pulmonary thromboembolism (PTE) is thought to usually stem from deep vein thrombosis (DVT). However, evidence of DVT could not be found in many cases. Furthermore, transient thyrotoxicosis is a rare but potentially life–threatening emergency involving a systemic hypercoagulable state. We report on an 18 year-old-girl with transient thyrotoxicosis with massive PTE without DVT. Case presentation An 18-year-old girl was admitted to the hospital with syncope. Patient had no history of trauma, any known underlying disease or oral contraceptives use. Chest computed tomography (CT) showed massive PTE in both central pulmonary arteries and diffuse goiter. However, a low extremity Doppler sonogram did not detect DVT. To manage the PTE, we administered low molecular weight heparin. On the other hands, thyroid function test indicated a state of thyrotoxicosis. In addition, patient had a partial protein S deficiency but no other immunologic abnormality. Therefore, the patient was diagnosed with massive PTE, thyrotoxicosis, and partial protein S deficiency. Patient was discharged with oral warfarin and methimazole. A follow-up echocardiogram obtained 3 months after anticoagulation therapy demonstrated normal dimensions and systolic function. After thyrotoxicosis was treated with methimazole for a month, a euthyroid state was achieved and the goiter decreased to a normal size. The methimazole was gradually tapered off and stopped at 4 months. At a 6-month follow up visit, PTE and pulmonary hypertension had disappeared but the patient still had a partial protein S deficiency. We decided to stop all medication with careful monitoring. During a 4-year follow-up period after the episode, she was asymptomatic without any evidence of recurrent systemic thromboembolism or hyperthyroidism. Conclusions Early recognition and appropriate treatment of PTE combined with transient thyrotoxicosis were vital to preventing other complications.
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Affiliation(s)
- Tong-Yoon Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea
| | - Sang-Hyun Ihm
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea
| | - Ji Woong Roh
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea
| | - Sungmin Lim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea
| | - Chan-Seok Park
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea
| | - Hee-Yeol Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea
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Jung MH, Shin ES, Ihm SH, Jung JG, Lee HY, Kim CH. The effect of alcohol dose on the development of hypertension in Asian and Western men: systematic review and meta-analysis. Korean J Intern Med 2020; 35:906-916. [PMID: 31795024 PMCID: PMC7373951 DOI: 10.3904/kjim.2019.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 01/10/2019] [Accepted: 02/08/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS There are inconsistencies in the effects of low to moderate dose alcohol consumption on the development of hypertension in adult men. We hypothesized that a region-specific effect might participate in this heterogeneity. METHODS We conducted a systematic review and meta-analysis to evaluate the effect of alcohol dose on hypertension incidence using contemporary data through December 2017. Subjects were categorized according to their level of alcohol consumption as non-drinkers (reference) and low- (0.01 to 20.0 g/day), moderate- (20.1 to 40.0 g/day), moderate- to high- (40.1 to 60.0 g/day), and high-dose (> 60.0 g/day) drinkers. We defined hypertension as a blood pressure ≥ 140/90 mmHg and/or the use of anti-hypertensive drugs. RESULTS In total, 11 articles (seven Asian and four Western) were selected for our analysis. Among Asian men, a significantly elevated risk was observed even in the low alcohol dose group in comparison with the group with no alcohol consumption, and the risk increased in a dose-dependent manner (pooled relative risks [95% confidence intervals (CI)]: 1.25 [1.13 to 1.38], 1.48 [1.27 to 1.72], 1.75 [1.43 to 2.15], and 1.78 [1.51 to 2.09]). Among Western men, a similar dose-response relationship was noted in general (p for subgroup difference > 0.1), but a significantly elevated risk was evident only in the high-dose group (pooled relative risks [95% CI]: 1.22 [0.85 to 1.74], 1.57 [0.90 to 2.75], 1.47 [0.44 to 4.91], and 1.49 [1.02 to 2.18]). CONCLUSION Even low doses of alcohol can lead to the development of hypertension, particularly in Asian men. Our findings could serve as additional evidence for developing an appropriate preventive strategy in each region.
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Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Ein-Soon Shin
- Research Agency for Clinical Practice Guidelines, KAMS Research Center, Korean Academy of Medical Sciences, Seoul, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Sang-Hyun Ihm, M.D. Division of Cardiology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea Tel: +82-32-340-7027, Fax: +82-32-340-2669, E-mail:
| | - Jin-Gyu Jung
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Park S, Lee HY, Cho EJ, Sung KC, Kim J, Kim DH, Ihm SH, Kim KI, Sohn IS, Chung WJ, Kim HC, Ryu SK, Pyun WB, Shin J. Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic? Clin Hypertens 2020; 26:11. [PMID: 32391169 PMCID: PMC7202902 DOI: 10.1186/s40885-020-00144-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 12/31/2022] Open
Abstract
Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-Angiotensin-Aldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Hae Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital., College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Juhan Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital., College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwang-il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Il-Suk Sohn
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong, Seoul, South Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, South Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, 222 Wangsimni-ro Sungdong-gu, Seoul, South Korea
| | - on behalf of the Korean Society of Hypertension
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital., College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital., College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, South Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, 222 Wangsimni-ro Sungdong-gu, Seoul, South Korea
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Chung WB, Ihm SH, Jang SW, Her SH, Park CS, Lee JM, Chang K, Jeon DS, Yoo KD, Seung KB. Effect of Fimasartan versus Valsartan and Olmesartan on Office and Ambulatory Blood Pressure in Korean Patients with Mild-to-Moderate Essential Hypertension: A Randomized, Double-Blind, Active Control, Three-Parallel Group, Forced Titration, Multicenter, Phase IV Study (Fimasartan Achieving Systolic Blood Pressure Target (FAST) Study). Drug Des Devel Ther 2020; 14:347-360. [PMID: 32158190 PMCID: PMC6986172 DOI: 10.2147/dddt.s231293] [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] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022]
Abstract
Purpose Head-to-head comparison of the blood pressure (BP) lowering effect of fimasartan versus valsartan, with olmesartan as a reference, on office blood pressure and ambulatory BP. Patients and Methods Of the 369 randomly assigned patients in this study, 365 hypertensive patients were referred as the full analysis set and divided into 3 groups with a 3:3:1 ratio (fimasartan group: 155, valsartan group: 157, olmesartan group: 53). After the 2-week single-blind placebo run-in period, initial standard doses of 60-mg fimasartan, 80-mg valsartan, and 10-mg olmesartan were administered for 2 weeks, then forcibly up-titrated higher doses (fimasartan 120 mg, valsartan 160 mg, olmesartan 20 mg) were given for 4 weeks. ABP was measured before and after the 6-week treatment. Primary endpoint was reduction of sitting office systolic BP (SiSBP) of fimasartan compared to valsartan after 6 weeks. Secondary endpoints were reduction of sitting office diastolic BP (SiDBP) and 24 hrs, day-time, and night-time mean systolic and diastolic ABP (ASBP, ADBP) after 6 weeks. Results Patients’ mean age was 58.34±7.68 years, and 289 patients were male (79.18%). After the 6-week treatment, SiSBP reduction of fimasartan and valsartan were −16.26±15.07 and −12.81±13.87 (p=0.0298) and SiDBP were −7.63±9.67 and −5.14±8.52 (p=0.0211). Reductions in 24 hrs mean ASBP were −15.22±13.33 and −9.45±12.37 (p=0.0009), and ADBPs were −8.74±7.55 and −5.98±7.85 (p=0.0140). Reductions of night-time ASBPs were −16.80±15.81 and −10.32±14.88 (p=0.0012), and those of night-time ADBPs were −8.89±9.93 and −5.55±9.70 (p=0.0152). Reduction of BP in olmesartan group did not demonstrate significant difference with fimasartan group in all end-points. Conclusion Fimasartan 120-mg treatment demonstrated superior efficacy in reduction of SiSBP, SiDBP, and 24 hrs ASBP and ADBP compared to valsartan 160 mg. Reduction of night-time ASBP from baseline was largest in fimasartan group, suggesting that fimasartan may be effective for recovering dipping pattern. NCT number NCT02495324 (Fimasartan Achieving SBP Target (FAST) study).
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Affiliation(s)
- Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 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
| | - Sung-Won Jang
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital
| | - Sung-Ho Her
- Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo-Soo Jeon
- Division of Cardiology, Department of Internal Medicine, In-Cheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Roh JW, Kwon BJ, Ihm SH, Lim S, Park CS, Chang K, Chung WS, Kim DB, Kim SR, Kim HY. Predictors of Significant Coronary Artery Disease in Patients with Cerebral Artery Atherosclerosis. Cerebrovasc Dis 2019; 48:226-235. [PMID: 31825937 DOI: 10.1159/000504927] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE There are few existing data on the status of coronary artery disease (CAD) in patients with atherosclerosis of the cerebral artery detected by brain imaging studies. We aimed to analyze the predictors of asymptomatic angiographically significant CAD detected by simultaneous cerebral and coronary angiography. METHODS This retrospective cohort study screened data obtained between August 2009 and April 2019; 11,047 patients underwent cerebral angiography for atherosclerotic change (>50% stenosis or aneurysm) seen in brain magnetic resonance angiography (MRA) or computed tomography angiography (CTA) at a single center by endovascular neurosurgeon's decision. Of these, 700 patients including 622 patients who underwent simultaneous coronary and cerebral angiography and 78 patients who underwent coronary angiography within a month were enrolled. We investigated the characteristics and predictors of angiographically significant CAD (>50% stenosis). Furthermore, we also analyzed the major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, myocardial infarction, and stroke for 5 years. RESULTS The frequency of significant CAD was 59% (413/700), the mean age was 68.9 ± 10.3 years, and 60.6% were male. During mean follow-up of 50 months, the MACCE rate of our whole cohort was significantly higher in the CAD group (21.5%) than in the non-CAD group (14.6%; hazard ratio 1.65, 95% CI 1.17-2.33, p value = 0.005). Considering that the embolic stroke is less associated with atherosclerotic change, our predictive model of significant CAD was made without embolic stroke (n = 599). In our multivariate model 2 including univariate <0.1, the independent predictors of significant CAD were male (OR 1.62, 95% CI 1.11-2.35, p = 0.012), diabetes mellitus (OR 1.81, 95% CI 1.22-2.68, p = 0.003), previous stroke (OR 1.63, 95% CI 1.02-2.60, p = 0.039), low ankle-brachial index (ABI; <0.9; OR 3.25, 95% CI 1.21-8.73, p = 0.019), left ventricular ejection fraction (EF) <50% on echocardiography (OR 2.82, 95% CI 1.25-6.35, p = 0.012), troponin I or T positive (OR 2.76, 95% CI 1.69-4.53, p < 0.001), and complex features on cerebral angiography (OR 2.73, 95% CI 1.78-4.19, p < 0.001). CONCLUSIONS Accurate coronary evaluation by coronary angiography might be considered when patients with atherosclerotic cerebral artery detected on brain MRA or CTA planned cerebral angiography were male or have diabetes mellitus, previous stroke, low ABI (<0.9), left ventricular EF <50% on echocardiography, troponin I or T positivity, and complex features on cerebral angiography.
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Affiliation(s)
- Ji Woong Roh
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Beom-Jun Kwon
- Department of Cardiology, Pyeongtaek St. Mary's Hospital, Gyeonggi-do, Republic of Korea
| | - Sang-Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Sungmin Lim
- Department of Cardiology, Uijeongbu St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Chan-Seok Park
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Kiyuk Chang
- Department of Cardiology, Seoul St Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Wook Sung Chung
- Department of Cardiology, Seoul St Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Dong-Bin Kim
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Seong-Rim Kim
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Hee-Yeol Kim
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea,
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Jung MH, Ihm SH, An SJ, Yi SW. P5728Association of systolic blood pressure and cardiovascular outcomes at different age groups in the healthy general population: a nationwide prospective cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0668] [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: 11/12/2022] Open
Abstract
Abstract
Background
Uncertainties remain regarding the effect of blood pressure on various cardiovascular outcomes in different age groups.
Purpose
We aimed to identify 1) whether a systolic blood pressure (SBP) of 130–139 mm Hg elevates cardiovascular disease (CVD) mortality and 2) whether SBP shows a linear association with cause-specific CVD mortality in all age groups among individuals without known hypertension and CVD.
Methods
We used the Korean National Health Insurance sample data (n=429,220). Participants were categorized into three groups by age (40–59, 60–69, and 70–80 years).
Results
A positive and graded association was generally observed between SBP and overall and cause-specific CVD mortality regardless of age, except for ischemic heart disease (IHD) mortality in those aged 70–80 years. Among those aged 70–80, the hazard ratios (HRs) (95% CIs) for overall CVD mortality were 1.08 (0.92–1.28), 1.14 (0.97–1.34), and 1.34 (1.14–1.58) for SBP values of 120–129, 130–139, and 140–149 mm Hg, respectively, compared to SBP <120 mm Hg. For total stroke mortality, the corresponding HRs were 1.29 (1.02–1.64), 1.37 (1.09–1.72), and 1.52 (1.20–1.93), while for IHD mortality, the corresponding HRs were 0.90 (0.64–1.26), 0.86 (0.62–1.19), and 1.29 (0.93–1.78). Nonlinear associations were significant for IHD (Fig 1).
Figure 1
Conclusion
In the elderly Korean population, SBPs of 130–139 mm Hg elevated total stroke mortality, but not IHD mortality, compared to normal BP, and a linear association was not observed for IHD mortality in the range <140 mm Hg. Regarding an appropriate diagnostic cutoff for hypertension, an individualized approach considering each person's organ susceptibility is needed for the elderly population.
Acknowledgement/Funding
None
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Affiliation(s)
- M H Jung
- Chuncheon Sacred Heart Hospital, Cardiovascular center, Chuncheon, Korea (Republic of)
| | - S H Ihm
- Bucheon St.Mary's Hospital, Cardiology, Bucheon, Korea (Republic of)
| | - S J An
- Catholic Kwandong University, Neurology, Incheon, Korea (Republic of)
| | - S W Yi
- Catholic Kwandong University, Preventive medicine and public health, Gangneung, Korea (Republic of)
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Jung MH, Ihm SH, Park SM, Jung HO, Hong KS, Baek SH, Youn HJ. Effects of sarcopenia, body mass indices, and sarcopenic obesity on diastolic function and exercise capacity in Koreans. Metabolism 2019; 97:18-24. [PMID: 31125536 DOI: 10.1016/j.metabol.2019.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 12/22/2022]
Abstract
AIMS Obesity induces left ventricular diastolic dysfunction and ultimately causes heart failure. Sarcopenic obesity is common in heart failure with preserved ejection fraction (HFpEF). However, the precise mechanism by which sarcopenic obesity is related to HFpEF is poorly understood. We aimed to evaluate the combined effect of sarcopenia (SP) and obesity on left ventricular diastolic function and exercise capacity. METHODS This study included 733 healthy subjects who underwent health check-ups in a tertiary hospital in Korea. All participants were categorized into four groups: non-SP/non-obese, SP/non-obese, non-SP/obese, and SP/obese. Comprehensive echocardiography with cardiopulmonary exercise testing was performed. Diastolic dysfunction was defined as an E/e' ratio ≥ 10. RESULTS Across SP and obesity groups, a gradual decrease in e' velocity and an increase in the E/e' ratio was noted after adjustment for age and sex. Furthermore, a gradual decrease in percent-predicted peak VO2 was observed across the groups. In the multivariate logistic regression analysis, the SP/obese group had the highest risk for diastolic dysfunction (OR 4.27, 95% CI 2.41-7.57), followed by the non-SP/obese group (OR 2.88, 95% CI 1.57-5.29) and the SP/non-obese group (OR 1.90, 95% CI 1.01-3.56) compared with the reference (non-SP/non-obese) group even after controlling for various confounders. CONCLUSION Sarcopenic obesity was associated with impaired diastolic function and decreased exercise capacity, suggesting a possible mechanism by which sarcopenic obesity contributes to the development of HFpEF.
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Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
| | - Sang Min Park
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hae Ok Jung
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Soon Hong
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sang Hong Baek
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho-Joong Youn
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, Kim KI, Kim JH, Lee JH, Park JM, Pyun WB, Chae SC. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens 2019; 25:20. [PMID: 31388453 PMCID: PMC6670135 DOI: 10.1186/s40885-019-0124-x] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [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: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
The standardized techniques of blood pressure (BP) measurement in the clinic are emphasized and it is recommended to replace the mercury sphygmomanometer by a non-mercury sphygmomanometer. Out-of-office BP measurement using home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM) and even automated office BP (AOBP) are recommended to correctly measure the patient’s genuine BP. Hypertension (HTN) treatment should be individualized based on cardiovascular (CV) risk and the level of BP. Based on the recent clinical study data proving benefits of intensive BP lowering in the high risk patients, the revised guideline recommends the more intensive BP lowering in high risk patients including the elderly population. Lifestyle modifications, mostly low salt diet and weight reduction, are strongly recommended in the population with elevated BP and prehypertension and all hypertensive patients. In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve rapid BP control. Especially, single pill combination drugs have multiple benefits, including maximizing reduction of BP, minimizing adverse effects, increasing adherence, and preventing cardiovascular disease (CVD) and target organ damage.
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Affiliation(s)
- Hae-Young Lee
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jinho Shin
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Gheun-Ho Kim
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungha Park
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Sang-Hyun Ihm
- 4Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Chang Kim
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Kwang-Il Kim
- 5Department of Internal Medicine, Seoul National University, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Jang Hoon Lee
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Moo Park
- 8Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Wook Bum Pyun
- 9Cardiovascular Center, Seoul Hospital, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Kim KI, Ihm SH, Kim GH, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Park S, Pyun WB, Shin J, Chae SC. 2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens 2019; 25:19. [PMID: 31388452 PMCID: PMC6670160 DOI: 10.1186/s40885-019-0123-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 04/23/2019] [Accepted: 06/14/2019] [Indexed: 01/05/2023] Open
Abstract
Treatment of hypertension improves cardiovascular, renal, and cerebrovascular outcomes. However, the benefit of treatment may be different according to the patients’ characteristics. Additionally, the target blood pressure or initial drug choice should be customized according to the special conditions of the hypertensive patients. In this part III, we reviewed previous data and presented recommendations for some special populations such as diabetes mellitus, chronic kidney disease, elderly people, and cardio-cerebrovascular disease.
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Affiliation(s)
- Kwang-Il Kim
- 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hyun Ihm
- 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gheun-Ho Kim
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- 4Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- 5Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Hae-Young Lee
- 6Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jang Hoon Lee
- 7Department of Internal Medicine, Kyungpook National University, School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, Korea
| | - Jong-Moo Park
- 8Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Sungha Park
- 9Department of Internal Medicine Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- 10Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jinho Shin
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- 7Department of Internal Medicine, Kyungpook National University, School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, Korea
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Kim HC, Ihm SH, Kim GH, Kim JH, Kim KI, Lee HY, Lee JH, Park JM, Park S, Pyun WB, Shin J, Chae SC. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension. Clin Hypertens 2019; 25:16. [PMID: 31388451 PMCID: PMC6670210 DOI: 10.1186/s40885-019-0121-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 04/28/2019] [Accepted: 06/03/2019] [Indexed: 02/08/2023] Open
Abstract
The Korean Society of Hypertension guideline defines hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, where the effectiveness of pharmacological treatment has been established. It is confirmed that higher blood pressure levels are associated with increased risk of cardiovascular disease and mortality also in the Korean population. About one third of Korean adults aged 30 years or older are estimated to have hypertension, and the prevalence of hypertension gradually increases as the age increases. The awareness, treatment, and control rates of hypertension are generally improving in Korea, but more efforts are required to increase awareness and treatment among younger patients with hypertension and to improve lifestyle modification compliance at all ages. More studies are required to determine the magnitude and impact of white coat hypertension and masked hypertension in the Korean population.
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Affiliation(s)
- Hyeon Chang Kim
- 1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Hyun Ihm
- 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gheun-Ho Kim
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Ju Han Kim
- 4Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, South Korea
| | - Kwang-Il Kim
- 5Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hae-Young Lee
- 6Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jang Hoon Lee
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 South Korea
| | - Jong-Moo Park
- 8Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Sungha Park
- 9Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wook Bum Pyun
- 10Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jinho Shin
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Shung Chull Chae
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721 South Korea
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Lee CJ, Ryu J, Kim HC, Ryu DR, Ihm SH, Kim YJ, Shin JH, Pyun WB, Kang HS, Park JH, Hwang J, Park S. Clinical Benefit of Treatment of Stage-1, Low-Risk Hypertension. Hypertension 2019; 72:1285-1293. [PMID: 30571236 DOI: 10.1161/hypertensionaha.118.11787] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence about the benefits of treating uncomplicated, low-risk, stage-1 hypertension is lacking. The study aimed to investigate the association between mean blood pressure (BP) and clinical outcomes, and to determine optimal BPs in treated, low-risk, stage-1 hypertension. From the National Health Insurance Service Health Examination Database, patients with stage-1 hypertension between 2005 and 2006 were selected. They had a systolic BP of 140 to 159 mm Hg or diastolic BP of 90 to 99 mm Hg. Patients were grouped as controlled (mean BP <140/90 mm Hg; n=99 301) and uncontrolled (mean BP ≥140/90 mm Hg; n=49 460) according to their mean BP recorded during the follow-up health examination. All-cause mortality and cardiovascular outcomes were examined. Mean BPs in the controlled and uncontrolled groups were 131.1/80.9 and 144.6/86.8 mm Hg, respectively. Controlled BP was associated with significantly lower risks of all-cause mortality, all stroke, hemorrhagic stroke, ischemic stroke, and end-stage renal disease. Subgroup analysis demonstrated benefits of controlled BP in hypertensive patients aged <50 years for all-cause mortality, all stroke, hemorrhagic stroke, ischemic stroke, and end-stage renal disease, with no significant interaction according to age. The BP associated with the lowest risk of all-cause mortality was 120 to <130 mm Hg (systolic BP) and 70 to <80 mm Hg (diastolic BP). There was an increased risk of myocardial infarction in patients with mean systolic BP <120 mm Hg and diastolic BP <80 mm Hg. BP <140/90 mm Hg was associated with a significant reduction in the risk of mortality, stroke, and end-stage renal disease, with the lowest mortality risk at BP ranges of 120 to <130 and 70 to <80 mm Hg.
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Affiliation(s)
- Chan Joo Lee
- From the Department of Health Promotion, Severance Hospital, Seoul, Republic of Korea (C.J.L.)
| | - Jiin Ryu
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea (J.R., J.H.)
| | - Hyeon-Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.-C.K.)
| | - Dong-Ryeol Ryu
- Division of Nephrology (R.R.), Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (S.-H.I.)
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Republic of Korea (Y.-J.K.)
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea (J.-H.S.)
| | - Wook Bum Pyun
- Cardiovascular Center (W.B.P.), Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hyoung-Soo Kang
- Department of Big Data Steering, National Health Insurance Service, Wonju, Gangwon, Republic of Korea (H.-S.K., J.-H.P.)
| | - Jong-Heon Park
- Department of Big Data Steering, National Health Insurance Service, Wonju, Gangwon, Republic of Korea (H.-S.K., J.-H.P.)
| | - Jinseub Hwang
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea (J.R., J.H.)
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea (S.P.)
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An SJ, Jung MH, Ihm SH, Yang YJ, Youn HJ. Effect of physical activity on the cardiometabolic profiles of non-obese and obese subjects: Results from the Korea National Health and Nutritional Examination Survey. PLoS One 2019; 14:e0208189. [PMID: 30822340 PMCID: PMC6396903 DOI: 10.1371/journal.pone.0208189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/13/2018] [Indexed: 11/21/2022] Open
Abstract
Background Physical inactivity is an important but often neglected risk factor for various cardiovascular diseases. We hypothesized that physical inactivity might have deleterious effects on metabolic health in obese and non-obese subjects. Methods We evaluated the effect of physical activity on the cardiometabolic profiles of a nationwide cohort of non-obese and obese individuals who did not have overt cardiovascular diseases. A total of 3,830 study subjects were divided into two groups based on their body mass index (BMI). Within each BMI group, participants were divided according to their physical activity level. To ascertain their cardiometabolic profiles, we collected data regarding the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index, high-density lipoprotein (HDL)-cholesterol level, systolic blood pressure, heart rate, and high-sensitivity C-reactive protein (hsCRP) level. Results Physically inactive subjects demonstrated markedly elevated HOMA-IR index and heart rates in each BMI category, even after adjustments for baseline covariates. They also tended to have worse profiles for HDL-cholesterol, systolic blood pressure, and hsCRP levels. A significant elevation in cardiometabolic risk was noted across the four physical activity/obesity groups (p<0.05). HOMA-IR index was largely affected by obesity, but within each BMI category, physical inactivity independently elevated the risk for worsening insulin resistance. In addition, physical inactivity significantly increased the risk of elevated heart rate in both non-obese and obese individuals. Notably, the detrimental effect of physical activity on heart rate was not modified by obesity. Conclusions Physical activity was associated with favorable cardiometabolic risk profiles with regard to insulin resistance status and heart rate level in both BMI groups. Our results suggest that increasing physical activity could be a helpful strategy for improving the cardiometabolic health in the Korean population, regardless of obesity status.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Mi-Hyang Jung
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
- * E-mail:
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yun-jung Yang
- Institute of Biomedical Science, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ihm SH, Shin J, Park CG, Kim CH. Efficacy of a fixed dose combination of irbesartan and atorvastatin (Rovelito ®) in Korean adults with hypertension and hypercholesterolemia. Drug Des Devel Ther 2019; 13:633-645. [PMID: 30858694 PMCID: PMC6387596 DOI: 10.2147/dddt.s191973] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose Coexistence of hypertension (HTN) and hypercholesterolemia is a major synergistic and modifiable risk factor for cardiovascular disease (CVD). Thus, a fixed-dose combination (FDC) of anti-HTN drugs and statins may be useful for treating CVD. This study evaluated the efficacy of an FDC of irbesartan and atorvastatin (Rovelito®) in Korean patients. Patients and methods Patients with HTN and hypercholesterolemia were screened for this prospective, observational, descriptive, multi-center, phase IV study. Eligible patients were administered with Rovelito for 3 months. Dose adjustment was allowed based on the physician’s discretion. Blood pressure (BP) goal was <140/90 mmHg, and blood lipid goal was based on Adult Treatment Panel III. Compliance with therapeutic lifestyle modification and safety of the study drugs were evaluated. Results Of the 2,777 patients enrolled in this study, 931 were analyzed for clinical efficacy. BP and low-density lipoprotein cholesterol (LDL-C) goals were achieved in 801 (86.04%) and 797 (85.61%) patients, respectively. For the BP goal, higher baseline BP and higher body mass index were risk factors for treatment failure. For LDL-C goal, baseline LDL-C level, number of concomitant drugs, smoking status, and alcohol consumption were risk factors for treatment failure. Of the 931 participants, 694 (74.54%) achieved the treatment goals for both BP and LDL-C. Smoking status, alcohol consumption, number of concomitant drugs, and higher baseline LDL-C and BP levels were risk factors for treatment failure in both BP and LDL-C goals. Adherence with Rovelito was 97.90%±5.79%, and incidence of adverse events was 4.19% (116). Conclusion FDC of irbesartan and atorvastatin (Rovelito) could be extremely helpful in treating patients with both HTN and hypercholesterolemia. Poor metabolic profiles were risk factors for poor treatment response and the reason for choosing Rovelito. Therapeutic lifestyle modification should still be underscored despite the 75% treatment success rate with Rovelito for both conditions.
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Affiliation(s)
- Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Chang-Gyu Park
- Cardiology Division, Korea University Guro Hospital, Seoul, South Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, Seongnam-si, South Korea,
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Ihm SH, Bakris G, Sakuma I, Sohn IS, Koh KK. Controversies in the 2017 ACC/AHA Hypertension Guidelines: Who Can Be Eligible for Treatments Under the New Guidelines? - An Asian Perspective. Circ J 2018; 83:504-510. [PMID: 30606943 DOI: 10.1253/circj.cj-18-1293] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Until the 2017 ACC/AHA Hypertension Guidelines were released, the target blood pressure (BP) for adults with hypertension (HTN) was 140/90 mmHg in most of the guidelines. The new 2018 ESC/ESH, Canadian, Korean, Japan, and Latin American hypertension guidelines have maintained the <140/90 mmHg for the primary target in the general population and encourage reduction to <130/80 if higher risk. This is more in keeping with the 2018 American Diabetes Association guidelines. However, the 2017 ACC/AHA guidelines classify HTN as BP ≥130/80 mmHg and generally recommend target BP levels below 130/80 mmHg for hypertensive patients independently of comorbid disease or age. Although the new guidelines mean that more people (nearly 50% of adults) will be diagnosed with HTN, the cornerstone of therapy is still lifestyle management unless BP cannot be lowered to this level; thus, more people will require BP-lowering medications. To date, there have been many controversies about the definition of HTN and the target BP. Targeting an intensive systolic BP goal can increase the adverse effects of multiple medications and the cardiovascular disease risk by excessively lowering diastolic BP, especially in patients with high risk, including those with diabetes, chronic kidney disease, heart failure, and coronary artery disease, and the elderly. In this review, we discuss these issues, particularly regarding the optimal target BP.
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Affiliation(s)
- Sang-Hyun Ihm
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - George Bakris
- Department of Medicine, Comprehensive Hypertension Center, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago Medicine
| | - Ichiro Sakuma
- Cardiovascular Medicine, Hokko Memorial Clinic.,Health Science University of Hokkaido
| | - Il Suk Sohn
- Department of Cardiology, Cardiovascular Center, Kyung Hee University Hospital at Gangdong
| | - Kwang Kon Koh
- Department of Cardiovascular Medicine, Heart Center, Gachon University Gil Medical Center.,Gachon Cardiovascular Research Institute
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Choo EH, Ha KH, Lee SW, Kim HC, Park S, Lee HY, Ihm SH. Low plasma renin activity is an independent predictor of near-term incidence of hypertension in Asian populations. Clin Exp Hypertens 2018; 41:330-335. [PMID: 29902069 DOI: 10.1080/10641963.2018.1481422] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Plasma renin activity is involved in the regulation of body salt content and blood pressure. However, there is a paucity of data regarding the association between low or high plasma renin activity and the development of hypertension. METHOD We investigated the relation of baseline plasma renin activity to increases in blood pressure and the incidence of hypertension after four years in 2,146 non-hypertensive individuals from a community-based Korean population (mean age, 50 years), 58% of whom were women. We defined an "increase in blood pressure" as an increment of systolic blood-pressure ≥ 10 mmHg or initiation of antihypertensive drugs and defined "hypertension" as a systolic blood pressure of 140 mm Hg or higher, a diastolic blood pressure of 90 mm Hg or higher, or the use of antihypertensive medications. RESULTS After 4 years, the increase in blood pressure had increased in 27.9% of the participants, and hypertension had developed in 17.9%. After adjustment, the lowest sex-specific tertile of plasma renin activity was an independent risk factor of an elevation in blood pressure (Adjusted Odds Ratio 1.37, 95% confidence interval 1.07-1.74, p = 0.011) and hypertension (Adjusted Odds Ratio 1.84, 95% confidence interval 1.36-2.50, p < 0.001) compared to the highest sex-specific tertile. The associations between the plasma renin activity and blood-pressure outcomes were evident in adults with especially high urine sodium excretion. CONCLUSION Low plasma renin activity was associated with the development of hypertension in the middle-aged Asian population, especially in peoples with high sodium intake.
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Affiliation(s)
- Eun Ho Choo
- a Division of Cardiology , The Catholic University of Korea, College of Medicine , Seoul , Korea
| | - Kyoung Hwa Ha
- b Department of Public Health , Graduate School of Yonsei University , Seoul , Korea
| | - Seung-Won Lee
- b Department of Public Health , Graduate School of Yonsei University , Seoul , Korea
| | - Hyeon Chang Kim
- c Department of Preventive Medicine , Yonsei University College of Medicine , Seoul , Korea
| | - Sungha Park
- d Division of Cardiology , Yonsei Cardiovascular Hospital , Seoul , Korea
| | - Hae Young Lee
- e Department of Internal Medicine , Seoul National University Hospital , Seoul , Korea
| | - Sang-Hyun Ihm
- a Division of Cardiology , The Catholic University of Korea, College of Medicine , Seoul , Korea
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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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Jung MH, Youn HJ, Ihm SH, Jung HO, Hong KS. Heart Rate and Bone Mineral Density in Older Women with Hypertension: Results from the Korea National Health and Nutritional Examination Survey. J Am Geriatr Soc 2018; 66:1144-1150. [PMID: 29608214 DOI: 10.1111/jgs.15359] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To determine whether high heart rate is associated with low bone mineral density (BMD) in older women with hypertension. DESIGN Retrospective cohort study. SETTING Population-based study conducted in Korea (Korea National Health and Nutritional Examination Survey 2009-10). PARTICIPANTS Postmenopausal women aged 60 and older with hypertension (N=981) divided into 2 groups according to resting heart rate, with a cut-off value of 80 bpm, which has been found to be associated with osteoporosis. MEASUREMENTS BMD profiles and clinical and laboratory data were collected. Osteoporosis was defined as a T-score of -2.5 or less, according to World Health Organization criteria. RESULTS BMD was significantly lower in participants with a high heart rate, even after adjustment for age, diabetes mellitus, white blood cell count, and fasting glucose and triglyceride levels. The prevalence of osteoporosis was also significantly higher in those participants. In multivariate logistic regression analysis, the group with high heart rate was 1.7 times as likely (95% confidence interval=1.2-2.3) to have osteoporosis as those with a lower heart rate, independent of age, body mass index, comorbidities, and laboratory findings. CONCLUSION High heart rate is independently associated with lower BMD in older women with hypertension; proactive surveillance of BMD could be helpful when managing older women with hypertension and a high heart rate.
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Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Soon Hong
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
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Jung MH, Ihm SH, Lee DH, Choi Y, Chung WB, Jung HO, Hong KS, Youn HJ. Prehypertension is a comorbid state with autonomic and metabolic dysfunction. J Clin Hypertens (Greenwich) 2018; 20:273-279. [DOI: 10.1111/jch.13180] [Citation(s) in RCA: 8] [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: 07/18/2017] [Revised: 09/02/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center; Chuncheon Sacred Heart Hospital; College of Medicine; Hallym University; Chuncheon Korea
| | - Sang-Hyun Ihm
- Division of Cardiology; Department of Internal Medicine; The Catholic University of Korea; Seoul Korea
| | - Dong-Hyeon Lee
- Division of Cardiology; Department of Internal Medicine; The Catholic University of Korea; Seoul Korea
| | - Young Choi
- Division of Cardiology; Department of Internal Medicine; The Catholic University of Korea; Seoul Korea
| | - Woo-Baek Chung
- Division of Cardiology; Department of Internal Medicine; The Catholic University of Korea; Seoul Korea
| | - Hae Ok Jung
- Division of Cardiology; Department of Internal Medicine; The Catholic University of Korea; Seoul Korea
| | - Kyung-Soon Hong
- Cardiovascular Center; Chuncheon Sacred Heart Hospital; College of Medicine; Hallym University; Chuncheon Korea
| | - Ho-Joong Youn
- Division of Cardiology; Department of Internal Medicine; The Catholic University of Korea; Seoul Korea
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Seo SM, Chung WB, Choi IJ, Koh YS, Ihm SH, Kim PJ, Chung WS, Seung KB. Visit-to-visit variability of systolic blood pressure predicts all-cause mortality in patients received percutaneous coronary intervention with drug-eluting stents. Heart Vessels 2017; 33:489-497. [PMID: 29151154 DOI: 10.1007/s00380-017-1085-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/10/2017] [Indexed: 11/29/2022]
Abstract
Blood pressure (BP) and its variability are associated with atherosclerotic disease and cardiovascular events. The prognostic implications of outpatient clinic visit-to-visit blood pressure variability (BPV) are unknown in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 1,463 patients undergoing PCI with DES were consecutively enrolled from January 2009 to December 2013. We analyzed the 1,234 patients, who measured clinic BP more than three times during the first year after PCI. The BPV is determined by standard deviation of systolic and diastolic BP, and coefficient of variation. Median follow-up duration was 905 days (interquartile range 529-1,310 days). All patients were divided into two groups according to the coefficient of variation of systolic BP (CVSBP); high CVSBP group (> 8.78, n = 617) and low CVSBP group (≤ 8.78, n = 617). High CVSBP group had significantly higher all-cause mortality (7.9% versus 3.1%, p < 0.001) and composite of all-cause mortality, myocardial infarction, and stroke (13.1% versus 6.2%, p < 0.001). In multivariate logistic regression analysis for prediction of all-cause mortality, and composite of all-cause mortality, myocardial infarction, and stroke after PCI with DES, hazard ratios of high CVSBP group were 2.441 (95% of confidence interval 1.042-5.718, p = 0.040), and 1.980 (95% of confidence interval 1.125-3.485, p = 0.018). The higher visit-to-visit BPV is associated higher mortality in patients undergoing PCI with DES. The clinic measured visit-to-visit BPV may serve as a predictor of all-cause mortality after PCI with DES.
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Affiliation(s)
- Suk Min Seo
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woo-Baek Chung
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Ik Jun Choi
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yoon-Seok Koh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang-Hyun Ihm
- Cardiovascular Center and Cardiology Division, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Pum-Jun Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Wook Sung Chung
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ki-Bae Seung
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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Hong SK, Choo EH, Ihm SH, Chang K, Seung KB. Dipeptidyl peptidase 4 inhibitor attenuates obesity-induced myocardial fibrosis by inhibiting transforming growth factor-βl and Smad2/3 pathways in high-fat diet-induced obesity rat model. Metabolism 2017; 76:42-55. [PMID: 28987239 DOI: 10.1016/j.metabol.2017.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/27/2022]
Abstract
Obesity-induced myocardial fibrosis may lead to diastolic dysfunction and ultimately heart failure. Activation of the transforming growth factor (TGF)-βl and its downstream Smad2/3 pathways may play a pivotal role in the pathogenesis of obesity-induced myocardial fibrosis, and the antidiabetic dipeptidyl peptidase 4 inhibitors (DPP4i) might affect these pathways. We investigated whether DPP4i reduces myocardial fibrosis by inhibiting the TGF-β1 and Smad2/3 pathways in the myocardium of a diet-induced obesity (DIO) rat model. Eight-week-old male spontaneously hypertensive rats (SHRs) were fed either a normal fat diet (chow) or a high-fat diet (HFD) and then the HFD-fed SHRs were randomized to either the DPP4i (MK-0626) or control (distilled water) groups for 12weeks. At 20weeks old, all the rats underwent hemodynamic and metabolic studies and Doppler echocardiography. Compared with the normal fat diet (chow)-fed SHRs, the HFD-fed SHRs developed a more intense degree of hyperglycemia and dyslipidemia and showed a constellation of left ventricular (LV) diastolic dysfunction, and exacerbated myocardial fibrosis, as well as activation of the TGF-β1 and Smad2/3 pathways. DPP4i significantly improved the metabolic and hemodynamic parameters. The echocardiogram showed that DPP4i improved the LV diastolic dysfunction (early to late ventricular filling velocity [E/A] ratio, 1.49±0.21 vs. 1.77±0.09, p<0.05). Furthermore, DPP4i significantly reduced myocardial fibrosis and collagen production by the myocardium and suppressed TGF-β1 and phosphorylation of Smad2/3 in the heart. In addition, DPP4i decreased TGF-β1-induced collagen production and TGF-β1-mediated phosphorylation and nuclear translocation of Smad2/3 in rat cardiac fibroblasts. In conclusion, DPP4 inhibition attenuated myocardial fibrosis and improved LV diastolic dysfunction in a DIO rat model by modulating the TGF-β1 and Smad2/3 pathways.
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Affiliation(s)
- Seul-Ki Hong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ihm SH, Hong SK, Chang K. GW28-e0701 Dipeptidyl peptidase 4 inhibitor attenuates obesity-induced myocardial fibrosis by inhibiting tissue growth factor-beta and Smad2/3 pathways in high-fat diet-induced obesity rat model. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.07.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ahn HS, Kim YK, Song HC, Choi EJ, Kim GH, Cho JS, Ihm SH, Kim HY, Park CS, Youn HJ. The impact of preload on 3-dimensional deformation parameters: principal strain, twist and torsion. Cardiovasc Ultrasound 2017; 15:22. [PMID: 28899401 PMCID: PMC5596939 DOI: 10.1186/s12947-017-0111-x] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background Strain analysis is feasible using three-dimensional (3D) echocardiography. This approach provides various parameters based on speckle tracking analysis from one full-volume image of the left ventricle; however, evidence for its volume independence is still lacking. Methods Fifty-eight subjects who were examined by transthoracic echocardiography immediately before and after hemodialysis (HD) were enrolled. Real-time full-volume 3D echocardiographic images were acquired and analyzed using dedicated software. Two-dimensional (2D) longitudinal strain (LS) was also measured for comparison with 3D strain values. Results Longitudinal (pre-HD: −24.57 ± 2.51, post-HD: −21.42 ± 2.15, P < 0.001); circumferential (pre-HD: −33.35 ± 3.50, post-HD: −30.90 ± 3.22, P < 0.001); and radial strain (pre-HD: 46.47 ± 4.27, post-HD: 42.90 ± 3.61, P < 0.001) values were significantly decreased after HD. The values of 3D principal strain (PS), a unique parameter of 3D images, were affected by acute preload changes (pre-HD: −38.10 ± 3.71, post-HD: −35.33 ± 3.22, P < 0.001). Twist and torsion values were decreased after HD (pre-HD: 17.69 ± 7.80, post-HD: 13.34 ± 6.92, P < 0.001; and pre-HD: 2.04 ± 0.86, post-HD:1.59 ± 0.80, respectively, P < 0.001). The 2D LS values correlated with the 3D LS and PS values. Conclusion Various parameters representing left ventricular mechanics were easily acquired from 3D echocardiographic images; however, like conventional parameters, they were affected by acute preload changes. Therefore, strain values from 3D echocardiography should be interpreted with caution while considering the preload conditions of the patients.
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Affiliation(s)
- Hyo-Suk Ahn
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong-Kyun Kim
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Ho Chul Song
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Euy Jin Choi
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Gee-Hee Kim
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jung Sun Cho
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang-Hyun Ihm
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hee-Yeol Kim
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chan Seok Park
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Ho-Joong Youn
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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