Clinical Hypertension最新文献

Although some evidence shows the beneficial effects of meal replacement (MR) on blood pressure (BP) and inflammation as one of the main factors of cardiovascular disease, there are still no comprehensive findings in this field. Therefore, we investigate the effects of total and partial MRs on BP and C-reactive protein (CRP) in this comprehensive study and meta-analysis. In order to identify all randomized controlled trials that investigated the effects of MRs on BP and CRP levels, a systematic search was conducted in the original databases using predefined keywords. The pooled weighted mean difference (WMD) and 95% confidence intervals (CIs) were computed using the random-effects model. Forty studies were included in this article. The findings indicated significant reductions in systolic blood pressure (SBP) (WMD, -2.51 mmHg; 95% CI, -3.48 to -1.54; P < 0.001), diastolic blood pressure (DBP) (WMD, -1.43 mmHg; 95% CI, -2.02 to -0.85; P < 0.001), and CRP (WMD, -0.50 mg/L; 95% CI, -0.89 to -0.11; P = 0.012) levels following MR consumption compared to the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater reduction in SBP in people over 50 years of age, and the duration of the intervention ≤ 24 weeks. Also, the subgroup analysis shows the greater effect of DBP and CRP, respectively, in the type of intervention with total meal replacement and less equal to 50 years. In conclusion, it appears that MR, along with other lifestyle factors, can lead to significant improvements in BP and CRP.

Background: Poor adherence to antihypertensive medication remains a significant barrier to blood pressure control in young patients. The objective of this study was to identify factors associated with antihypertensive medication adherence among young adults with hypertension.

Methods: From the Korean National Health Insurance Service database, we included 141,132 participants aged 20 to 39 years (80.4% male), without cardiovascular disease, who initiated antihypertensive medication between 2013 and 2018. Participants were categorized as exhibiting good adherence (proportion of days covered [PDC] ≥ 0.8) or poor adherence (PDC < 0.8) to antihypertensive medication during the first year of treatment. We investigated the associations of demographic, lifestyle, and clinical factors with good medication adherence based on logistic regression analysis.

Results: Only 43.3% (n = 61,107) of young adults with hypertension showed good adherence to antihypertensive medication. Male sex, older age, higher income, urban residence, non-smoking, and higher physical activity were associated with good medication adherence. Initial combination therapy, especially with single-pill combination (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), was associated with good adherence. Among patients under monotherapy, initial use of renin-angiotensin blockers (OR, 5.24; 95% CI, 4.47-6.15) or calcium-channel blockers (OR, 4.07; 95% CI, 3.47-4.78) was associated with better adherence than initial diuretics.

Conclusions: Although antihypertensive medication adherence is generally poor among young adults, we identified potential demographic and clinical factors associated with good adherence to antihypertensive treatment. Initial use of a single-pill combination may promote adherence in young patients, and its long-term clinical outcomes warrant further investigation.

Background: Despite extensive research on blood pressure (BP) progression, the impact of cardiometabolic risk factors on different stages of hypertension (HTN) remains poorly understood. This study aimed to investigate how these factors affect HTN progression.

Methods: A community-based study of 1,740 women aged > 20 years was followed from 1999 to 2019. A multi-state model with six transitions was employed to analyze the data.

Results: Our findings revealed that the hazard of transition from normal BP to elevated BP intensified by age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.04-1.08), body mass index (BMI) (HR, 1.07; 95% CI, 1.04-1.09), and a family history of HTN (HR, 2.65; 95% CI, 1.27-5.38). In addition, age (HR, 1.04; 95% CI, 1.01-1.06), BMI (HR, 1.03; 95% CI, 1.01-1.07), and parity (HR, 0.87; 95% CI, 0.77-0.97) were significantly associated with the hazard of transition from normal BP to HTN stage 1. BMI was the only risk factor in the transition from normal BP to HTN stage 2 (HR, 1.12; 95% CI, 1.01-1.24). Moreover, the family history of HTN (HR, 3.01; 95% CI, 1.02-6.83) and the type 2 diabetes mellitus (T2DM) (HR, 3.98; 95% CI, 1.81-7.73) were strongly related to the transition risk from elevated BP to HTN stage 1. Furthermore, T2DM (HR, 3.21; 95% CI, 1.11-7.26) and menopausal status (HR, 3.33; 95% CI, 1.11-7.95) were significantly associated with an increased risk of progression from HTN stage 1 to HTN stage 2.

Conclusions: This study demonstrates that age, BMI, and family history of HTN are key risk factors for the initial progression of HTN in women with normal BP, whereas T2DM and menopausal status play a more critical in the progression to higher stages of HTN.

Background: The distribution of cardiovascular health (CVH) and its association with vascular health among Asian adolescents is understudied. We examined the distribution of optimal CVH metrics and their association with carotid intima-media thickness (cIMT) in Korean adolescents.

Methods: We analyzed data from a cohort of 694 healthy Korean adolescents with an average follow-up period of 2.4 years. CVH scores were assessed at baseline and follow-up using 6 metrics from Life's Essential 8 (LE8), excluding diet and sleep. Additionally, we developed an experimental set of 7 metrics by incorporating a psychological health indicator. We examined the association between CVH and cIMT using 2 approaches: 1) aggregated CVH, calculated as the average of the 2 time points, and 2) changes in CVH over time. High cIMT, defined as the highest sex-specific quartile measured at the follow-up visit, was analyzed using multivariable logistic regression.

Results: Among participants (mean age, 15.9 years at baseline), approximately 25% maintained an optimal-level CVH, with physical activity being the most challenging metric. Higher CVH was associated with lower odds of high cIMT; gradually decreasing odds according to higher aggregated CVH were evident. Maintaining optimal CVH resulted in 50% lower odds of high cIMT compared to those with persistently suboptimal CVH. The results remained consistent when the psychological health metric was incorporated into CVH.

Conclusions: Among Korean adolescents, CVH scores for 6 of LE8 metrics, excluding diet and sleep, were comparable to those of non-Hispanic Asian adolescents in the U.S. Higher CVH was associated with lower odds of high cIMT at age 18.

Background: In order to ascertain the impact of the Dietary Approach to Stop Hypertension (DASH) diet on blood pressure (BP), a systematic review and meta-analysis of randomized controlled trials were carried out. DASH is advised for lowering BP.

Methods: Scopus databases were searched from the beginning of 2024. A total of 579 articles from 2019 to 2023 from PubMed: 15, Scopus: 164 and Crossref: 400. There were 8 articles included in the meta-analysis.

Results: Systolic BP (1.29 mmHg to 4.6 mmHg, 95% CI, -2.17, -0.41; P < 0.005) and diastolic BP (0.76 mmHg to 1.1 mmHg, 95% CI, -1.39, -0.13; P < 0.005) were found to be significantly reduced by the DASH diet, while total cholesterol concentrations (5.2 mmol/L; P < 0.005), low-density lipoprotein (8.2 mmol/L; P = 0.03), and high-density lipoprotein increased by 8.2% (P < 0.005) were lowered by 0.9 points.

Conclusions: When followed consistently, the DASH diet can reduce BP's systolic and diastolic readings.

Trial registration: PROSPERO Identifier: CRD42023494005.

Background: This study evaluated the effectiveness of inspiratory muscle strength training (IMST) as a time-efficient alternative to widely recommended aerobic exercise (AE) for reducing and maintaining blood pressure in hypertensive patients.

Methods: Twenty-eight hypertensive patients (aged 61 ± 7 years) were randomly assigned to IMST (n = 14) and AE (n = 14) groups. The IMST performed 30 breaths/session at 75% of maximal inspiratory pressure (PI_max), totaling about 8 minutes, 5 days/week. The AE group exercised at 70% of heart rate reserve for 30 minutes/session, 5 days/week. Both supervised interventions lasted 8 weeks, followed by a 4-week detraining period. Brachial and central systolic blood pressure (SBP) were taken at baseline, 8-week post-intervention, and post-detraining.

Results: The mean (standard deviation) change in brachial SBP from baseline to 8 week post-intervention significantly decreased in both the IMST group [-9.1 (12.1) mmHg, P = 0.01] and the AE group [-6.2 (7.2) mmHg, P = 0.01], with no significant difference between groups (P = 0.46). Central SBP also significantly reduced in the IMST group [-9.0 (11.9) mmHg, P = 0.01] and in the AE group [-5.7 (6.2) mmHg, P = 0.01], with no significant difference between groups (P = 0.37). However, the IMST group did not show significant persistence in SBP reduction, whereas the AE group did.

Conclusions: Both IMST and AE effectively reduced brachial and central BP after 8-week interventions in hypertensive patients. While IMST presents a time-efficient adjunctive option to AE, its long-term effectiveness remains uncertain.

We read with interest the study by Han et al., offering important insights into the associations between different levels of physical and muscle-strengthening activities and chronic kidney disease (CKD) prevalence in hypertensive patients in Korea. However, when reading the paper, we noticed some issues that warrant discussion. First and most important one, the definition used for CKD is incomplete as the authors define CKD solely based on a single measurement of eGFR < 60 mL/min/1.73 m², neglecting other essential components of the CKD definition and therefore, misdiagnose CKD in several circumstances. This has likely led to misclassification of cases and underestimation of the true prevalence of CKD. Additionally, characteristics of residential environment as an independent variable, which have been reported by recent studies to be the only factors strongly associated with CKD patients' physical activity, were not considered in the analysis. Finally, the assessment of physical and muscle-strengthening activity relied only on self-reported questionnaires, which may have introduced recall biases and misclassification of activity levels. Overall, although novel, the observed findings need to be confirmed by future, larger and optimally designed studies.

Background: The combined impact of achieving target systolic blood pressure (SBP) and blood pressure variability (BPV) on long-term clinical outcomes in patients with coronary artery disease following percutaneous coronary intervention (PCI) remains unclear. This study aimed to investigate the combined effect of SBP target achievement and BPV on the risk of cardiovascular events in patients undergoing PCI.

Methods: Consecutive patients who underwent PCI between 2012 and 2016 were included. Patients were classified into four groups based on average follow-up SBP (< 130 or ≥ 130 mmHg) and BPV (categorized as low or high, using the median of the standard deviation of SBP during follow-up). The primary outcome was net adverse clinical events (NACE; defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or major bleeding) for up to 5 years.

Results: Among 2,845 patients, 787 (27.7%) experienced NACE during a median follow-up of 5.43 years. Patients with high BPV had a significantly increased risk of long-term clinical outcomes, regardless of whether the target SBP was achieved. Additionally, patients with SBP ≥ 130 mmHg and high BPV had a significantly higher risk of 5-year major adverse cardiac and cerebrovascular events (adjusted hazard ratio [HR], 1.342; 95% confidence interval [CI], 1.067-1.688; P = 0.012) and NACE (adjusted HR, 1.262; 95% CI, 1.036-1.537; P = 0.021) than those with SBP < 130 mmHg and low BPV.

Conclusions: The combined impact of SBP target achievement and BPV was significantly associated with the risk of long-term adverse outcomes in patients who underwent PCI. These findings underscore the importance of achieving target SBP while recognizing that patients with high BPV represent a high-risk group requiring focused monitoring and management to mitigate cardiovascular events.

Trial registration: ClinicalTrials.gov Identifier: NCT05935397.

Background: While blood viscosity is recognized as a contributing factor in cerebrovascular disease pathophysiology, the specific role of diastolic blood viscosity (DBV) in functional outcomes after acute ischemic stroke (AIS) remains unclear. This study investigates the relationship between admission DBV levels and 3-month functional outcomes in patients with AIS.

Methods: We analyzed 413 AIS patients admitted within 7 days of symptom onset. We utilized a scanning capillary-tube viscometer to measure whole blood viscosity and categorized DBV into three groups based on established norms. Multivariable logistic regression was employed to assess the association between DBV levels and 3-month outcomes, as determined by the modified Rankin Scale (mRS).

Results: The cohort had a mean age of 70.0 ± 13.2 years and 59.6% were male. Patients with high DBV tended to be younger, predominantly male, with higher body mass index, and more likely to be smokers. These individuals also exhibited higher levels of hemoglobin, low-density lipoprotein, and fasting blood sugar. Despite similar stroke etiology and initial severity, high DBV was significantly associated with poor 3-month outcomes (mRS 3-6; adjusted odds ratio 2.899; 95% confidence interval, 1.119-7.514).

Conclusions: Elevated DBV on admission is linked to worse functional outcome three months after AIS. These findings highlight the importance of incorporating DBV assessments into AIS prognosis and suggest a potential avenue for therapeutic intervention targeting blood rheology to improve cerebral microcirculation and stroke recovery.

Background: This report provides an overview of hypertension prevalence, management, and trends in South Korea.

Methods: The analysis is based on data from Korean adults aged 20 and older, using the 1998-2022 Korea National Health and Nutrition Examination Survey (KNHANES) and the 2002-2022 National Health Insurance (NHI) Big Data.

Results: An estimated 30% of Korean adults (13 million) have hypertension, including 7.2 million men, 5.8 million women, and 5.8 million aged 65 or older. Overall awareness, treatment, and control rates were 77%, 74%, and 59%, respectively, showing a tendency to increase with advancing age. Medical utilization for hypertension has steadily increased, with 11.5 million patients accessing medical services, 10.9 million receiving antihypertensive prescriptions, and 8.1 million undergoing continuous treatment in 2022. Prescription patterns reveal monotherapy (40%), dual therapy (44%), and combination therapy with three or more drugs (16%). The most commonly prescribed antihypertensive medications include angiotensin receptor blockers (76%), calcium channel blockers (62%), diuretics (23%), and beta-blockers (15%). Among young adults aged 20-39 with hypertension, 59.2% do not utilize healthcare services, and 84.9% are non-adherent to treatment. Awareness (36%), treatment (35%), and control rates (33%) in this group are notably lower than all age groups of above 40, with treatment continuity rates at 24% for individuals in their 20s and 40% for those in their 30s.

Conclusions: While South Korea has achieved relatively high rates of hypertension management compared to many countries, further efforts are needed to reduce hypertension prevalence and improve awareness and treatment adherence, particularly among younger adults.