Clinical Hypertension最新文献

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.

Background: This subanalysis of BENEFIT-KOREA cohort assessed the impact of baseline pulse rate (PR) and posttreatment PR reduction on the blood pressure (BP)-lowering efficacy of nebivolol in patients with hypertension.

Methods: South Korean patients with hypertension were enrolled in the BENEFIT-KOREA study; 3,011 patients received nebivolol as monotherapy/add-on therapy. Time-averaged BP, calculated by sum of the product of BPs at weeks 12 and 24 corrected for number of participants at these timepoints, was evaluated with/without adjustment for baseline BP. Change in BP in baseline PR groups of < 70, 70-79, and ≥ 80 beats/min and posttreatment PR reduction groups of < 1, 1-9, and ≥ 10 beats/min at 24 weeks were evaluated.

Results: The unadjusted time-averaged systolic BP (SBP) at 24 weeks was not significantly different within baseline PR groups or posttreatment PR reduction groups, but the unadjusted time-averaged diastolic BP (DBP) was significantly different within both baseline PR (P < 0.001) and posttreatment PR reduction groups (P < 0.001). Significant differences were observed in adjusted time-averaged SBP (≥ 10 beats/min group: β, -3.4148; P = 0.006) and time-averaged DBP (≥ 10 beats/min: β, -4.5781; P < 0.001) only within the posttreatment PR reduction groups. The majority of adverse events reported with nebivolol were mild.

Conclusions: The efficacy of nebivolol for BP reduction seems to be indicated not by baseline PR but by posttreatment PR reduction. These findings suggest the presence of other mechanisms in addition to sympathetic inhibition which potentially weaken the relationship between baseline PR and BP reduction.

Trial registration: ClinicalTrials.gov Identifier: NCT03847350.

Background: The correlation between serum uric acid/creatinine (SUA/Cr) ratio and hypertension risk has not been well studied. This study aims to examine whether the SUA/Cr ratio is a predictor of hypertension.

Methods: This cohort study comprised 171 men aged 64 ± 11 (mean ± standard deviation) years and 266 women aged 65 ± 10 years recruited for a survey at the community-based annual medical check-up. The main outcome was the presence of hypertension (antihypertensive medication) and having systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) ≥ 90 mmHg.

Results: The baseline SUA/Cr ratio was significantly correlated only with DBP at 3 years in men (r = 0.217, P = 0.004) and women (r = 0.126, P = 0.040), and with both SBP (r = 0.103, P = 0.031) and DBP (r = 0.15, P = 0.001) in the overall participants of men and women. A plausible prognostic cut-off of SUA/Cr ratio (≥ 7.41) was found and was the same in women and in all participants. Multivariable logistic regressions showed that SUA/Cr ratio was significantly linked with hypertension (as a categorical variable, SUA/Cr ratio-2 vs. SUA/Cr ratio-1: odds ratio [OR], 1.68; 95% confidence interval [CI], 0.66-4.30; P = 0.275, SUA/Cr ratio-3 vs. SUA/Cr ratio-1: OR, 2.86; 95% CI, 1.08-7.60; P = 0.035, SUA/Cr ratio-4 vs. SUA/Cr ratio ratio-1: OR, 4.05; 95% CI, 1.32-12.5; P = 0.031, and SUA/Cr ratio ≥ 7.41 vs. SUA/Cr ratio < 7.41: OR, 2.25; 95% CI, 1.32-3.84; P = 0.003). Significant ORs were found for age < 65 years, women, and BMI <25 kg/m², but no interactions were identified within each group.

Conclusions: These results suggest that the baseline SUA/Cr ratio could be an important predictor for the incidence of hypertension in Japanese community-dwelling persons.

Background: This cross-sectional study investigated the multi-stage and phenotype-specific association between urine-estimated salt intake and hypertension (HTN) in the Tehran Lipid and Glucose Study.

Methods: Adult participants (n = 1,782, mean age of 43.0 ± 13.7 years and 46.0% were men) were recruited (2015-2017) for 24-hour urine (24hU)-estimated salt intake and blood pressure (BP) measurements. Multivariable-adjusted multinomial logistic regression was used to estimate the association between 24hU-estimated salt intake (quintile categories and per each 1 g increment over recommended level) and HTN stages (Pre-HTN, stage 1 [S₁-HTN], and stage 2 [S₂-HTN]) and HTN phenotypes (isolated systolic HTN [ISH], isolated diastolic HTN [IDH], and systolic-diastolic HTN [SDH]).

Results: The prevalence of Pre-HTN, S₁- and S₂-HTN was 5.7%, 29.3%, and 9.1%, respectively. The prevalence of ISH, IDH, and SDH was 2.5%, 27.9%, and 8.0%, respectively. 24hU-estimated salt intake > 10.9 vs. < 6.7 g/day was associated with an elevated probability of Pre-HTN and S₁-HTN, IDH, and SDH by 2.50, 1.65, 1.74, and 2.03-fold, respectively. Every 1 g-increment of salt intake over 5 g/day was associated with an increased chance of having Pre-HTN, S₁-HTN, and IDH by 15%, 8%, and 8%, respectively.

Conclusions: The contribution of high salt intake to the development of HTN might be more pronounced during the initial stages of BP elevation, potentially impacting diastolic BP to a greater extent than systolic BP.

Background: The aim of this study was to determine the association between low density lipoprotein cholesterol (LDL-C) and risks of stroke and mortality in the hypertensive patients with high risk of atherosclerotic cardiovascular disease (ASCVD).

Methods: A total of 19,507 hypertensive patients with high risk of ASCVD from the Kailuan cohort study were included in the present study. Patients were categorized into 5 groups by the levels of LDL-C: < 1.40 mmol/L (55 mg/dL), 1.40-1.79 mmol/L (55-69 mg/dL), 1.80-2.59 mmol/L (70-99 mg/dL), 2.60-3.39 mmol/L (100-130 mg/dL), and ≥ 3.40 mmol/L (131 mg/dL). The primary outcomes of this study included hemorrhagic stroke (HS), ischemic stroke (IS), and all-cause mortality. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HS, IS, and all-cause mortality among hypertensive patients with high risk of ASCVD across LDL-C groups.

Results: During a median follow-up of 15.81 years, 3,055 cases of stroke (including 500 cases of HS and 2,555 cases of IS) and 5,340 cases of all-cause mortality were documented. Patients with LDL-C < 1.40 mmol/L had the highest incidences of HS and all-cause mortality among the 5 LDL-C groups. After adjusting for potential confounders, the HRs of HS, IS, and all-cause mortality were 1.34 (95% CI, 1.01-1.80), 1.08 (95% CI, 0.94-1.24), and 1.10 (95% CI, 1.01-1.21) for patients with LDL-C < 1.40 mmol/L compared with those with LDL-C 1.80-2.59 mmol/L. Similar results were generated across LDL-C groups with several sensitivity analyses.

Conclusions: LDL-C < 1.40 mmol/L was associated with increased risk of HS and all-cause mortality in hypertensive patients with high-risk of ASCVD.

Background: Although the association between C-reactive protein (CRP) and hypertension has been acknowledged, the associations between parental high-sensitive CRP (hs-CRP) levels and offspring hypertension remain unexplored. To investigate the relationship between parental and offspring hs-CRP levels, as well as the association between parental hs-CRP levels and offspring hypertension.

Methods: We included 6,848 father-offspring and 1,588 mother-offspring pairs from the Kailuan study. Time-weighted average hs-CRP (TWA-CRP) was calculated by cumulative hs-CRP/Time_start-end. Hypertension were defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. The generalized estimating equation model was used to explored the relationship between parental TWA-CRP and offspring TWA-CRP, and the association between parental TWA-CRP and offspring hypertension. The Cox proportional hazard model was applied to examine the relationship between offspring TWA-CRP and hypertension risk.

Results: The regression coefficient and 95% confidence intervals (CIs) for offspring TWA-CRP were 0.50 (0.38-0.62) in father-offspring pairs and 0.53 (0.29-0.76) in mother-offspring pairs with high parental TWA-CRP. The odds ratios (ORs) and 95% CIs for offspring hypertension were 1.30 (1.11-1.52) in father-offspring pairs and 1.32 (0.95-1.84) in mother-offspring pairs with high parental TWA-CRP. When both parent and offspring had a high TWA-CRP, the ORs (95% CIs) for offspring hypertension were 1.92 (1.43-2.56) in father-offspring pairs and 2.44 (1.35-4.35) in mother-offspring pairs. The hazard ratios and 95% CIs for offspring hypertension were 1.43 (1.15-1.76) in father-offspring pairs and 2.48 (1.18-5.22) in mother-offspring pairs with high offspring TWA-CRP.

Conclusions: Parental high TWA-CRP may increase the risk of offspring hypertension.

Trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000029767.

Background: Hypertension, a significant risk factor for global public health, is well-known to be preventable and manageable through physical activity (PA). However, many studies suggest that excessive PA may not provide additional benefits. Thus, we aimed to conduct a quantitative analysis of the relationship between hypertension and PA levels.

Methods: This study analyzed the association between PA and hypertension using data from 2,429,588 South Korean adults aged 30 years and older from the Korean Community Health Survey conducted from 2009 to 2022. We used weighted binary logistic regression and generalized additive models to examine the relationship, adjusting for various sociodemographic factors. PA was categorized into moderate-intensity PA (MPA) and vigorous-intensity PA (VPA) based on World Health Organization guidelines to study the association between hypertension and PA intensity.

Results: The greatest reduction in hypertension risk was associated with 1,090 metabolic equivalent of task (MET) minutes per week, with no additional reduction beyond this point. Additionally, MPA (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.90-0.93) had a stronger association with reducing hypertension risk compared to VPA (OR, 0.95; 95% CI, 0.94-0.97) at higher levels of PA (> 1,800 MET minutes per week). Subgroup analyses showed that older age, lower education level, and lower income were associated with greater reductions in hypertension risk at the same PA levels.

Conclusions: Moderate amounts of PA are associated with a lower risk of hypertension, but additional activity beyond this may not provide further benefits. With a high amount of PA, MPA is more effective than VPA in reducing hypertension risk. Since the effectiveness of PA in preventing hypertension varies across different sociodemographic factors, appropriate policies tailored to specific groups are necessary.