Asian management of hypertension: Current status, home blood pressure, and specific concerns in Korea

Abstract

Korean prevalence rates for hypertension range from 24% in women to 33% in men. 1 In 2016, deaths from coronary artery disease (CAD) in Korea made up 10% of total mortality, and the age-adjusted death rate from CAD was 30.76 per 100 000. 2 Corresponding values for stroke were 12% of total mortality at a rate of 34.98 per 100 000. 2The incidence of hemorrhagic stroke is decreasing, and ischemic stroke is increasing. However, overall mortality from stroke has decreased substantially, by 28.3% over the first decade of the 21st century. 3 The incidence of myocardial infarction also appears to be decreasing. 4 The decrease in hemorrhagic stroke and stroke mortality can be attributed to control of hypertension. However, the overall hypertension control rate has been stable for more than a decade, at approximately 45%. 5 The control rate in treated patients is about 70%, highlighting that improving the treatment rate or adherence to therapy is an important priority for better hypertension control. 1 | CURRENT S TATUS OF HB PM IN THE MANAG EMENT OF HYPERTEN S I ON IN KO RE AA recent Korean survey showed that most physicians did not believe in the accuracy of home BP monitoring (HBPM) devices and had limited time and resources to educate individual patients. 6 Overall, the use of HBPM is seen as indispensable to monitoring and achieving BP control, including confirmation of compliance AbstractHypertension is present in almost one-quarter of women and one-third of men in Korea. Although mortality rates from stroke and myocardial infarction (MI) appear to be decreasing, stroke is a more common cause of cardiovascular death than MI.This may be due to better control of hypertension, but national control rates have remained stable for more than a decade (at about 45%). Korean Society of Hypertension

Clinical outcomes of renin angiotensin system inhibitor-based dual antihypertensive regimens in chronic kidney disease: a network meta-analysis

“…Among 16 clinical trials included in this study, 9 clinical trials evaluated outcomes from 7 different antihypertensive regimen in CKD patients with diabetes: ACEI monotherapy, ARB monotherapy, ACEI-based spironolactone, ARB-based spironolactone, ARB and ACEI combination, and ARB-based renin inhibitor. The risk of major CVD events was substantially higher in ACEI + SPR (OR 5.53; 95% CI 1.05–29.19) when compared to ARB monotherapy (reference), the most prescribed antihypertensive regimen in Korea (Supplementary Figure S2 ) 9 , 41 . Meanwhile, the risk of hyperkalemia was similar among the treatment regimens when referenced with ARB monotherapy (Supplementary Figure S3 ).…”

“…Frequentist network meta-analyses were conducted to simultaneously compare the outcomes of interest by integrating direct and indirect effects of each RASi-based dual antihypertensive treatment regimen against a control group generated by the network meta-analysis in CKD patients 48 . ARB-based dual antihypertensive regimen with calcium channel blocker (CCB) was applied as the control antihypertensive treatment regimen for network analysis 9 , 41 . Dichotomous variables including major CVD events, ESRD diagnosis, all-cause mortality, and hyperkalemia were analyzed with a Mantel–Haenszel random effects model and odds ratio (OR) with 95% confidence intervals (CI) were calculated for each antihypertensive regimen.…”

A Count-Based Binary Decision Method For Target Blood Pressure Achievement in Home Blood Pressure Monitoring Data Interpretation For Clinical Practices

“…N <-100 K <-16 SD <-c (5,10,15,20) sd_label <-c("SD = 5", "SD = 10", "SD = 15", "SD = 20") mk<-matrix (NA, ncol = k, nrow = N) sbp <-list(mk, mk, mk, mk) dbp <-list(mk, mk, mk, mk) names(sbp)<-sd_label; names(dbp)<-sd_label dimnames <-list(paste0("Pt", 1:N), sd_label) msd <-matrix(NA, ncol = NROW(SD), nrow = N, dimnames = dimnames) meansbp <-msd; meandbp <-msd shtn <-msd; dhtn <-msd nsbp135 <-msd; ndbp85 <-msd for (j in 1:NROW(SD)){ 5) Assessments and comparisons of the diagnostic performances for uncontrolled BPs Sensitivity, speci city, PPV, NPV, CCR and C-statistic were assessed as diagnostic performance indexes of the high BP counts. Although Delong's method can be employed to generate CIs for C-statistics and to compare 2 C-statistics, there have been no stable methods to compare the other diagnostic performance indexes among 3 or more groups.…”

“…It would be di cult for physicians to make a quick decision regarding whether target BP is achieved without ready-to-use analysis of the HBP records. This di culty acts as a barrier to stop broadening the use of HBPM in daily practice 10,11 . Some HBPM devices provide built-in systems or solutions allowing storage and transfer of BP records through Bluetooth or wireless internet technology.…”

“…Therefore, we developed a simple method to make a binary decision for the control of HBP through high BP counts. We simulated 100 cases of HBP series for each combination of 3 numbers of BP readings (K = 16, 20, 24) and 4 levels of the standard deviations (SDs = 5,10,15, 20). A high BP was de ned as an individual BP ≥ 135/85 mmHg, and an uncontrolled HBP was de ned as a mean HBP ≥ 135/85 mmHg.…”