Diversity of and initiatives for hypertension management in Asia—Why we need the HOPE Asia Network

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The impact of hypertension-related cardiovascular disease and target organ damage, and therefore the benefits of blood pressure (BP) control, is greater in Asian than in Western countries. Asia-specific features of hypertension and its effective management are important and active areas of research. The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was formed in 2016and is now a member of the World Hypertension League. The main goal of the HOPE Asia Network is to improve the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia. Considerable work has already been done on the journey to achieving this goal. We have shown that BP control status in Asia differs between countries, and even between regions within the same country. Several expert panel consensus recommendations and clinical guidance papers are available to support the use of home and ambulatory BP monitoring in the region. In addition, the AsiaBP@Home study prospectively investigated home BP control status across 15 specialist centers using the same validated device and measurement schedule. We have also proposed the concept of systemic hemodynamic atherothrombotic syndrome (SHATS), a vicious cycle of BP variability and vascular disease on cardiovascular events and organ damage, and suggested a SHATS score for risk stratification for clinical practice. This special issue of the journal collates Asia-specific resources and data, contributing to advances in hypertension management and cardiovascular disease prevention in the region.

Section: Resultsmentioning

confidence: 99%

Section: Perspectivesmentioning

confidence: 99%

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

Kario

2020

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“…This comparative analysis is the first study to analyze the prognostic effect of each definition of resistant hypertension in Asian hypertension patients. Our findings have important clinical implications as Asian hypertension patients have unique features, including a high preva-lence of masked hypertension and disrupted BP variability that differ from those of other ethnicities 32,33.…”

mentioning

confidence: 80%

Prevalence and prognosis of the 2018 vs 2008 AHA definitions of apparent treatment‐resistant hypertension in high‐risk hypertension patients

Park

et al. 2020

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Resistant hypertension was defined according to the 2008 scientific statement as office blood pressure ≥ 140/90 mm Hg and the 2018 scientific statement as office blood pressure ≥ 130/80 mm Hg. We investigated the prognostic significance of lowered blood pressure threshold for defining resistant hypertension in the 2018 American Heart Association scientific statement compared with that in the 2008 scientific statement. The participants of this prospective cohort were enrolled from December 2013 to November 2018. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke, and heart failure hospitalization. Renal event was defined as a ≥ 50% decline in estimated glomerular filtration rate or progression to end‐stage renal disease. A total of 206 patients among 2018 (10.2%) were diagnosed with resistant hypertension by the previous definition (≥140/90 mm Hg), and 276 patients among 2011 (13.7%) were diagnosed with resistant hypertension by the updated definition (≥130/80 mm Hg). During a median follow‐up of 4.5 years, 33 MACEs (3.7 per 1000 patient‐years) and 164 renal events (19.9 per 1000 patient‐years) occurred in the study population. Treatment‐resistant hypertension groups had a higher incidence rate of MACEs and renal events than the control groups. In multivariate Cox proportional hazards regression analysis, resistant hypertension by both definitions was significantly associated with increased risk of MACE and renal event. Both the previous and updated definitions of resistant hypertension were significant predictors of MACEs and renal events. This finding supports the adoption of the updated criteria for resistant hypertension in clinical practice.

“…It represents a new but simple approach in the comprehensive management of hypertension. This is the solution to diversified problems and obstacles encountered particularly in Asia …”

Section: Data Demonstration Of the Philippine Sub‐analysis Of Asiabp@mentioning

confidence: 99%

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Philippines (a country report)

Sison¹,

Divinagracia

Nailes

2020

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Incidence of CVD in the Philippines based on the Philippine HeartAssociation survey among hospital-based population showed hypertension as the highest (38.6%), followed by stroke (30%), coronary artery disease (CAD) (17.5%), and heart failure (10.4%). 1 Based on Philippine FNRI data, the prevalence of coronary, cerebrovascular, and peripheral arterial diseases were 1.1%, 0.9%, and 1.0%, respectively. Cardiovascular risk factor prevalence were the following: diabetes at 3.9%, dyslipidemia at 72%, smoking at 31%, obesity at 4.9% (BMI), and 10.2% and 65.6% by waist-hip ratio in men and women, respectively. 2In a more recent study on risk factors, urban dwellers were more hypertensive, overweight, obese, and with impaired fasting glucose.More smokers and dyslipidemia by high TC, high non-HDL-C, and low HDL-C were seen in those living in the rural areas. Subjects with higher level of education were more overweight, obese and have dyslipidemia by a high TC, TG, and LDL-C while there were more smokers, low HDL-C, and hypertensive participants who have reached a lower level of education. 3 Abstract Incidence of cardiovascular diseases (CVD) in the Philippines based on the PhilippineHeart Association survey among hospital-based population showed hypertension as the highest (38.6%), followed by stroke (30%), coronary artery disease (CAD) (17.5%), and heart failure (10.4%). Based on Philippine FNRI data, the prevalence of coronary, How to cite this article: Sison J, Divinagracia R, Nailes J.Asian management of hypertension: Current status, home blood pressure, and specific concerns in Philippines (a country report). J Clin Hypertens. 2020;22:504-507.