Hypertension Is Related to Positive Global Sagittal Alignment: A Cross-Sectional Cohort Study

Hideyuki Arima,Daisuke Togawa,Tomohiko Hasegawa,Yu Yamato,Go Yoshida,Sho Kobayashi,Tatsuya Yasuda,Tomohiro Banno,Shin Oe,Yuki Mihara,Hiroki Ushirozako,Hironobu Hoshino,Yukihiro Matsuyama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Cross-sectional cohort study. Purpose: This study aimed to investigate the relationship between hypertension and spino-pelvic sagittal alignment in middle-aged and elderly individuals. Overview of Literature: Positive global sagittal alignment is associated with poor health-related quality of life. Hypertension is associated with tissue microcirculation disorders of the skeletal muscle. We hypothesized that hypertension may be involved in positive global sagittal alignment. Methods: In this institutional review board-approved study, 655 participants (262 men and 393 women; mean age, 72.9 years; range, 50–92 years) who underwent musculoskeletal screening in Toei town, Aichi, Japan were included. Whole spine and pelvic radiographs were taken, and radiographic parameters (thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and sagittal vertical axis [SVA]) were measured using an image-analysis software. Hypertension was assessed using the standard criteria. The study participants were divided into three subgroups as per age (50–64 years, 65–74 years, and ≥75 years). We examined the differences in the radiographic parameters of those with and without hypertension in each age subgroup. Results: In each age subgroup, there was no significant difference in the age and sex of those with and without hypertension. SVA was significantly shifted forward in the hypertension group than in the non-hypertension group in those aged 50–64 years old (32.4 mm vs. 16.0 mm, p=0.018) and in those aged 65–74 years old (42.7 mm vs. 30.6 mm, p=0.012). There was no significant difference between the hypertension and non-hypertension groups in terms of the alignment of the lumbar and thoracic spine in all the subgroups. In multivariate analysis, hypertension was a significant independent factor of forward-shifted SVA (standardized beta 0.093, p=0.015). Conclusions: This study showed that hypertension was associated with forward-shifted global sagittal alignment.

일부 남성근로자의 3년간 고혈압 발생률과 위험요인

서현주,김종순,장윤균,박일근,김수근,Seo, Hyun-Ju,Kim, Chong-Soon,Chang, Yun-Kyun,Park, Il-Geun,Kim, Soo-Geun 대한예방의학회 2006 예방의학회지 Vol.39 No.3

Objectives: Cardiovascular disease is one of the main causes of death and morbidity in Korea. In this study, the prevalence and incidence of developing hypertension in a male-workers' cohort were investigated during 3-years follow-up with a view to find the risk factors that affected the development of hypertension. Methods: Among the 5,374 people who participated in a routine health check up, 3,852 people with normal blood pressure and who had no history of hypertension were prospectively followed up for 3 years. The classification of hypertension was based on the JNC7 report (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure). Life style factors and underlying diseases that were related to the risk factors of hypertension were collected by using a self-report questionnaires via the internet. Results: The prevalence of hypertension was 28.3% (1,520/5,374) at the first screening (2001). It was found that the incidence in 2004 of hypertension for the follow-up subjects (3,711) who had normal blood pressure in 2001 was 7.6 per 100 person-year. Multiple logistic regression analysis of the variables related to the risk factors of hypertension was carried out. The relative risks were 1.037 (95% CI=1.022-1.053) as the age increased 1 year and 1.039 (95% CI=1.023-1.055) as the body mass index increased $1kg/m^2$. The relative risk for the prehypertensive group was 2.501 (95% CI=1.986-3.149) compared to the normotensive group. These results showed that age, body mass index and the baseline blood pressure were significantly related to the incidence of hypertension. Conclusions: The incidence of hypertension was 7.6 per 100 person-year during follow-up. It was concluded that the risk factors for developing hypertension in the short-term were age, BMI, and prehypertension; Especially, this showed that it is necessary for prehypertensives to manage their body weight and blood pressure to prevent hypertension in middle-age by modifying their life style.

Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis

Chowdhury Mohammad Ziaul Islam,Rahman Meshbahur,Akter Tanjila,Akhter Tania,Ahmed Arifa,Shovon Minhajul Arifin,Farhana Zaki,Chowdhury Nashit,Turin Tanvir C. 대한고혈압학회 2020 Clinical Hypertension Vol.26 No.3

Background: Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and threequarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods: We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results: Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I2 = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions: The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.

Korea hypertension fact sheet 2021: analysis of nationwide population-based data with special focus on hypertension in women

Kim Hyeon Chang,Lee Hokyou,Lee Hyeok-Hee,서은선,Kim Eunji,한지연,Kwon Ja-Young 대한고혈압학회 2022 Clinical Hypertension Vol.28 No.-

The Korean Society of Hypertension has published the Korea Hypertension Fact Sheet 2021 to provide an overview of the magnitude and management status of hypertension and their recent trends.The Fact Sheets were based on the analyses of Korean adults aged 20 years or older of the 1998–2019 Korea National Health and Nutrition Examination Survey and the 2002–2019 National Health Insurance Big Data.Currently, the population average of systolic/diastolic blood pressure was 119/76 mmHg in Korean adults aged 20 years or older showing little change in the recent decade. It is estimated that 28% of the adult population aged 20 or older (33% of adults aged 30 or older) have hypertension. The estimated number of people with hypertension was 6.30 million for men and 5.77 million for women, and 1.96 million for men and 2.99 million for women among the population aged 65 or older. The number of people diagnosed with hypertension increased from 3.0 million in 2002 to 10.1 million in 2019. During the same period, the number of people using antihypertensive medication increased from 2.5 million to 9.5 million, and the number of people adherent to treatment increased from 0.6 million to 6.9 million. Among antihypertensive prescriptions, 40.6% of the patients received monotherapy, 43.4% received dual therapy, and 16.0% received triple or more therapy. The most commonly prescribed antihypertensive medication was angiotensin receptor blockers (ARB), followed by calcium channel blockers (CCB) and diuretics. In young women, angiotensin-converting enzyme inhibitors (ACEi), ARB and CCB are less frequently prescribed than in men, but 59.5% of hypertensive women aged 20–39 are prescribed ACEi or ARBs. Hypertensive disorders during pregnancy have been increasing over the past 10 years. In 2019, 5.4% of women who gave birth were diagnosed with chronic hypertension and 3.1% with pregnancy-induced hypertension.To achieve further improvement in management of hypertension, we need to encourage awareness and treatment in young adults. It is required to develop tailored prevention and management strategies that are appropriate for and inclusive of various demographics.

The Relationship between Family History and Hypertension by Serum Glucose Levels and Age in Korean Men and Women

류미경,설재웅,지선하,조일훈 대한의생명과학회 2022 Biomedical Science Letters Vol.28 No.4

Hypertension is associated with cardiovascular disease. The environmental and genetic factors can cause the development of hypertension. In this study, the relationship between hypertension and family history of hypertension in Koreans was analyzed in consideration of serum fasting blood glucose levels and age. The study subjects were 2,484 subjects who had a medical examination at a university hospital. The main statistical analysis method was multiple logistic regression analysis. Hypertension prevalence was 16.4% of all subjects, and subjects with a family history of hypertension were 23.5%. The risk of hypertension was 2.36 times higher in subjects with a family history of hypertension than subjects without a family history of hypertension. In addition, in the subjects with fasting blood glucose levels more than 120 mg/dL, the risk of hypertension was 4.44 times higher in subjects with a family history of hypertension compared with subjects without a family history of hypertension. The relationship between family history and hypertension was slightly higher in the older group than in the younger group. To assess the association between hypertension and family history, further cohort study is necessary in the future.

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationallyrepresentative surveys

Fariha Binte Hossain,Gourab Adhikary,Ariful Bari Chowdhury,Md Shajedur Rahman Shawon 대한고혈압학회 2020 Clinical Hypertension Vol.26 No.1

Background: Although there has been a well-established association between overweight-obesity and hypertension, whether such associations are heterogeneous for South Asian populations, or for different socioeconomic groups is not well-known. We explored the associations of overweight and obesity using South Asian cut-offs with hypertension, and also examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups. Methods: We analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal, with a total of 821,040 men and women. Hypertension was defined by 2017 ACC/AHA cut-offs and by Joint National Committee 7 (JNC7) cut-offs for measured blood pressure and overweight and obesity were defined by measured height and weight. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI. Results: The prevalence of hypertension using JNC7 cut-offs among participants increased by age in all three countries. The prevalence ranged from 17.4% in 35–44 years to 34.9% in ≥55 years in Bangladesh, from 4.6% in 18– 24 years to 28.6% in 45–54 years in India, and from 3.8% in 18–24 years to 39.2% in ≥55 years in Nepal. Men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity using both WHO and South Asian cut-offs were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65–1.93), 1.59 (95% CI: 1.58–1.61), and 2.03 (95% CI: 1.90–2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household’s wealth index. Conclusions: Our study shows that the association of BMI with hypertension is stronger for South Asian populations at even lower cut-offs points for overweight and obesity. Therefore, public health measures to reduce population-level reduction in BMI in all population groups would also help in lowering the burden of hypertension.

Korea Hypertension Fact Sheet 2023: analysis of nationwide population-based data with a particular focus on hypertension in special populations

Kim Hyeon Chang,Lee Hokyou,Lee Hyeok-Hee,손다솜,Cho Minsung,Shin Sojung,Seo Yeeun,kim Eun-Jin,Ahn Song Vogue,Jee Sun Ha,Park Sungha,Lee Hae-Young,Shin Min Ho,Ihm Sang Hyun,Lee Seung Won,Park Jong Ku,Suh 대한고혈압학회 2024 Clinical Hypertension Vol.30 No.-

Background The Korea Hypertension Fact Sheet 2023, presented by the Korean Society of Hypertension, ofers an overview of the prevalence and management of hypertension, along with recent trends. Methods Data for the Fact Sheet were derived from the Korea National Health and Nutrition Examination Survey spanning 1998 to 2021, and the National Health Insurance Big Data from 2002 to 2021. Results As of 2021, hypertension afected 28.0% of Korean adults aged 20 and older, totaling approximately 12.3 mil‑ lion individuals, with 5.3 million (43.5%) aged 65 or older. Among those with hypertension, awareness stood at 74.1%, treatment rates at 70.3%, and control rates at 56.0%. Over the years, the number of hypertension diagnoses increased from 3.0 million in 2002 to 11.1 million in 2021. During the same period, the utilization of antihypertensive medica‑ tions rose from 2.5 million to 10.5 million, with treatment adherence also improving from 0.6 million to 7.8 million individuals. In 2021, the predominant antihypertensive drug class was angiotensin receptor blockers (75.1%), followed by calcium channel blockers (61.7%), diuretics (23.4%), and beta blockers (15.3%). Notably, 60.2% of all antihyper‑ tensive prescriptions involved combination therapy with at least two classes of antihypertensive medication. There was a positive trend towards stricter blood pressure control targets (systolic/diastolic blood pressure<130/80 mmHg) among elderly hypertensive patients, as well as those with diabetes, obesity, and high-risk hypertension. However, this trend declined in individuals aged 80 years or older and those with chronic kidney disease in recent years. Conclusion In Korea, hypertension management is making strides, yet the total number of hypertensive individu‑ als is rising. Efectively addressing the growing population of elderly hypertensive patients and the persistently low treatment rates among younger individuals with hypertension is a critical challenge. Additionally, developing more efcient and customized policies for blood pressure control and cardiovascular disease prevention is imperative.

Sex-Specific Trends in the Prevalence of Hypertension and the Number of People With Hypertension: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 1998–2018

Eunsun Seo,Sunjae Jung,Hokyou Lee,Hyeon Chang Kim 대한심장학회 2022 Korean Circulation Journal Vol.52 No.5

Background and Objectives: As the Korean population ages fast, it is estimated that the people with hypertension, especially female patients, will increase rapidly. However, there are few data comparing the size of female and male hypertensive patients in the Korean population. Thus we assessed sex-specific trends in the prevalence and the number of people with hypertension. Methods: We analyzed data for 128,949 adults aged ≥20 years with valid blood pressure measurements from the 1998 to 2018 Korea National Health and Nutrition Examination Survey (KNHANES). The prevalence and the absolute number of hypertension were estimated with taking into the sampling weights separately for women and men. Results: Overall prevalence of hypertension is higher in men than in women. But, in older adults, women show higher prevalence and the number of people with hypertension. Between 1998 and 2018, prevalence of hypertension increased from 61.8% to 65.9% in elderly (age 65+) women, and from 49.0% to 59.4% in elderly men. During the same period, the number of elderly women with hypertension increased from 1.18 to 2.70 million, while the number of elderly men with hypertension increased from 0.57 to 1.78 million. Among hypertensive patients, undiagnosed hypertension and diagnosed-but-untreated hypertension were more common in men, while treated-but-uncontrolled hypertension were more common in women. Conclusion: The fast-growing number of elderly women with hypertension will be an important public health challenge for the Korean society to solve in order to reduce the burden of cardiovascular disease.

Sex-specific effects of social networks on the prevalence, awareness, and control of hypertension among older Korean adults

Baek, Jiwon,Hur, Nam Wook,Kim, Hyeon Chang,Youm, Yoosik Science Press 2016 Journal of geriatric cardiology Vol.13 No.7

<P><B>Background</B></P><P>Hypertension is a common chronic disease among older adults, and is associated with medical complications and mortality. This study aimed to examine the effects of social network characteristics on the prevalence, awareness, and control of hypertension among older adults.</P><P><B>Methods</B></P><P>The Korean Social Life, Health, and Aging Project (KSHAP) interviewed 814 ≥ 60-year-old residents and their spouses from a rural township between December 2011 and March 2012 (response rate: 95%). We evaluated the data from 595 participants. Multivariate logistic regression models were used to assess the effects of network characteristics on hypertension.</P><P><B>Results</B></P><P>We observed strong sex-specific network effects on the prevalence, awareness, and control of hypertension. Among older women, network density was associated with hypertension awareness [odds ratio (OR): 2.63, 95% confidence interval (CI): 1.03–5.37] and control (OR: 1.72; 95% CI: 0.94–3.13). Among older men, large networks were associated with a lower prevalence of hypertension (OR: 0.75; 95% CI: 0.58–0.96). Compared to older women, older men with coarse networks exhibited better hypertension awareness (OR: 0.37; 95% CI: 0.14–0.95) and control (OR: 0.42; 95% CI: 0.19–0.91). Network size interacted with density for hypertension control (<I>P</I> = 0.051), with controlled hypertension being associated with large and course networks.</P><P><B>Conclusions</B></P><P>A large network was associated with a lower risk for hypertension, and a coarse network was associated with hypertension awareness and control among older men. Older women with dense networks were most likely to exhibit hypertension awareness and control.</P>

When and how to use ambulatory blood pressure monitoring and home blood pressure monitoring for managing hypertension

Lee Eun Mi 대한고혈압학회 2024 Clinical Hypertension Vol.30 No.-

Many individuals have different blood pressure (BP) values in the office setting compared to that outside the office setting. Therefore, confirming hypertension based on office BP (OBP) measurement alone can lead to misdiagnosis and mistreatment. The limitations of OBP measurement have led to the complementary use of out-of-office BP measurements, including 24-hour ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). This review aims to describe when and how ABPM or HBPM can be used to accurately diagnose and treat hypertension. Both methods should be performed using validated automated oscillometric devices. To minimize user errors, ABPM should be performed using standard techniques, whereas HBPM requires patient education regarding proper BP measurements. ABPM provides short-term comprehensive information on BP, including daytime, nighttime, morning, and 24-h BP. Therefore, ABPM is recommended for the initial diagnosis of hypertension, assessment of BP phenotypes and circadian patterns, and detection of nocturnal hypertension, Furthermore, ABPM plays a critical role in confirming true resistant hypertension thereby excluding pseudo-resistant hypertension. However, it is not suitable for long-term follow-up of patients with hypertension. In contrast, HBPM involves multiple BP readings taken at specific times during the day and evening over a long period. Therefore, HBPM is recommended for diagnosing hypertension and assessing BP phenotypes. However, this method has limitations in measuring nocturnal BP and circadian BP patterns. HBPM is preferred over ABPM for the long-term follow-up of patients with hypertension. This approach improves patient adherence to treatment and ultimately enhances the rate of control of hypertension. Additionally, both methods play an important role in diagnosing and treating white coat hypertension during pregnancy. Consequently, out-of-office BP measurement is essential to prevent the misdiagnosis and mistreatment of hypertension. However, these two methods offer different information regarding the BP status of an individual, and they indeed show discrepancies in the diagnosis of hypertensive phenotypes. Therefore, it is crucial to understand the advantages and limitations of both ABPM and HBPM to ensure their appropriate use in clinical practice.