There are a few changes in the management of diabetic nephropathy (DN) in 2015 Korean Diabetes Association (KDA) Clinical Practice Guideline. Among them, restricting protein intake in patients with DN has been in controversy. Several guidelines in other countries recommend not to reduce the daily protein intake less than 0.8 g/kg/day in patients with DN, which is in agreement with the KDA guideline. Although the current KDA recommendation does not comment about high protein intake, several guidelines warn a high protein intake (> 1.3 g/kg/day) since it aggravates the progression of DN. The other issue is a target blood pressure (BP) in DN. It has been recommended that BP should be maintained at a lower level in patients with DN than in diabetic patients without nephropathy. Recently, failure to demonstrate the beneficial effects of lowering BP in reducing mortality or cardiovascular disease lead to increase the optimal BP target in diabetes from 130/80 to 140/90 mm Hg. Therefore, BP target should be individualized based on their comorbidities and life expectancy in DN patients. In this section, we recommend the optimization of BP control to reduce the risk or slow the progression of DN, rather than specify target BP levels.
Blood Pressure ; Cardiovascular Diseases ; Comorbidity ; Diabetic Nephropathies* ; Humans ; Life Expectancy ; Mortality

The recently published 2017 American College of Cardiology (ACC)/American Heart Association (AHA)/American Academy of Physician Assistants/Association of Black Cardiologists/American College of Preventive Medicine/American Geriatrics Society/American Pharmacists Association/American Society of Hypertension (ASH)/American Society for Preventive Cardiology/National Medical Association/Preventive Cardiovascular Nurses Association (2017 ACC/AHA/ASH guideline for short) lowered the threshold for diagnosis of hypertension from 140/90 mm Hg to 130/80 mm Hg. Also, the revised guideline recommends pharmacological treatment for all hypertensive patients with either previous cardiovascular disease or 10-year atherosclerotic cardiovascular disease (ASCVD) risk greater than 10%. Since most diabetic hypertensive patients have ASCVD risk greater than 10%, the guideline recommends that all diabetics with blood pressure (BP) above 130/80 mm Hg be treated both pharmacologically and with active lifestyle modification. Although the evidence suggests that intensive lowering of BP may be beneficial in diabetic patients, there is lack of evidence that pharmacologic treatment in subjects with baseline BP below 140 mm Hg is beneficial, with some studies suggesting actual potential for harm. Also, there are data to suggest a potential risk of increased risk of cardiovascular events and mortality in subjects whose diastolic BP (DBP) was lowered to below 60 mm Hg. As such, strict BP lowering may be beneficial if the target BP could be achieved without side effects such as orthostatic hypotension and decreased renal function. Also, lowering of DBP below 60 mm Hg should be avoided. Lastly, treatment should be started in subjects with baseline BP above 140/90 mm Hg until further evidence suggests otherwise.
Blood Pressure* ; Cardiology ; Cardiovascular Diseases ; Diagnosis ; Geriatrics ; Heart ; Humans ; Hypertension ; Hypotension, Orthostatic ; Life Style ; Mortality ; Pharmacists

In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure (BP) lowering was associated with significant reduction in composite cardiovascular (CV) outcomes in hypertension. Subsequently, several meta-analyses have corroborated the findings from SPRINT and these benefits were more prominent in subjects with higher cardiovascular risk at baseline. As such, the recent American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline and the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guideline recommended the lowering of target BP to less than 130/80 mmHg in most hypertensive subjects. However, one should keep in mind the potential harm of too much BP lowering. Post hoc analysis of clinical trials have demonstrated increased cardiovascular mortality and events with too much BP lowering. Therefore, although intensive BP lowering may be beneficial in further reducing CV outcomes, too much reduction below 120/70 mmHg may actually harmful. In conclusion, although intensive BP lowering to achieve target BP below 130/80 mmHg is beneficial in reducing CV outcomes, one should do so cautiously as to avoid adverse events. As such, the first target of anti-hypertensive treatment should be to achieve BP lowering below 140/90 mmHg. Once that target is achieved, one could target BP below 130/80 mmHg keeping in mind to avoid signs of organ hypoperfusion such as orthostatic hypotension, orthostatic dizziness, weakness and serum creatinine elevation.
Blood Pressure ; Cardiology ; Cardiovascular Diseases ; Creatinine ; Dizziness ; Heart ; Hypertension ; Hypotension, Orthostatic ; Mortality

Hypertension affects the majority of patients with chronic kidney disease (CKD) and increases the risk of cardiovascular disease, end-stage renal disease and mortality. Previously, many hypertension guidelines have suggested blood pressure targets in patients with CKD. Recently, the American College of Cardiology/American Heart Association 2017 Guideline for Hypertension suggests a new definition for hypertension and therapeutic targets, which were equally applicated to patients with CKD. These changes reflect the results of the Systolic Blood Pressure Intervention Trial (SPRINT) study, but the renal outcome of intensive blood pressure control was not good. Furthermore, the majority of hypertension guidelines including those of the Korean Society of Hypertension and the European Society of Hypertension have retained the traditional definition. Herein, we intend to analyze in detail the effect of intensive blood pressure control on kidney through the post-hoc analyses of the SPRINT study.
Blood Pressure ; Cardiovascular Diseases ; Diagnosis ; Heart ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Insufficiency, Chronic

OBJECTIVETo study the relative risk (RR) of mortalities of cerebro-cardiovascular diseases (CVD) in Guangzhou workers with hypertension.

METHODProspective cohort study was conducted in 78,379 workers, aged >or= 35, from 399 factories. Cox regression model were mainly used for data analysis.

RESULTS(1) There were 48,705 male and 29,674 female workers in the cohort. All workers were followed-up for 8 years. 363 CVD deaths (male 305, female 58) mainly died of stroke, coronary heart disease and hypertension. The crude mortalities were 78.58/100,000 person years in male and 24.55/100,000 person years in female. (2) Compared with the optimal or normal blood pressure (ONBP), the RR (95%) of CVD deaths with high blood pressure (HBP) were 6.19 (4.85 - 7.91) in male and 2.78 (1.59 - 4.85) in female. In male, compared with ONBP, the RR of CVD deaths without illness but with 1st-grade HBP at baseline, and of those suffered non-CVD but with 1st-grade HBP at baseline, and of those suffered CVD with 2nd-grade HBP at baseline were 3.98, 3.25 and 3.15 respectively (P < 0.01). (3) After stratifying of age, smoking, drinking, educational levels and occupational exposure, the RR of CVD deaths was higher in those who were younger, or ever-smoking, non-drinking, higher educational level, exposed to occupational hazards and with hypertension.

CONCLUSIONThere is relationship between BP levels and CVD mortality. High BP may affect CVD deaths at younger age. Comprehensive measures should be used to reduce the risk of CVD deaths.

Adult ; Aged ; Blood Pressure ; Cardiovascular Diseases ; mortality ; Cerebrovascular Disorders ; mortality ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies

OBJECTIVES: Even though experimental studies have suggested that iron can be involved in generating oxidative stress, epidemiologic studies on the association of markers of body iron stores with cardiovascular disease or cancer remain controversial. This study was performed to examine the association of serum ferritin and transferrin saturation (%TS) with all-cause, cancer, and cardiovascular mortality. METHODS: The study subjects were men aged 50 years or older and postmenopausal women of the Third National Health and Nutrition Examination Survey 1988-1994. Participants were followed-up for mortality through December 31, 2006. RESULTS: Serum ferritin was not associated with all-cause, cancer, or cardiovascular mortality for either men or postmenopausal women. However, all-cause, cancer, and cardiovascular mortality were inversely associated with %TS in men. Compared with men in the lowest quintile, adjusted hazard ratios for all-cause, cancer, and cardiovascular mortality were 0.85, 0.86, 0.76, and 0.74 (p for trend < 0.01), 0.82, 0.73, 0.75, and 0.63 (p for trend < 0.01), and 0.86, 0.81, 0.72, and 0.76 (p for trend < 0.01), respectively. For postmenopausal women, inverse associations were also observed for all-cause and cardiovascular mortality, but cancer mortality showed the significantly lower mortality only in the 2nd quintile of %TS compared with that of the 1st quintile. CONCLUSIONS: Unlike speculation on the role of iron from experimental studies, %TS was inversely associated with all-cause, cancer and cardiovascular mortality in men and postmenopausal women. On the other hand, serum ferritin was not associated with all-cause, cancer, or cardiovascular mortality.
Aged ; Cardiovascular Diseases/blood/*mortality ; Cause of Death ; Female ; Ferritins/*blood ; Follow-Up Studies ; Health Surveys ; Humans ; Male ; Middle Aged ; Neoplasms/*mortality ; Republic of Korea/epidemiology ; Transferrins/*blood

Objective: To quantify the burden of cardiovascular disease (CVD) deaths that attributed to metabolic disorders in population aged ≥25 years in Jiangsu province. Methods: The data we used were from the following three sources: 1) 2015 Jiangsu Chronic Disease Risk Factor and Nutrition Survey, 2) death surveillance, 3) results of the 2016 Global Burden of Disease Study, based on population attributable fractions (PAF), to analyze related parameters as mortality, years of life lost (YLL), life expectancy (LE) and premature mortality. Results: Most people died from ischemic stroke (IS) showed the standard mortality as 87.48/100 000. High SBP appeared as the major cause on CVD deaths. PAF with high cholesterol and high BMI decreased along with the increase of age while high fasting plasma glucose increased. Deaths due to ischemic heart diseases, IS or hemorrhagic stroke that attributed to metabolism disorders would reduce the LE by 1.08, 1.07 or 0.55 years, respectively. Males appeared to have higher YLL than females and were more likely to die from premature CVD, as the consequence of having metabolism disorders. Conclusions: Blood pressure control should be considered an important approach to reduce the burden of CVD. According to the characteristics of gender-related risks and the distinct impact of age-related metabolism disorders on different CVD diseases, stratified strategies should be strengthened for comprehensive prevention and control of CVD, in Jiangsu province.
Adult ; Blood Pressure ; Cardiovascular Diseases/epidemiology* ; Chronic Disease ; Cost of Illness ; Female ; Humans ; Life Expectancy ; Male ; Metabolic Diseases/epidemiology* ; Mortality/trends* ; Mortality, Premature ; Risk Factors

Elevated blood pressure (BP) is the most common cause of cardiovascular disease. Salt intake has a strong influence on BP, and plasma sodium (pNa) is increased with progressive increases in salt intake. However, the associations with pNa and BP had been reported inconsistently. We evaluated the association between pNa and BP, and estimated the risks of all-cause-mortality according to pNa levels. On the basis of data collected from health checkups during 1995-2009, 97,009 adult subjects were included. Positive correlations between pNa and systolic BP, diastolic BP, and pulse pressure (PP) were noted in participants with pNa > or =138 mM/L (P<0.001). In participants aged > or =50 yr, SBP, DBP, and PP were positively associated with pNa. In participants with metabolic syndrome components, the differences in SBP and DBP according to pNa were greater (P<0.001). A cumulative incidence of mortality was increased with increasing pNa in women aged > or =50 yr during the median 4.2-yr-follow-up (P<0.001). In women, unadjusted risks for mortality were increased according to sodium levels. After adjustment, pNa > or =145 mM/L was related to mortality. The positive correlation between pNa and BP is stronger in older subjects, women, and subjects with metabolic syndrome components. The incidence and adjusted risks of mortality increase with increasing pNa in women aged > or =50 yr.
Adult ; Blood Pressure/*physiology ; Cardiovascular Diseases/blood/*mortality ; Female ; Humans ; Hypertension/*physiopathology ; Incidence ; Male ; Metabolic Syndrome X/blood ; Middle Aged ; Risk ; Risk Factors ; Sex Factors ; Sodium/*blood

BACKGROUNDIncreased blood pressure and elevated total cholesterol (TC) level are the two most important modifiable risk factors of cardiovascular disease (CVD) in the world. Hypertension and hypercholesterolemia co-exist more often than would be expected and whether there is a synergistic impact on fatal CVD between elevated TC and hypertension need to be further examined in Chinese population.

METHODSWe conducted a cohort study which recruited 5092 Chinese male steelworkers aged 18 - 74 years in 1974 - 1980 and followed up for an average of 20.84 years. Totally 302 fatal CVD events were documented by the year of 2001. Cox proportional hazards regression models were undertaken to adjust for baseline variables with fatal CVD events as the outcome variable. Additive interaction model was used to evaluate the interaction between elevated TC and hypertension.

RESULTSHypercholesterolemia and hypertension were significantly associated with an increased hazard ratio (HR) of fatal CVD (1.67 (95%CI 1.18 - 2.38) and 2.91 (95%CI 2.23 - 3.80) respectively. Compared to participants with normotension and TC < 240 mg/dl, the HRs were 1.11 (95%CI 0.56 - 2.21), 2.74 (95%CI 2.07 - 3.64) for hypercholesterolemia and hypertension respectively, and 5.51 (95%CI 3.58 - 8.46) for participants with both risk factors. There was an additive interaction with a 2.65 (95%CI 0.45 - 4.85) relative excess risk (RERI) between hypercholesterolemia and hypertension on CVD.

CONCLUSIONWe found that the risk of fatal CVD was significantly associated with an additive interaction due to hypercholesterolemia and hypertension besides a conventional main effect derived from either of them, which highlights that the prevention and treatment of both risk factors might improve the individual risk profile thus reduce the CVD mortality.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Cardiovascular Diseases ; blood ; etiology ; mortality ; Cholesterol ; blood ; Humans ; Hypercholesterolemia ; blood ; complications ; Hypertension ; blood ; complications ; Male ; Middle Aged ; Steel ; Young Adult

Over the past century, salt has been the subject of intense scientific research related to blood pressure elevation and cardiovascular mortalities. Moderate reduction of dietary salt intake is generally an effective measure to reduce blood pressure. However, recently some in the academic society and lay media dispute the benefits of salt restriction, pointing to inconsistent outcomes noted in some observational studies. A reduction in dietary salt from the current intake of 9-12 g/day to the recommended level of less than 5-6 g/day will have major beneficial effects on cardiovascular health along with major healthcare cost savings around the world. The World Health Organization (WHO) strongly recommended to reduce dietary salt intake as one of the top priority actions to tackle the global non-communicable disease crisis and has urged member nations to take action to reduce population wide dietary salt intake to decrease the number of deaths from hypertension, cardiovascular disease and stroke. However, some scientists still advocate the possibility of increased risk of CVD morbidity and mortality at extremes of low salt intake. Future research may inform the optimal sodium reduction strategies and intake targets for general populations. Until then, we have to continue to build consensus around the greatest benefits of salt reduction for CVD prevention, and dietary salt intake reduction strategies must remain at the top of the public health agenda.
Blood Pressure ; Cardiovascular Diseases ; Consensus ; Dissent and Disputes ; Health Care Costs ; Hypertension* ; Income ; Mortality ; Public Health ; Sodium ; Stroke ; World Health Organization