BACKGROUND: The use of ambulatory blood pressure monitoring (ABPM) in childhood hypertension has been in great advance. ABPM has been able to detect significantly high blood pressure (BP) and also helpful for identifying white coat hypertension. METHODS: Between March 2007 and December 2009, we evaluated individuals aged from 7 to 19 years who were referred as high BP with ABPM, echocardiogram, and abdominal computerized tomography, calculation of body mass index (BMI) at Ajou University Hospital. ABPM was performed using the Tonoport V monitors and SpaceLab 90217 monitors. Seventy were evaluated with 55 boys and 5 girls. The mean age of them was 13.1 +/- 2.8 years (mean +/- standard deviation). RESULTS: Forty of seventy (57.1%) were diagnosed as hypertension in ABPM and 8 of 40 were diagnosed as secondary hypertension with underline diseases such as hyperthyroidism, chronic renal disease, Takayasu's arteritis, coarctation of aorta. The mean BMI in 40 was 24.8 +/- 4.72 kg/m2. Twenty-three of seventy (32.8%) were obese with higher prevalence than in general population. White coat hypertension was diagnosed in 30 of 70 (42.9%). CONCLUSIONS: ABPM could provide more detailed data including mean values of BP, load, and night dip in assessment of children's BP. According to increasing children's obesity, use of ABPM was thought to be necessary for evaluation of their risk of hypertension and useful for diagnosis of masked hypertension and white coat hypertension. Further more study of ABPM in children and adolescents would be needed for absolute standards of ABPM.
Adolescent ; Aged ; Aortic Coarctation ; Blood Pressure Monitoring, Ambulatory ; Body Mass Index ; Child ; Humans ; Hypertension ; Hyperthyroidism ; Masked Hypertension ; Obesity ; Prevalence ; Renal Insufficiency, Chronic ; Takayasu Arteritis ; White Coat Hypertension

BACKGROUND: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. METHODS: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile < 70/min, n = 129; middle tertile 70-80/min, n = 114; upper tertile > 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. RESULTS: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction, ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p < 0.001). Patients with upper tertile had a higher predictive value for the incidence of death (hazard ratio, 5.8; p = 0.036) and hospitalization for HF (hazard ratio, 6.4; p < 0.001) than in those with middle and lower tertile. In multivariate analysis, NYHA class III/IV, resting HR > 80/min, and ejection fraction < 35% were independent predictors of adverse events. CONCLUSIONS: High resting HR (> 80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF.
Coronary Artery Disease ; Developed Countries ; Heart ; Heart Failure ; Heart Rate ; Hospitalization ; Humans ; Hypertension ; Incidence ; Multivariate Analysis ; Myocardial Infarction ; New York ; Prognosis ; Prospective Studies ; Stroke

BACKGROUND: Wide pulse pressure associates with atherosclerosis, but it is unclear whether pulse pressure within a relatively normal range is associated with atherosclerosis in younger populations. The aim of this study was to investigate the association between pulse pressure and the carotid intima-media thickness (IMT) in healthy adolescents. METHODS: Study participants included 250 (129 males and 121 females) adolescents who were 17 to 19 years old and in the third grade of a high school in Jangseong, Korea between November 20 and December 1, 2009. Pulse pressure was determined as the difference between systolic blood pressure and diastolic blood pressure which were measured with an oscillometric sphygmomanometer. IMT values were ultrasonographically measured at right and left common carotid arteries, and average of the mean IMT at each artery was used for analysis. RESULTS: There was a significant correlation between pulse pressure and carotid IMT before (Pearson coefficient r = 0.2037, p = 0.001) and after (r = 0.1479, p = 0.020) adjustment for sex. When adjusted for sex, age, waist circumference, fasting blood glucose, and total/high-density lipoprotein cholesterol ratio, 10 mm Hg increase in pulse pressure was associated with increase of IMT in total (beta = 10.9 microm, p = 0.003), in males (beta = 17.3 microm, p < 0.001), but not in females (beta = 3.609 microm, p = 0.518). CONCLUSIONS: This study suggests that higher pulse pressure may be associated with increased carotid IMT even in healthy male adolescents.
Adolescent ; Arteries ; Atherosclerosis ; Blood Glucose ; Blood Pressure ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Cholesterol ; Fasting ; Female ; Humans ; Korea ; Lipoproteins ; Male ; Reference Values ; Sphygmomanometers ; Waist Circumference

In spite of being several results of efficacy obtained by randomized controlled trials about new health technologies, evidences related to real effectiveness confirmed by head-to-head direct comparison should be needed in order to improve qualities of healthcare. The comparative effectiveness evaluation (CEE) as outcomes research have suggested as the important tool for developing evidence-based information to patients, clinicians, and other decision makers about which technologies are most effective for which patients under specific circumstances. Four major methods of outcomes research are applied as systematic reviews and meta-analyses, cohort studies using registries, linkage of large databases, and pragmatic clinical trials. Through activating the CEE, the best and most effective technologies should be adopted rapidly in routine clinical practices.
Cohort Studies ; Comparative Effectiveness Research ; Delivery of Health Care ; Humans ; Outcome Assessment (Health Care) ; Registries ; Technology Assessment, Biomedical

To reduce cardio-cerebro-vascular and renal morbidity and mortality, the current guidelines on the treatment of hypertension recommend evaluating and managing total cardiovascular risks of the patient with hypertension, not just focused on reducing blood pressure itself. In this point of view, the angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are considered to be ideal drugs in the treatment of hypertension, because the angiotensin II plays a pivotal role in every stage of cardiovascular disease continuum. Many studies have shown that the ARBs were not only effective in lowering blood pressure, but also had another role in reducing morbidity and mortality of heart failure, myocardial infarction, stroke, diabetic nephropathy, chronic kidney disease, and the recurrence of atrial fibrillation, so called beyond blood pressure lowering effects or pleiotropic effects. However, these favorable effects of ARBs are counter-balanced by some debating issues, myocardial infarction paradox or cancer risk. Furthermore, the issue whether ARBs could replace the role of ACEIs in the treatment of cardiovascular diseases is not resolved yet. Because there have been no randomized studies proving the ARBs are better than ACEIs in terms of cardiovascular morbidity or mortality, the current status of the role of ARBs are an reasonable alternative of ACEIs. In this review, the current issues and status of ARBs will be discussed.
Angiotensin II ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Atrial Fibrillation ; Blood Pressure ; Cardiovascular Diseases ; Diabetic Nephropathies ; Heart Failure ; Humans ; Hypertension ; Myocardial Infarction ; Receptors, Angiotensin ; Recurrence ; Renal Insufficiency, Chronic ; Stroke

This review represents the clinical significance of home blood pressure (BP) and its possible practical application. Home BP is highly reproducible and its reproducibility is better than ambulatory BP. According to this feature home BP has a greater prognostic value at least than clinic BP and is extremely effective for the evaluation of drug effects and their duration. The introduction of home BP to the diagnosis and treatment of hypertension facilitates long-term BP control. Home BP is particularly important for the diagnosis and treatment of hypertension in diabetes mellitus, pregnancy, children and renal diseases. Home BP measurements improve the adherence to medications and medical consultations, and are indispensable for diagnosis of white coat hypertension and masked hypertension. Such efficiency of home BP improves medical economy. Home BP can detect minimal charge in BP mediated by medication, and intrinsic and extrinsic stimuli and detect long-term change in BP. Thus, home BP is now indispensable for improvement in the management of hypertension in medical practice as well as for the recognition of hypertension in the general population. Standardization of the measurement procedure may elevate the position of home BP in the practice of diagnosing and treating hypertension.
Blood Pressure ; Child ; Diabetes Mellitus ; Fees and Charges ; Humans ; Hypertension ; Masked Hypertension ; Pharmacology, Clinical ; Pregnancy ; Referral and Consultation ; White Coat Hypertension

BACKGROUND: Hypertension is a common problem for hemodialysis patients and is associated with an increased cardiovascular mortality. We analyzed ambulatory blood pressure (ABP) in hemodialysis patients and investigated if an adjustment of dry weight can be used to control blood pressure. METHODS: ABP was measured for twenty-four hours after hemodialysis. A bioimpedance Analysis (BIA) was conducted. Patients were divided into two groups by the edema index. A normohydration (NH) group included patients with the edema index less than 0.40, and an overhydration (OH) group included patients with the edema index 0.40 or more. We accordingly adjusted the dry weight based on BIA results. RESULTS: Thirty-six patients were recruited, comprising twenty-two men and fourteen women. In regard to the ABP, 24-hour systolic and diastolic blood pressures were 140.2 +/- 19.7 mm Hg and 79.0 +/- 10.6 mm Hg, respectively. There was a significant association between 24-hour systolic blood pressure and the edema index (r = 0.501, p = 0.002). Twenty four-hour systolic blood pressure was significantly different between the NH and OH groups (median value, 132.0 vs. 150.5 mm Hg; p = 0.008). In OH group, after adjustment of the dry weight, the edema index was decreased from 0.411 +/- 0.009 to 0.389 +/- 0.047 and office systolic blood pressure was also decreased from 144.7 +/- 32.7 mm Hg to 125.3 +/- 15.4 mm Hg in OH group (p = 0.028 and p = 0.018, respectively). CONCLUSIONS: The edema index obtained by the bioimpedance analysis is significantly correlated with 24-hour systolic blood pressure in hemodialysis patients. Also, an adjustment of dry weight can be used to control blood pressure in hemodialysis patients.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Edema ; Female ; Humans ; Hypertension ; Male ; Renal Dialysis

BACKGROUND: Pulse Wave Velocity (PWV) correlates well with arterial distensibility and stiffness and is a useful approach for evaluating the severity of systemic arteriosclerosis in adults. In addition, measurement of brachial-ankle PWV (baPWV) has been commonly reported as a simple, noninvasive, and practicable method. Arterial stiffness assessed by PWV could predict cardiovascular morbidity and mortality. In this study, we investigated the association between the changes of baPWV and cardiovascular risk factors in Korean women using data from follow-up evaluations. METHODS: The subjects were 626 women (age, 47.2 +/- 8.2) in whom we measured baPWV and cardiovascular risk factors at baseline and about one year later. Arterial stiffness was evaluated by baPWV and biological parameters were evaluated on the same day. We retrospectively analyzed the relationships between changes of baPWV and those other factors. All analyses were performed with SPSS ver. 20.0 and p-values < 0.05 were considered significant. RESULTS: In correlation analysis, changes of baPWV were affected by changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, total cholesterol, high density lipoprotein-cholesterol, and low density lipoprotein-cholesterol. Multiple regression analysis of relationship between changes of baPWV and other associated variables shows that improvement of baPWV was significantly positively associated with changes of SBP and hemoglobin A1c (HbA1c), and worsening of baPWV was significantly negatively associated with changes of DBP, age, and SBP in sequence. CONCLUSIONS: In improvement of baPWV, decreases of SBP and HbA1c and in worsening of baPWV, increases of DBP, age, and SBP were significant factors in Korean women.
Adult ; Animals ; Ankle ; Arteriosclerosis ; Blood Pressure ; Cholesterol ; Female ; Follow-Up Studies ; Hemoglobins ; Humans ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors ; Vascular Stiffness

BACKGROUND: The present study aimed to determine the changes of endothelin (ET), nitric oxide, and atrial natriuretic peptide (ANP) systems in the kidney and aorta in angiotensin (Ang) II-induced hypertension. METHODS: Male Sprague-Dawley rats were used. Ang II (100 ng.min-1.kg-1) was infused through entire time course. Fourteen days after beginning the regimen, aorta and kidney were taken. The protein expression of nitroc oxide synthase (NOS) was determined by semiquantitative immunoblotting. The mRNA expression of components of ET, NOS, ANP system was determined by real-time polymerase chain reaction. RESULTS: Hypertension was developed in the experimental group. mRNA expression of ET-1 in the aorta and kidney was increased. The protein expression of endothelial NOS (eNOS) was decreased in the aorta, while that of inducible NOS and neuronal NOS remained unaltered. mRNA expression of ANP, natriuretic peptide type (NPR)-A, and NPR-C was not changed in the aorta. CONCLUSIONS: Based on these results, it seems that in Ang II-induced hypertensive rats, increased expression of ET-1 in the aorta and kidney, and decreased eNOS expression in the aorta contribute to the pathogenesis of hypertension.
Angiotensin II ; Angiotensins ; Animals ; Aorta ; Atrial Natriuretic Factor ; Endothelins ; Humans ; Hypertension ; Immunoblotting ; Kidney ; Male ; Neurons ; Nitric Oxide ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger

Arterial hypertension leads to both structural and functional changes of the heart. Hypertensive heart disease (HHD) is characterized by complex changes in myocardial structure (e.g., enhanced cardiomyocyte growth, excessive cardiomyocyte apoptosis, accumulation of interstitial and perivascular collagen fibers, disruption of endomysial and perimysial collagen network) that cause the remodeling of the myocardium. In the 1970s, hypertrophic growth of cardiomyocytes is compensatory to reduce wall stress on the ventricular wall imposed by pressure overload. Recent data from animal studies suggest that inhibition of ventricular hypertrophy was not associated with ventricular dilatation or reduced wall motion despite elevated wall stress. The genetic complexity (gene-gene and/or gene-environment interactions) may modulate left ventricular mass and transcriptional regulators are participated in pathologic myocardial growth. Many hormones and cytokines lead to a profibrotic and inflammatory environment. Excess of ventricular collagen in hypertensive patients is the result of both increased collagen synthesis by fibroblasts and stimulated myofibroblasts, and unchanged or decreased collagen degradation by matrix metalloproteinase. Several biochemical markers of myocardial remodeling will prove to be useful. The development of noninvasive methods like echoreflectivity, cardiac magnetic resonance imaging, speckle tracking echocardiography, and cardiac molecular imaging would enable broader application. Meta-analysis showed that there was a significant difference among medication classes in decreasing left ventricular mass.
Animals ; Apoptosis ; Biomarkers ; Collagen ; Cytokines ; Dilatation ; Echocardiography ; Fibroblasts ; Heart ; Heart Diseases ; Humans ; Hypertension ; Hypertrophy ; Magnetic Resonance Imaging ; Molecular Imaging ; Myocardium ; Myocytes, Cardiac ; Myofibroblasts ; Track and Field ; Ventricular Remodeling