BACKGROUND: The value of metabolic syndrome (MetS) evaluation in predicting cardiovascular disease is recently criticized. We investigated, in hypertensive patients without diabetes mellitus, the influence of MetS on the target organ damage. METHODS: Data from the fourth Korean National Health and Nutrition Examination Survey performed in 2008 were analyzed. Metabolic syndrome is defined by the 2001 National Cholesterol Education Program-Third Adult Treatment Panel guideline. The category of hypertension is defined following the seventh report of the Joint National Commitee-7 guideline. RESULTS: The prevalence of target organ damage (TOD), defined as history of myocardial infarction/angina/stroke/chronic renal disease as well as the presence of macroalbuminuria, was increased according to blood pressure; 8.5% in the population of normal blood pressure, 12.5% in those of prehypertensive range, and 20.5% in hypertensive population. Hypertensive population associated with MetS showed greater prevalence of TOD than those without MetS even excluding diabetic population. The presence of MetS in hypertensive population showed 2.2 fold increased risk for TOD. Any single parameter of MetS diagnostic criteria as well as obesity did not show the comparable range of risk prediction as MetS. CONCLUSIONS: These results indicate a strong relationship of Mets with TOD in hypertensive population. Evaluating the metabolic components in hypertensive population is necessary in establishing management strategies for overall risk.
Adult ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus ; Humans ; Hypertension ; Joints ; Nutrition Surveys ; Obesity ; Prevalence

BACKGROUND: To validate Omron HEM 907 XL blood pressure monitor (test device) against auscultatory mercury sphygmomanometer in children aged 7-8 years old in accordance with International Protocol of European Society of Hypertension revised in 2010 (ESH-IP2) and British Hypertension Society (BHS) protocol. METHODS: Seventy-five children and adolescents were recruited for the study. A validation procedure was performed following the protocol which was prepared on the basis of ESH-IP2 and BHS protocol for children and adolescents. Each underwent 7 sequential BP measurements alternatively with a mercury sphygmomanometer and the test device. The results were analyzed according to the validation criteria of ESH-IP2. RESULTS: The mean (blood pressure [BP], +/- standard deviation [SD]) difference of absolute value between the test device and mercury sphygmomanometer readings in all the 75 subjects was 3.26 +/- 3.08 mm Hg for systolic BP and 4.11 +/- 3.50 mm Hg for diastolic BP. These results fulfilled AAMI criterion of mean +/- SD below 5 +/- 8 mm Hg for both systolic and diastolic BP. The proportion of test device-observer mercury sphygmomanometer BP differences within 5, 10 and 15 mm Hg were 81%, 96%, 99% for SBP and 72%, 93%, 99% for diastolic blood pressure (DBP), respectively, in the part 1 analysis, so both systolic blood pressure (SBP) and DBP passed the part 1 criteria. As for the part 2 analysis, SBP passed the criteria, bur DBP failed. CONCLUSIONS: Omron HEM 907 XL BP monitor failed an adapted ESH-IP2, though SBP passed. When comparing the BP readings by oscillometers with mercury sphygmomanometer, the differences between them, particularly in diastolic BP, should be taken into account, because DBP can be underestimated.
Adolescent ; Aged ; Blood Pressure ; Blood Pressure Determination ; Blood Pressure Monitors ; Child ; Humans ; Hypertension ; Organothiophosphorus Compounds ; Oscillometry ; Reading ; Sphygmomanometers

BACKGROUND: The aim of this study was to compare the antihypertensive effect of S-(-)-amlodipine nicotinate with ramipril in patients with essential hypertension. METHODS: Total 138 patients (54.5 +/- 10.5 years, 69 males) were enrolled in this study between 2008 and 2010. Amlodipine 2.5 mg or ramipril 2.5 mg was treated once in a day for 8 weeks. Epidemiologic analysis was performed in intend-to-treat (ITT) group. Efficacy analysis was performed in the differences of diastolic blood pressure in study groups. Abnormal reactions were divided with severities and drug-relationship. RESULTS: The change of diastolic blood pressures were more prominent with -12.7 +/- 7.02 mm Hg in amlodipine group, and -9.6 +/- 7.38 mm Hg in ramipril group (p = 0.023). The change of systolic blood pressures was higher in amlodipine group with -18.1 +/- 7.91 mm Hg, and -14.3 +/- 11.96 mm Hg in ramipril group (p = 0.047). Blood pressure normalization rates were 81.3% (48 of 59 patients) in amlodipine group, and 61.4% (35 of 57 patients) in ramipril group (p = 0.017). Abnormal reaction occurred in 5.8% (4 of 68 patients) of amlodipine group and 14.2% (10 of 70 patients) of ramipril group (p = 0.102). The most frequent abnormal reaction was respiratory symptom. CONCLUSIONS: S-Amlodipine-Nicotinate was more effective than ramipril in hypertensive patients without significant abnormal reaction.
Amlodipine ; Blood Pressure ; Humans ; Hypertension ; Niacin ; Ramipril

BACKGROUND: Aronox is an anthocyanin-rich extract from Aronia melanocarpa E which is known to have anti-inflammatory effect in atherosclerosis due to high anti-oxidative activity. This study was conducted to evaluate the preventive and therapeutic effect of Aronox on hypertension and metabolic status in spontaneously hypertensive rats (SHR). METHODS: Seven-week-old male SHR were orally administrated with Aronox (low dose; 100 mg/kg, n = 4 or high dose; 200 mg/kg, n = 3) or amlodipine (10 mg/kg, n = 7) and sham (n = 10) for 8 weeks. Aronox was administered 30 mg/kg for the first 3 weeks and then increased to 100 mg/kg (low dose group) or 100 mg/kg to 200 mg/kg (high dose group). Systolic blood pressure (SBP) was measured every week by tail cuff method. At 8 weeks, fasting lipid level was measured. Heart and kidney stained with Masson's trichrome. RESULTS: Aronox or amlodipine treatment showed significantly lower SBP compared with sham (202.2 +/- 10.2 mm Hg in low dose group, 202.0 +/- 12.6 mm Hg in high dose group and 187.4 +/- 22.7 mm Hg in amlodipine group vs. 224.4 +/- 12 mm Hg in sham-SHR, p < 0.005). There were no significant differences in cardiac and renal weight corrected by body weight among 3 groups. Aronox and amlodipine treatments significantly decreased fasting glucose and showed a trend of decrease in triglyceride level. Aronox or amlodipine treatment for 8 weeks showed less collagen deposition changes compared to sham. CONCLUSIONS: Aronox showed significant antihypertensive effects, decreased fasting glucose, and less cardiac and renal fibrosis in SHR. These results suggest that Aronox can be used as an adjuvant therapy or functional food in hypertension.
Amlodipine ; Atherosclerosis ; Blood Pressure ; Body Weight ; Collagen ; Fasting ; Fibrosis ; Functional Food ; Glucose ; Heart ; Humans ; Hypertension ; Kidney ; Male ; Photinia ; Rats, Inbred SHR ; Salicylamides ; Tail

Considering that an aging population is increasing due to a low birth rate in most developed nations, the maintenance of healthy state and physical and social activities is needed to maintain the national productivities. Among the diseases which deprive elderly people of activities and impose medical and care expenditure, cardiovascular diseases such as stroke, ischemic heart disease, heart failure and renal failure take major parts. These cardiovascular diseases occur based on the development and progression of arteriosclerotic vascular lesions, namely, vascular aging. Because hypertension is a major risk factor for vascular aging, the adequate control of blood pressure is pivotally important in order to prevent the incidence of cardiovascular events in the later stage of life. This is also concerned with the socio-economical issues and national productivity.
Aged ; Aging ; Antihypertensive Agents ; Atherosclerosis ; Birth Rate ; Blood Pressure ; Cardiovascular Diseases ; Developed Countries ; Efficiency ; Health Expenditures ; Heart Failure ; Humans ; Hypertension ; Incidence ; Myocardial Ischemia ; Renal Insufficiency ; Risk Factors ; Stroke

BACKGROUND: The present study was designed to evaluate the possible renoprotective effects of tamoxifen in deoxycorticosterone acetate (DOCA)-salt hypertensive (DSH) rats and its role in inflammation and fibrosis in the kidney. METHODS: Male Sprague-Dawley rats, weighing 180 to 200 g, were used. All rats underwent unilateral nephrectomy. One week later, one group of rats (n = 8) was implanted with DOCA strips (200 mg/kg) and another group of rats (n = 8) was implanted with DOCA strips with co-treated with tamoxifen (10 mg/kg) through gavage feeding. Rats that did not implanted DOCA strips served as controls (n = 6). Two weeks later, the systolic blood pressure (SBP) was measured by tail-cuff method. The protein expression of transforming growth factor-beta (TGF-beta), Smad, alpha-smooth muscle actin (alpha-SMA), E-cadherin, ED-1, cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS) was determined in the kidney by immunoblotting. The mRNA expression of tumor necrosis factor-alpha (TNF-alpha), monocyte chemotactic protein-1 (MCP-1), and vascular cell adhesion molecule-1 (VCAM-1) was determined by real-time polymerase chain reaction. RESULTS: In DSH rats, SBP was increased, which was not affected by tamoxifen treatment. Serum creatinine level was comparable in DSH rats compared with controls, which was not affected by tamoxifen treatment. In DSH rats, the protein expression of TGF-beta, Smad 2/3, Smad 4, alpha-SMA, ED-1, COX-2, iNOS was increased compared with controls, and these changes were attenuated by tamoxifen treatment except that of TGF-beta. The mRNA expression of TNF-alpha, MCP-1, and VCAM-1 was increased, and expression of MCP-1 and VCAM-1 was counteracted by tamoxifen treatment. CONCLUSIONS: Tamoxifen is effective in preventing the progression of nephropathy in DSH rats, the mechanism of which is associated with anti-inflammation and anti-fibrotic effects.
Actins ; Animals ; Blood Pressure ; Cadherins ; Chemokine CCL2 ; Creatinine ; Cyclooxygenase 2 ; Desoxycorticosterone Acetate ; Desoxycorticosterone* ; Fibrosis ; Humans ; Hypertension ; Immunoblotting ; Inflammation ; Kidney ; Male ; Methods ; Muscles ; Nephrectomy ; Nitric Oxide Synthase Type II ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Tamoxifen* ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha ; Vascular Cell Adhesion Molecule-1

BACKGROUND: Left ventricular hypertrophy (LVH) offers prognostic information beyond that provided by the evaluation of traditional cardiovascular risk factors. However, the validation of electrocardiogram (ECG) criteria for the diagnosis of LVH is limited in Korea general population. The purpose of this study is to investigate the diagnostic accuracy of ECG criteria for the detection of LVH in general population. METHODS: In the present study, we investigated a total of 1,946 adults from the community-based cohort. The left ventricular mass index (LVMI) was estimated with echocardiographic measurement and adjusted with body surface area. LVH was defined as a value greater than or equal to the sex-specific 90th percentile value of LVMI. ECG criteria for the diagnosis of LVH were Sokolow-Lyon criteria and Cornell criteria. RESULTS: The LVMI was significantly higher in male subjects (91.1 +/- 23.9 g/m2 vs. 83.9 +/- 21.7 g/m2, p < 0.001). The cutoff values were 120.8 g/m2 in male subjects and 112.2 g/m2 in female subjects. The sensitivity and specificity of Sokolow-Lyon criteria were 5.6% and 93.6% in male, 4.1% and 97.8% in female. Those of Cornell criteria were 2.8% and 98.7% in male, 14.3% and 95.8% in female. In male, the area under the receiver operating characteristic curves of Sokolow-Lyon voltage and Cornell voltage were 0.55 and 0.52. And those in female were 0.59 and 0.60. CONCLUSIONS: In our community-based sample, ECG criteria showed low sensitivity and high specificity. The performance of ECG criteria for detection of LVH was suboptimal, suggesting limited usefulness of ECG as mass screening tools.
Adult ; Body Surface Area ; Cohort Studies* ; Diagnosis ; Echocardiography ; Electrocardiography* ; Female ; Humans ; Hypertrophy, Left Ventricular* ; Korea ; Male ; Mass Screening ; Risk Factors ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: Endothelial dysfunction has been documented in patients with type 2 diabetes especially when combined with hypertension. We prospectively investigated the effects of pioglitazone in improving endothelial function in hypertensive type 2 diabetic patients during the 6-month follow-up. METHODS: Hypertensive type 2 diabetic patients were randomly assigned to pioglitazone (n = 25) or placebo (n = 25). Primary endpoint was to compare changes in brachial artery flow-mediated dilation (baFMD) between the 2 groups during the 6-month follow-up. Secondary endpoints were to compare changes in the circulating levels of microRNA-17, -21, 92a, -126, and -145 which have been known as indicators of endothelial cell migration and atherosclerosis progression during the 6-month follow-up. Inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), high-sensitive C-reactive protein, adiponectin, soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1) were compared during the follow-up. RESULTS: The prevalences of risk factors such as hyperlipidemia, smoking, stroke, and family history of coronary artery disease did not show significant differences between the 2 groups. Increases in baFMD (0.33 +/- 0.34 mm vs. 0.02 +/- 0.25 mm, p < 0.05, respectively) and in the level of circulating microRNA-21 (0.23 +/- 0.05 vs. -0.06 +/- 0.04, p < 0.05, respectively) were significantly greater in the pioglitazone group when compared to the placebo group during the 6-month follow-up. No significant differences in the prevalences of new onset heart failure, fracture, and bladder cancer were noted during the follow-up between the 2 groups. Decreases in the levels of inflammatory marker such as IL-6 (-2.54 +/- 2.32 pg/mL vs. -1.34 +/- 2.12 pg/mL, p < 0.05, respectively), TNF-alpha (-1.54 +/- 1.51 pg/mL vs. 0.14 +/- 1.12 pg/mL, p < 0.05, respectively), sICAM-1 (-39 +/- 52 ng/mL vs. 6 +/- 72 ng/mL, p < 0.05, respectively), and sVCAM-1 (-154 +/- 198 ng/mL vs. -11 +/- 356 ng/mL, p < 0.05, respectively) were significantly greater in the pioglitazone group compared to the placebo group during the follow-up. CONCLUSIONS: In hypertensive type 2 diabetic patients, pioglitazone may increase baFMD and circulatory microRNA-21 and decrease inflammatory cytokines including IL-6, TNF-alpha, sICAM-1, and sVCAM-1.
Adiponectin ; Atherosclerosis ; Brachial Artery* ; C-Reactive Protein ; Coronary Artery Disease ; Cytokines ; Diabetes Mellitus ; Endothelial Cells ; Follow-Up Studies ; Heart Failure ; Humans ; Hyperlipidemias ; Hypertension ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; MicroRNAs ; Prevalence ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Tumor Necrosis Factor-alpha ; Urinary Bladder Neoplasms ; Vascular Cell Adhesion Molecule-1

BACKGROUND: To assess the association between ambient particulate matter and cardiovascular death in seven cities in the Republic of Korea during the period of 2002-2008. METHODS: A time-stratified case-crossover design was used to examine association between particulate matter and deaths from cardiovascular or cerebrovascular disease; hypertensive disease 12,821, ischemic heart disease 39,577, cardiac arrhythmia 1,627, cerebrovascular disease 88,047. Mortality data was obtained from National Statistical Office, and hourly mean concentrations of particulate matter < or = 10 microm in aerodynamic diameter and meteorological data were obtained from the Ministry of Environment. The percent increase in the risk of death associated with an interquartile range increase in particulate matter was determined by conditional logistic regression analysis after adjusting for national holidays and meteorological factors. RESULTS: The largest association was a 0.8% increase (95% confidence interval [CI], 0.1-1.6) in death risk related to an interquartile range increase in particulate matter < or = 10 microm (average of 0 to 2 days prior to the day of death). Classified as the cause of death, the association was a 1.2% increase (95% CI, 0.2-2.2) in death from cerebrovascular disease related to an interquartile range increase in particulate matter < or = 10 microm. But others were statistically not significant. After stratification of death cases by year of death, statistically significant associations were a 2.3% increase (95% CI, 0.1-4.4) in death risk from ischemic heart disease in 2002-2004 and 2.0% increase in death from cerebrovascular disease (95% CI, 0.3-3.8) in 2006-2008. CONCLUSIONS: Our results suggest that ambient air pollution increases the risk of deaths from cardiovascular and cerebrovascular disease in the Republic of Korea.
Air Pollution ; Arrhythmias, Cardiac ; Cardiovascular Diseases ; Cause of Death ; Cerebrovascular Disorders ; Cross-Over Studies ; Holidays ; Logistic Models ; Myocardial Ischemia ; Particulate Matter ; Republic of Korea

BACKGROUND: Heavy alcohol consumption increases the risk of hypertension, but the effect of light to moderate alcohol consumption on the risk of hypertension remains controversial. In this cross-sectional study we aimed to identify the association between alcohol consumption and hypertension, and verify whether this association is influenced by age. METHODS: Study participants were 498 men and 610 women, aged 23 to 88 years, who underwent periodic health examinations at one institute in Incheon, Korea. RESULTS: Compared with nondrinkers, multivariate-adjusted odds ratio (OR) (95% confidence interval, CI) for hypertension according to the number of standard drinks consumed weekly was as follows: 1 to 3 drinks, OR = 1.13 (95% CI, 0.56-2.29); 4 to 10 drinks, OR = 0.51 (95% CI, 0.27-0.97); 11 to 18 drinks, OR = 1.11 (95% CI, 0.55-2.20); > or = 19 drinks per week, OR = 1.97 (95% CI, 1.18-3.29). A positive association between the prevalence of hypertension and alcohol consumption of > or = 19 drinks per week was found for patients aged > or = 60 years (OR = 2.47; 95% CI, 1.21-5.05), but not in patients aged < 60 years (OR = 1.54; 95% CI, 0.72-3.32). Light to moderate alcohol consumption from 4 to 10 drinks per week was significantly associated with a decreased risk of hypertension in subjects aged < 60 years (OR = 0.32; 95% CI, 0.11-0.97), but not in subjects aged > or = 60 years (OR = 0.70; 95% CI, 0.31-1.58). CONCLUSIONS: Light to moderate alcohol consumption can decrease the risk of hypertension, whereas heavy alcohol intake is associated with an increased risk of hypertension. The association between alcohol consumption and hypertension may be changed by age.
Age Factors ; Aged ; Alcohol Drinking ; Coronary Disease ; Cross-Sectional Studies ; Female ; Humans ; Hypertension ; Light ; Male ; Odds Ratio ; Prevalence