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Obesity Increases Blood Pressure Variability during the Night.

Hong Ju AN ; Wan KIM ; Chung KANG ; Dong In NAM ; Il Hyung JUNG ; Hoon KANG ; Sang Sun LEE ; Ho Yeong SONG ; Sang Cheol CHO ; Won Yu KANG ; Sun Ho HWANG

Journal of the Korean Society of Hypertension.2014;20(1):1-7. doi:10.5646/jksh.2014.20.1.1

BACKGROUND: Previous studies have reported that obesity increases heart rate variability. Body mass index (BMI) has been reported to affect blood pressure variability (BPV) over 24 hours. However, the diurnal variation in the effect of BMI on BPV has not been evaluated. This study aimed to clarify the diurnal variation in the effect of BMI on BPV. METHODS: A total of 2,044 patients were consecutively enrolled in this study, and the data were analyzed retrospectively. All patients underwent 24-hour ambulatory blood pressure monitoring. We divided patients into two groups according to BMI (non-obese group: n = 1,145, BMI < 25; obese group: n = 899, BMI > or = 25). We compared BPV during daytime and nighttime between the non-obese and obese groups. We also evaluated the impact of BMI on BPV by multivariate regression analysis. RESULTS: On univariate regression analysis, there was no significant difference in BPV during daytime (systolic BP [SBP] variability: 20.7 vs. 21.7, p = 0.511; diastolic BP [DBP] variability: 16.8 vs. 17.5, p = 0.539). However, both SBP variability (13.8 vs. 17.6, p = 0.009) and DBP variability (11.7 vs. 14.3, p = 0.042) during nighttime were affected significantly by BMI. After adjusting other compounding variables (age > 60 years, current smoking habit, hypertension, diabetes mellitus, and use of calcium channel blockers and renin-angiotensin-aldosterone system blockers), multivariate analysis showed that BMI was an independent factor associated with increase in BPV during the night (SBP variability: p = 0.039; DBP variability: p = 0.034). CONCLUSIONS: Obesity increased BPV during nighttime.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Body Mass Index ; Calcium Channel Blockers ; Diabetes Mellitus ; Heart Rate ; Humans ; Hypertension ; Multivariate Analysis ; Obesity* ; Renin-Angiotensin System ; Retrospective Studies ; Smoke ; Smoking

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Spontaneous Renal Hematoma Caused by Hypertension with Left Ventricular Hypertrophy.

Byoung Won PARK ; Min Gyu KONG ; Hye Young JU ; Jin Wook CHUNG ; Duk Won BANG ; Min Su HYON ; Soon Hyo KWON ; Seong Sook HONG

Journal of the Korean Society of Hypertension.2012;18(2):71-74. doi:10.5646/jksh.2012.18.2.71

Spontaneous renal hematoma is rare. We report a 43-year-old man presented with sudden left flank pain and severe hypertension. Renal hematoma was confirmed on computed tomography. Renal angiography showed no active bleeding or vascular malformation. Echocardiography showed severe concentric left ventricular hypertrophy. Hypertension was the only cause for the condition. Symptoms and size of the hematoma decreased on antihypertensive medication and conservative treatment. Severe hypertension might have a role for developing renal hematoma.
Adult ; Angiography ; Echocardiography ; Flank Pain ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Kidney ; Vascular Malformations

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Usefulness of Home Blood Pressure Reflected Anti-hypertensive Treatment and the Evolution of Blood Pressure Profiles.

Ju Hee LEE ; Sang Min KIM ; Sang Yeub LEE ; Jang Whan BAE ; Kyung Kuk HWANG ; Dong Won KIM ; Myeong Chan CHO

Journal of the Korean Society of Hypertension.2012;18(2):63-70. doi:10.5646/jksh.2012.18.2.63

BACKGROUND: It is still unclear how self-measured home blood pressure (BP) evolves over time in treated hypertensive patients, and the usefulness of home BP based treatment is under debate. METHODS: The patients whose anti-hypertensive medications had not been changed at least 6 months were enrolled. They measured home BP at enrollment and at study end. The patients were classified into controlled hypertension (CH), hypertension with white coat effect (WCH), hypertension with reverse white coat effect (RWCH), and uncontrolled hypertension (UH), based on their clinic and home BP. Their home BP profiles were reflected in the patients' treatments, instead of relying solely on clinic BP. RESULTS: Ninety patients (mean age, 56.5 +/- 9.9; male, 57.8%) were analyzed and mean follow-up duration was 34.1 +/- 3.6 months. CH, WCH, RWCH, and UH patients were 33.3% (30 patients), 37.8% (34 patients), 5.6% (5 patients), and 23.3% (21 patients), respectively at enrollment. Almost all CH and WCH patients remained in normal range of home BP whereas about half of RWCH and UH patients moved to CH or WCH. As a result, the proportion of RWCH and UH decreased at the end of follow-up. Overall clinic and home BP reduced significantly in all groups. Clinic BP declined significantly in WCH and UH, whereas home BP declined significantly in RWCH and UH. That means the BP profiles shifted toward more reasonable states. CONCLUSIONS: BP profiles shifted toward more reasonable states after home BP based adjustment of anti-hypertensive medication. Measurement of home BP might be beneficial in anti-hypertensive treatment.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; European Continental Ancestry Group ; Follow-Up Studies ; Humans ; Hypertension ; Male ; Reference Values

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Salt, Hypertension, and Cardiovascular Diseases.

Yuhei KAWANO

Journal of the Korean Society of Hypertension.2012;18(2):53-62. doi:10.5646/jksh.2012.18.2.53

The relationship between salt and hypertension is well established, and salt restriction is widely recommended in the management of hypertension. However, people living in northeast Asia have consumed large amount of salt, and the prevalence of hypertension and the incidence of stroke have been high in that area. Mechanisms of salt-induced hypertension may be complex, but volume expansion in the presence of impaired natriuretic capacity of the kidney and action on the central nervous system and neurohormoral pathways seem to be important. Salt is also involved in changes in blood pressure (BP) caused by other factors, such as weight gain, stress, exercise, potassium, catecholamines, angiotensin, and aldosterone. The interaction between sodium and aldosterone appears to play a critical role in the development of organ damage. The depressor effect of salt restriction in hypertensive patients is well demonstrated although the response of BP varies widely among individuals. Salt restriction decreases BP throughout 24 hours, and its effect may be greater during night compared to daytime in salt-sensitive nondippers. Although excess salt consumption can cause cardiovascular diseases through its effect on BP, recent studied have shown that the association of salt consumption and cardiovascular diseases, such as stroke and heart failure, is independent of BP. Salt reduction is important in the prevention of cardiovascular diseases, however, the effect and safety of aggressive salt restriction remain to be clarified. It is difficult to accomplish and maintain the salt reduction. Both population strategy and individualized approach are important to reduce salt consumption.
Aldosterone ; Angiotensins ; Asia ; Blood Pressure ; Cardiovascular Diseases ; Catecholamines ; Central Nervous System ; Heart Failure ; Humans ; Hypertension ; Incidence ; Kidney ; Potassium ; Prevalence ; Sodium ; Stroke ; Weight Gain

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Effects of Valsartan on Carotid Arterial Stiffness in Patients with Newly Diagnosed Hypertension: A Comparative Study with Global Arterial Stiffness.

Yi Rang YIM ; Kye Hun KIM ; Jae Yeong CHO ; Hyun Ju YOON ; Young Joon HONG ; Hyung Wook PARK ; Ju Han KIM ; Youngkeun AHN ; Myung Ho JEONG ; Jeong Gwan CHO ; Jong Chun PARK

Journal of the Korean Society of Hypertension.2014;20(1):21-30. doi:10.5646/jksh.2014.20.1.21

BACKGROUND: To compare the parameters of local carotid stiffness with those of global arterial stiffness and to investigate the effects of angiotensin II receptor blocker (ARB) on the parameters of local carotid arterial stiffness as well as global arterial stiffness. METHODS: The correlations of the parameters between local carotid and global arterial stiffness were compared at baseline, and the changes of these parameters were evaluated after 6 months of valsartan therapy in 50 patients with newly diagnosed hypertension. Diameter change, strain, and 2-dimensional circumferential strain (2D CS) of the carotid artery measured by speckle tracking method were used as parameters of local arterial stiffness, and the parameters of pulse wave velocity (PWV) and pulse wave analysis (PWA) were used as standard parameters of global arterial stiffness. RESULTS: Carotid 2D CS, not conventional strain or diameter change, showed significant correlation with age (r = -0.592, p < 0.01), brachial-ankle PWV (r = -0.338, p < 0.05), and augmentation index (r = -0.298, p < 0.05). After 6 months of medical therapy, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were decreased significantly (SBP: 155.9 +/- 14.2 to 137.6 +/- 10.5 mm Hg, p < 0.01; DBP: 90.1 +/- 11.8 to 81.6 +/- 8.0 mm Hg, p < 0.01). The parameters of PWV and PWA were significantly improved, but the parameters of carotid arterial stiffness were not changed significantly. CONCLUSIONS: In hypertensives, carotid 2D CS showed better correlation with ageing and the parameters of global arterial stiffness than conventional strain or diameter change of the carotid artery. Global arterial stiffness was improved by 6 months of medical treatment with ARB, but the local carotid arterial stiffness was not changed.
Angiotensin Receptor Antagonists ; Blood Pressure ; Carotid Arteries ; Humans ; Hypertension* ; Pulse Wave Analysis ; Receptors, Angiotensin ; Vascular Stiffness* ; Valsartan

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Analysis for the Patterns of Medical Care Utilization during 19 Years (1990-2008) and Its Related Factors in Hypertensive Patients Using National Patient Survey in Korea.

Nam Wook HUR ; Hyeon Chang KIM

Journal of the Korean Society of Hypertension.2014;20(1):8-20. doi:10.5646/jksh.2014.20.1.8

BACKGROUND: To analyze the patterns of medical care utilization and its related factors in hypertensive patients during 19 years (1990-2008), utilizing national patient survey in Korea. METHODS: Using seven surveyed data, age-standardized medical care utilization increasing ratios for the inpatients and outpatients compared to the year of 1990 were calculated, respectively. Changes of medical facilities (%) of patients used in 1990, 1999, and 2008 were compared. For the outpatients, median length of stay and discharge mortality rate per 1,000 persons were calculated. Multivariate logistic regression methods were used to identify related factors of the resident patients and the comparison characteristics between hypertensives and the others of all subjects. Sample weights were used. RESULTS: The medical care utilization of hypertensives were increased for both inpatients and outpatients. However, the ratios were dramatically diminished after the standardization. Age-standardized ratios were 3.6 in outpatients and 5.9 in inpatients compared to 1990. For the outpatients, mainly used medical facilities were changed from general hospital to convalescent hospital. Also, median length of stay and discharge mortality rate were increased up to 5 times and 4 times compared to 1990. The odds of being resident patients were related with discharge as death and using oriental medical center convalescent hospital in 2008. Hypertensive patients were older than the others. Confined to hypertensive patients, member of National Health Insurance was more tend to be outpatients but less inpatients. CONCLUSIONS: Aging population and long-term care Act were presumed as the main reason for the increasing of medical care utilization in 1990 to 2008.
Aging ; Health Care Surveys ; Hospitals, Convalescent ; Hospitals, General ; Humans ; Hypertension ; Inpatients ; Korea ; Length of Stay ; Logistic Models ; Long-Term Care ; Mortality ; National Health Programs ; Outpatients ; Utilization Review ; Weights and Measures

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Ambient Particulate Matter and the Risk of Deaths from Cardiovascular and Cerebrovascular Disease.

Kyoung Hwa HA ; Mina SUH ; Dae Ryong KANG ; Hyeon Chang KIM ; Dong Chun SHIN ; Changsoo KIM

Journal of the Korean Society of Hypertension.2011;17(2):74-83. doi:10.5646/jksh.2011.17.2.74

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

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Association between Alcohol Consumption and Hypertension.

Myoung Kyun SON

Journal of the Korean Society of Hypertension.2011;17(2):65-73. doi:10.5646/jksh.2011.17.2.65

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

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Expression of Lectin like Oxidized Low Density Lipoprotein Receptor-1 in the Spontaneous Hypertensive Rat with High Cholesterol Diet.

Ki Seok KIM ; No Kwan PARK ; Song Yi KIM ; Dong Woon KIM ; Seung Jae JOO ; Myeong Chan CHO

Journal of the Korean Society of Hypertension.2011;17(2):57-64. doi:10.5646/jksh.2011.17.2.57

BACKGROUND: Lectin-like, oxidized, low-density lipoprotein receptorreceptors (LOX-1) recognizes recognize vascular oxidized low-density lipoprotein (LDL), which may play an important role in the pathogenesis of atherosclerosis. We investigated the expressions expression of LOX-1 and redox-regulating thyoredoxinthioredoxin systems in a hypertension and hypercholesterolemia rat model. METHODS: Spontaneously hypertensive rats (SHR) and Wistar-Kyoto rat (WKY) rats were fed with a normal cholesterol diet (NC) and a high cholesterol diet (HC) for 4 weeks. Plasma LDL cholesterol levels and blood pressure were measured at 1 and 4 weeks. Histological changes of atherosclerosis in the vessel was evaluated by hematoxylin and eosin staining and immunocytochemistry. The expressions expression of LOX-1 and thyoredoixnthioredoxin were measured by Western western blot analysis. RESULTS: In the SHR groupsgroup, blood pressure after 4 weeks was significantly higher than initial levels. LDL-cholesterol levels in the SHR-HC group were increased at 4 weeks (15.3 +/- 2.6 mg/dL vs. 20.2 +/- 2.6 mg/dL, p < 0.01) compared with the SHR-NC group. In oxyblot analysis, the degree of oxidative stress of in the SHR-HC group was significantly higher than in the SHR-NC group (p < 0.05). The expressions expression of LOX-1 and Trx were was significantly increased in the SHR-HC group compared with the SHR-NC group (p < 0.05) on western blot analysis. Focal overexpressions overexpression of LOX-1 were was observed at the intima layer of the thoracic aorta, and was which wereonly observed in the SHR-HC group. CONCLUSIONS: The expressions expression of LOX-1 and oxidative stress were was significantly increased in the "hypertension with hypercholesterol" rat model. These findings suggested suggest that LOX-1 and redox systems may play a certain role in development and progression of atherosclerosis.
Animals ; Aorta, Thoracic ; Atherosclerosis ; Blood Pressure ; Blotting, Western ; Cholesterol ; Cholesterol, LDL ; Diet ; Eosine Yellowish-(YS) ; Glycosaminoglycans ; Hematoxylin ; Hypercholesterolemia ; Hypertension ; Immunohistochemistry ; Lipoproteins ; Lipoproteins, LDL ; Oxidation-Reduction ; Oxidative Stress ; Plasma ; Rats ; Rats, Inbred SHR

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Imatinib Mesylate Attenuates Cardiac Fibrosis in Spontaneously Hypertensive Rats.

Eun Ho CHOO ; Sang Hyun IHM ; Ok Ran KIM ; Sung Won JANG ; Chan Seok PARK ; Hee Yeol KIM ; Kiyuk CHANG ; Ho Joong YOUN ; Wook Sung CHUNG ; Ki Bae SEUNG ; Jae Hyeong KIM

Journal of the Korean Society of Hypertension.2011;17(2):48-56. doi:10.5646/jksh.2011.17.2.48

BACKGROUND: Hypertensive myocardial fibrosis promotes abnormalities of cardiac function that may adversely affect the clinical outcome of hypertensive patients. Imatinib mesylate blocks receptor tyrosine kinase and is clinically used to treat leukemia. Platelet-derived growth factor (PDGF) is a downstream target of receptor tyrosine kinases. Cardiac fibroblasts can be activated by PDGF. Thus we evaluated whether imatinib attenuate myocardial fibrosis and prevents diastolic dysfunction in spontaneously hypertensive rats (SHR). METHODS: 8 weeks old male SHRs were subjected to treatment with 8 weeks of low dose imatinib (SHR-10; 10 mg/kg), high dose imatinib (SHR-30; 30 mg/kg) or saline (SHR-C; n = 6 in each group). At the age of 16 weeks, all rats underwent hemodynamic studies and Doppler echocardiography, and were sacrificed. Their hearts were extracted for histopathological, immunoblotting and quantitative reverse transcriptase-polymerase chain reaction analyses. RESULTS: While imatinib did not affect blood pressure (BP), it markedly reduced perivascular and interstitial fibrosis in the hearts of SHR. Echocardigram showed that high-dose imatinib significantly reduced left ventricular (LV) wall thickness (septal/posterior wall; SHR-C vs. SHR-30: 18 +/- 2/19 +/- 2 mm vs. 15 +/- 1/14 +/- 1 mm; p < 0.05) and improved the parameters of LV diastolic function such as E/A ratio (SHR-C vs. SHR-30: 1.60 +/- 0.10 vs. 1.86 +/- 0.20; p < 0.05). Imatinib also significantly reduced mRNA expression of collagen III and PDGF beta-receptor tyrosine phosphorylation in the hearts of SHR. CONCLUSIONS: These results suggest that imatinib, especially high dose, could attenuate myocardial fibrosis and prevent LV diastolic dysfunction in hypertensive rat model by decreased activity of PDGF. Imatinib may provide a potential therapeutic approach for hypertensive heart disease.
Animals ; Benzamides ; Blood Pressure ; Collagen ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Fibroblasts ; Fibrosis ; Heart ; Heart Diseases ; Hemodynamics ; Humans ; Immunoblotting ; Leukemia ; Male ; Mesylates ; Phosphorylation ; Phosphotransferases ; Piperazines ; Platelet-Derived Growth Factor ; Protein-Tyrosine Kinases ; Pyrimidines ; Rats ; Rats, Inbred SHR ; RNA, Messenger ; Tyrosine ; Imatinib Mesylate

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