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.

우리 나라 농어촌지역 성인의 고혈압 유병률

오병희(Byung Hee Oh),김창엽(Chang Yup Kim),이건세(Kun Sei Lee),강영호(Young Ho Khang),이영조(Young Jo Lee),강위창(Wee Chang Kang) 대한내과학회 1999 대한내과학회지 Vol.56 No.3

N/A Objectives : To establish prevalence of hypertension in rural area of Korea, we surveyed adult residents older than 30 years, based on the recommendation and classification of JNC-5(Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure). Methods : From December 1996 to February 1997, we studied 4,209 persons in 41 rural areas purposely sampled nationwide. Blood pressure was checked twice at the time of the first visit and again checked twice after one week later for the person fell under hypertension criteria at the first visit. Persons fell under hypertension criteria at the first visit without second visit for recheck were categorized as suspected hypertension. For the suspected hypertension, we predicted whether fell under criteria by logistic regression model. Results : 1) The distributions of blood pressures show unimodal curve, skewed to the right. The peaks of the systolic blood pressure was between 120∼129㎜Hg, tending to move to the right for the age of 50-and-over in male, 70-and-over in female. But peaks of the diastolic blood pressure were consistent between 80∼84㎜Hg in both sexes. The distributions of blood pressures for male were slightly deviated to the right compared with those of the female. 2) The crude prevalence rate of hypertension, defined as systolic blood pressure ≥140㎜Hg or diastolic blood pressure ≥90㎜Hg or taking anti-hypertensive medication, was 25.94%. And the prevalence rate of suspected hypertension was 5.54%. Through the logistic regression model, the prevalence of hypertension was estimated as 29.94%. Age-sex-adjusted prevalence rate for the rural area-Myon regions- was 25.94%, if adjusted to the age-sex composition of the 1995 national census population. 3) Prevalence rate was 27.76% in male and 30.03% in female, if adjusted to the age-sex composition of the base population of this study. Prevalence rate progressively increased with age, higher in men than women before about age 60. 4) Prevalence rates among eight Provinces(Do) was different. Unadjusted rates for Kyonggi Province was 24.74%, and rates for Chonnam Province was 34.18%. But there was no significant differences of the prevalence rate between inland and seaside. 5) By logistic regression model, 65.39% of stage 1 hypertension and 75.51% of stage 2 hypertension at the first visit were estimated as to be included in hypertension criteria. 6) By the JNC-5 classification, only 22.33% of the patients taking anti-hypertensive medication was being controlled. Conclusion : The prevalence rate of hypertension by classification of JNC-5 at rural area was 25.94%. We could not find significant differences of prevalence rate between inland and seaside. Follow-up measurement of blood pressures will be needed to establish more valid prevalence rates of hypertension.

Differences in prevalence of hypertension subtypes according to the 2018 Korean Society of Hypertension and 2017 American College of Cardiology/American Heart Association guidelines: The Korean National Health and Nutrition Examination Survey, 2007–2017

조소미,이호규,김현창 대한고혈압학회 2020 Clinical Hypertension Vol.26 No.1

Background: The significance of high systolic and diastolic blood pressure remains controversial. We assessed the differences in prevalence of hypertension and its subtypes according to the different hypertension diagnostic criteria embodied by the 2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) and 2018 Korean Society of Hypertension (2018 KSH) guidelines. Methods: We used the 2007–2017 Korea National Health and Nutrition Examination Survey (KNHANES) data to calculate guideline-specific hypertension prevalence among untreated, adult participants. By the 2017 ACC/AHA guideline, a mean SBP ≥130 mmHg, DBP ≥80 mmHg, or currently using antihypertensive medications were considered to have hypertension. Isolated diastolic hypertension (IDH) was defined as DBP ≥80 mmHg and SBP < 130 mmHg, isolated systolic hypertension (ISH) as SBP ≥130 mmHg and DBP <80 mmHg, and systolic diastolic hypertension (SDH) as SBP ≥130 mmHg and DBP ≥80 mmHg. In a similar manner, by the 2018 KSH guideline, all hypertension and its subtype prevalence were calculated using the 140/90 mmHg cutoff. The two versions of all hypertension and its corresponding subtype prevalence were calculated among all study participants and separately by sex and age then compared via analysis of variance. Results: The prevalence of all hypertension increased from 25.9% (95% confidence interval (CI) 25.4–26.5) defined by the 2018 KSH guideline to 46.3% (95% CI 45.6–46.9) classified by the 2017 ACC/AHA guideline. Such increase was primarily manifested through substantial increase in IDH prevalence, from 5.2% (95% CI 4.9–5.4) defined by the 2018 KSH guideline to 17.9% (95% CI 17.4–18.3) defined by the 2017 ACC/AHA guideline, and was most notably observed in young age groups, 30-49 years. ISH prevalence showed minimal differences. SDH prevalence moderately increased from 3.5% (95% CI 3.3–3.7) defined by the 2018 KSH guideline to 11.1% (95% CI 10.7–11.4) defined by the 2017 ACC/AHA guideline, achieved primarily among participants aged 50 years or above. Conclusions: Changes in each subtype prevalence made differential contribution to additionally classified hypertension cases by the 2017 ACC/AHA guideline. Future studies should investigate the diastolic-associated cardiovascular risks and benefits of its long-term primary prevention in the young population.

2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension

김현창,Sang-Hyun Ihm,김근호,Ju Han Kim,Kwang-Il Kim,Hae-Young Lee,이장훈,Jong-Moo Park,박성하,편욱범,신진호,채성철 대한고혈압학회 2019 Clinical Hypertension Vol.25 No.4

The Korean Society of Hypertension guideline defines hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, where the effectiveness of pharmacological treatment has been established. It is confirmed that higher blood pressure levels are associated with increased risk of cardiovascular disease and mortality also in the Korean population. About one third of Korean adults aged 30 years or older are estimated to have hypertension, and the prevalence of hypertension gradually increases as the age increases. The awareness, treatment, and control rates of hypertension are generally improving in Korea, but more efforts are required to increase awareness and treatment among younger patients with hypertension and to improve lifestyle modification compliance at all ages. More studies are required to determine the magnitude and impact of white coat hypertension and masked hypertension in the Korean population.

일개 내과 의원을 방문한 고혈압 환자의 고혈압 질환에 대한 인지도

공은희,최종순 고신대학교(의대) 고신대학교 의과대학 학술지 2006 고신대학교 의과대학 학술지 Vol.21 No.1

Background : Hypertension is one of the most important risk factors of cardiovascular disease and coronary artery disease. Awareness of hypertension by patients is important in controlling of the disease. 丁he purpose of this study was to compare awareness regarding hypertension by demographic and socio-economic status of the patients. Methods : This study involved 71 hypertensive patients who visited a physician’s out-patient clinic from November 1 to November 30,2005. All subjects were drawn up a questionnaire including demographic characteristics and awareness of hypertension, and compared by age, sex, education and economic status. Results : The correct rate to the questions concerning 'cause of hypertension* and 'protection of hypertension* were significantly higher in men(P<(乂05). The correct rate to the questions concerning 'blood pressure need to be once checked per day、 'anti-hypertensive medication should be taken for life* and 1 weight control is essential1 were significantly different by the age(P<0,05 乂 It was significantly different that the questions about * blood pressure check one per day、 ’cause of hypertension' ’symptom of hypertension \ * regular ant 卜 hypertensive medication、and ’modification of life style* were correctly answered by the high level of education(P<0乂)5), Conclusion : In order to correct wrong awareness of hypertension,the necessity of developing special program to achieve better compliance of hypertensive patients is mandatory. Background : Hypertension is one of the most important risk factors of cardiovascular disease and coronary artery disease. Awareness of hypertension by patients is important in controlling of the disease. 丁he purpose of this study was to compare awareness regarding hypertension by demographic and socio-economic status of the patients. Methods : This study involved 71 hypertensive patients who visited a physician’s out-patient clinic from November 1 to November 30,2005. All subjects were drawn up a questionnaire including demographic characteristics and awareness of hypertension, and compared by age, sex, education and economic status. Results : The correct rate to the questions concerning 'cause of hypertension* and 'protection of hypertension* were significantly higher in men(P<(乂05). The correct rate to the questions concerning 'blood pressure need to be once checked per day、 'anti-hypertensive medication should be taken for life* and 1 weight control is essential1 were significantly different by the age(P<0,05 乂 It was significantly different that the questions about * blood pressure check one per day、 ’cause of hypertension' ’symptom of hypertension \ * regular ant 卜 hypertensive medication、and ’modification of life style* were correctly answered by the high level of education(P<0乂)5), Conclusion : In order to correct wrong awareness of hypertension,the necessity of developing special program to achieve better compliance of hypertensive patients is mandatory.

Korea hypertension fact sheet 2020: analysis of nationwide population-based data

김현창,So Mi Jemma Cho,이호규,Lee Hyeok-Hee,Baek Jongmin,Heo Ji Eun,the Korean Society of Hypertension (KSH) – Hyperte 대한고혈압학회 2021 Clinical Hypertension Vol.27 No.2

Background: The Korean Society of Hypertension has published the Korea Hypertension Fact Sheet 2020 to provide an overview of the magnitude and management status of hypertension and their recent trends. Methods: The Fact Sheets were based on the analyses of Korean adults aged 20 years or older of the 2007–2018 Korea National Health and Nutrition Examination Survey (KNHANES) and the 2002–2018 National Health Insurance Big Data (NHI-BD). Results: Currently, the population average of systolic/diastolic blood pressure was 118/76 mmHg in Korean adults aged 20 years or older showing little change in the recent decade. However, the number of people with hypertension increased steadily, exceeding 12.0 million. Indeed, the number of people diagnosed with hypertension increased from 3.0 million in 2002 to 9.7 million in 2018. During the same period, the number of people using antihypertensive medication increased from 2.5 million to 9.0 million, and the number of people adherent to treatment increased from 0.6 million to 6.5 million. Hypertension awareness, treatment, and control rates increased rapidly until 2007, but showed plateaued thereafter. In 2018, the awareness, treatment, and control rates of hypertension among all adults were 67, 63, and 47%, respectively. However, the awareness and treatment rates were only 17 and 14% among adults aged 20 to 39 years old with hypertension. Among patients treated for hypertension, 61% of them were also using glucose-lowering or lipid-lowering drugs. Among antihypertensive prescriptions, 41% of the patients received monotherapy, 43% received dual therapy, and 16% received triple or more therapy. The most commonly prescribed antihypertensive medication was angiotensin receptor blockers, followed by calcium channel blockers and diuretics. Conclusion: 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 Korean Society of Hypertension has published the Korea Hypertension Fact Sheet 2020 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 2007–2018 Korea National Health and Nutrition Examination Survey (KNHANES) and the 2002–2018 National Health Insurance Big Data (NHI-BD).Currently, the population average of systolic/diastolic blood pressure was 118/76 mmHg in Korean adults aged 20 years or older showing little change in the recent decade. However, the number of people with hypertension increased steadily, exceeding 12.0 million. Indeed, the number of people diagnosed with hypertension increased from 3.0 million in 2002 to 9.7 million in 2018. During the same period, the number of people using antihypertensive medication increased from 2.5 million to 9.0 million, and the number of people adherent to treatment increased from 0.6 million to 6.5 million. Hypertension awareness, treatment, and control rates increased rapidly until 2007, but showed plateaued thereafter. In 2018, the awareness, treatment, and control rates of hypertension among all adults were 67, 63, and 47%, respectively. However, the awareness and treatment rates were only 17 and 14% among adults aged 20 to 39 years old with hypertension. Among patients treated for hypertension, 61% of them were also using glucose-lowering or lipid-lowering drugs. Among antihypertensive prescriptions, 41% of the patients received monotherapy, 43% received dual therapy, and 16% received triple or more therapy. The most commonly prescribed antihypertensive medication was angiotensin receptor blockers, followed by calcium channel blockers and diuretics.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.

신규 고혈압 환자에서 치료지속성이 고혈압 조절에 미치는 영향

한진욱 ( Jin Ok Han ),오대규 ( Dae Kyu Oh ),임준 ( Jun Yim ),고광필 ( Kwang Pil Ko ),이희영 ( Hee Young Lee ),박종헌 ( Jong Heon Park ),임정수 ( Jeong Soo Im ) 한국보건행정학회 2014 보건행정학회지 Vol.24 No.2

Background: This study is to research on how hypertension control is associated with adherence in newly diagnosed hypertension patients. Methods: The study is based on 255,916 patients who were diagnosed with hypertension in 2009 and didn`t have any previous medical history of hypertension or associated complication for the past year using data collected by National Health Insurance Corporation. Newly diagnosed hypertension patients are divided into two group by visiting medical center numbers (more than 300 days was adherence group, if not non-adherence group). Patients are considered to have successfully controlled their hypertension based on blood pressure measured by health examination. Chi-square test and logistic regression, repeated measured analysis of variance was used to analyze. Results: The relations between adherence and hypertension control show that 1.12 times of patients in adherence group was able to control their hypertension. The additional analysis proves that adherence group are more decreased level of blood pressure than non-adherence group except for patients who are over 70. Comparison of the average of systolic blood pressure and diastolic blood pressure between adherence and non-adherence groups shows that the blood pressure has been significantly among the adherence group. Conclusion: The study proves that constant treatment for hypertension could control the blood pressure and encourages patients to put more effort for persistent treatment. It also shows that hypertension treatment are more effective in younger patients than the elderly and strategies of approaching are different depending on age.

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.

Application of artificial intelligence in hypertension

조정선,Park Jae-Hyeong 대한고혈압학회 2024 Clinical Hypertension Vol.30 No.-

Hypertension is an important modifiable risk factor for morbidity and mortality associated with cardiovascular disease. The incidence of hypertension is increasing not only in Korea but also in many Western countries due to the aging of the population and the increase in unhealthy lifestyles. However, hypertension control rates remain low due to poor adherence to antihypertensive medications, low awareness of hypertension, and numerous factors that contribute to hypertension, including diet, environment, lifestyle, obesity, and genetics. Because artificial intelligence (AI) involves data-driven algorithms, AI is an asset to understanding chronic diseases that are influenced by multiple factors, such as hypertension. Although several hypertension studies using AI have been published recently, most are exploratory descriptive studies that are often difficult for clinicians to understand and have little clinical relevance. This review aims to provide a clinician-centered perspective on AI by showing recent studies on the relevance of AI for patients with hypertension. The review is organized into sections on blood pressure measurement and hypertension diagnosis, prognosis, and management. Graphical Abstract Hypertension is an important modifiable risk factor for morbidity and mortality associated with cardiovascular disease. The incidence of hypertension is increasing not only in Korea but also in many Western countries due to the aging of the population and the increase in unhealthy lifestyles. However, hypertension control rates remain low due to poor adherence to antihypertensive medications, low awareness of hypertension, and numerous factors that contribute to hypertension, including diet, environment, lifestyle, obesity, and genetics. Because artificial intelligence (AI) involves data-driven algorithms, AI is an asset to understanding chronic diseases that are influenced by multiple factors, such as hypertension. Although several hypertension studies using AI have been published recently, most are exploratory descriptive studies that are often difficult for clinicians to understand and have little clinical relevance. This review aims to provide a clinician-centered perspective on AI by showing recent studies on the relevance of AI for patients with hypertension. The review is organized into sections on blood pressure measurement and hypertension diagnosis, prognosis, and management.

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.