Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis

Chowdhury Mohammad Ziaul Islam,Rahman Meshbahur,Akter Tanjila,Akhter Tania,Ahmed Arifa,Shovon Minhajul Arifin,Farhana Zaki,Chowdhury Nashit,Turin Tanvir C. 대한고혈압학회 2020 Clinical Hypertension Vol.26 No.3

Background: Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and threequarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods: We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results: Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I2 = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions: The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.

Hypertensive emergencies: a new clinical approach

Alfonso Lagi,Simone Cencetti 대한고혈압학회 2015 Clinical Hypertension Vol.21 No.16

The expression ‘hypertensive urgencies’ includes many diseases. The unifying features of these diseases are a high level of arterial pressure and acute distress of one or more organs. The aim of the review was to define the idea of the ‘acute hypertension’ as a new concept, different from ‘chronic hypertension’. Acute hypertension might be related to ‘organ damage’ because it is the cause, the consequence or an effect of the acute stress. We compounded a narrative review which has included analyses of 373 articles. The structure of the search strategy included a literature search of PubMed, MEDLINE, Cochrane Library and Google Scholar databases. We applied the following inclusion criteria: prospective double-blind randomised controlled trials, experimental animal work studies, case–control studies and recruiting patients representative of the general sick population. In this review, the diseases included in the term ‘hypertensive emergencies’ share ‘acute’ hypertension. This is a new idea that emphasises the suddenly increased arterial pressure, irrespective of the initial arterial pressure and independent of the goals of hypertension control. The ‘hypertensive emergencies’ have been grouped together in three subsets: (1) diseases that result from acute hypertension that is caused by faulty regulation of the peripheral circulation (acute primary hypertension), (2) diseases that produce hypertension (acute secondary hypertension) and 3) diseases that have hypertension as an effect of the acute stress caused by the principle disease (acute associated hypertension). This review highlights a novel idea: acute hypertension is a common sign of different diseases characterised by the sudden surge of arterial pressure, so overwhelming the difference between hypertensive emergencies and urgencies. The judgment of acute hypertension is independent of the initial arterial pressure, normotension or hypertension and is linked with the transient failure of the baroreflex. Hypertensive emergencies are grouped together because all of these diseases require prompt therapy to prevent the negative outcomes of acute 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.

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.

The Prevalence and Awareness of Hypertension and the Relationship between Hypertension and Snoring in the Korean Population

(Jin Seok Kim),(Woo Hyuk Song),(Chol Shin),(Chang Gyu Park),(Hong Seog Seo),(Wan Joo Shim),(Dong Joo Oh),(Sae Hwa Ryu),(Young Moo Rho) 대한내과학회 2001 The Korean Journal of Internal Medicine Vol.16 No.2

N/A Background: Hypertension is the most important, and yet modifiable, risk factor for cardiovascular diseases. But in many countries, hypertension remains poorly controlled. Moreover, sleep apnea syndrome has shown that it is correlated with hypertension. The purpose of this study was to investigate the prevalence, awareness and control of hypertension among the Korean people and to evaluate the relationship between hypertension and snoring. Methods: A total of 640 subjects living in Ansan, a regional city in Korea, were selected randomly, and trained nursing students investigated their age, sex, medical history, blood pressure, body mass index (BMI) and snoring score. Blood pressures were measured three times with a 10 - minute interval and then averaged. The degree of snoring was estimated using a questionnaire. We divided the subjects into hypertensive (BP≥140/90 mmHg) versus normotensive group and snorer versus non-snorer group, and correlated hypertension with snoring. Results: Of 640 subjects, 311 were male. The mean age was 39.7±14.6 years (18-77 years), the mean BMI (body mass index) was 22.4±3.0 kg/m2. The mean systolic and diastolic blood pressure was 121±15.7 mmHg and 79.5±11.6 mmHg. The prevalence and awareness of hypertension were 22.2% and 16.9%, respectively, and the prevalence of snoring was 35.2%. With the increment of age, in the male, the prevalence of hypertension and snoring were higher, and the snorer group showed a higher risk of hypertension than the non-snorer group (Odds ratio 2.32, CI=1.56-3.39, p=0.0001). Conclusion: In Korea, the prevalence of hypertension was similar to that in the western countries, but the awareness of hypertension was much lower compared with western countries. The prevalence of hypertension was higher in the snorer group, so more research on the correlation between the two conditions should be advanced in the future.

The Relationship between Family History and Hypertension by Serum Glucose Levels and Age in Korean Men and Women

류미경,설재웅,지선하,조일훈 대한의생명과학회 2022 Biomedical Science Letters Vol.28 No.4

Hypertension is associated with cardiovascular disease. The environmental and genetic factors can cause the development of hypertension. In this study, the relationship between hypertension and family history of hypertension in Koreans was analyzed in consideration of serum fasting blood glucose levels and age. The study subjects were 2,484 subjects who had a medical examination at a university hospital. The main statistical analysis method was multiple logistic regression analysis. Hypertension prevalence was 16.4% of all subjects, and subjects with a family history of hypertension were 23.5%. The risk of hypertension was 2.36 times higher in subjects with a family history of hypertension than subjects without a family history of hypertension. In addition, in the subjects with fasting blood glucose levels more than 120 mg/dL, the risk of hypertension was 4.44 times higher in subjects with a family history of hypertension compared with subjects without a family history of hypertension. The relationship between family history and hypertension was slightly higher in the older group than in the younger group. To assess the association between hypertension and family history, further cohort study is necessary in the future.

부산 · 경남 지역의 고혈압 사례관리사업 실시 효과

최일호,유병철 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Background : Hypertension is one of the high prevalence disease and 9th common death cause of Korean in 2006. The effective management for hypertension is continuous treatments and maintenance of healthy life style. So, we started this study to verify effect of the case management program as a method for maintenance of hypertension management which is conducted by the National Health Insurance Corporation. Method : We studied effect of the case management for hypertension patients during the period from January to December in 2006. Investigation subjects were 364 hypertension patients residing in Busan and Gyeongsangnam-do. We conducted the case management program for hypertension patient that case managers in each areas performed 3 times visiting and 1 time phone arbitration according to protocol of the case management program by the National Health Insurance Corporation. We evaluated effect of the case management program based on changes of blood pressure, knowledge level for hypertension, self-management level for hypertension patients. Data analysis was performed with t-test and paired t-test using SPSS Win(ver 12.0K) program. Result : After the case management program, mean blood pressure was improved from 113.88 ± 29.41 mmHg to 107.84 ± 25.47 mmHg(p<0.01), systolic blood pressure and diastolic blood pressure were decreased from 139.44 ±17.54 mmHg to 130.98 ± 12.82 mmHg and from 88.33 ± 10.73 mmHg to 84.70 ± 7.84 mmHg(p<0.01). The level of knowledge on 9-point scale for hypertension was increase from 5.65 ± 1.77 before the case management to 7.65 ± 1.36 after the case management(p<0.01) and the level of self-management behaviors for hypertension(sum of the score was 35 points) was improved from 22.69 ± 3.96 to 26.06 ± 3.48(p<0.01). Smoking quantity(cigarette per day) and drinking frequency(time per week) were reduced from 14.74 ± 7.48 and 3.45 ± 4.66 to 12.41 ± 8.24 and 2.56 ± 1.74(p<0.05), exercise frequency(time per week) was increased from 4.60 ± 1.75 to 4.79 ± 1.67(p<0.01). Conclusion : From the result, we can concluded that the case management program conducted by the National Health Insurance Corporation showed decrease of blood pressure, improvements of self-management and knowledge level for hypertension. The case management program for hypertension needs to be developed in a way that increases not only hypertension patient's motivation to manage their diseases but also improvement of public heath system. For the widespread use of the case management program among hypertension patients, media-based promotional campaign and supporting of public health system are much required

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.

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationallyrepresentative surveys

Fariha Binte Hossain,Gourab Adhikary,Ariful Bari Chowdhury,Md Shajedur Rahman Shawon 대한고혈압학회 2020 Clinical Hypertension Vol.26 No.1

Background: Although there has been a well-established association between overweight-obesity and hypertension, whether such associations are heterogeneous for South Asian populations, or for different socioeconomic groups is not well-known. We explored the associations of overweight and obesity using South Asian cut-offs with hypertension, and also examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups. Methods: We analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal, with a total of 821,040 men and women. Hypertension was defined by 2017 ACC/AHA cut-offs and by Joint National Committee 7 (JNC7) cut-offs for measured blood pressure and overweight and obesity were defined by measured height and weight. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI. Results: The prevalence of hypertension using JNC7 cut-offs among participants increased by age in all three countries. The prevalence ranged from 17.4% in 35–44 years to 34.9% in ≥55 years in Bangladesh, from 4.6% in 18– 24 years to 28.6% in 45–54 years in India, and from 3.8% in 18–24 years to 39.2% in ≥55 years in Nepal. Men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity using both WHO and South Asian cut-offs were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65–1.93), 1.59 (95% CI: 1.58–1.61), and 2.03 (95% CI: 1.90–2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household’s wealth index. Conclusions: Our study shows that the association of BMI with hypertension is stronger for South Asian populations at even lower cut-offs points for overweight and obesity. Therefore, public health measures to reduce population-level reduction in BMI in all population groups would also help in lowering the burden of hypertension.

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.