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The aim of this study was to evaluate the efficacy of olmesartan/amlodipine (OLM/AML) single‐pill combination (SPC) therapy using ambulatory blood pressure monitoring (ABPM) in non‐responders to valsartan or candesartan monotherapy. Isolated systolic hypertension (ISH) is the most prevalent form of hypertension in middle‐aged and elderly individuals. Patients aged over 55 years who did not achieve the target systolic blood pressure (SBP < 140 mmHg) with valsartan 80 mg or candesartan 8 mg for at least 4 weeks were included. Doses were escalated from 20/5 mg to 40/5 mg and finally to 40/10 mg of OLM/AML SPC until patients reached the target SBP. Efficacy was assessed via ABPM by comparing baseline values with those in the 12th week. Office blood pressure (OBP) and brachial‐ankle pulse wave velocity (baPWV) were assessed at baseline, weeks 4, 8, and 12. Fifty‐four patients (average age 64 ± 6 years; 33 males) participated. The 24‐h mean BPs decreased significantly from an average of 146.2 ± 12.7/93.3 ± 9.2 mmHg to 129.7 ± 14.3/83.4 ± 10.7 mmHg (p < 0.001), and pulse pressures (PPs) from ABPM were reduced (p < 0.001). Additionally, significant reductions in night‐time SBP standard deviations (SDs) (14.7 ± 4.7 vs. 12.5 ± 3.9, p = 0.029) were observed at 12 weeks compared to baseline. OBPs significantly dropped from 151.1 ± 9.7/89.3 ± 8.3 mmHg to 125.5 ± 13.8/77.8 ± 8.8 mmHg after 12 weeks of SPC therapy (p < 0.001). Reductions in PPs of OBP and baPWVs were also observed. OLM/AML SPC therapy effectively reduced the 24‐h mean BP, as measured by ABPM, in hypertensive patients over 55 years old who failed to achieve a target SBP (< 140 mmHg) with angiotensin receptor blocker (ARB) monotherapy using valsartan 80 mg or candesartan 8 mg. Trial Registration: ClinicalTrials.gov identifier: NCT01713920

This study evaluated an oscillometric device (OD), Microlife WatchBP Office AFIB, and a hybrid manual auscultatory device (AD), Greenlight 300TM, to determine a suitable blood pressure (BP) measurement device for the Korea National Health and Nutrition Examination Survey in a mercury‐free context. Adhering to the 2018 Universal Standard's suggested consensus, the study involved 800 subjects (mean age 51.2 ± 17.5 years; 44.3% male), who underwent triplicate BP measurements following 5 min of rest in a randomized order (OD‐first: 398 participants; AD‐first: 402 participants). BP difference was calculated as OD value minus AD value, with results stratified by measurement sequence. The overall BP difference and tolerable error probability were ‐1.1 ± 6.5/‐2.6 ± 4.9 mmHg and 89.2%/92.5% for systolic/diastolic BP (SBP/DBP), respectively. Lin's concordance correlation coefficient was 0.907/0.844 for SBP/DBP (OD‐first/AD‐first: 0.925/0.892 for SBP, 0.842/0.845 for DBP). The overall agreement for hypertension (BP ≥ 140 and/or 90 mmHg) was 0.71 (p < 0.0001), and the OD underestimated the overall hypertension prevalence by 5.1%. Analysis of the AD‐first data revealed a lower level of agreement compared to the OD‐first data; however, the observed blood pressure difference adhered to Criterion 1 of the 2018 Universal Standard. Microlife met the Criterion 1 of 2018 Universal Standard but underestimated the prevalence of hypertension. The BP discrepancy increased with higher BP levels, male sex, and smaller AC. With increasing age, the discrepancy decreased for SBP and increased for DBP.

Cuffless wearable devices are currently being developed for long-term monitoring of blood pressure (BP) in patients with hypertension and in apparently healthy people. This study evaluated the feasibility and measurement stability of smartwatch-based cuffless BP monitoring in real-world conditions. Users of the first smartwatch-based cuffless BP monitor approved in Korea (Samsung Galaxy Watch) were invited to upload their data from using the device for 4 weeks post calibration. A total of 760 participants (mean age 43.7 ± 11.9, 80.3% men) provided 35,797 BP readings (average monitoring 22 ± 4 days [SD]; average readings 47 ± 42 per participant [median 36]). Each participant obtained 1.5 ± 1.3 readings/day and 19.7% of the participants obtained measurements every day. BP showed considerable variability, mainly depending on the day and time of the measurement. There was a trend towards higher BP levels on Mondays than on other days of the week and on workdays than in weekends. BP readings taken between 00:00 and 04:00 tended to be the lowest, whereas those between 12:00 and 16:00 the highest. The average pre-post calibration error for systolic BP (difference in 7-day BP before and after calibration), was 6.8 ± 5.6 mmHg, and was increased with higher systolic BP levels before calibration. Smartwatch-based cuffless BP monitoring is feasible for out-of-office monitoring in the real-world setting. The stability of BP measurement post calibration and the standardization and optimal time interval for recalibration need further investigation.

背景:我们评估了二肽基肽酶‐4抑制剂(DPP‐4i)对接受胰岛素治疗的2型糖尿病(T2DM)患者中梗阻性冠状动脉疾病(OCAD)进展的影响。 方法:使用多中心临床数据仓库, 我们分析了接受胰岛素治疗的T2DM患者, 他们接受了至少两次冠状动脉计算机断层扫描血管造影(CCTA)。根据两次CCTA检查之间是否存在DPP‐4i处方, 将患者分为两组。分析了OCAD的患病率(CCTA上>50%的狭窄)、新血管重建率以及冠状动脉钙积分(CCS)的变化。 结果:共有623名患者被纳入研究, 其中380名(60.9%)患者接受了DPP‐4i治疗。两次CCTA之间的中位时间差为39.0(17.0–61.4)个月。在随访的CCTA中, DPP‐4i组有62名(16.3%)患者新发OCAD, 而未使用DPP‐4i组有76名(31.3%)患者新发OCAD(p<0.001)。DPP‐4i组的新OCAD或新血管重建风险较低(19.7% vs. 38.7%, p<0.001)。经过倾向评分匹配后, DPP‐4i组新发OCAD的患病率(15.9% vs. 29.5%, p=0.001)和新发OCAD或新血管重建的综合发生率(18.7% vs. 37.3%, p<0.001)也较低。两组的CCS每年变化率没有显著差异(9.1 [0.1 – 56.8] vs. 13.5 [0.0 – 78.6], p=0.715)。 结论:对于接受胰岛素治疗的T2DM患者, 添加DPP‐4i治疗有助于预防冠状动脉疾病的进展。

Background The prevention of subsequent cardiovascular disease (CVD) is an essential part of cancer survivorship care. We conducted the present study to investigate the association between the TyG index (a surrogate marker of insulin resistance) and the risk of cardiovascular disease (CVD) events in cancer survivors. Methods Adult cancer patients, who underwent routine health examinations during 2009–2010 and were survived for more than 5 years as of January 1, 2011, were followed for hospitalization of CVD (either ischemic heart disease, stroke, or heart failure) until December 2020. Cox model was used to calculate hazard ratios associated with baseline TyG index (log e [fasting triglyceride (mg) × fasting glucose (mg)/2]) for the CVD hospitalization. Results A total of 155,167 cancer survivors (mean age 59.9 ± 12.0 years, female 59.1%) were included in this study. A graded positive association was observed between TyG and CVD hospitalization. An 8% elevated risk for CVD hospitalization was observed for a TyG index of 8-8.4 (aHR 1.08 [95% CI 1.01–1.14]); 10% elevated risk for a TyG index of 8.5–8.9 (aHR 1.10 [95% CI 1.03–1.17]); 23% elevated risk for a TyG index of 9.0-9.4 (aHR 1.23 [95% CI 1.15–1.31]); 34% elevated risk for a TyG index of 9.5–9.9 (aHR 1.34 [95% CI 1.23–1.47]); and 55% elevated risk for a TyG index  ≥  10 compared to the reference group (TyG index < 8). Per 1-unit increase in the TyG index, a 16% increase in CVD hospitalization and a 45% increase in acute myocardial infarction hospitalization were demonstrated. Graded positive associations were evident for atherosclerotic CVD subtypes, such as ischemic heart disease, acute myocardial infarction, and ischemic stroke, but not for hemorrhagic stroke or heart failure. Conclusions The TyG index may serve as a simple surrogate marker for the risk stratification of future CVD events, particularly atherosclerotic subtypes, in cancer survivors.

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.

This multicenter, phase 4, Prospective Randomized Open, Blinded End‐point (PROBE) study aimed to evaluate safety and efficacy of telmisartan/rosuvastatin single‐pill combination (SPC) therapy on lowering central blood pressure (BP) compared with telmisartan monotherapy in hypertensive patients with dyslipidemia in Korea. Study was terminated earlier than planned due to COVID‐19 pandemic, thus should be considered as a pilot study. Among 125 patients who met the inclusion criteria of hypertension and dyslipidemia (defined as 10‐year Atherosclerotic Cardiovascular Disease risk score over 5%), 80 patients went through 4‐week single‐group run‐in period with telmisartan 40–80 mg, then randomized to telmisartan 80 mg + rosuvastatin (10 or 20 mg) SPC group or telmisartan 80 mg monotherapy group. The central/brachial BP, brachial‐ankle pulse wave velocity (baPWV), and augmentation index (AIx) were assessed at baseline and 16 weeks later. Mean brachial SBP changed from 135.80 ± 14.22 mmHg to 130.69 ± 13.23 mmHg in telmisartan/rosuvastatin group and from 134.37 ± 12.50 mmHg to 133.75 ± 12.30 mmHg in telmisartan monotherapy group without significant difference (between‐group difference p = .149). Mean central SBP were reduced significantly in the telmisartan/rosuvastatin group with change from 126.72 ± 14.44 mmHg to 121.56 ± 14.56 mmHg while telmisartan monotherapy group showed no significant change (between‐group difference p = .028). BaPWV changed from 1672.57 ± 371.72 m/s to 1591.75 ± 272.16 m/s in telmisartan/rosuvastatin group and from 1542.85 ± 263.70 m/s to 1586.12 ± 297.45 m/s in telmisartan group with no significance (between‐group difference p = .078). Change of AIx had no significant difference (between‐group difference p = .314). Both groups showed excellent compliance rate of 96.9 ± 4.5% with no significant difference in adverse rate. Telmisartan/rosuvastatin SPC therapy was more effective in lowering central BP compared with the telmisartan monotherapy. The results of this study showed benefit of additive statin therapy in hypertensive patients combined with dyslipidemia.

The authors evaluated the efficacy, safety, and characteristics of patients who respond well to standard dose triple combination therapy including chlorthalidone 25 mg with telmisartan 80 mg plus amlodipine 5 mg in hypertensive patients. This is a multicenter, double‐blind, active‐controlled, phase 3, randomized trial. Patients are randomized to triple combination (telmisartan 40 mg/amlodipine 5 mg/chlorthalidone 12.5 mg, TEL/AML/CHTD group) or dual combination (telmisartan 40 mg/amlodipine 5 mg, TEL/AML group) treatment and then dose up titration to TEL 80/AML5/CHTD25mg and TEL80/AML5, respectively. The primary endpoint is the change of mean sitting systolic blood pressure (MSSBP) at week 8. A Target BP achievement rate, a response rate, and the safety endpoints are also evaluated. Total 374 patients (mean age = 60.9 ± 10.7 years, male = 78.3%) were randomized to the study. The baseline MSSBPs/diastolic BPs were 149.9 ± 12.2/88.5 ± 10.4 mm Hg. After 8 weeks treatment, the change of MSSBPs at week 8 are −19.1 ± 14.9 mm Hg (TEL/AML/CHTD) and −11.4 ± 14.7 mm Hg (TEL/AML) ( p  < .0001). The achievement rates of target BP (53.8% vs. 37.8%, p  = .0017) and responder rate (54.8% vs. 35.6%, p  = .0001) at week 8 were significantly higher in TEL/AML/CHTD. There are no serious adverse event and no one discontinued medication due to adverse event. Among the TEL 80/AML5/CHTD25mg treatment group, patients of female or age ≥ 65 years old showed higher rate of target BP achievement than relatively young male. (61.4 vs. 46.8%, p  = .042) Our study showed standard dose triple combination of telmisartan 80 mg/amlodipine 5 mg/chlorthalidone 25 mg is efficacious and safe in treatment of primary hypertension. Target BP achievement with triple therapy would be facilitated in female or old age.

Home blood pressure (HBP) is useful to decide whether blood pressure (BP) is controlled. However, applying HBP to daily clinical practices is still challenging without easy access to the average HBP. Therefore, we developed a simple method to make a quick decision regarding the controlledness of HBP through high BP counts. We simulated 100 cases of HBP series for each combination of 3 numbers of BP readings ( K  = 16, 20, 24) and 4 levels of the standard deviations (SDs = 5, 10, 15, 20). A high BP was defined as an individual BP ≥ 135/85 mmHg, and an uncontrolled HBP was defined as a mean HBP ≥ 135/85 mmHg. Validation for the decision method was conducted using actual HBP data. The C-statistics and the accuracy of the high BP counts for the uncontrolled HBP were generally high (> 0.85) for all combinations of K s and SDs and decreased as SDs increased but remained steady as K s increased. In validation, the C-statistic of the high BP count-to-total BP reading (C/T) ratio was 0.985, and the C/T ratio ≥ 0.5 showed a sensitivity of 0.957, a specificity of 0.907, and an accuracy of 0.927. The count-based decision method can provide an accurate quick assessment of the controlledness of HBP.

Physical inactivity is an important but often neglected risk factor for various cardiovascular diseases. We hypothesized that physical inactivity might have deleterious effects on metabolic health in obese and non-obese subjects. We evaluated the effect of physical activity on the cardiometabolic profiles of a nationwide cohort of non-obese and obese individuals who did not have overt cardiovascular diseases. A total of 3,830 study subjects were divided into two groups based on their body mass index (BMI). Within each BMI group, participants were divided according to their physical activity level. To ascertain their cardiometabolic profiles, we collected data regarding the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index, high-density lipoprotein (HDL)-cholesterol level, systolic blood pressure, heart rate, and high-sensitivity C-reactive protein (hsCRP) level. Physically inactive subjects demonstrated markedly elevated HOMA-IR index and heart rates in each BMI category, even after adjustments for baseline covariates. They also tended to have worse profiles for HDL-cholesterol, systolic blood pressure, and hsCRP levels. A significant elevation in cardiometabolic risk was noted across the four physical activity/obesity groups (p<0.05). HOMA-IR index was largely affected by obesity, but within each BMI category, physical inactivity independently elevated the risk for worsening insulin resistance. In addition, physical inactivity significantly increased the risk of elevated heart rate in both non-obese and obese individuals. Notably, the detrimental effect of physical activity on heart rate was not modified by obesity. Physical activity was associated with favorable cardiometabolic risk profiles with regard to insulin resistance status and heart rate level in both BMI groups. Our results suggest that increasing physical activity could be a helpful strategy for improving the cardiometabolic health in the Korean population, regardless of obesity status.