Background:Cardiovascular risk stratification in patients with hypertension and diabetes remains suboptimal. We evaluated the prognostic and incremental value of Dr. Noon CVD, a deep learning (DL)-based retinal biomarker, for 10-year atherosclerotic cardiovascular (ASCVD) mortality. Methods:This retrospective, single-center, primary prevention cohort study included 7,832 Korean patients with hypertension or diabetes diagnosed on or before retinal fundus photography (2005 to 2022). Patients with prior cardiovascular disease were excluded. The primary outcome of 10-year ASCVD mortality and a sensitivity analysis of 5-year mortality were stratified using 4-tier and 3-tier Dr. Noon CVD systems, respectively. Multivariable Cox proportional hazards models were adjusted for traditional risk factors and chronic kidney disease (CKD), and incremental predictive value was assessed using the change in the C-index (ΔC-index) and net reclassification improvement (NRI). Results:In the overall population, the Dr. Noon CVD score was independently associated with 10-year ASCVD mortality (hazard ratio [HR] trend, 1.49; 95% confidence interval [CI], 1.21 to 1.85; P < 0.001) after full adjustment for traditional factors and CKD. Adding Dr. Noon CVD to the clinical model significantly improved discrimination (ΔC-index, 0.030; P = 0.001) and risk reclassification (NRI, 0.484; 95% CI, 0.233 to 0.666; P < 0.001). This independent prognostic value was consistent in both hypertension (10-year HR trend, 1.48; P = 0.006) and diabetes (10-year HR trend, 1.42; P = 0.003) subgroups. The reclassification improvement was greater in the diabetes than the hypertension subgroup (10-year NRI, 0.481 vs. 0.413). The score's prognostic value was independent of diabetic retinopathy status. Conclusions:DL-based retinal imaging provides prognostic value for 10-year ASCVD mortality independent of the available clinical risk factors (age, sex, hypertension, diabetes, and CKD) and consistent under adjustment for available laboratory measures, supporting its role as an accessible opportunistic screening tool for long-term primary prevention in cardiometabolic clinics.
Background:Intradialytic hypotension (IDH) is a frequent complication of hemodialysis that is associated with adverse cardiovascular consequences. The contribution of right ventricular (RV) functional reserve to hemodynamic stability during dialysis remains unclear. We investigated whether dynamic changes in RV strain are associated with IDH. Methods:In this prospective single-center study, 50 patients with end-stage renal disease undergoing maintenance hemodialysis underwent comprehensive echocardiography with speckle-tracking analysis immediately before and after dialysis. IDH was defined as a decrease in systolic blood pressure (SBP) of ≥ 20 mmHg from pre- to post-dialysis. Right ventricular free wall strain (RVFWS) was analyzed offline by a blinded specialist. Changes in RVFWS were compared between patients with and without IDH, and correlations between SBP change and RVFWS change were assessed. Results:In the analyzed 33 patients, 15 patients (45%) developed IDH. Baseline clinical characteristics, ultrafiltration volume (mean, 2.9 L), and pre-dialysis SBP were comparable between groups. Left ventricular ejection fraction was preserved in most patients, and baseline RVFWS did not differ significantly. However, the IDH group showed a significantly greater post-dialysis reduction in RVFWS than the non-IDH group (-7.0 ± 7.2% vs. -1.7 ± 4.6%, P = 0.017). Moreover, the magnitude of SBP decline correlated moderately with the decrease in RVFWS (r = 0.50, P = 0.003). Receiver operating characteristic analysis suggested a modest discriminatory ability of dialysis-induced changes in RVFWS for IDH (area under the curve, 0.74; 95% confidence interval, 0.56-0.92). Conclusions:IDH was associated with a greater dialysis-induced decline in RVFWS despite similar baseline RV function, suggesting that acute volume unloading may unmask impaired RV contractile reserve. These findings provide preliminary evidence that dynamic RV strain assessment could help identify patients vulnerable to intradialytic hemodynamic instability, warranting further validation in larger studies.
Background:Evidence shows that the weekend warrior physical activity (PA) pattern (1-2 days/week) is associated with a lower risk of hypertension, but it is unclear whether this association differs by socioeconomic status (SES). This study aimed to examine whether the association between the weekend warrior PA pattern and prevalent hypertension differs according to SES in Korean adults. Methods:We analyzed 28,039 adults (aged ≥ 19 years) from the 2018-2023 Korea National Health and Nutrition Examination Survey. PA patterns were categorized as inactive, insufficiently active, weekend warrior, or regularly active. Educational attainment (high school or less vs. college or higher) and household income (Q1-Q2 vs. Q3-Q4) were used as proxies of SES. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, a physician diagnosis, or use of antihypertensive medication. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for prevalent hypertension across PA patterns, stratified by educational attainment and household income level. Results:Among 28,039 adults, 8,842 (31.5%) had hypertension. In multivariable-adjusted models, compared with inactive participants, insufficiently active (OR, 0.85; 95% CI, 0.77-0.93), weekend warrior (OR, 0.74; 95% CI, 0.59-0.92), and regularly active (OR, 0.84; 95% CI, 0.77-0.91) PA patterns were each associated with lower odds of prevalent hypertension. There was no significant educational attainment-by-weekend warrior interaction for prevalent hypertension (P for interaction = 0.349), whereas a significant household income-by- weekend warrior interaction was observed (P for interaction = 0.049), with a more pronounced inverse association among lower-income adults. Conclusions:PA patterns, including the weekend warrior pattern, were associated with lower odds of prevalent hypertension among Korean adults. The inverse association between the weekend warrior pattern and hypertension appeared to differ by household income level, with a more pronounced inverse association among lower-income adults. Further studies in large longitudinal cohorts are warranted to confirm these findings.
Renal denervation (RDN) has re-emerged as a potential adjunctive therapy for hypertension following advances in device technology, trial design, and patient selection. Early enthusiasm for RDN declined after neutral findings from initial sham-controlled trials; however, subsequent randomized studies have consistently demonstrated modest but significant reductions in blood pressure (BP) across a range of clinical settings. Contemporary sham-controlled trials using radiofrequency-, ultrasound-, and alcohol-mediated approaches have shown that RDN lowers office and ambulatory BP both in the presence and absence of background antihypertensive therapy. Long-term follow-up data extending up to 3 years suggest that BP-lowering effects can be sustained, with no consistent signal of late-emerging safety concerns. Recent meta-analyses further support these findings, reporting modest but consistent reductions in systolic BP compared with sham procedures. Despite these advances, several limitations remain. The magnitude of BP reduction is modest, treatment response is heterogeneous, and definitive evidence for cardiovascular outcome benefit is lacking. Current international guidelines therefore position RDN as an adjunctive, rather than replacement, therapy for carefully selected patients with uncontrolled or resistant hypertension. This review summarizes the mechanistic rationale, key clinical trial evidence, long-term durability, safety considerations, and current guideline recommendations for RDN, and discusses future directions to better define its role in hypertension management.
Background:Assessing adherence to antihypertensive medication remains a major challenge for healthcare professionals. The objective of this study was to compare the evaluation of adherence to antihypertensive medication between direct and indirect methods, and to identify variables associated with nonadherence. Methods:A cross-sectional study was conducted with 253 persons with hypertension followed at a hypertension unit of a tertiary teaching hospital. Participants aged over 18 years and under antihypertensive drug treatment were included. Persons with secondary hypertension, end-stage chronic kidney disease, or pregnancy were excluded. Biopsychosocial, anthropometric, lifestyle, comorbidity, and medication data were collected. Indirect assessment of treatment adherence was performed using the 4-item Morisky-Green Medication Adherence Scale, while direct assessment was based on urine analysis using high-performance liquid chromatography coupled with mass spectrometry. Variables with P < 0.20 in the bivariate analysis were included in the multiple logistic regression model. The significance level was set at 5%. Cohen's Kappa coefficient (CKC) was used to assess agreement between the methods. Results:The sample consisted predominantly of women (61.7%), white individuals (63.2%), and married participants (52.8%), with a mean age of 65 ± 13.3 years and median education of 12.0 (7-12) years. Participants were using an average of 3.2 ± 1.3 antihypertensive drugs, and 69.2% had controlled blood pressure (BP). The prevalence of adherence according to the direct method was 32.4%, while 90.1% were adherent according to the indirect method. Agreement between the direct and indirect methods was low (CKC = 0.014). Variables independently associated with nonadherence according to the direct method were regular physical activity (odds ratio [OR], 0.370; 95% confidence interval [CI], 0.158-0.853), proteinuria (OR, 2.406; 95% CI, 1.066-5.751), number of antihypertensive medications (OR, 1.570; 95% CI, 1.127-2.225), and systolic BP (OR, 1.051; 95% CI, 1.010-1.097). Indirect adherence assessment was associated only with the presence of common mental disorders (OR, 1.163; 95% CI, 1.035-1.307). Conclusions:The prevalence of adherence to antihypertensive drug treatment assessed by the indirect method was substantially higher than that observed with the direct method. The results were inconsistent between the 2 approaches. Moreover, the direct method identified a broader range of variables associated with nonadherence.
Background:Nocturnal blood pressure (BP) during sleep is a stronger predictor of cardiovascular events than daytime BP. This pilot randomized controlled trial (RCT) aimed to assess feasibility and preliminary effectiveness of mindfulness-based stress reduction (MBSR) in managing nocturnal hypertension. Methods:Eligible patients were randomized to either a generic MBSR program or usual care (1:1). Primary outcomes included recruitment rate, dropout rate, adherence to ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), and MBSR participation. Secondary outcomes encompassed BP measurements from ABPM, mood symptoms, sleep quality, mindfulness levels, and safety at 8 weeks, with acceptability evaluated through interviews. Results:All eligible patients were recruited (76/113), with 13 participants recruited monthly and a retention rate of 100%. The 83.3% of MBSR participants attended at least six classes, and they engaged in home practices on 77% of days during the 8-week program. All participants completed ABPM at baseline and 8 weeks; however, only 55.3% reported adequate nocturnal HBPM readings. While MBSR significantly reduced nocturnal systolic BP (121.9 vs. 128.6 mmHg, P < 0.001), no significant differences were observed on other outcomes and no adverse events were detected. Patients noted benefits from the MBSR course, although HBPM and ABPM disrupted sleep for a minority. Conclusion:This is the first RCT to investigate the effect of mindfulness on nocturnal BP in a Chinese population. We confirm the feasibility of a definitive RCT regarding patient recruitment and retention, acceptability of the intervention (i.e., MBSR), and data collection (e.g., repeated ABPM). Although MBSR may reduce nocturnal systolic BP by 7 mmHg, this needs to be confirmed in a definitive RCT. Trial Registration:ClinicalTrials.gov Identifier: NCT06510907.
Background: While the transgenerational impact of famine on adult health is well-documented, its impact on blood pressure (BP) trajectories from childhood to adolescence remains poorly understood. We aimed to capture multi-generational BP trajectories and identify the primary drivers of adolescent BP elevation. Methods: Utilizing data from the China Health and Nutrition Survey, we analyzed BP trajectories in the F1 (n = 5,357) and F2 (n = 2,349) generations. The F1 generation was categorized into 2 groups: famine exposed and non-exposed groups, while the F2 generation was divided into 4 groups: no parental exposure, father-only-exposed, mother-only-exposed, and both-parents-exposed. Linear mixed-effects models and causal mediation analyses were conducted to ascertain BP trajectories and the mediation of parental body mass index (BMI). Results: In the F1 generation, BP of famine-exposed individuals surpassed that of controls after age 40. In the F2 generation, BP trajectory divergence occurred at approximately age 14. By age 18, all exposed groups had significantly higher BP than controls, independent ofparental hypertension (P < 0.01). Notably, the mother-only-exposed group exhibited the highest velocity of BP elevation; however, after excluding offspring with hypertensive parents, the father-only-exposed group exhibited the fastest velocity of BP increase. Mediation analysis revealed that over 85% of this effect was direct, with parental BMI accounting for only 14.51% and 10.08% of the effect for systolic and diastolic BP, respectively. Conclusions: Individuals with direct famine exposure possess higher rate of BP elevation. Furthermore, parental famine exposure programs an accelerated BP velocity in offspring that manifests during early adolescence. These findings suggest that the famine exposure creates a subclinical vascular risk that requires early monitoring, independent of adiposity and hypertension.
Background:Patients with repaired coarctation of the aorta (CoAo) remain at risk for left ventricular hypertrophy (LVH) even in the absence of hypertension. Alterations in wave reflection and the timing of reflected pressure waves may contribute to ventricular remodeling beyond pressure load alone. Methods:We performed a cross-sectional analysis of patients with repaired CoAo. Office and ambulatory blood pressure (ABPM), non-invasive central hemodynamics, and echocardiographic indices of left ventricular structure were assessed. Linear and multivariable regression models evaluated associations with posterior wall thickness in diastole (PWTd) and interventricular septal thickness in diastole. Computational simulations were conducted to examine the impact of heart rate on ventricular remodeling. Results:Fifty-seven patients (median post-repair follow-up 11 years) were included. LVH prevalence was 15.2% (95% confidence interval [CI], 4.8, 25.6). Although 42% met criteria for hypertension based on ABPM, no patients exhibited elevated central blood pressure and LVH. Heart rate-adjusted augmentation index (AIX@75) was inversely associated with PWTd and remained independently associated after multivariable adjustment (R2 = 0.40, P < 0.01). Replacing AIX@75 by heart rate improved model performance (R2 = 0.44), with lower heart rate independently associated with greater PWTd. Simulation modeling showed that a 10% increase in heart rate reduced mean PWTd and decreased posterior wall hypertrophy prevalence from 30.9% to 2.4% (odds ratio, 0.10; 95% CI, 0.01, 0.44). Conclusions:Ventricular remodeling occurs despite normal central blood pressure in CoAo. A lower heart rate associates with increased ventricular mass. Heart rate-mediated modulation of wave reflection timing represents a potential mechanistic and therapeutic target.
Renal denervation (RDN) has re-emerged as a therapeutic option for hypertension following contemporary sham-controlled randomized trials demonstrating modest but consistent blood pressure (BP) reductions. Despite these advances, substantial heterogeneity in treatment response persists, sustaining debate regarding the clinical value and appropriate role of RDN. Increasing evidence suggests that patient-related factors, rather than device technology alone, may critically determine therapeutic success. This narrative review synthesizes evidence from randomized clinical trials, meta-analyses, and key observational studies published between 2009 and 2024. Relevant literature was identified through searches of PubMed, Embase, and major cardiovascular society publications. We evaluated the influence of hypertension phenotype, baseline BP, medication adherence, sympathetic nervous system activity, renal artery anatomy, and comorbid conditions on BP response to RDN. Accumulating data indicate that response to RDN is highly variable and strongly influenced by patient-specific characteristics. Sustained hypertension confirmed by ambulatory BP monitoring, higher baseline BP, features suggestive of sympathetic overactivity, favorable renal artery anatomy, and challenges with long-term medication adherence are consistently associated with greater BP reduction. In contrast, pseudoresistance, white-coat hypertension, advanced arterial stiffness, and unfavorable anatomy are linked to attenuated or inconsistent responses. Reassessment of sham-controlled trials highlights that observed BP reductions, although modest, are clinically meaningful when appropriately contextualized. The efficacy of RDN is highly context-dependent and should not be viewed as universal or ineffective. By shifting from a device-centered paradigm to mechanism-based patient phenotyping, RDN may be more accurately positioned as a targeted, adjunctive therapy within personalized hypertension management. A structured framework for patient selection may help reconcile prior controversies, optimize clinical implementation, and inform the design of future trials.
Hypertension remains a leading contributor to global cardiovascular (CV) morbidity and mortality, yet blood pressure (BP) control rates remain suboptimal worldwide. Therapeutic inertia, delayed treatment intensification, dose-dependent adverse effects, and limited healthcare access continue to hinder effective management. Low-dose combination therapy has emerged as a strategy to enhance efficacy while improving tolerability by targeting complementary pathophysiological pathways at reduced drug doses. This review describes the evolution of low- and ultra-low-dose combination therapy from its pharmacologic rationale and early proof-of-concept studies to contemporary randomized and pragmatic trials. Meta-analytic and clinical evidence have demonstrated that combining antihypertensive agents at fractional doses produces additive BP reductions with fewer dose-related adverse effects. Subsequent trials evaluating quarter-dose and one-third-dose multidrug regimens confirmed substantial BP lowering with favorable safety profiles. Pragmatic studies further supported the feasibility of simplified, protocol-based single-pill strategies in real-world and resource-limited settings. More recent phase III trials have shown that single-pill low- and ultra-low-dose triple combinations achieve BP reductions comparable to or greater than those of standard-dose monotherapy, without compromising safety. Current evidences support low- and ultra-low-dose single-pill combination therapy as a practical and scalable first-line approach to improving global hypertension control. However, the current evidence base is dominated by trials evaluating short-term BP lowering rather than long-term CV outcomes. Although the magnitude and consistency of BP reduction provide a strong rationale for this strategy, evidence for reductions in CV events and mortality is warranted.
Background: Childhood hypertension is strongly associated with the development of cardiovascular diseases in adulthood. Understanding the epidemiological patterns of disease burden is crucial for developing effective prevention strategies. Methods: This cross-sectional study utilized data from the Global Burden of Disease Study (GBD) 2021, including 204 countries and territories. The analysis estimated deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributable to high systolic blood pressure (sBP) among individuals under the age of 20 within the GBD comparative risk assessment (CRA) framework, covering the period from 1990 to 2021. Trends and regional disparities in disease burden were examined, emphasizing correlations between DALY rates and socio-demographic indices (SDI). Results: In 2021, the global DALY rate was 2.39 (95% uncertainty interval [UI], 1.75 to 2.88) per 100,000 population, representing a 20.11% decrease (95% UI, -35.02 to 10.21) compared to 1990. The YLL rate showed a decrease of 21.06% (95% UI, -36.21 to 9.95), contributing to the decline in the DALY rate, whereas the YLD rate showed an increase of 22.33% (95% UI, 4.16 to 40.74). The DALY rates were negatively correlated with Socio-demographic Index. Among the 21 GBD regions in 2021, Middle East and North Africa (MENA) showed the highest disease burden across all metrics. Western Sub-Saharan Africa (SSA) demonstrated a pronounced gender disparity. High-income North America experienced the largest increase in disease burden. Conclusions: Global DALYs and deaths attributable to high sBP among children and adolescents suggested a declining trend from 1990 to 2021, although the 95% UIs were compatible with no clear change. DALYs showed a negative correlation with SDI, with highest burden in MENA and notable gender disparities in Western SSA. High-income North America showed the largest increase since 1990.
The recently released 2026 Korean Society of Hypertension (KSH) guidelines incorporate contemporary advances in the diagnosis and management of hypertension. This highlight summarizes the most important updates, focusing on the underlying evidence and key changes, particularly the newly introduced and revised recommendations. The major additions include the incorporation of isolated diastolic hypertension into blood pressure (BP) classification, the first integration of cuffless BP devices into clinical practice, and the incorporation of a new therapy with a BP-lowering effect (angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and aldosterone synthase inhibitors). A dose-based classification of single-pill combination therapies has been introduced to enhance treatment adherence. In addition, obesity, hypertension in young adults, hypertensive emergencies, and patient-centered care have been incorporated and emphasized. Major updates include expanded screening for primary aldosteronism, adoption of more intensive BP targets, and risk-based initiation of pharmacological therapy in individuals with prehypertension. Lifestyle recommendations have been broadened to include e-smoking cessation and mind-body practices. Furthermore, the definition and management of uncontrolled (or resistant) hypertension have been updated, and BP targets in older adults are now individualized according to frailty status and overall cardiovascular risk; intensive BP lowering to 130/80 mmHg is recommended in selected high-risk older individuals. Finally, BP management during pregnancy has also been refined to emphasize active BP control at < 140/90 mmHg and the use of out-of-office BP measurements for more accurate diagnosis. Overall, the new KSH guidelines provide a more evidence-based framework for hypertension management, with the goal of improving BP control and reducing cardiovascular morbidity and mortality.
Background:Although catheter-based renal denervation (RDN) has emerged as a potential treatment for resistant hypertension, it has limitations, including incomplete denervation and anatomical constraints. To address these challenges, we introduce the HyperQure™ RDN System, a novel extravascular RDN procedure targeting the renal artery adventitia, where renal sympathetic nerves are primarily distributed, for a more complete denervation. Methods:This pilot, single-arm, multicenter, first-in-human trial will evaluate the efficacy and safety of an extravascular RDN system in patients with hypertension. Ten patients aged 19-79 years with uncontrolled hypertension despite using three or more antihypertensive medications will undergo extravascular RDN. The procedure involves a retroperitoneal laparoscopic approach to achieve circumferential ablation of the sympathetic nerves surrounding the renal artery. A repeat procedure can be performed at different locations on the artery or by targeting branch vessels and accessory arteries. The primary efficacy outcome is the change in 24-hour ambulatory systolic blood pressure at 3 months post-procedure. Safety endpoints include the incidence of overall, major, acute/procedural, and chronic adverse events. Conclusions:Extravascular RDN has the potential to overcome the limitations of catheter-based techniques by enabling more complete sympathetic denervation that targets a broader range of renal sympathetic nerve fibers. This trial will generate critical first-in-human data to guide future clinical applications of extravascular RDN. Trial registration:Clinical Research Information Service Identifier: KCT0009209.
Background:Fundoscopy is of pivotal importance in patients with suspected hypertensive emergency in order to detect hypertensive retinopathy and determine the need for prompt intravenous antihypertensive treatment. However, direct fundoscopy by an ophthalmologist is time-consuming and delays treatment. In this pilot study in the emergency department (ED), we evaluated whether smartphone ophthalmoscopy is a feasible and faster alternative. Methods:We evaluated duration of ED-treatment in patients who underwent smartphone ophthalmoscopy for suspected hypertensive emergency. Smartphone ophthalmoscopy included 30-second retinal video recordings captured by the attending physicians, which were remotely evaluated by an ophthalmologist. Patients in the smartphone-group were matched in a 1:2-ratio to a historical cohort who underwent direct fundoscopy by an ophthalmologist. We evaluated total ED-length-of-stay (total ED-LOS; defined as the interval between ED-admission and ED-discharge) and 'treatment time' (defined as total ED-LOS minus time in waiting room). Results:In the present analysis, we included 54 patients in the smartphone-group and matched them with 108 historical controls. On average, total ED-LOS was 29 minutes shorter in the smartphone-group as compared to controls (217 ± 73 minutes vs. 246 ± 73 minutes; P = 0.016). Treatment time was 40 minutes shorter in the smartphone-group (193 ± 68 minutes vs. 233 ± 71 minutes; P = 0.002). Stratified analyses suggested that the reduction in treatment time was most pronounced outside office hours. Smartphone ophthalmoscopy was feasible in 87% of the patients, the other 13% (n = 10) required additional direct fundoscopy by an ophthalmologist. Conclusions:Smartphone ophthalmoscopy in suspected hypertensive emergency was feasible and faster as compared to direct fundoscopy by an ophthalmologist, which may allow earlier treatment and reduce ED-crowding.
Background: The role of social isolation in the connections between the hypertension care cascade, cognitive function, and cardiovascular disease (CVD) remains unclear. This study aims to investigate the relationships between the hypertension care cascade, cognitive performance, and CVD among middle-aged and older adults with varying levels of social isolation. Methods: Eight thousand two hundred eighty-seven participants aged 45 years and older from the China Health and Retirement Longitudinal Study were included in the analysis. Participants were categorized based on their social isolation status, either as socially isolated or not. Both multivariable linear regression and logistic regression models were employed. All analyses were weighted to account for the multistage, probability-proportional-to-size sampling design of the study. Hypertension was defined according to European, Chinese, and American guidelines. Results: The weighted rates of hypertension awareness, treatment, and control were 55.0%, 44.5%, and 25.4%, respectively, with a more favorable performance in the hypertension care cascade observed among individuals without social isolation. When applying American guidelines to define hypertension, the rates of awareness, treatment, and control significantly declined, irrespective of social isolation status. Compared to non-hypertensive individuals, participants with treated and controlled blood pressure (BP) exhibited similar cognitive function and odds of CVD. In contrast, individuals with treated but uncontrolled BP and those who were unaware of hypertension demonstrated poorer cognitive performance and a heightened risk of CVD. Social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD risk. Isolated individuals who are unaware of hypertension faced a more higher risk of worsen prognosis than that of the non-isolated individuals (P for interaction < 0.05). Conclusions: Individuals experiencing social isolation exhibited poor performance in the hypertension care cascade. Furthermore, social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD. Our study emphasizes that addressing social isolation could be a significant factor for improving the hypertension care cascade and health outcomes among middle-aged and older adults in China.
Background: Air pollution, particularly nitrogen dioxide (NO2), adversely affects cardiovascular health by inducing systemic inflammation. Evidence remains limited regarding short-term exposure to traffic-related air pollution, including NO2, and whether statin use modifies susceptibility to pollution-related acute cardiovascular events. This study evaluated whether the short-term effects of NO2 exposure and ischemic heart disease (IHD) hospitalization differ by statin-use status, focusing on patients with hypertension. Methods: A time-stratified case-crossover analysis was conducted using data from National Health Insurance Service for patients hospitalized with IHD in Seoul from 2018 to 2020. The included patients had a prior diagnosis of hypertension and had used antihypertensive medication within the previous 3 years. This group was further stratified as prescription-based statin users and non-users based on whether they had received a statin prescription within 1 year before their IHD admission. The daily average NO2 concentrations in Seoul were retrieved from Air Korea for the admission day and the preceding 7 days. Weighted conditional logistic regression models were applied separately for each subgroup after adjusting for meteorological conditions and national holidays. The risk of IHD hospitalization was presented as odds ratios (ORs) per 0.01 ppm increase in NO2, with 95% confidence intervals (CIs). Differences in risk between statin users and non-users were tested (Pfor interaction). Results: Of the 72,753 IHD cases analyzed, 24% were statin non-users and 76% were statin users. A 0.01 ppm increase in NO2 at lag0 was associated with higher odds of IHD-related hospitalization (OR, 1.012; 95% CI, 1.003-1.020), with similar results for lag0-lag5 and cumulative windows (lag01, lag02). A significant interaction between NO2 exposure and statin use was identified (P for interaction < 0.05). The associations differed by statin-use status, with generally lower, non-significant estimates among statin users. Among non-users, significant positive associations were observed at lag1, lag2, and lag01(ORs > 1). In contrast, estimates among statin users were lower and non-significant. Conclusions: Short-term NO2 exposure was associated with an increased risk of hospitalization for IHD among patients with hypertension. However, this association differed by statin-use status, with lower estimates observed among statin users than non-users.
Background:Whether higher volumes of physical activity (PA) and a greater proportion of vigorous-intensity physical activity (VPA) within total PA volume are associated with lower risks of major adverse cardiovascular events (MACE) and mortality remains unclear. This study aimed to examine the associations of total PA volume and the proportion of VPA within total PA volume with all-cause mortality and MACE among adults with hypertension. Methods:This nationwide cohort study included 124,370 adults with hypertension from the Korean National Health Insurance Service database (2009-2012), with follow-up through 2019. MACE was defined as a composite of cardiovascular disease (CVD) mortality, myocardial infarction (MI), and ischemic stroke. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality and MACE. Results:During a median follow-up of 9.1 years, 11,063 deaths occurred. Higher PA volumes were associated with stepwise reductions in all-cause and CVD mortality. In contrast, risk reductions for ischemic stroke plateaued at higher volumes, whereas reductions in MI risk were evident primarily at the highest volumes. Among 91,113 participants who engaged in any PA, a higher proportion of VPA was associated with lower risks of all-cause mortality (HR, 0.92; 95% confidence interval [CI], 0.87-0.98 for < 50% VPA and HR, 0.85; 95% CI, 0.78-0.93 for ≥ 50% VPA), MI (HR, 0.77; 95% CI, 0.67-0.89 and HR, 0.71; 95% CI, 0.58-0.86, respectively), and ischemic stroke (HR, 0.84; 95% CI, 0.76-0.92 for ≥ 50% VPA) after adjusting for total PA volume. No significant associations were observed between the proportion of VPA and CVD mortality. Conclusions:Among adults with hypertension, a higher PA volume was associated with lower risks of all-cause and CVD mortality. Additionally, a greater proportion of VPA, after accounting for total PA volume, was associated with lower risks of MI and ischemic stroke. These findings suggest that both PA volume and intensity composition may be relevant for cardiovascular risk reduction in individuals with hypertension.
Background:Postprandial hypotension (PPH), which is associated with adverse cardiovascular outcomes, is a prevalent but often overlooked in individuals with type 2 diabetes mellitus (T2DM). In addition, its relationship with comprehensive 24-hour hemodynamic profiles remains poorly defined. We aimed to assess the prevalence and characteristics of PPH in patients with T2DM and to determine its association with systolic blood pressure (SBP) variability and circadian blood pressure (BP) patterns. Methods:We prospectively enrolled T2DM patients with stable glycemic control. PPH was defined as a post-meal SBP fall of ≥ 20 mmHg or a drop to < 90 mmHg within 2 hours after a meal. Hemodynamic patterns, including SBP variability (standard deviation) and circadian rhythms, were analyzed via 24-hour ambulatory BP monitoring. Results:We analyzed 67 T2DM patients (59.2 ± 11.9 years, 33 females). PPH was observed in 28 patients (41.8%). PPH occurred most frequently after dinner (64.3%), and less frequently after breakfast (25.9%). While average 24-hour BP levels were similar between groups, the PPH group exhibited significantly higher 24-hour SBP variability (21.4 ± 5.7 vs. 16.2 ± 4.3, P < 0.001) and a higher prevalence of morning surge (53.6% vs. 25.6%, P = 0.024). Multivariate logistic regression revealed that 24-hour SBP variability was the sole independent predictor of PPH (odds ratio, 1.211; 95% confidence interval, 1.043-1.406; P = 0.012). Conclusions:In our cohort, PPH was found in 41.8% of patients with T2DM and was independently associated with increased SBP variability. These results suggest that BP variability could be a valuable marker for identifying individuals at higher risk for postprandial hemodynamic instability.
Background:This report utilizes the latest national data to describe the prevalence, management status, and treatment patterns of hypertension in South Korea, with a special analysis of the growing burden of hypertensive disorders of pregnancy (HDP). Methods:Two nationwide datasets were analyzed: the Korea National Health and Nutrition Examination Survey (KNHANES, 1998-2023) and the National Health Insurance (NHI) Big Data (2002-2023). In KNHANES, hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current use of antihypertensive medication. HDP prevalence was analyzed using NHI data for childbearing women aged 15-49 years from 2005 to 2023. Results:In 2023, an estimated 12.6 million Korean adults (29% of adults aged ≥ 20 years) had hypertension. Management indicators continued to improve, with awareness, treatment, and control rates reaching 79%, 76%, and 62%, respectively. However, among young adults aged 20-39 years, awareness and treatment rates remained below 50% despite recent substantial gains. Healthcare utilization also increased, with 11.9 million individuals receiving hypertension-related care and 8.3 million achieving continuous treatment adherence (≥ 290 days/year) in 2023. Dual therapy was the most common regimen (44%), followed by monotherapy (40%). Angiotensin receptor blockers (77%) and calcium channel blockers (62%) were the most frequently prescribed drug classes. The burden of HDP has risen markedly over time. The number of women with HDP increased from approximately 22.8 thousand in 2005 to over 30 thousand in 2023, representing a 32% increase despite a substantial decline in total births. In 2023, HDP affected 13.2% of maternity healthcare users, comprising chronic hypertension (7.2%), pregnancy-induced hypertension (4.7%), and preeclampsia/eclampsia (2.9%). Conclusions:South Korea continues to demonstrate high performance in hypertension management at the population level, with steady improvements in awareness, treatment, and control. Nevertheless, the rising absolute number of individuals with hypertension and the substantial, accelerating increase in HDP underscore the need for strengthened public health strategies. Targeted early detection and tailored management approaches are essential to improve cardiovascular, maternal, and fetal health outcomes.
