Korea hypertension fact sheet 2021: analysis of nationwide population-based data with special focus on hypertension in women

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

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

Clinical Hypertension ◽

10.1186/s40885-021-00166-2 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Hyeon Chang Kim ◽

◽

So Mi Jemma Cho ◽

Hokyou Lee ◽

Hyeok-Hee Lee ◽

...

Keyword(s):

National Health ◽

Antihypertensive Medication ◽

Angiotensin Receptor Blockers ◽

Dual Therapy ◽

Lipid Lowering ◽

Channel Blockers ◽

Korean Society ◽

Fact Sheet ◽

Korean Adults ◽

And Control

Abstract 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.

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Abstract 3783: Antihypertensive Medications in the Department of Veterans Affairs (VA) 1999–2006

Circulation ◽

10.1161/circ.116.suppl_16.ii_860-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Julio R Lopez ◽

Sonya Wong ◽

Joy L Meier ◽

Fran Cunningham ◽

David Siegel

Keyword(s):

Antihypertensive Medication ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Medication Use ◽

Angiotensin Converting Enzyme Inhibitors ◽

Steady Increase ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors

Objective: To evaluate national antihypertensive medication use we collected data from 2003–2006 and compared it to previously collected data from 1999 –2002. We examine the cost implications of shifts in antihypertensive medications prescribed. Methods: National VA pharmacy data were used to determine the use of beta blockers (BB), calcium channel blockers (CCB), thiazide diuretics (TD) alone or with K sparing diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and combinations of the aforementioned classes for 2003–2006. Total number of treatment days, determined from days supply of the prescription, was used to determine patterns of use over time. Results: Antihypertensive medication use in the VA represented more than 1.5 billion days in 2006 and increased 2.5 fold from the 577 million estimated for 1999. ACEI were most commonly used, representing 31.8% and 31.7% of treatment days in 1999 and 2006, respectively. In the ACEI class lisinopril is the most commonly used drug. Increases in use from 1999 to 2006 were 21.2% to 25.2% for BB, 14.4% to 17.8% for TD, and 1.2% to 5.2% for ARB. Decreases in use from 1999 to 2006 were 26.7% to 17.6% for CCB. The decline in CCB was inversely correlated to the increase in BB or TD (p<0.001). Shifts in medication use are estimated to save the VA $33 million annually. Conclusions: ACEI remain the most prescribed antihypertensive drug class in the VA, followed by BB, TD, CCB, and ARBs. TD use shows a slow steady increase while CCB use continues to decline. These findings suggest that VA has increasing adherence to JNC7 and VA HTN guidelines.

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Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10040771 ◽

2021 ◽

Vol 10 (4) ◽

pp. 771

Author(s):

In-Jeong Cho ◽

Jeong-Hun Shin ◽

Mi-Hyang Jung ◽

Chae Young Kang ◽

Jinseub Hwang ◽

...

Keyword(s):

Antihypertensive Drugs ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors ◽

Incident Cancer ◽

Increased Risk ◽

Risk Of Cancer

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696–0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775–0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs.

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Abstract P258: The Use Of Ace Inhibitors And Angiotensin Receptor Blockers Is Associated With Decreased Mortality And Increased Hospitalization Rate In Covid-19 Patients

Hypertension ◽

10.1161/hyp.78.suppl_1.p258 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Aaron Douen ◽

Jeremy Oh ◽

Wesley Romney ◽

Ryan Panetti ◽

Prakash Ramdass ◽

...

Keyword(s):

Logistic Regression ◽

Angiotensin Receptor Blockers ◽

Hospitalization Rate ◽

Host Cells ◽

Channel Blockers ◽

Multivariate Logistic Regression ◽

Converting Enzyme Inhibitors ◽

All Cause Mortality ◽

Receptor Blockers ◽

Secondary Outcomes

Introduction: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well known for upregulating ACE2 receptors. SARS-Cov-2 (COVID-19) infection utilizes the ACE2 receptor for proliferation and infection of host cells. Hypothesis: We hypothesize that the use of ACEI/ARBs will lead to a higher mortality and hospitalization rate among COVID-19 infected patients. Methods: The electronic health database at a public hospital in New York City was queried retrospectively for patients 18 years and older with a positive test for COVID-19 between 3/1/2020 - 4/1/2021. We examined baseline characteristics including comorbidities and whether they were prescribed ACEI/ARBs versus other medications including beta-blockers, calcium channel blockers, thiazides, or hydralazine. We categorized patients based on ACEI/ARB. The primary outcomes were all-cause mortality and hospitalization. The secondary outcomes were acute kidney injury, ventricular arrhythmia, myocardial infarction, heart failure, and intubation. We adjusted for comorbidities using multivariate logistic regression. Results: We identified 23,068 patients positive for SARS-CoV-2; 1,385 on ACEI/ARBs and 21,683 not on ACE/ARBs. The mean age in years was 65.90 +- 14.35 (SEM 0.386) and 44.01+-16.76, (SEM 0.114) for ACEI/ARB and non-ACEI/ARB respectively (p<0.001). The incidence of all cause mortality and hospitalization rate were significantly greater in the ACEI/ARB group. However, when adjusted for comorbidities using multivariate logistic regression, OR for mortality was 0.41 (CI 0.32-0.52, p<0.001) and for hospitalization was 4.12 (CI 3.49-4.86 p<0.001). For the secondary outcomes, non-ACEI/ARB patients had significantly increased unadjusted odds of all outcomes (p<0.001), except for ventricular tachycardia (p<0.618) and intubation (p< 0.214). Conclusion: Patients in the ACEI/ARB group demonstrated significantly lower mortality and increased hospitalization rates. Increased hospitalization may be due to more comorbidities. These results highlight the importance of continuing the use of ACEI and ARBs in COVID-19 patients for treatment of comorbidities and cardioprotective effects.

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Antihypertensive Drugs and Diabetic Retinopathy in Patients with Type 2 Diabetes

Ophthalmologica ◽

10.1159/000441958 ◽

2015 ◽

Vol 235 (2) ◽

pp. 87-96

Author(s):

Jen-Chieh Lin ◽

Mei-Shu Lai

Keyword(s):

Diabetic Retinopathy ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Incidence Rates ◽

Diabetic Patients ◽

Channel Blockers ◽

Type 2 Diabetic Patients ◽

Converting Enzyme Inhibitors ◽

Type 2 Diabetic

Objective: To evaluate the association between the development of sight-threatening diabetic retinopathy (STDR) and antihypertensive drugs (AHDs) use among type 2 diabetic patients with concomitant hypertension. Methods: Type 2 diabetic patients aged 20-100 years who had at least one prescription for AHDs between 2000 and 2011 were identified from the Longitudinal Health Insurance Database (LHID) 2005. The incidence rates of STDR were followed and Cox proportional hazard models were used to analyze the risk associated with AHDs. Results: Users of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were associated with a significantly higher risk than users of calcium channel blockers (CCBs), independent of baseline characteristics. After adjusting for time-varying use of concomitant medications for propensity score-matched or -unmatched cohorts, the results showed that patients receiving ACEIs/ARBs and CCBs were associated with a significantly greater risk compared with β-blocker users. Conclusions: Our study did not support a superiority of ACEIs/ARBs and CCBs over β-blockers for lowering the progression of diabetic retinopathy.

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Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽

10.1515/med-2018-0048 ◽

2018 ◽

Vol 13 (1) ◽

pp. 304-323 ◽

Cited By ~ 3

Author(s):

Hernando Vargas-Uricoechea ◽

Manuel Felipe Cáceres-Acosta

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Angiotensin Receptor Blockers ◽

Pharmacological Therapy ◽

Current Evidence ◽

Diabetic Patients ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Patients With Diabetes ◽

The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

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Lack of association between angiotensin blockade and severity of influenza: a nationwide case-control study

10.21203/rs.3.rs-227875/v1 ◽

2021 ◽

Author(s):

Yaa-Hui Dong ◽

Jo-Hsuan Wu ◽

Jiun-Ling Wang ◽

Ho-Min Chen ◽

James L. Caffrey ◽

...

Keyword(s):

Influenza A ◽

Case Control Study ◽

Viral Infections ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Case Control ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Severe Influenza ◽

Control Study

Abstract Purpose Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may modulate ACE2 level and the risk of viral infections. However, studies of the risk of the severity of influenza associated with ACEIs or ARBs in the real-world settings were limited and the findings are conflicting. Methods This case-control study evaluated the risk of developing severe influenza disease associated with ACEIs and ARBs in hypertension patients hospitalized for influenza from a population-based Taiwanese database. Logistic regression models were conducted to estimate ORs and 95% CIs associated with ACEIs or ARBs within 30 days before hospitalization. Results We included 1,369 cases (severe influenza patients) and 4,107 matched controls (non-severe influenza patients). ORs for any use of ACEIs and ARBs were 1.15 (95% CI, 0.93–1.42) and 0.97 (0.84–1.12) versus nonuse. Similarly, no significant association was observed for monotherapy with ACEIs (1.47; 0.95–2.29) or ARBs (0·76; 0.53–1.10) versus nonuse. Combination therapy between calcium channel blockers (CCBs) and either ACEIs (1.57; 0.91–2.70) or ARBs (1.23; 0·93-1.62) were not significantly different from CCBs alone. Conclusions Our findings did not suggest an association between ACEIs and/or ARBs and the severity of influenza. Stable patients should maintain their anti-hypertensive regimens in the influenza epidemic era.

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Pharmacology of vasodilators

ESC CardioMed ◽

10.1093/med/9780198784906.003.0034 ◽

2018 ◽

pp. 180-184

Author(s):

Stéphane Laurent

Keyword(s):

Enzyme Inhibitors ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Organic Nitrates ◽

Channel Blockers ◽

Resistance Arteries ◽

Converting Enzyme Inhibitors ◽

Receptor Blockers ◽

Small Resistance ◽

Direct Acting

Antihypertensive and antianginal agents are differentially able to vasodilate small resistance arteries, large conducting arteries, and epicardial coronary arteries. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and alpha-adrenergic antagonists are not addressed here, since they are discussed in specific chapters. This chapter discusses the pharmacology of calcium channel blockers, nitrovasodilators, and direct-acting vasodilators. Dihydropyridines, such as nifedipine and amlodipine, are compared to the non-dihydropyridine agents verapamil and diltiazem. Organic nitrates, such as nitroglycerine and isosorbide dinitrate, are compared to inorganic nitrates, such as sodium nitroprusside. Molsidomine and nicorandil are also discussed. Finally, the pharmacology of direct-acting vasodilators focuses on minoxidil and hydralazine. Pharmacology of mechanisms of action is detailed to better understand therapeutic indications and side effects.

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PRESCRIPTION PATTERN OF CARDIOVASCULAR AND/OR ANTIDIABETIC DRUGS IN ABUJA DISTRICT HOSPITALS

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2019v11i9.34525 ◽

2019 ◽

pp. 21-27

Author(s):

NKEIRUKA GRACE OSUAFOR ◽

CHINWE VERONICA UKWE ◽

MATTEW JEGBEFUME OKONTA

Keyword(s):

Enzyme Inhibitors ◽

Angiotensin Receptor Blockers ◽

Age Groups ◽

Angiotensin Converting Enzyme Inhibitors ◽

World Health ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Prescribing Indicators ◽

Prescription Pattern ◽

District Hospitals

Objective: The study aimed to describe the prescription pattern of cardiovascular and/or anti-diabetic drugs and adherence to the World Health Organization (WHO) prescribing indicators in Abuja District Hospitals. Methods: This descriptive retrospective study was carried out in Asokoro and Maitama District Hospitals Abuja. One thousand and nine prescriptions that contained a cardiovascular drug (CVD) and/or anti-diabetic drug issued between June 2017 and May 2018 from the Medical Outpatient Department were analyzed. Data were collected from the pharmacy electronic database, prescription pattern and adherence to WHO prescribing indicators were assessed. The analysis was done using descriptive statistics. Results were presented as percentages, means, and standard deviations. Results: The frequency of treatment was higher among women (58.8%) and the age group of 41–60 (54.8%). The average number of drugs prescribed was 3.3±1.6: the percentage of drugs prescribed in generic was (64%) and (78.8%) were from the Essential Drug List (EDL). Calcium Channel Blockers (CCB, 71.7%) and Biguanides (B, 92.4%) were the most prescribed CVD and anti-diabetic drug. The majority of the CVD (74.5%) and diabetes (63.6%) patients were on combination therapy. The most frequent CVD combination was CCB plus Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (29.7%). Compared to men, the proportion of females taking one or more CVD (61.3%) or antidiabetic (56.4%) was higher. Conclusion: The prescribing indicators are not optimal in Abuja district hospitals. Women received more treatment for cardiovascular and diabetes diseases than men while the age range of 41-60 was more treated than other age groups.

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Evaluation of Prescription Adaptation Following Changes to A Provincial Drug Insurance Formulary

Pharmacy ◽

10.3390/pharmacy7010006 ◽

2019 ◽

Vol 7 (1) ◽

pp. 6

Author(s):

Robert T. Pammett

Keyword(s):

Nurse Practitioners ◽

Clinical Pharmacist ◽

Angiotensin Receptor Blockers ◽

Community Pharmacists ◽

Patient Specific ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Reference Drug ◽

Drug Insurance ◽

Insurance Program

On 1 December 2016, British Columbia’s (BC) provincial drug insurance program changed which medications in certain classes would benefit under the insurance program in an attempt to reduce expenditure. As part of the modernization, HMG-CoA reductase inhibitors (Statins), Angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (CCB) were affected. Prescribers and pharmacists had six months to discuss the changes with patients, and change medications if deemed necessary. Purpose: To quantify the changes made to prescriptions and to adjust to the Modernized Reference Drug Program. Methods: A retrospective chart review was conducted at two clinics in Prince George, BC. Charts for patients that were prescribed any drugs in the affected classes were reviewed to determine if, and when, they had been changed, and by which health care professional. In December 2016, a clinical pharmacist, integrated within the study clinics, informed prescribers of the changes, and made patient-specific clinical notes within the charts. The notes described the changes and recommended alternative agents and appropriate dosing in order to assist the prescriber to have a conversation with the patient regarding the switch. Results: Out of 429 unique patients, 233 patients were prescribed a Statin, 229 patients an ACEI, 110 an ARB and, 83 a CCB. Sixty-five drug changes were indicated to reflect the modernization, and with guidance from a clinical pharmacist, nurse practitioners (NPs), and family physicians (FPs), 65% of these identified drugs were switched to reflect the modernization. Community pharmacists made no drug changes in the study sample, despite the prescriptive authority and compensation available to do so. Province-wide, approximately 21% to 33% of affected drugs were switched during the same time-frame. Direct collaboration between a clinical pharmacist, working alongside NPs and FPs, was more successful in optimizing these medications when compared to standard practice, or community pharmacists alone.

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