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CPP : Cardiovascular Prevention and Pharmacotherapy

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Review Articles
Diverse perspectives on remote collaborative care for chronic disease management
Seo Yeon Baik, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim
Cardiovasc Prev Pharmacother. 2024;6(1):26-32.   Published online January 25, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e5
  • 950 View
  • 18 Download
Abstract PDF
Remote collaborative care is a program that improves medical services by linking local and remote physicians with residents in areas where access to medical facilities is limited, utilizing information and communication technology. As a result, patients can obtain medical advice and counseling at local hospitals without needing to travel to distant facilities. This care model involves communication between doctors, facilitating the accurate transfer of medical information and reducing the risk of misunderstandings. For instance, managing conditions such as blood pressure or blood glucose is more straightforward because a local hospital can assess the patient's status while a remote hospital simultaneously provides high-quality, specialized medical services. With the rise in poorly controlled hypertension or diabetes, the need for remote collaborative care has also increased. This care model enables local hospitals to maintain continuous patient care with the support of remote facilities. This is particularly true following acute cardiovascular treatment, where local hospitals, assisted by remote institutions, can safely offer high-quality services such as rehabilitation and follow-up care. Although remote hospitals have many advantages with the increasing number of patients, many difficulties remain in commercializing unsystematized remote collaborative care. Specifically, low reimbursements for medical services must be addressed, proper equipment is needed, more time and effort must be invested, and the liability issue must also be dealt with. Nevertheless, remote collaborative care using information and communication technology will be necessary in the future. Medical staff need to objectively examine the advantages and disadvantages of remote collaborative care from various perspectives and find ways to revitalize it.
Recent evidence on target blood pressure in patients with hypertension
Hack-Lyoung Kim
Cardiovasc Prev Pharmacother. 2024;6(1):17-25.   Published online January 22, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e3
  • 1,280 View
  • 55 Download
Abstract PDF
Hypertension is a significant risk factor for a variety of cardiovascular diseases, including stroke, coronary artery disease, heart failure, and peripheral arterial disease. Achieving and maintaining a specific target blood pressure (BP) is crucial for effectively reducing the risk associated with these conditions. This involves customizing treatments to meet the individual needs of patients with hypertension, ensuring that each person receives the most appropriate care for their particular circumstances. Previously, based on the findings from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study conducted over the past decade, the target BP for patients with hypertension was set at <140/90 mmHg, regardless of the patient's risk profile. However, new insights from reanalyzed data of studies such as the SPRINT (Systolic Blood Pressure Intervention Trial), the STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) study, and ACCORD subgroup reanalysis have led to a change in this approach. These studies support a more aggressive target BP of <130/80 mmHg, especially for high-risk patients. The purpose of this article is to offer a thorough review of these updated recommendations and to explain the reasoning behind the revised target BP guidelines for individuals with hypertension.
Original Article
Current status of remote collaborative care for hypertension in medically underserved areas
Seo Yeon Baik, Kyoung Min Kim, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim
Cardiovasc Prev Pharmacother. 2024;6(1):33-39.   Published online January 22, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e2
  • 1,069 View
  • 17 Download
Abstract PDF
Background
Remote collaborative care (ReCC) is a legally recognized form of telehealth that facilitates communication between physicians. This study aimed to analyze the effectiveness of ReCC services and establish a foundation for the usefulness and effectiveness of ReCC.
Methods
This retrospective cohort study utilized data from the Digital Healthcare Information System (DHIS) managed by the Korea Social Security Information Service. We extracted data on patients who were registered from January 2017 through September 2023 to investigate the effects of various factors.
Results
A total of 10,407 individuals participated in the remote collaborative consultation service provided by the DHIS. Of these participants, those aged ≥80 years represented 39.2% (4,085 patients), while those aged 70 to 79 years comprised 36.9% (3,838 patients). The conditions treated included hypertension, affecting 69.2% (7,203 patients), and diabetes, affecting 21.1% (2,201 patients). Although various measurement items were recorded, most data beyond blood pressure readings were missing, posing a challenge for analysis. Notably, there was a significant reduction in blood pressure that was sustained at follow-up intervals of 1, 3, 6, and 12 months post-baseline (all P<0.05).
Conclusions
Owing to the lack of data, follow-up assessments for conditions other than hypertension proved to be challenging. Medical staff should increase their focus on and engagement with the system. Remote consultations have demonstrated efficacy in managing hypertension in medically underserved areas, where access to healthcare services is often limited. This suggests the potential for expanded use of remote chronic care in the future.
Review Articles
Calcium channel blockers for hypertension: old, but still useful
Eun Mi Lee
Cardiovasc Prev Pharmacother. 2023;5(4):113-125.   Published online October 30, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e16
  • 6,742 View
  • 463 Download
  • 2 Citations
Abstract PDF
Calcium channel blockers (CCBs) constitute a heterogeneous class of drugs that can be divided into dihydropyridines (DHPs) and non-DHPs. DHP-CCBs are subcategorized into four generations based on the duration of activity and pharmacokinetics, while non-DHP-CCBs are subcategorized into phenylethylamine and benzodiazepine derivatives. DHP-CCBs are vascular-selective and function as potent vasodilators, whereas non-DHP-CCBs are cardiac-selective and are useful for treating tachyarrhythmia, but reduce cardiac contractility and heart rate. Traditional DHP-CCBs (nifedipine) mainly block L-type calcium channels, whereas novel CCBs block N-type (amlodipine) and/or T-type channels (efonidipine) in addition to L-type channels, leading to organ-protective effects. DHP-CCBs have a potent blood pressure–lowering effect and suppress atherosclerosis and coronary vasospasm. Diltiazem, a non-DHP-CCB, is highly effective for vasospasm control. CCBs reduce left ventricular hypertrophy and arterial stiffness. Amlodipine, a DHP-CCB, reduces blood pressure variability. L/N- and L/T-type CCBs combined with renin-angiotensin system blockers reduce proteinuria and improve kidney function compared with L-type CCBs. According to large-scale trials, DHP-CCBs reduce cardiovascular events in patients with isolated systolic hypertension, as well as in elderly and high-risk patients. Accordingly, CCBs are indicated for hypertension in elderly patients, isolated systolic hypertension, angina pectoris, and coronary vasospasm. Non-DHP-CCBs are contraindicated in high-grade heart block, bradycardia (<60 beats per minute [bpm]), and heart failure with reduced ejection fraction (HFrEF). DHP-CCBs should be used with caution in patients with tachyarrhythmia, HFrEF, and severe leg edema, and non-DHP-CCBs should be used carefully in those with constipation. Each CCB has distinct pharmacokinetics and side effects, underscoring the need for meticulous consideration in clinical practice.

Citations

Citations to this article as recorded by  
  • Design of Experimental Approach for Development of Rapid High Performance Liquid Chromatographic Process for Simultaneous Estimation of Metoprolol, Telmisartan, and Amlodipine from Formulation: Greenness and Whiteness Evaluation
    Mahesh Attimarad, Mohammed Jassim Alali, Hussain Ali Alali, Dana Hisham Alabdulmuhsin, Aljohara Khalid Alnajdi, Katharigatta Narayanaswamy Venugopala, Anroop B. Nair
    Molecules.2024; 29(5): 1087.     CrossRef
  • The Evolving Role of Calcium Channel Blockers in Hypertension Management: Pharmacological and Clinical Considerations
    Kamryn E. Jones, Shaun L. Hayden, Hannah R. Meyer, Jillian L. Sandoz, William H. Arata, Kylie Dufrene, Corrado Ballaera, Yair Lopez Torres, Patricia Griffin, Adam M. Kaye, Sahar Shekoohi, Alan D. Kaye
    Current Issues in Molecular Biology.2024; 46(7): 6315.     CrossRef
Optimal target blood pressure in older patients with hypertension
Kwang-il Kim
Cardiovasc Prev Pharmacother. 2023;5(2):41-48.   Published online April 24, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e4
  • 3,959 View
  • 213 Download
Abstract PDF
Hypertension is a common condition among older adults, and blood pressure (BP) control is effective for preventing cardiovascular morbidity and mortality even among the oldest-old adults. However, the optimal target BP for older patients with hypertension has been a subject of debate, with previous clinical trials providing conflicting evidence. Determining the optimal target BP for older adults is a complex issue that requires considering comorbidities, frailty, quality of life, and goals of care. As such, BP targets should be individualized based on each patient's unique health status and risk factors, and treatment should be closely monitored to ensure that it is effective and well-tolerated. The benefits and risks of intensive BP control should be carefully weighed in the context of the patient's overall health status and treatment goals. Ultimately, the decision to pursue intensive BP control should be made through shared decision-making between patients and their healthcare providers.
Blood pressure control in hypertensive disorders of pregnancy
Helsi Rismiati, Hae-Young Lee
Cardiovasc Prev Pharmacother. 2022;4(3):99-105.   Published online July 29, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e16
  • 3,959 View
  • 160 Download
  • 1 Citations
Abstract PDF
Hypertension is a major cause of maternal morbidity and occurs as a complication in up to one in ten pregnancies. Hypertensive disorders of pregnancy encompass gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. However, the management of hypertensive disorders of pregnancy remains a matter of debate, particularly the blood pressure thresholds and targets for managing hypertension in pregnancy. Previously, there was no clear evidence of the effectiveness of aggressive blood pressure control in pregnancy due to the risk of fetal growth restriction. Recent clinical trials have shown that aggressive control of blood pressure in pregnant women is safe for both the mother and fetus. The purpose of this paper is to present a clinically oriented guide to the drugs of choice in patients with hypertension during pregnancy, present contrasts among different guidelines and recent clinical trials, and discuss the blood pressure thresholds and targets for hypertension during pregnancy based on recent studies.

Citations

Citations to this article as recorded by  
  • Combined Effects of Methyldopa and Baicalein or Scutellaria baicalensis Roots Extract on Blood Pressure, Heart Rate, and Expression of Inflammatory and Vascular Disease-Related Factors in Spontaneously Hypertensive Pregnant Rats
    Michał Szulc, Radosław Kujawski, Przemysław Ł. Mikołajczak, Anna Bogacz, Marlena Wolek, Aleksandra Górska, Kamila Czora-Poczwardowska, Marcin Ożarowski, Agnieszka Gryszczyńska, Justyna Baraniak, Małgorzata Kania-Dobrowolska, Artur Adamczak, Ewa Iwańczyk-S
    Pharmaceuticals.2022; 15(11): 1342.     CrossRef
Original Article
Association between reproductive aging and hypertension among Korean women
Eunji Kim, Youngrong Lee, Hyeon Chang Kim
Cardiovasc Prev Pharmacother. 2022;4(1):34-41.   Published online January 19, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e2
  • 2,443 View
  • 54 Download
Abstract PDFSupplementary Material
Background
Although postmenopausal women are well known to have a high prevalence of hypertension, it is unclear whether menopause itself increases blood pressure independently from the known risk factors of hypertension. This study sought to determine whether an association exists between reproductive aging, analyzed as a gradual transition, and an increased risk of hypertension among Korean women.
Methods
This cross-sectional study used baseline data from 5,456 women aged 30 to 64 years who participated in the Cardiovascular and Metabolic Diseases Etiology Research Center study in Korea from 2013 to 2018. The participants’ stage of reproductive aging was assessed by a questionnaire and categorized as premenopause, perimenopause, and postmenopause. Multiple logistic regression models were used to analyze the association between menopausal status and hypertension after adjusting for age, education level, marital status, employment, household income, smoking, drinking, physical activity, body mass index, and hormone replacement therapy use.
Results
The prevalence of hypertension increased with reproductive aging: 9.8% in premenopause, 25.2% in perimenopause, and 27.7% in postmenopause. The adjusted odds ratio (95% confidence interval) for having hypertension was 1.70 (1.07–2.72) for perimenopausal women and 1.14 (0.88–1.48) for postmenopausal women, compared to premenopausal women.
Conclusions
Our study shows that perimenopausal women are at high risk of developing hypertension. Since the menopausal transition may last months or years, blood pressure monitoring and early interventions are crucial for not only postmenopausal women, but also those in the transition.
Review Article
Perioperative Management of Hypertensive Patients
Helsi Rismiati, Hae-Young Lee
Cardiovasc Prev Pharmacother. 2021;3(3):54-63.   Published online July 31, 2021
DOI: https://doi.org/10.36011/cpp.2021.3.e7
  • 14,585 View
  • 847 Download
Abstract PDF
Due to the high prevalence of hypertension, hypertensive patients undergo perioperative evaluation and management. Severe hypertension may increase the operative risk. However, hypertension with a diastolic blood pressure of less than 110 mmHg usually does not appear to increase the risk. In general, it is recommended that oral antihypertensive drugs be continued before and after surgery. In particular, sympathetic blockers, such as beta-blockers, should be maintained. It is generally recommended to continue intake of calcium channel blockers, especially for surgeries with a low bleeding risk. However, in the case of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, it is recommended that they be stopped 24 hours before surgery because they can inhibit excessive compensatory renin-angiotensin activation during surgery. Statin and aspirin medications are often prescribed for patients with hypertension. It is recommended to continue intake of statins in the perioperative period. Aspirins are recommended for low-risk patients undergoing noncardiac surgery.
Special Articles
Shifting from Pharmacotherapy to Prevention of Hypertension
Bernard Man Yung Cheung, Man-Fung Tsoi
Cardiovasc Prev Pharmacother. 2020;2(2):33-42.   Published online April 30, 2021
DOI: https://doi.org/10.36011/cpp.2020.2.e8
  • 4,510 View
  • 22 Download
  • 1 Citations
Abstract PDF
Hypertension is a common chronic disease affecting a large section of the general population. As hypertension is usually asymptomatic, awareness, treatment and control rates are low. Drug side-effects also affect compliance. Hypotension and electrolyte abnormalities in the elderly can be severe. Therefore, prevention is better than cure. As blood pressure rises with age, prevention should be started early. As there are many genes affecting blood pressure, genetic tests are not useful. Good antenatal care and care of preterm infants can help to prevent adult cardiovascular diseases including hypertension. Childhood obesity is an important determinant of blood pressure in childhood and adolescence. This is a window of opportunity for prevention. The current American College of Cardiology/American Heart Association guideline on hypertension defines stage 1 hypertension as a systolic blood pressure of 130–139 mmHg or a diastolic blood pressure of 80–89 mmHg. Although this makes many people in the general population hypertensive, stage 1 hypertension in young adults is already associated with increased cardiovascular and mortality risk. Fortunately, hypertension at this early stage is easy to control and weight loss is easier in young males, who can get exercise from work or exercise after work. Leisure-time physical activity seems more beneficial than occupational physical activity. Cardiovascular risk assessment and promoting a healthy lifestyle in the young are likely to forestall hypertension and future cardiovascular disease. Preventing or reversing hypertension is no longer an impossible dream.

Citations

Citations to this article as recorded by  
  • The Association Between Dietary Inflammatory Index (DII) and Risk of Hypertension: A Case–Control Study
    Niloofar Shoaei, Nafiseh Shokri-Mashhadi, Awat feizi, Reza Ghiasvand
    High Blood Pressure & Cardiovascular Prevention.2022; 29(6): 611.     CrossRef
Barriers in Salt Reduction Strategies: Time to Acting for the Future
Yong-Jae Kim
Cardiovasc Prev Pharmacother. 2020;2(4):134-141.   Published online October 31, 2020
DOI: https://doi.org/10.36011/cpp.2020.2.e16
  • 2,622 View
  • 39 Download
Abstract PDF
Salt reduction is important for reducing hypertension and the risk of cardiovascular events and stroke. Despite knowledge about the ill consequences, many people continue to consume high levels of salt in their diet. This paper introduces salt-reducing programs for individual, population, and country-level strategies to reduce salt intake. To effectively decrease salt intake, it is necessary to reduce the consumption of high-salt foods and replace high-salt seasonings with low-salt alternatives. Thus, healthcare professionals must effectively provide information on salt-reduction for patients with hypertension. Social strategies, such as voluntary sodium reduction targets for the food industry, are necessary to promote population strategies for salt reduction. In this paper, we examine a brief report on new salt intake values based on chronic disease risk reduction and explain the utilization of mobile health technologies to reduce salt consumption. Considering the relationship between dietary salt intake and the risk of chronic disease, ways to remove the barriers to strategies for salt reduction should be considered, as it is the most effective way for the prevention and control of hypertension and cardiovascular disease in the future.

CPP : Cardiovascular Prevention and Pharmacotherapy