The prevalence of both hypertension and diabetes mellitus is increasing worldwide. Both diseases lead to severe complications such as cardiovascular and chronic kidney diseases, which increase the ...risk of death over a long period of time. Therefore, the prevention and aggravation of hypertension and diabetes mellitus are major challenges. Because few review articles have focused on the epidemiological perspective of hypertension and diabetes mellitus, we reviewed major observational studies mainly from Japan and from Western countries that have reported on the prevalence of hypertension and diabetes mellitus, the binominal risk of hypertension and diabetes mellitus, and the risk of their coexistence. Our investigation found that approximately 50% of diabetic patients had hypertension, and approximately 20% of hypertensive patients had diabetes mellitus. Those with either hypertension or diabetes mellitus had a 1.5- to 2.0-fold higher risk of having both conditions. These results were similar for both Japan and Western countries. Although comparing the results between Japan and Western countries was difficult because the risks were estimated using widely varying statistical analyses, it was revealed that the coexistence of hypertension and diabetes mellitus certainly increased the risk of complications regardless of the country. The definition, prevalence and medical treatment of hypertension and diabetes mellitus will change in the future. For early intervention based on the latest evidence to prevent severe complications, it is important to accumulate epidemiological knowledge of hypertension and diabetes mellitus and to update the evidence for both Japan and other countries.
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected more than seven million people worldwide, contributing to 0.4 million deaths ...as of June 2020. The fact that the virus uses angiotensin-converting enzyme (ACE)-2 as the cell entry receptor and that hypertension as well as cardiovascular disorders frequently coexist with COVID-19 have generated considerable discussion on the management of patients with hypertension. In addition, the COVID-19 pandemic necessitates the development of and adaptation to a "New Normal" lifestyle, which will have a profound impact not only on communicable diseases but also on noncommunicable diseases, including hypertension. Summarizing what is known and what requires further investigation in this field may help to address the challenges we face. In the present review, we critically evaluate the existing evidence for the epidemiological association between COVID-19 and hypertension. We also summarize the current knowledge regarding the pathophysiology of SARS-CoV-2 infection with an emphasis on ACE2, the cardiovascular system, and the kidney. Finally, we review evidence on the use of antihypertensive medication, namely, ACE inhibitors and angiotensin receptor blockers, in patients with COVID-19.
Epidemiology of Hypertension in Japan Miura, Katsuyuki; Nagai, Masato; Ohkubo, Takayoshi
Circulation Journal,
2013, Volume:
77, Issue:
9
Journal Article
Peer reviewed
Open access
Analyses of data from national surveys of the Japanese population have shown a clear decreasing tendency in mean systolic blood pressure (BP) level over the past 50 years in all age groups of men and ...women; however, mean diastolic BP level clearly did not decrease in men. Hypertension prevalence is high among older people and may increase in the future, especially in men aged ≥50 years. The treatment and control rates of hypertension are not sufficiently high, although they have been continuously improving. Recent epidemiological studies also showed that the burden of cardiovascular diseases and total mortality because of the adverse BP level of the nation is still the highest among other preventable risk factors. To overcome this epidemic, the first priority should be primary prevention of a lifetime increase in BP through lifestyle improvement. Lowering the distribution of BP in the whole population and maintaining BP at optimal levels contributes to the achievement of this goal. (Circ J 2013; 77: 2226–2231)
The Ohasama Study is a long-term prospective cohort study of the general population in the town of Ohasama (currently, Hanamaki city) in Iwate Prefecture, Japan, that was started in 1986. Ohasama is ...a typical farming village in the Tohoku region that consists of part-time farming households that cultivate mainly fruit trees. At the start of the study, the prevention of hypertension, a main cause of strokes, was taken to be an important issue in public health activities because of the many people who died or needed care as a result of strokes in Ohasama. A home blood pressure measurement program was then begun with the aim of preventing hypertension while increasing a sense of solidarity among community residents and the awareness that “one must protect one’s own health.” As a result, this project became the world’s first community-based epidemiological study using home blood pressure, as well as 24-hour ambulatory blood pressure, for which measurements were also initiated. In the 1990s, the Ohasama Study reported a linear “the lower, the better” relationship between out-of-office blood pressure and cardiovascular risk. To date, we have accumulated advanced evidence regarding the clinical significance of out-of-office blood pressure. Those have contributed to hypertension management guidelines around the world. This article summarizes the results of representative long-term follow-up studies of the Ohasama Study.
Data regarding ambulatory blood pressure (ABP) or self-BP measurements at home (HBP) have been accumulated. The difference between ABP and HBP is that ABP monitoring (ABPM) provides BP information at ...many time points on a particular day during unrestricted routine daily activities, whereas HBP provides extensive amounts of BP information obtained under fixed times and conditions over a long period of time; thus, the mean values of HBP are stable, and the reproducibility are high. The high reproducibility of HBP is the rationale for its overall superiority over HBP compared with ABP and clinic BP (CBP). The higher practicality of HBPM over ABPM is definitely recognized. HBPM allows for ongoing disease monitoring by patients and can provide health-care providers with timely clinical data and direct and immediate feedback regarding the diagnosis and treatment of hypertension. HBP is better able than CBP to predict hypertensive target organ damage and a prognosis of cardiovascular disease. Unlike CBPM, HBPM provides BP information in relation to time, that is, BP in the morning, in the evening and at night during sleep. HBPM is an essential tool for the diagnosis of white-coat hypertension and masked hypertension. Day-to-day variability of HBP has clinical significance. HBPM yields minimal alerting effects and placebo effects. HBPM can distinguish small but significant serial changes in BP and is the most practical way to monitor BP in the day-by-day management of hypertension. HBPM improves compliance with antihypertensive medication. The operational threshold of HBP has been established. HBPM is suspected to have a great effect on the medical economy. The superiority of HBPM over ABPM and CBPM is apparent from almost all practical and clinical research perspectives. These characteristics of HBPM indicate that this method is ideal for the diagnosis and treatment of hypertension in daily practice.
Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of ...Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.
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