Epidemiology and Health

Original article

Age-period-cohort analysis of dietary sodium, potassium, and sodium-to-potassium ratio in Korea: Hee Ju Jun, Shieon Kim, Garam Jo; Epidemiol Health. 2025;47:e2025062. Published online November 4, 2025; DOI: https://doi.org/10.4178/epih.e2025062

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Abstract Summary PDF: Abstract
OBJECTIVES
Excessive sodium and insufficient potassium consumption are major dietary contributors to hypertension (HTN) and cardiovascular diseases. The sodium-to-potassium ratio is a known predictor of blood pressure (BP) and HTN. This study evaluated 16-year-trends in dietary sodium, potassium, and the sodium-to-potassium ratio, and their associations with BP and HTN in Korea.
METHODS
Data from 76,484 participants aged 19-79 years were obtained from the Korea National Health and Nutrition Examination Survey conducted in 2007-2022. Sodium and potassium intake were assessed using 24-hour recalls, and the sodium- to-potassium ratio was calculated. All values were energy-adjusted using the residual method. Age-period-cohort (APC) models were used to analyze temporal trends. Associations with BP and HTN were examined using multivariate linear and logistic regression models, adjusting for confounders.
RESULTS
Energy-adjusted sodium intake decreased across all age groups, and potassium slightly increased in the recent 5 years, though both remained suboptimal relative to recommendations. APC analyses showed increasing potassium intake with age and a reversed U-shape cohort pattern. The sodium-to-potassium ratio decreased with age and calendar year but increased in recent cohorts. A higher sodium-to-potassium ratio was strongly associated with elevated systolic (β=0.028, p<0.001) and diastolic BP (β=0.036, p<0.001), and increased odds of HTN (odds ratio, 1.19; 95% confidence interval, 1.07 to 1.33). A linear association appeared when the sodium-to-potassium ratio exceeded 1.00 in the spline model.
CONCLUSIONS
Despite improvements, sodium intake remains excessive, and potassium insufficient, particularly in younger adults and recent cohorts. Public health interventions should prioritize reducing sodium and promoting potassium-rich foods to reduce cardiovascular risk.; Summary

Korean summary
한국 성인의 나트륨 섭취는 지난 16년간 감소했지만 여전히 과도한 수준이고, 칼륨 섭취는 최근 증가했으나 권장량에 미치지 못했습니다. 연령·기간·코호트(APC) 분석 결과, 나트륨-칼륨 비율이 최근 출생 코호트에서 높아지는 경향을 보였습니다. 나트륨-칼륨 비율이 높을수록 혈압 상승과 고혈압 위험 증가가 유의하게 연관되는 만큼, 공중보건적 관리가 필요합니다.

Key Message
Over the past 16 years, sodium intake among Korean adults has decreased but remains high, while potassium intake has recently increased yet still falls below recommended levels. Age-period-cohort (APC) analyses showed that the sodium-to-potassium ratio has tended to increase in more recent cohorts. Because a higher sodium-to-potassium ratio is significantly associated with elevated blood pressure and a higher risk of hypertension, targeted public health efforts are needed.

Original Articles

Evaluation of a telemedicine pilot project for hypertension in Korea: a nationwide real-world data study: Jeong-Yeon Kim, Yeryeon Jung, Seongwoo Seo, Youseok Kim, Min Jung Ko, Hun-Sung Kim; Epidemiol Health. 2025;47:e2025048. Published online August 25, 2025; DOI: https://doi.org/10.4178/epih.e2025048

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Abstract

OBJECTIVES
A telemedicine pilot project has received temporary authorization in Korea. The clinical effectiveness of telemedicine is well established; however, ongoing research must assess medical utilization, sustainability, prescription continuity, and safety.

METHODS

This study evaluated medical utilization, sustainability, prescription continuity, and safety before and after the implementation of a telemedicine pilot project between June 2022 and December 2023. Data were obtained from the Korean National Health Insurance Service (NHIS), and participants were divided into those who received non-face-to-face hypertension treatment at least once and those who did not.

RESULTS

This study included 124,210 patients diagnosed with hypertension who received telemedicine (the Tele_G group) and 124,210 propensity score-matched control individuals. The difference-in-difference (DID) for medical utilization between the Tele_G and control groups was 0.10 (-0.03 vs. -0.12, p<0.001). The DID for the Modified Modified Continuity Index was -0.005 (-0.003 vs. 0.002, p<0.001), while that for Most Frequent Provider Continuity was -0.006 (-0.004 vs. 0.002, p<0.001). The DID for the prescription day rate was 0.41 (-0.61 vs. -1.02, p<0.001), and that for the appropriate prescription continuation rate was 0.52 (-1.23 vs. -1.75, p<0.01).

CONCLUSIONS

Telemedicine did not fully achieve the same standard as face-to-face treatment for hypertension management; however, it showed comparable safety, suggesting potential as secondary care. As the first NHIS-based study on this topic in Korea, this research highlights the benefits of telemedicine when appropriately utilized for patients with hypertension. Nevertheless, due to limitations regarding long-term continuity and policy design, cautious interpretation is required, and further prospective studies are warranted.

Summary

Korean summary
비대면진료는 대면진료를 완전히 대체하지 않고, 특히 만성질환 관리에서 추적관찰을 보완하는 역할을 한다. 비대진료는 안정적인 고혈압 환자나 원거리 거주 환자에게 특히 유용하지만, 안전한 시행을 위해서는 의사 중심의 가이드라인과 정책이 필수적이다.

Key Message
This study evaluates the clinical impact of a telemedicine on hypertension management, focusing on medical utilization, prescription continuity, and patient safety using real-world data from the Korean National Health Insurance Service. This study’s findings show statistically significant differences in key outcomes such as medical utilization and prescription adherence between telemedicine and control groups. Specifically, telemedicine participants demonstrated better continuity in appropriate prescriptions and fewer barriers to consistent care compared to those receiving face-to-face care. These findings suggest that, when appropriately implemented, telemedicine may provide care that is comparable to or supportive of conventional face-to-face care for stable hypertensive patient.

Citations

Citations to this article as recorded by

Telemedicine for hypertension: opportunities and responsibilities in management
Jiwon Shinn, Hakyoung Park, Hun-Sung Kim
Cardiovascular Prevention and Pharmacotherapy.2025; 7(4): 155. CrossRef

Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study: Hyesung Lee, Bin Hong, Chris Tzu-Ting Su, Sungho Bea, Han Eol Jeong, Kyungyeon Jung, Michael Chun-Yuan Cheng, Zoe Chi-Jui Chang, Edward Chia-Cheng Lai, Jongyoung Lee; Epidemiol Health. 2025;47:e2025029. Published online May 28, 2025; DOI: https://doi.org/10.4178/epih.e2025029

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Abstract

OBJECTIVES
This study investigated the safety of azilsartan and amlodipine combination therapy versus other angiotensin receptor blockers (ARBs) and amlodipine in patients with hypertension.

METHODS

We conducted a cohort study utilizing healthcare databases from Korea and Taiwan. Patients aged between 18 years and 75 years who were newly prescribed both an ARB and amlodipine within 6 months of hypertension diagnosis were included. Safety outcomes assessed were hypotension, angioedema, acute pancreatitis, hyperkalemia, hypokalemia, toxic liver disease, hepatic failure, nausea and vomiting, and fall-related injury. Hazard ratios (HRs) with 95% confidence intervals (CIs) for each safety outcome associated with azilsartan medoxomil and amlodipine versus other ARBs combined with amlodipine were calculated within a 1:1 propensity score (PS)-matched cohort. Summary HRs across databases were computed using random-effects meta-analysis.

RESULTS

We identified 2,472 eligible patients (1,521 from Korea, 951 from Taiwan) initiating treatment with azilsartan medoxomil and amlodipine, and 671,468 patients (312,322 from Korea, 355,409 from Taiwan) initiating other ARBs with amlodipine. After PS matching, baseline characteristics were well-balanced between treatment groups. During the 180-day follow-up, most adverse outcomes did not occur even once in either group, thus precluding the calculation of HRs. The risk of acute pancreatitis was not significantly different between the azilsartan medoxomil and amlodipine group and the other ARB and amlodipine groups (summary HR, 0.86; 95% CI, 0.14 to 5.37).

CONCLUSIONS

In this population-based cohort study, azilsartan medoxomil combined with amlodipine was not associated with an increased risk of adverse outcomes compared to other ARBs combined with amlodipine.

Summary

Korean summary
Azilsartan medoxomil과 amlodipine 병용요법의 장기적인 안전성을 평가한 연구는 제한적임. 본 코호트 연구에서는 azilsartan과 amlodipine 병용요법이 다른 ARB-amlodipine 병용요법에 비해 중대한 이상반응 발생 위험을 증가시키지 않는 것으로 나타났음. 이러한 결과는 고혈압 환자에서 azilsartan-amlodipine 병용요법의 실제 진료 환경에서의 안전성을 뒷받침함.

Key Message
Limited studies have evaluated the long-term safety of combined azilsartan medoxomil and amlodipine therapy. This cohort study found the azilsartan and amlodipine combination therapy was not associated with increased risk of serious adverse events compared to other ARB-amlodipine combinations. These results support the real-world safety of azilsartan-amlodipine caombination therapy in patients with hypertension.

Citations

Citations to this article as recorded by

Letter to the Editor: Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study
Zhanyi Zhou
Epidemiology and Health.2025; 47: e2025053. CrossRef
Authors’ Reply: Safety of combination therapy of azilsartan medoxomil and amlodipine: a population-based cohort study
Hyesung Lee, Bin Hong, Chris Tzu-Ting Su, Sungho Bea, Han Eol Jeong, Kyungyeon Jung, Michael Chun-Yuan Cheng, Zoe Chi-Jui Chang, Edward Chia-Cheng Lai, Jongyoung Lee
Epidemiology and Health.2025; 47: e2025054. CrossRef

Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in Korea: Yehrhee Son, Noorhee Son, Sungyoun Chun, Ki-Bong Yoo, Jung Hyun Chang, Woo-Ri Lee; Epidemiol Health. 2025;47:e2025019. Published online April 18, 2025; DOI: https://doi.org/10.4178/epih.e2025019

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The prevalence of hypertension is increasing as a result of rapid population aging, which elevates the societal burden of the disease. In Korea, the hospitalization rate for hypertension-related admissions exceeds the average reported by the Organization for Economic Cooperation and Development; however, the impact of these hospitalizations has not been evaluated. Therefore, this study investigates the association between hypertension-related avoidable hospitalizations and all-cause mortality.
METHODS
We included patients aged ≥60 years diagnosed with hypertension, identified using data from the National Health Insurance Services Senior Cohort spanning 2008 to 2019. The primary outcome was all-cause mortality measured at 3 years and 5 years after the hypertension diagnosis. The key independent variable was the incidence of hypertension-related avoidable hospitalizations within the first year following the initial hypertension diagnosis. Cox proportional hazards regression analysis was employed to assess these associations. To ensure robust findings and minimize selection bias, several sensitivity analyses were conducted.
RESULTS
Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.53 to 2.94; 5-year: HR, 2.13; 95% CI, 1.68 to 2.68).
CONCLUSIONS
Hypertension-related avoidable hospitalizations among older adults are associated with an increased risk of both short-term and long-term all-cause mortality. These findings underscore the importance of timely hypertension management to prevent such hospitalizations.; Summary

Korean summary
- 고혈압 관련 회피가능한 입원은 한국의 노인 고혈압 환자의 3년 및 5년 사망률과 유의미한 연관성을 보인다. - 사회경제적 및 지역적 건강 격차가 관찰되었으며, 저소득층과 대도시 이외 지역에 거주하는 환자의 사망 위험이 더 높았다. - 약물 복용을 포함한 조기 및 지속적인 고혈압 관리는 회피가능한 입원을 예방하고 장기 생존 결과를 개선하는데에 도움이 될 수 있다.

Key Message
- Hypertension-related avoidable hospitalizations are significantly associated with both 3-year and 5-year all-cause mortality among older patients with hypertension in Korea. - Socioeconomic and regional disparities were observed, with greater mortality risks among patients from low-income groups and non-metropolitan areas. - Early and consistent hypertension management—including medication adherence—may help prevent avoidable hospitalizations and improve long-term survival outcomes.

Effect of long-term blood pressure trajectory on the future development of chronic kidney disease: an analysis of data from the Korean National Insurance Health Checkup Study: Wonmook Hwang, Eu Jin Lee, Jae-Hyeong Park, Soon-Ki Ahn; Epidemiol Health. 2024;46:e2024090. Published online November 19, 2024; DOI: https://doi.org/10.4178/epih.e2024090

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Abstract

OBJECTIVES
Chronic kidney disease (CKD) is a prevalent health issue that causes the irreversible loss of functioning nephrons, end-stage renal disease, cardiovascular disease, and premature mortality. Hypertension is the leading cause of CKD. However, the effect of long-term blood pressure (BP) changes on the development of CKD is still unknown. Therefore, the current study investigated the association between BP trajectory and the future development of CKD.

METHODS

In this study, 246,874 individuals aged ≥40 years who underwent health examinations during the screening period (2002-2009) were evaluated. The systolic blood pressure (SBP) trajectory was determined using latent-class mixture modeling. New-onset CKD was identified during the follow-up period (2010-2019). The association between SBP trajectories and new-onset CKD was assessed.

RESULTS

In total, 111,900 adults (53,420 females, 51.9±6.4 years old) presented with 2 SBP trajectory classes: class 1 (n=66,935) and class 2 (n=44,965). During the follow-up period, patients with SBP trajectory class 2 had an approximately 2.1-fold increased risk of developing CKD (unadjusted hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.99 to 2.25; p<0.001). In the multivariate analysis adjusted for other significant variables, SBP trajectory class 2 was significantly associated with CKD in males (HR, 1.09; 95% CI, 1.00 to 1.19; p=0.037), but not in females (HR, 1.06; 95% CI, 0.95 to 1.18; p=0.321).

CONCLUSIONS

An elevated longitudinal BP was associated with a higher incidence of CKD in male participants aged ≥40 years. Nevertheless, further studies are needed to validate the clinical significance of an elevated SBP trajectory on CKD development.

Summary

Korean summary
궤적분석으로 평가한 수축기 혈압의 지속적 상승은 40세 이상의 남성 피험자에서 만성 신장 질환 발생률 증가와 관련이 있었다.

Key Message
Elevated longitudinal systolic blood pressure, as determined by trajectory, was found to be associated with an increased risk of developing chronic kidney disease in male subjects over the age of 40.

Citations

Citations to this article as recorded by

Chronic kidney disease and sex dimorphism
Sarah Abu Kar, Raymond C. Harris
Current Opinion in Nephrology & Hypertension.2025; 34(4): 314. CrossRef
Dynamic changes in metabolic syndrome components and chronic kidney disease risk: a population-based prospective cohort study
Yue Huang, Rong Fu, Juwei Zhang, Jinsong Zhou, Siting Chen, Zheng Lin, Xiaoxu Xie, Zhijian Hu
BMC Endocrine Disorders.2025;[Epub] CrossRef

Association of healthy lifestyle factors with the risk of hypertension, dyslipidemia, and their comorbidity in Korea: results from the Korea National Health and Nutrition Examination Survey 2019-2021: Ji-Sook Kong, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024049. Published online May 1, 2024; DOI: https://doi.org/10.4178/epih.e2024049

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Abstract

OBJECTIVES
We investigated the association of individual healthy lifestyle factors (HLFs) and their combined healthy lifestyle score (HLS) with hypertension and/or dyslipidemia.

METHODS

We analyzed data from 10,693 adults aged ≥19 from the 2019 to 2021 Korea National Health and Nutrition Examination Survey. HLS was evaluated based on smoking status, alcohol consumption, body mass index (BMI), diet, and physical activity. Using logistic regression models, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the associations of HLFs and HLS with hypertension, dyslipidemia, and their comorbidity.

RESULTS

The prevalence of hypertension alone, dyslipidemia alone, and their comorbidity was 8.7%, 24.6%, and 15.0%, respectively. Multivariable models showed an inverse association of hypertension (OR, 0.37; 95% CI, 0.30 to 0.46) and dyslipidemia (OR, 0.36; 95% CI, 0.32 to 0.41) with healthy BMI. Hypertension was inversely associated with healthy alcohol consumption (OR, 0.46; 95% CI, 0.35 to 0.61) and diet (OR, 0.79; 95% CI, 0.63 to 0.99), whereas dyslipidemia was inversely associated with non-smoking (OR, 0.51; 95% CI, 0.43 to 0.60). Physical activity was inversely associated with their comorbidity (OR, 0.69; 95% CI, 0.56 to 0.85). Adherence to HLS was associated with significantly lower odds of hypertension (81%), dyslipidemia (66%), and their conditions (89%) (all ptrend<0.001). Stratified analyses consistently showed inverse associations between HLS and hypertension and/or dyslipidemia independently of demographic factors (pinteractions>0.05).

CONCLUSIONS

HLFs were associated with lower risk for hypertension and/or dyslipidemia. Obesity may contribute significantly to the risk of these conditions, while relevant HLFs for individual chronic diseases may vary significantly.

Summary

Korean summary
건강한 생활 습관 요인(HLFs)의 개별 구성 요인들은 고혈압 및 이상지질혈증의 동반 위험과 각각의 상태와 음의 연관성을 보였다. 다양한 HLFs 중에서 BMI 상태가 중요한 요인으로 확인되었지만, 개별 만성 질환에 대한 관련 HLFs는 상당히 다를 수 있다. 또한, 명확한 용량-반응 관계가 관찰되어, 더 HLFs를 준수할수록 고혈압, 이상지질혈증 및 그들의 동반 가능성이 유의미하게 감소하는 것으로 나타났다.

Key Message
Individual components of healthy lifestyle factors (HLFs) were inversely associated with the risk of comorbid hypertension and dyslipidemia, as well as with each condition. Among the various HLFs, BMI status was identified as a significant factor, while relevant HLFs for individual chronic diseases may vary significantly. Additionally, clear dose-response associations were observed, indicating that adherence to more HLFs was significantly associated with decreasing odds of hypertension, dyslipidemia, and their comorbidity.

Citations

Citations to this article as recorded by

Prevalence of dyslipidemia and its associated risk factors in hypertensive population: A single-center cross-sectional study in southern China
Junming Sun, Bin Huang, Weikun Zhao, Qiurui Li, Siwei Yin, Ying Zhang, Rongjie Huang
Journal of the Renin-Angiotensin-Aldosterone System.2025;[Epub] CrossRef
Nutriomics and artificial intelligence nutrition obesity cohort (NAINOC): a design paper for a prospective cohort for nutrition and obesity research
Minyoung Lee, Sungha Park, Soo-Hyun Park, Ho-Young Park, Yu Ra Lee, Min-Sun Kim, Miso Nam, Jangho Lee, Hyein Seo, Yong-ho Lee, Chan Joo Lee, Jae-Ho Park, Hye Hyun Yoo, Hyun-Jin Kim, Kyong-Oh Shin, Yoshikazu Uchida, Kyungho Park
Clinical Hypertension.2025;[Epub] CrossRef

Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans: Ju Young Jung, Chang-Mo Oh, Hyun chul Jo, Sung Keun Park; Epidemiol Health. 2024;46:e2024034. Published online February 27, 2024; DOI: https://doi.org/10.4178/epih.e2024034

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Abstract

OBJECTIVES
The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.

METHODS

The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.

RESULTS

The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1: reference; quartile 2: 1.71 [95% CI, 1.59 to 1.82]; quartile 3: 2.41 [95% CI, 2.25 to 2.58]; and quartile 4: 3.46 [95% CI, 3.23 to 3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year, and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.

CONCLUSIONS

The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.

Summary

Korean summary
고혈압은 심혈관 질환의 주요 원인이다. 내장 지방은 비만에서 고혈압의 병태 생리에 중요한 역할을 한다. 최근의 연구는 Chinese visceral adiposity index (CVAI)가 다른 비만 지표 보다 아시아 인에서 심혈관 질환의 고 위험군을 더욱 잘 구분해 낸다는 것을 보고하였다. 우리는 체질량 지수, 허리 둘레, visceral adiposity index, CVAI의 고혈압에 대한 예측력을 비교 하였다. 우리의 연구는 CVAI가 고혈압을 예측하는데 있어 다른 지표 보다 우월하다는 것을 보여주었다.

Key Message
Hypertension is a leading risk factor for cardiovascular disease. It is known that visceral adiposity has an important role in the pathogenesis of hypertension in obesity. Recent studies have demonstrated that Chinese visceral adiposity index (CVAI) is more discriminative the high risk group for cardiovascular disease in Asians than other obesity indices. We compared the predictive ability for the development hypertension among body mass index, waist circumference, visceral adiposity index, and CVAI. Our study showed that CVAI is superior to predict hypertension than other indices.

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Assessment of six surrogate insulin resistance indexes for predicting hypertension risk in rural Chinese adults
Ge Liu, Lu Cao, Hongwei Wen, Mengna Liu, Xinxin He, Mengdi Wang, Yijia Su, Fan Xu, Jingli Kong, Canjie Piao, Aijun Xu, Ming Zhang, Fulan Hu, Dongsheng Hu, Yang Zhao
Hypertension Research.2025; 48(4): 1285. CrossRef
Association of long working hours with visceral adiposity index, anthropometric indices, and weight management behaviors: a study of Korean workers
Seong-Uk Baek, Jin-Ha Yoon
Family Practice.2025;[Epub] CrossRef
Association of physical fitness with visceral fat status and metabolic dysfunction-associated fatty liver disease in individuals with spinal cord injury using manual wheelchair in Korea
Minjun Kim, Inhwan Lee
Preventive Medicine Reports.2025; 57: 103182. CrossRef
Association of traditional and novel obesity indicators with stroke risk: Findings from the Rural Chinese cohort study
Dongdong Zhang, Weifeng Huo, Weiling Chen, Xi Li, Pei Qin, Ming Zhang, Jing Li, Xizhuo Sun, Yu Liu, Dongsheng Hu
Nutrition, Metabolism and Cardiovascular Diseases.2024; 34(9): 2065. CrossRef
Comparison of obesity indicators for predicting cardiovascular risk factors and multimorbidity among the Chinese population based on ROC analysis
Xiang Feng, Jinhua Zhu, Zhaolai Hua, Shenghua Yao, Haiyuan Tong
Scientific Reports.2024;[Epub] CrossRef
Impact of Chinese visceral adiposity index on all-cause mortality risk in community-dwelling older adults: a prospective cohort study
Yuyu Zhang, Mingyue Shi, Zhao Dong, Tingting Li, Yangfan Gong, Wei Ge
Aging Clinical and Experimental Research.2024;[Epub] CrossRef

Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents: Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae; Epidemiol Health. 2024;46:e2024028. Published online February 13, 2024; DOI: https://doi.org/10.4178/epih.e2024028

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure (EBP) in Korean adolescents, and that the association is dose dependent.

METHODS

This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were EBP and hypertension. Statistical analyses were conducted using SAS version 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.

RESULTS

A total of 2,518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean± standard deviation participant age was 15.3±1.7 years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2,090 (83.0%). Analysis of the 2,518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an odds of elevated blood pressure of 3.00 (95% confidence interval [CI], 1.14 to 7.89). The odds of hypertension were 3.61 (95% CI, 1.13 to 11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.

CONCLUSIONS

It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents’ blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.

Summary

Korean summary
청소년기의 고혈압은 성인기의 다양한 질병을 초래할 수 있는 주요 원인이다. 흡연과 고혈압의 관계에 관한 다수의 연구들이 있으나 상반된 결과들이 보고되었고 국내 청소년의 직 간접적 담배 연기 노출과 혈압과의 연관성은 명확하게 밝혀지지 않았다. 따라서 본 연구에서는 한국 청소년에서 담배 연기 노출과 혈압 상승과의 연관성을 확인해 보고자 하였다. 연구 결과 직접 흡연을 하는 청소년들은 비흡연군에 비하여 3배 이상 혈압이 증가하는 것으로 나타났다.

Key Message
Hypertension during adolescence is a leading cause of disease in adults. The relationship between smoking and hypertension has been studied, but findings between studies are conflicting. Nicotine is a known toxin, but the relationship between active and passive smoking and blood pressure in adolescents is not clear. So that we tested and found adolescents in Korea who were active smokers showed over 3-fold increased risk of elevated blood pressure.

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Current status of elevated blood pressure and hypertension among adolescents in Asia: a systematic review
Binish Islam, Tasiu Ibrahim Ibrahim, Wang Tingting, Mingyang Wu, Qin Jiabi
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Association of blood pressure measurements in sitting, supine, and standing positions with the 10-year risk of mortality in Korean adults: Inkyung Baik, Nan Hee Kim, Seong Hwan Kim, Chol Shin; Epidemiol Health. 2023;45:e2023055. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023055

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This prospective cohort study investigated the association between blood pressure (BP) as measured in different body postures and all-cause and cardiovascular (CV) mortality risk.

METHODS

This population-based investigation included 8,901 Korean adults in 2001 and 2002. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured sequentially in the sitting, supine, and standing positions and classified into 4 categories: (1) normal, SBP <120 mmHg and DBP <80 mmHg; (2) high normal/prehypertension, SBP 120-129 mmHg and DBP <80 mmHg/SBP 130-139 mmHg or DBP 80-89 mmHg; (3) grade 1 hypertension (HTN), with SBP 140-159 mmHg or DBP 90-99 mmHg; and (4) grade 2 HTN, SBP ≥160 mmHg or DBP ≥100 mmHg. The date and cause of individual deaths were confirmed in the death record data compiled until 2013. Data were analyzed using Cox proportional hazard regression.

RESULTS

Significant associations were found between the BP categories and all-cause mortality, but only when BPs were measured in the supine position. The multivariate hazard ratios (95% confidence intervals, [CIs]) were 1.36 (95% CI, 1.06 to 1.75) and 1.59 (95% CI, 1.06 to 2.39) for grade 1 HTN and grade 2 HTN, respectively, compared with the normal category. The associations between the BP categories and CV mortality were significant regardless of body posture among participants ≥65 years, whereas they were significant for supine BP measurements only in those <65 years.

CONCLUSIONS

BP measured in the supine position predicted all-cause mortality and CV mortality better than BP measured in other postures.

Summary

Korean summary
본 역학 연구는 한국 성인 8,901명을 연구대상자로 하여 기초조사에서 세가지 자세, 즉 앉은 자세, 누운 자세, 일어선 자세에서 혈압을 측정하고, 이후 10년 동안의 사망 여부를 추적조사하여, 측정 자세에 따른 혈압과 사망 위험과의 관련성을 분석하였다. 그 결과, 누운 자세에서 측정된 고혈압(기준: 수축기 혈압이 140 mmHg 이상 혹은 이완기 혈압이 90 mmHg 이상)인 사람은 정상 혈압(기준: 수축기 혈압이 120 mmHg 미만이고 이완기 혈압이 80 mmHg 미만)인 사람에 비해 36%(1단계 고혈압) 혹은 59%(2단계 고혈압) 가량 총 사망 위험이 유의적으로 증가하는 것으로 나타났다. 이에 비해, 앉은 자세 및 일어선 자세에서 측정, 정의된 고혈압은 총 사망 위험을 증가시켰지만 유의적인 결과를 나타내지 못했다. 추후 연구에서 재확인이 필요하지만, 본 연구 결과가 시사하는 바는 앉은 자세나 일어선 자세보다 누운 자세에서 측정하는 혈압이 총 사망 위험을 더 잘 예측하므로, 고혈압 진단 외의 추가적인 활용 가능성이 있는 것으로 평가된다.

Key Message
The current epidemiological study revealed that blood pressure measured in a supine position could predict all-cause mortality and cardiovascular mortality better than blood pressure measured in a sitting or standing position. As a result, blood pressure measurements in a supine position may be useful in assessing mortality risk.

Citations

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Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality
Duc M. Giao, Hannah Col, Fredrick Larbi Kwapong, Ruth-Alma Turkson-Ocran, Long H. Ngo, Jennifer L. Cluett, Lynne Wagenknecht, B. Gwen Windham, Elizabeth Selvin, Pamela L. Lutsey, Stephen P. Juraschek
JAMA Cardiology.2025; 10(3): 265. CrossRef
Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients Undergoing Coronary Angiography
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Association of multiple anthropometric indices with in 944,760 elderly Chinese people: Lirong Dong, Yuanyuan Wang, Jinshui Xu, Yang Zhou, Guiju Sun, Dakang Ji, Haijian Guo, Baoli Zhu; Epidemiol Health. 2023;45:e2023046. Published online April 17, 2023; DOI: https://doi.org/10.4178/epih.e2023046

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN.

METHODS

Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN.

RESULTS

The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% confidence interval, 64.6 to 64.8). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant non-linear positive dose-response associations with HTN across sex (pnonlinear<0.001). Among participants with BMI <28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN.

CONCLUSIONS

The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.

Summary

Key Message
We have conducted a comprehensive review of the supplementary material and have implemented the necessary modifications. We would like to extend our sincere apologies for any inconvenience that may have been caused during your work. Additionally, we have taken note of the fact that certain fields within the Author Contribution and ORCID sections were not previously verified. To rectify this situation and eliminate any potential ambiguity, we have diligently re-entered the information in question.

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Meryem Cakir, Yasemin Ozkaya, Nafiye Ebru Terzi, Olgu Aygun, Halime Seda Kucukerdem, Elif Saki, Nir Y. Krakauer,
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Association of Body Mass Index and Metabolic Health Status With Cerebrovascular Diseases in 617 755 Chinese Older People
Lirong Dong, Yuanyuan Wang, Dakang Ji, Zhengkai Shen, Jinshui Xu, Guiju Sun, Shanhu Qiu, Jianan Xu, Haijian Guo
Journal of the American Heart Association.2025;[Epub] CrossRef
Association of body shape index and body fat percentage with geriatric assessment outcomes
Meryem Çakir, Olgu Aygün, Ayça Asma Sakalli, Yasemin Özkaya, Nafiye Ebru Terzi, Öykü Kahraman
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The associations of obesity phenotypes with the risk of hypertension and its transitions among middle-aged and older Chinese adults: Ziyue Sheng, Shang Lou, Jin Cao, Weidi Sun, Yaojia Shen, Yunhan Xu, Ziyang Ren, Wen Liu, Qian Yi, Peige Song; Epidemiol Health. 2023;45:e2023043. Published online April 10, 2023; DOI: https://doi.org/10.4178/epih.e2023043

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese.
METHODS
Using the 2011-2015 waves of the China Health and Retirement Longitudinal Study, we conducted a cross-sectional analysis included 9,015 subjects and a longitudinal analysis included 4,961 subjects, with 4,872 having full data on the hypertension stage and 4,784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex.
RESULTS
NWCO was associated with normal→stage 2 (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.11 to 3.42), maintained stage 1 (OR, 1.62; 95% CI, 1.14 to 2.29), and normal→ISH (OR, 1.39; 95% CI, 1.05 to 1.85). AWCO was associated with normal→stage 1 (OR, 1.75; 95% CI, 1.40 to 2.19), maintained stage 1 (OR, 2.77; 95% CI, 2.06 to 3.72), maintained stage 2 (OR, 2.80; 95% CI, 1.50 to 5.25), normal→ISH (OR, 1.56; 95% CI, 1.20 to 2.02), and normal→SDH (OR, 2.54; 95% CI, 1.72 to 3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages.
CONCLUSIONS
This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.; Summary

Key Message
This study elucidates the distinct associations between obesity phenotypes and various hypertension stages and phenotypes. Furthermore, it reveals significant sex differences in the risk for hypertension stages, phenotypes, and transitions, providing essential insights for targeted interventions and personalized medicine.

COVID-19: Health Statistics

Changes in the management of hypertension, diabetes mellitus, and hypercholesterolemia in Korean adults before and during the COVID-19 pandemic: data from the 2010-2020 Korea National Health and Nutrition Examination Survey: Yoonjung Kim, Suyeon Park, Kyungwon Oh, Hongseok Choi, Eun Kyeong Jeong; Epidemiol Health. 2023;45:e2023014. Published online February 1, 2023; DOI: https://doi.org/10.4178/epih.e2023014

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to analyze the changes in chronic disease management indicators, including hypertension, diabetes mellitus, and hypercholesteremia, from 2010-2020 and before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This study included 58,504 individuals aged ≥30 years who participated in the Korea National Health and Nutrition Examination Survey 2010-2020. Trends in the prevalence, awareness, treatment, and control of chronic diseases and the difference in those between before and during the COVID-19 pandemic were analyzed using the SAS program PROC SURVEYREG.

RESULTS

From 2010-2020, the awareness, treatment, and control in adults aged ≥30 years for hypertension and hypercholesterolemia continuously improved, whereas no significant change in the management indicators of diabetes mellitus was observed. The prevalence of hypertension, diabetes mellitus, and hypercholesterolemia in men increased from before to during the COVID- 19 pandemic. However, there was no significant change in the management indicators of hypertension and diabetes mellitus in men and women, and the awareness, treatment, and control rates for hypercholesterolemia increased by 5.5%p, 6.9%p, and 4.1%p respectively.

CONCLUSIONS

In 2020, the first year of the COVID-19 pandemic, the prevalence of hypertension, diabetes mellitus, and hypercholesterolemia increased, but the management indicators of the chronic diseases did not significantly deteriorate. Considering the ongoing COVID-19 pandemic, it is necessary to monitor changes in chronic disease management indicators and to develop efficient and accessible chronic disease prevention and management programs.

Summary

Korean summary
국민건강영양조사 자료를 분석한 결과 11년간(2010-2020년) 성인의 고혈압, 고콜레스테롤혈증 인지율, 치료율, 치료자 중 조절률은 개선된 반면 당뇨병은 변화가 없었다. 코로나19 유행 전(2019년)·후(2020년) 비교시 남자에서 고혈압, 당뇨병, 고콜레스테롤혈증 유병률이 증가했다. 그러나 고혈압, 당뇨병 관리지표는 변화가 없었고, 고콜레스테롤혈증 관리지표만 개선되었다.

Key Message
The rates of awareness, treatment, and control in adults aged ≥30 years for hypertension and hypercholesterolemia continuously improved, whereas no significant change in the management indicators of diabetes mellitus was observed over the past 11 years (2010-2020). The prevalence of hypertension, diabetes mellitus, and hypercholesterolemia in men increased from before (2019) to during (2020) the COVID-19 pandemic. However, there was no significant change in the management indicators of hypertension and diabetes mellitus in men and women, and that of hypercholesterolemia improved.

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Original Articles

The associations of job strain and leisure-time physical activity with the risk of hypertension: the population-based Midlife in the United States cohort study: Xinyue Liu, Timothy A. Matthews, Liwei Chen, Jian Li; Epidemiol Health. 2022;44:e2022073. Published online September 7, 2022; DOI: https://doi.org/10.4178/epih.e2022073

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Job strain is positively associated with incident hypertension, while increasing leisure-time physical activity (LTPA) can reduce incident hypertension. However, the joint associations of job strain and LTPA with incident hypertension among United States workers have yet to be investigated. This study examined the independent and joint associations of job strain and LTPA with incident hypertension.

METHODS

This prospective cohort study (n=1,160) utilized data from the population-based Midlife in the United States study. The associations of job strain and LTPA at baseline with incident hypertension during follow-up were examined using Cox proportional hazards models. High job strain was derived from a combination of high job demands and low job control, and high LTPA was defined as engagement in moderate or vigorous LTPA at least once per week.

RESULTS

During 9,218 person-years of follow-up, the hypertension incidence rate was 30.6 (95% confidence interval [CI], 27.3 to 34.3) per 1,000 person-years. High job strain was associated with a higher risk for hypertension than low job strain (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.00 to 1.67). High LTPA was associated with lower hypertension risk than low LTPA (aHR, 0.77; 95% CI, 0.60 to 0.98). Hypertension risk was higher among workers with high job strain and low LTPA than among those with low job strain and high LTPA (aHR, 1.70; 95% CI, 1.18 to 2.43).

CONCLUSIONS

Job strain and LTPA showed positive and inverse associations, respectively, with incident hypertension. The combination of high job strain and low LTPA was associated with the highest risk for hypertension.

Summary

Key Message
High job strain and low leisure-time physical activity are independent risk factors for hypertension among workers, and those with high job strain and low leisure-time physical activity are at the highest risk, so it is critical that policy interventions target job strain and leisure-time physical activity to reduce hypertension.

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Physical activity lowers hypertension risk: A 2-sample Mendelian randomization study
Chenlu Zhang, Sicong Chen, Wei Song
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Prospective associations of occupational and leisure-time physical activity with risk of diabetes: a cohort study from the United States
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Adulthood Psychosocial Disadvantages and Risk of Hypertension in U.S. Workers: Effect Modification by Adverse Childhood Experiences
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International Journal of Environmental Research and Public Health.2022; 20(1): 144. CrossRef

Late eating, blood pressure control, and cardiometabolic risk factors among adults with hypertension: results from the Korea National Health and Nutrition Examination Survey 2010-2018: Jee-Seon Shim, Hyeon Chang Kim; Epidemiol Health. 2021;43:e2021101. Published online November 24, 2021; DOI: https://doi.org/10.4178/epih.e2021101

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Despite growing concerns regarding the timing of eating, little is known about the association between late eating and health. This study aimed to investigate whether late eating is associated with blood pressure (BP) control and cardiometabolic risk factors among Korean adults with hypertension.

METHODS

Data from the Korea National Health and Nutrition Examination Survey 2010-2018 were used. Adults with hypertension aged 30-79 years (n=13,361) were included in this study. Dietary intake and information on meal timing were assessed using 1-day 24-hour recall. Late eating was defined as after the median midpoint between the times of the first and the last eating episode during the recall day. Logistic and linear regression models were used to estimate the associations of late eating with BP control and cardiometabolic risk factors.

RESULTS

Among late eaters, there were more men than women. Compared to early eaters, late eaters were younger, had a higher body mass index (BMI) and unhealthier habits, and their overall dietary quality score was lower. A negative association between late eating and BP control was found in a univariate model (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.94 to 1.12), but this association disappeared after adjustment for confounders (OR, 1.03; 95% CI, 0.94 to 1.12). Late eating was independently associated with higher BMI (p=0.03) and blood triglyceride concentration (p<0.01).

CONCLUSIONS

Our results do not support a link between late eating and BP control among adults with hypertension, but suggest that late eating is associated with cardiometabolic risk factors.

Summary

Korean summary
식사시간이 건강에 미치는 영향에 대한 관심이 증가하고 있지만, 이에 대한 근거는 많지 않다. 이 연구는 국민건강영양조사 자료를 활용하여 고혈압이 있는 성인의 늦은 식사와 혈압 조절, 심장대사 위험인자의 연관성을 분석하였다. 늦은 식사와 혈압 조절의 독립적 연관성은 찾지 못했지만, 늦은 식사는 높은 체질량지수, 혈중 지질 농도와 연관성을 보여 식사 시간 조정이 고혈압 환자의 예후 개선을 위한 유용한 대책이 될 수 있으리라는 근거를 지지한다.

Key Message
This study investigated whether late eating is associated with blood pressure (BP) control and cardiometabolic risk factors among Korean adults with hypertension using data from the Korea National Health and Nutrition Examination Survey 2010–2018. We did not find an independent association between late eating and BP control among Korean adults with hypertension, but found that late eating was significantly associated with higher BMI and a higher blood concentration of triglycerides, independent of potential confounders. Our findings support the suggestion that a time-based dietary approach can be used as a useful strategy to improve the prognosis of adults with hypertension.

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The combination of physical activity and late-time-restricted eating improves eating behavior, cognitive performance and cardiovascular parameters in women living with excess body weight
Sarra Miladi, Omar Hammouda, Samar J. Miladi Trabelsi, Sirine C. Miladi, Ranya Ameur, Tarak Driss
Physiology & Behavior.2026; 306: 115200. CrossRef
Later eating timing in relation to an individual internal clock is associated with lower insulin sensitivity and affected by genetic factors
Janna Vahlhaus, Beeke Peters, Silke Hornemann, Anne-Cathrin Ost, Michael Kruse, Andreas Busjahn, Andreas F.H. Pfeiffer, Olga Pivovarova-Ramich
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Azadeh Lesani, Neda Soveid, Cain C. T. Clark, Bahar Barkhidarian, Fatemeh Gholami, Mansooreh Sadat Mojani-Qomi
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Bratislava Medical Journal.2025; 126(10): 2698. CrossRef
Late-eating adolescents consume more energy, make poorer dietary choices, and are more likely to have excess weight: An analysis of the Brazilian Household Budget Survey (2008–2009)
Maria Carliana Mota, Laura Cristina Tibiletti Balieiro, Luana Thomazetto Rossato, Claudia Roberta de Castro Moreno, Cibele Aparecida Crispim
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A hypertension risk score for adults: a population-based cross-sectional study from the Dubai Household Survey 2019: Ibrahim Mahmoud, Nabil Sulaiman, Amal Hussein, Heba Mamdouh, Wafa K. AL Nakhi, Hamid Y. Hussain, Gamal M. Ibrahim; Epidemiol Health. 2021;43:e2021064. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021064

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Abstract Summary PDF

Abstract

OBJECTIVES
The aim of this study was to develop a risk score model for predicting hypertension specific to the population of Dubai in the United Arab Emirates (UAE) to facilitate prevention and early intervention.

METHODS

A retrospective analysis of data from the Dubai Household Health Survey 2019 was conducted. Demographic and physical parameters, as well as blood glucose levels, were included in the data. The risk factors for hypertension were identified using bivariate analysis. A risk score model was developed using the enter method, where all significant predictors of hypertension in bivariate analyses were entered in a single step with the primary outcome of hypertension status (yes/no). The model was validated internally by splitting the data into Emirati and non-Emirati populations.

RESULTS

A total of 2,533 subjects were studied. The significant risk factors for hypertension identified were male sex, older age (≥40 years), education level, body mass index, diabetes mellitus, and dyslipidaemia. The model showed a high discrimination ability between individuals with and without hypertension, with an area under the curve of 0.77 (95% confidence interval [CI], 0.75 to 0.79), excellent sensitivity (81.0%; 95% CI, 71.9 to 88.2) and moderate specificity (56.0%; 95% CI, 45.7 to 65.9).

CONCLUSIONS

The model developed by this study is simple, convenient, and based on readily available demographic and medical characteristics. This risk score model could support initial hypertension screening and provide an effective tool for targeted lifestyle counselling and prevention programs.

Summary

Key Message
To prevent hypertension in Dubai's adult population, primary health care physicians can use our risk score model to recommend preventative measures, with a focus on men over 40 years old, with a low educational level, who are obese, and who have other morbidities, such as diabetes mellitus and dyslipidemia.

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Predictive variables and diagnostic performance of cross-sectional models for hypertension detection: a systematic review
Víctor Juan Vera-Ponce, Fiorella E. Zuzunaga-Montoya, Jhosmer Ballena-Caicedo, Carmen Inés Gutierrez De Carrillo, Darwin A. León-Figueroa, Mario J. Valladares-Garrido
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Nur Chamidah, Budi Lestari, Hendri Susilo, Mochamad Yusuf Alsagaff, I Nyoman Budiantara, Dursun Aydin
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Trends in the prevalence and management of major metabolic risk factors for chronic disease over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Yoonjung Kim, Sun Jin Nho, Gyeongji Woo, Hyejin Kim, Suyeon Park, Youngtaek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021028. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021028

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to explore trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from 1998 to 2018 using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The study participants included 79,753 individuals aged ≥ 30 years who had participated in the health examination and health interview of the first (1998) to the seventh (2016-2018) KNHANES. The prevalence and management as well as annual percent change (APC) in chronic diseases were analyzed using SAS and the Joinpoint software program.

RESULTS

The prevalence of obesity in men significantly increased from 26.8% in 1998 to 44.7% in 2018 (APC= 1.9, p< 0.001), whereas that in women decreased slightly from 30.5% in 1998 to 28.3% in 2018 (APC= -0.5, p< 0.001). The prevalence of hypertension in men was 33.2% in 2018, with no significant change, whereas that in women slightly decreased to 23.1% in 2018 (APC= -0.9, p< 0.001). The prevalence of diabetes in men increased slightly from 10.5% in 2005 to 12.9% in 2018 (APC= 1.6, p< 0.001), whereas that in women remained at approximately 8%, with no significant change. The prevalence of hypercholesterolemia in both men and women increased 3-fold in 2018 (20.9% in men [APC = 8.2, p < 0.001] and 21.4% in women [APC= 7.1, p< 0.001]) compared to that in 2005. The awareness rate, treatment rate, and control rate of hypertension and hypercholesterolemia increased 2-3 fold. Regarding diabetes, the treatment rate increased, but the control rate did not change.

CONCLUSIONS

Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리나라 성인의 비만, 고혈압, 당뇨병, 고콜레스테롤혈증 유병률 및 관리수준을 분석한 결과, 20년 동안 비만(남자), 당뇨병, 고콜레스테롤혈증 만성질환의 유병 수준은 악화되고 있는 반면, 만성질환의 인지율, 치료율, 치료자 중 조절률 등 관리지표는 지속적으로 개선되고 있었다.

Key Message
We examined trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

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Clinical outcomes of COVID-19 following the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers among patients with hypertension in Korea: a nationwide study: Ju Hwan Kim, Yeon-Hee Baek, Hyesung Lee, Young June Choe, Hyun Joon Shin, Ju-Young Shin; Epidemiol Health. 2021;43:e2021004. Published online December 29, 2020; DOI: https://doi.org/10.4178/epih.e2021004

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Abstract Summary PDF

Abstract

OBJECTIVES
Recent evidence has shown no harm associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). We sought to further clarify the possible association between ACEI/ARB use and the risk of poor clinical outcomes of COVID-19.

METHODS

From the completely enumerated COVID-19 cohort in Korea, we identified 1,290 patients with hypertension, of whom 682 had and 603 did not have records of ACEI/ARB use during the 30-day period before their COVID-19 diagnosis. Our primary endpoint comprised clinical outcomes, including all-cause mortality, use of mechanical ventilation, intensive care unit admission, and sepsis. We used inverse probability of treatment weighting (IPTW) to mitigate selection bias, and a Poisson regression model to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for comparing outcomes between ACEI/ARB users and non-users.

RESULTS

Compared to non-use, ACEI/ARB use was associated with lower clinical outcomes (IPTW-adjusted RR, 0.60; 95% CI, 0.42 to 0.85; p=0.005). For individual outcomes, ACEI/ARB use was not associated with all-cause mortality (IPTW-adjusted RR, 0.62; 95% CI, 0.35 to 1.09; p=0.097) or respiratory events (IPTW-adjusted RR, 0.99; 95% CI, 0.84 to 1.17; p=0.904). Subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against overall outcomes in men (IPTW-adjusted RR, 0.84; 95% CI, 0.69 to 1.03; pinteraction=0.008) and patients with pre-existing respiratory disease (IPTW-adjusted RR, 0.74; 95% CI, 0.60 to 0.92; pinteraction=0.002).

CONCLUSIONS

We present clinical evidence to support continuing ACE/ARB use in COVID-19 patients with hypertension based on the completely enumerated Korean cohort.

Summary

Korean summary
– 코로나-19 검사를 받은 69,793명 중에 코로나-19 양성이며 고혈압이 있는 1,290명을 연구대상자로 선정했으며, 이중 코로나-19 진단일로부터 30일이내에 ACEI 또는 ARB를 사용한 환자는 682명이었음. – ACEI 또는 ARB 사용은 비사용 대비 사망 또는 폐 관련 질환의 위험과의 관련성이 없었음. – 하위그룹 분석에서 남성 또는 기저 폐질환 보유 환자에서 ACEI 또는 ARB 사용이 코로나-19 예후 악화를 예방하는 트렌드를 보였음.

Key Message
– Among 69,793 individuals screened for COVID-19, we identified 1,290 patients with hypertension who tested positive, of whom 682 had records of using ACEIs or ARBs in the 30 days before their COVID-19 diagnosis. – ACEI/ARB use (compared with non-use) was not associated with all-cause mortality or respiratory events. – A subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against the overall composite endpoint of poor outcomes in men and those with pre-existing respiratory disease.

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The patterns of lifestyle, metabolic status, and obesity among hypertensive Korean patients: a latent class analysis: Suyoung Kim, Seon Cho, Eun-Hee Nah; Epidemiol Health. 2020;42:e2020061. Published online August 31, 2020; DOI: https://doi.org/10.4178/epih.e2020061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to identify latent classes in hypertensive patients based on the clustering of factors including lifestyle risk factors, metabolic risk factors, and obesity in each sex.

METHODS

This cross-sectional study included 102,780 male and 103,710 female hypertensive patients who underwent health check-ups at 16 centers in Korea, in 2018. A latent class analysis approach was used to identify subgroups of hypertensive patients. Multinomial logistic regression was performed to examine the association between latent classes and comorbidities of hypertension.

RESULTS

A four-class model provided the best fit for each sex. The following latent classes were identified: Class I (male: 16.9%, female: 1.7%; high risk of lifestyle behaviors [HB] with metabolic disorders and obesity [MO]), Class II (male: 32.4%, female: 47.1%; low risk of lifestyle behaviors [LB] with MO), Class III (male: 15.3%, female: 1.8%; HB with metabolic disorders and normal weight [MNW]), Class IV (male: 35.5%, female: 49.4%; LB with MNW). Lifestyle patterns in the latent classes were classified as high-risk or low-risk according to smoking and high-risk drinking among male, and presented complex patterns including physical inactivity alone or in combination with other factors, among female. Stage 2 hypertensive or diabetic individuals were likely to belong to classes including obesity (HB-MO, LB-MO) in both sexes, and additionally belonged to the HB-MNW class in male.

CONCLUSIONS

Metabolic disorders were included in all latent classes, with or without lifestyle risk factors and obesity. Hypertensive females need to manage obesity, and hypertensive males need to manage lifestyle risk factors and obesity. Sex-specific lifestyle behaviors are important for controlling hypertension.

Summary

Korean summary
고혈압 환자에서 이질적인 집단을 확인하기 위해, 생활습관, 대사이상 및 비만에 기반한 잠재계층분석을 실시한 결과, 각 성별에서 4개 계층으로 분류되었다. 모든 계층에는 대사이상 상태가 포함되었으며, 고위험 생활습관과 비만(HB-MO), 저위험 생활습관과 비만(LB-MO), 고위험 생활습관과 정상체중(HB-MNW), 저위험 생활습관과 정상체중(LB-MNW)으로 유형화하였다. 생활습관 및 비만 여부와 상관없이 모든 잠재계층에 대사이상 상태가 포함된 점으로 고혈압과 대사상태의 긴밀한 관련성을 확인하였으며, 성별에 따라 이질적인 생활습관 패턴(여성에서는 비만 관리와 남성에서는 비만과 생활습관 개선을 강조)을 확인하였다.

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Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study: Ahmad Khosravi, Mohammad Hassan Emamian, Hassan Hashemi, Akbar Fotouhi; Epidemiol Health. 2018;40:e2018026. Published online June 23, 2018; DOI: https://doi.org/10.4178/epih.e2018026

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Abstract

OBJECTIVES
The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.

METHODS

In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.

RESULTS

The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.

CONCLUSIONS

Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Summary

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Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran: Maryam Eghbali, Alireza Khosravi, Awat Feizi, Asieh Mansouri, Behzad Mahaki, Nizal Sarrafzadegan; Epidemiol Health. 2018;40:e2018020. Published online May 18, 2018; DOI: https://doi.org/10.4178/epih.e2018020

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Abstract

OBJECTIVES
Hypertension (HTN) is an important risk factor for cardiovascular disease. Considering the importance of this disease for public health, this study was designed in order to determine the prevalence, awareness, treatment, control, and risk factors of HTN in the Iranian adult population.

METHODS

This cross-sectional study was conducted among 2,107 residents of Isfahan, Iran. Samples were selected through multi-stage random cluster sampling in 2015-2016. The outcome variable was HTN, determined by measuring blood pressure in the right arm via a digital arm blood pressure monitor. Awareness, treatment, and control of HTN were assessed by a validated and reliable researcher-developed questionnaire. Other demographic and clinical variables were assessed via a demographic questionnaire.

RESULTS

The overall prevalence of HTN was 17.3% (18.9 and 15.5% in men and women, respectively). The prevalence of HTN increased in both genders with age. The prevalence of awareness of HTN among people with HTN was 69.2%, of whom 92.4 and 59.9% were taking medication for HTN and had controlled HTN, respectively. Logistic regression identified age, body mass index, having diabetes and hyperlipidemia, and a positive family history of HTN as determinants of awareness of HTN.

CONCLUSIONS

The results showed that HTN was highly prevalent in the community, especially in men and in middle-aged and older adults. Approximately 30.8% of patients were unaware of their disease, and there was less awareness among younger adults. Despite the high frequency of taking medication to treat HTN, it was uncontrolled in more than 40.1% of patients. Health policy-makers should therefore consider appropriate preventive and therapeutic strategies for these high-risk groups.

Summary

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Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population: Soo Jeong Kim, Jakyoung Lee, Sun Ha Jee, Chung Mo Nam, Kihong Chun, Il Soo Park, Soon Young Lee; Epidemiol Health. 2010;32:e2010003. Published online May 1, 2010; DOI: https://doi.org/10.4178/epih/e2010003

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Abstract

<sec><title>OBJECTIVES</title>The aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea.</sec><sec><title>METHODS</title>A total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN.</sec><sec><title>RESULTS</title>With regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial.</sec><sec><title>CONCLUSION</title>Improvements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.</sec>

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Review

Stress and Cardiovascular Disease.: Byung Yeol Chun; Korean J Epidemiol. 2002;24(2):131-136.

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Abstract PDF: Abstract
Stress is a newly recognized risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, by clustering of traditional cardiovascular risk factors, endothelial dysfunction, myocardial ischemia, plaque rupture, thrombosis, and malignant arrhythmia. And it is necessary to study on the role of stress in the causation of developing cardiovascular disease by a direct hormonal effect on heart or an indirect behavioral change. A better understanding of the behavioral and physiologic associations between psychological stress and cardiovascular disease will assist researchers in developing effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality in Korea.; Summary

Original Articles

Intervention Study for the Effectiveness of Alcohol Restriction to Blood Pressure.: Yeon Ee Song, Kang Sook Lee; Korean J Epidemiol. 2001;23(2):25-32.

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Abstract PDF: Abstract
PURPOSE
To assess whether blood pressure is reduced by the intervention of intensive weekly counseling to lower alcohol intake for 12 weeks in heavy drinkers with elevated blood pressure, we conducted the quasi-experimental study through workplace health promotion program.
METHODS
Thirty workers with an average intake of alcohol over 180 g/week(2 bottles of Soju, Korean popular liquor) and with over 90 mm Hg in diastolic blood pressure(DBP) or over 140 mm Hg systolic blood pressure(SBP) assigned to intervention group(15 men, IG) and control group(15 men, CG) voluntarily. Mean age was 47.2 6.5 and 43.0 5.4 years old respectivel. The goal of intervention was below 45g/week(1/2 bottle of Soju).
RESULTS
Average weekly alcohol intake after 12 weeks in IG was significantly reduced(before 300.6 114.8g/week, after 24.8 24.5g/week) compared with CG(before 334.4 150.7g/week, after 311.3 150.8g/week). In IG, SBP(before 141.5 9.4mm Hg, after 128.7 13.0mm Hg) and DBP(before 95.5 6.3mm Gg, after 88.0 10.8mm Hg) was significantly decreased after 12 weeks of alcohol restriction program, but in CG there was no change.
CONCLUSION
Restriction program of alcohol intake in workplace was so effective to reduce blood pressure among hypertensives, although this study has a limitation of small subjects, short duration of follow up and no randomized controlled design.; Summary

The Association of Hyperinsulinemia with Other Cardiovascular Risk Factors.: Kang Sook Lee, Bok Rye Song; Korean J Epidemiol. 1998;20(1):167-177.

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Abstract PDF: Abstract
BACKGROUND
Hypertension, obesity, non-insulin dependent diabetes(NIDDM), and dyslipidemia are common metaolic disorders that afflict the majority of the elderly who live in Westernized societies. To explore whether the hyperinsulinemia associated with other cardiovascular risk factors in Asian populations such as Koreans.
METHODS
In this cross-sectional study we evaluated the association of hyperinsulinemia with hypertension, obesity, diabetes and hyperlipidemia. Subjects were 600 men and 396 women at least 20 years old who visited the prevention center at St. Mary's Hospital in Seoul, between March and August 1997 for a multiphasic health examination.
RESULTS
In hyperinsulinemia group( >90 percentile of fasting blood insulin 10.01uU/ml in men and 8.54 uU/mlin women), body mass index(BMI), fasting blood sugar, and triglyceride and systolic or diastolic blood pressure were significantly higher than normal insulin goup in both of men and women. The major contributable risk factor to blood insulin concentration was BMI(14% in men, 13% in women). In person with the highest tertile of insulin concentration compared with those in the lowest tertile, age adjusted odds ratio of hypertension, obesity, and hypertriglyceride were 2.22(95% Confidence Interval: 1.38-3.63), 6.96(4.31-11.51), and 4.05(1.88-9.75) in men, and 2.05(95% CI: 1.10-3.86), 4.34(2.39-8.16) and 6.84(1.18-129.40) in women. Age adjusted odds ratio for clusterin of cardiovascular risk factors in the higest tertile of insulin compared with those in lower insulin than that level were 8.74(2.82-29.27) in men and 4.91(1.19-21.79) in women.
CONCLUSION
The hyperinsulinemia was associated with hypertension, obesity, NIDDM and hypertriglyceridemia. Further prospective studies are required to investigate the effects of intervetion to improve insulin sensitivity such as calorie restriction and exercise.; Summary

Association of Lifestyle and Hypertension in Rural Population.: Byung Mann Cho; Korean J Epidemiol. 1998;20(1):51-59.

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Abstract PDF: Abstract
To evaluate the association of individual health-related lifestyle and hypertension in rual population, data from a population sample of 633(257 men and 376 women) aged 40 years and older and residing in a rural area were analyxed cross-sectionally. The data had been collected by personal interview using structured questionnaire during August 1996. In multivariate analysis, adjusted prevalence rate ration of bypertension increased significantly with increasing amount of coffee drinkin(cups/day) in men(p=0.029) and body mass indes(kh/m2) in women(p=0.013). The level of perceiving his or her own health status was a positive correlate of hypertension in men(p=0.034) and women(p=0.107). Thus, in this population hypertension appears to be associated with coffee drinking in men, body mass index in women and the proportion of awareness of his or her own hypertension seems to be low.; Summary

Dietary Factors Related to the Chronic Diseases Assessed by Semiquantitaive Food Frequency Questionnaire in Korean Adults Living in Rural Area.: J E Shim, J Y Ryu, H Y Paik, C S Shin, H K Lee, Y S Park; Korean J Epidemiol. 1997;19(1):42-57.

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Abstract PDF: Abstract
This study was conducted to assess dietary intake of adults in rural ares and to determine the dietary factors associated with the development of chronic diseases. A cross sectional dietary survey using semiquantitative food frequency questionnaire was conducted together with a health survey including health questionnaire, physical examination and glucose tolerance test. Mean dairy energy intake of subjects was 1872.5kcal and mean percent of RDA for energy intake was 88.4%. Nutrients of average intake below 75% of RDA were vitamine A, vitamin B2, calcium. Older subjects tend to have lower nutrient intake. Intakes of most nutrients and proportion of energy from alcohol were signifi-cantly higher in men than in woman. Newly diagnosed diabetic patients and hypertensives had higher age, BMI, blood pressure, fasting serum glucose levels and serum lipid levels compared with subjects without the diseases, respectively. After adjusted for age and sex, newly-diagnosed hypertencives had more intakes of charbohydrate and niacin, and higher proportion of energy from fat. The odds ratio(OR) for hypertension in higher quartile of subjects compared with subjects in the lowest quartile of intake increased significantly for energy, fat,protein, carbohydrate, vitamin B1, vitamin B2 and niacin after adjusted for age and sex. Also, compared with subjects consumed nutrients in 75-125% of RDA, the OR for hypertension in subjects with intake levels above 125% of RDA were 0.75 for energy, 1.69 for calcium and 0.68 for niacin, and those in below 75% of RDA were 1.33 for energy 1.42 for calcium, 1.23 for vitamin B1, 1.41 for vitamin B2. These inverse associations suggest that the development of hypertension in rural area of Korea is partialey attributed to the intake of several nutrients, generally of undernu-trition. Therefore these results suggests that dietary factors related to chronic diseases in Korea are different from those in the Western society.; Summary

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