Kim, So-Young;Cho, In-Sook;Lee, Jae-Ho;Kim, Ji-Hyun;Lee, Eun-Jung;Park, Jong-Hyock;Lee, Jin-Seok;Kim, Yoon
Journal of Preventive Medicine and Public Health
/
v.40
no.6
/
pp.487-494
/
2007
Objectives : Little is known about the physician-related factors that are associated with the management of Hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. Methods : We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do, Forty-one physicians completed the survey (response rates : 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the self-reported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center#s information system. We compared the physicians# perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians# antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physician-related factors. Results : The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients# control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI : 1.17-1.48). Conclusions : Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians# overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician# awareness regarding the management of patients with hypertension are needed.
Kim, Won-Jae;Lee, Jong-Un;Park, Yong-Hyun;Nam, Sang-Chae
The Korean Journal of Physiology and Pharmacology
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v.1
no.5
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pp.529-535
/
1997
The present study was aimed at investigating whether the vascular calcium regulation is altered in hypertension. Two-kidney, one clip (2K1C) and deoxycorticosterone acetate (DOCA)-salt hypertension were made in rats, and their thoracic aortae were taken 4 weeks later. The isometric contractile response and calcium uptake of the endothelium-denuded aortic preparations were determined. Caffeine ($0.1{\sim}35\;mmol/L$) induced a greater contraction in 2K1C and DOCA-salt hypertension than in normotensive control. When the vascular calcium store was functionally-depleted by a repeated exposure to caffeine, it took longer to reload the store and to resume the initial contraction force in response to caffeine in both 2K1C and DOCA-salt hypertension. The vascular $^{45}Ca$ uptake following the functional depletion of the cellular store was also greater in both models of hypertension than in control. Ryanodine, calcium channel activator of the sarcoplasmic reticulum, attenuated the restoration of caffeine-induced vascular contraction, which was not affected by either 2K1C or DOCA-salt hypertension. Nifedipine, an L-type $Ca^{2+}$ channel blocker, attenuated the restoration of caffeine-induced contraction, which was not affected by DOCA-salt hypertension, but was more pronounced in 2K1C hypertension. Nifedipine also diminished the vascular $^{45}Ca$ uptake, which was not affected by DOCA-salt hypertension, but was more pronounced in 2K1C hypertension. Ouabain, a $Na^+,\;K^+-ATPase$ inhibitor, increased the caffeine-induced contraction by a similar magnitude in control and 2K1C hypertension, which was, however, markedly attenuated in DOCA-salt hypertension. Ouabain enhanced the vascular $^{45}Ca$ uptake, the degree of which was not affected by 2K1C hypertension, but was markedly attenuated in DOCA-salt hypertension compared with that in control. Cyclopiazonic acid, a selective inhibitor of $Ca^{2+}-ATPase$ of the sarcoplasmic reticulum, attenuated the restoration of caffeine-induced contraction, which was not affected by 2K1C hypertension, but was more marked in DOCA-salt hypertension. These results suggest that the increased vascular calcium storage may be attributed to an enhanced calcium influx in 2K1C hypertension, and to an impaired $Na^+-K^+$ pump activity of the cell membrane and subsequently increased calcium pump activity of the cellular store in DOCA-salt hypertension.
Lee, Dong-Han;Choi, Youn-Hee;Lee, Kang-Hee;Kang, Dae-Ryong;Jee, Sun-Ha;Nam, Chung-Mo;Suh, Il
Journal of Preventive Medicine and Public Health
/
v.36
no.3
/
pp.289-297
/
2003
Objectives : The main objectives of this study are to identify the factors associated with hypertension control and to determine the influencing factors associated with antihypertensive therapy. Methods : The study was conducted on 107 subjects who participated in the 1999 and 2002 Gwacheon Study and who had had uncontrolled hypertension (systolic$\geq$140 or diastolic$\geq$ 90mmHg) in 1999, We compared the characteristics of the controlled and uncontrolled hypertensive group and investigated the characteristics of those taking antihypertensive medication. Univariate associations between hypertension control and its characteristics and the association between antihypertension treatment and its characteristics were tested with $x^2$-test. We also peformed logistic regression analysis. Results : The participants who had their blood pressure checked within 6 months before their first measurement and those who had taken the antihypertensive medication showed significantly better hypertension control during the follow-up. The multivariate analysis showed that baseline antihypertensive therapy was the most important determinant factor of hypertension control during the follow-up. Socioeconomic level and life style did not affect hypertension control when controlled by the treatment variable in this study. The factors associated with antihypertensive therapy at follow-up were previous antihypertensive therapy, old age, and high educational level. Conclusions : Those who received antihypertensive therapy and those who had their blood pressure re-checked within 6 months both showed well controlled hypertension. The subjects with high educational level complied well with the antihypertensive regimen, but those in their forties did not.
Objective: To access the safety of chemotherapy for elderly cancer patients complicated with hypertension. Methods: Elderly cancer patients who were complicated with hypertension and treated by chemotherapy were recruited. All patients were treated by chemotherapy after an intervention on hypertension by psychotherapy, exercise guidance, salt regulation and nutrition support, therapy on hypertension, as well as prevention on hypertension associated complications. Results: In 68 eligible patients, two suspended chemotherapy because of adverse reactions and 4 because of disease progression. The remaining 62 patients completed chemotherapy smoothly based on good hypertension control. Conclusion: With effective control of blood pressure, chemotherapy for elderly cancer patients complicated with hypertension is generally safe.
Objectives : To access the safety and efficacy of Black Ginseng (BG), a traditional herbal medicine on hypertension, we examined various parameters involved in the pathogenesis of hypertension. Methods : We made deoxycorticosterone acetate (DOCA;25 mg/kg/3times/weeks for 3 weeks)-induced hypertension Sprague-Dawley (SD) rats. And experiment group was treated with extract of black ginseng (BG;200 mg/kg/day). Results : In results, the weight of experiment group treated with BG was increased compared with normal and control group. And the heart and lung weights of experiment group were decreased compared with control group. The blood pressure and pulse rate of group treated with BG were significantly decreased compared with control group. In addition, BG greatly reduced the levels of aldosterone. These results suggested that BG has suppressive effects on hypertension, and BG has potential as a safe and effective therapeutics for hypertension. Conclusions : The present data show evidences on anti-hypertension activity of BG in an experimental animal system, which can provide further insights into the development of anti-hypertension therapeutic agents.
The present study was aimed at investigating whether the calcium current in the vascular smooth muscle (VSM) cells is altered in renal hypertension. Two-kidney, one clip (2K1C) and deoxycorticosterone acetate (DOCA)-salt hypertension were made in Sprague-Dawley rats. Rats without clipping the renal artery or implanting DOCA were used as control for 2K1C and DOCA-salt hypertension, respectively. Four weeks after clipping, systolic blood pressure was significantly higher in 2K1C rats than in control $(192{\pm}24\;and\;119{\pm}4$ mmHg, respectively, n=16 each). DOCA-salt rats also showed a higher blood pressure $(180{\pm}15$ mmHg, n=18) compared with control $(121{\pm}6$ mmHg, n=14). VSM cells were enzymatically and mechanically isolated from basilar arteries. Single relaxed VSM cells measured $5{\sim}10\;{\mu}m$ in width and $70{\sim}150\;{\mu}m$ in length were obtained. VSM cells could not be differentiated in size and shape between hypertensive and normotensive rats under light microscopy. High-threshold (L-type) calcium currents were recorded using whole-cell patch clamp technique. The amplitude of the current recorded from VSM cells was larger in 2K1C hypertension than in control. Neither the voltage-dependence of the calcium current nor the cell capacitance was significantly affected by 2K1C hypertension. By contrast, the amplitude of the calcium current was not altered in DOCA-salt hypertension. These results suggest that high-threshold calcium current of the VSM cells is altered in 2K1C hypertension, and that calcium channel may not be involved in calcium recruitment of VSM in DOCA-salt hypertension.
The purpose of this study is to contribute basic data toward the efficient management of Hypertension by comprehensive analysis of several factors which make influences on indicators of Hypertension management. To achieve this, using the data of 2007, 2008 Korea National Health and Nutrition Examination Survey, 2,580 adults aged over 19 who suffered from hypertension have been analyzed comprehensively. The major results can be summarized as follows: First, in regard to the influential factors for awareness and treatment of hypertension, the older the patients were, the poorer their self-rated health status were. And when they had experienced a health examination, the more likely the hypertensive patients were aware of their hypertension and took the treatment for it. Second, as for the influential factors for control of hypertension, those who were older and those who had a health examination were significantly more likely to control their hypertension irrespective of gender. However, regular drinkers fell significantly behind in that aspect. The findings of this study show that systematic hypertension management, focusing on health behavior factors that affect the level of hypertension management, in accordance with the patients' sex and age will provide a more efficient way.
Purpose: This study was done to verify the effects of a self-regulation program for management of hypertension. Method: Thirty patients with hypertension registered in a community health center were selected as the experiment group, and control group were patients in another community health center, matched for age and gender. The self-regulation program included daily blood pressure checks, periodic counseling, and health education. A self-check digital device with instructions was provided for self-monitoring of blood pressure, and the participants were interviewed before they took part in the program. Results: The first hypothesis was supported: There will be a greater reduction in both systolic and diastolic blood pressure for patients with hypertension who participate in the self-regulation program compared to patients in the control group. The second hypothesis was also supported: Patients with hypertension who participate in the self-regulation program will perform self-care activities better than those in the control group. Conclusion: The findings indicate that a self-regulation program reduces systolic and diastolic blood pressure and improves self-care in patients with hypertension. It is recommended that this self-regulation program be used in community health clinics for management of hypertension and prevention of complications.
The etiologic role of renin-angiotensin system and sodium-volume status in the pathophysiology of various forms of hypertension was investigated. Plasma renin activity (PRA) was measured by radioimmunoassay, while sodium-volume status was evaluated by the determination of total exchangeable sodium(NaE) using isotope dilution method. The subjects consisted of 25 controls, 24 patients with essential hypertension, with chronic renal failure (13 with hypertension, 9 without hypertension) and with malignant hypertension. The results were as follows: 1. An inverse correlation between NaE and PRA was noted in control subjects (r=-0.598, p<0.001) and normal renin essential hypertension(r=-0.551, p<0.05) and the chronic renal failure with hypertension. (r=-0.790, p<0.001) 2. NaE increased markedly the in chronic renal failure with hypertension ($66.9{\pm}8.69mEq/kg$ of LBM, p<0.001) and the chronic renal failure without hypertension ($54.9{\pm}9.28mEq/kg$ of LBM, p<0.05), while mild increase was noted in malignant hypertension ($51.7{\pm}6.24mEq/kg$ of LBM, 0.05
$50.1{\pm}7.24mEq$) as well as in its renin subgroups.(p>0.1) 3. Absolute value of PRA was not deviated significantly from control group ($2.53{\pm}1.416ng/ml/hr$) except in malignant hypertension ($6.09{\pm}2.042$, p<0.001). But PRA was inappropriately high in relation to prevailing NaE in the chronic renal failure with hypertension (eleven of thirteen patients) and malignant hypertension (ten of fourteen patients), while PRA variatiation was within physiologic range in the chronic renal failure without hypertension. 4. The NaE-PRA product was markedly increased in the chronic renal failure with hypertension ($514.4{\pm}42.10$, p<0.001) and in malignant hypertension ($442.7{\pm}55.03$, p<0.001), while moderately increased NaE-PRA product was noted in the chronic renal failure without hypertension ($402.6{\pm}59.67$, p<0.001). No significant difference in NaE-PRA product was noted in essential hypertension ($354.4{\pm}62.38$, p>0.1). It is suggested that renin-angiotensin system plays a predominant role in the pathogenesis of malignant hypertension and in hypertension of chronic renal failure, though sodium retention is also contributing factor. PRA variation in essential hypertension does not appear to be associated with any consistent change in Na-volume status, suggesting the existence of another mechanism in the genesis of hypertension and PRA variation.
Hypertension excessively affects national health is the basic disease that causes death and disablement after the middle-aged. Therefore, The detection and control of hypertension is essential to health care. In general, It is known that the systolic blood pressure should be below 140mmHg, the diastolic blood pressure should be below 90mmHg. Presently, the treatment of hypertension is mostly taking anti-hypertension drug, diet and stability. but Taking anti-hypertension drug has such side effects as depression. and that, We were making a study of various treatments of hypertension. In a course of hypertension study, We applied aromatherapy to the control of hypertension. Aromatherapy is the practice of using of volate plant oils including essential oils, for psychological and physical well-being. Essential oils are drawn into the body by the sense smell not only does the aroma of the true plant stimulate the brain to the trigger a positive effect, but supply physical benefits also. In Europe and North America, The study and development of aromatherapy is lively in progress. In the control of hypertension, We applied Lavender, Majoram, Ylang-Ylang to forty-two hypertensive patients. After aromatherapy for controlling hypertension. We measured the changes of the systolic blood pressure & the diastolic blood pressure of patients by time. As the result of above study, We identified the significance of blood pressure down by aromatherapy.
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