Hypertensive emergencies in Asia: A brief review.

Hypertensive emergency is one of the most challenging conditions to treat in the emergency department (ED). From previous studies, about 1%-3% of hypertensive individuals experienced hypertensive emergencies. Its prevalence varied by country and region throughout Asia. Asian populations have more different biological and cultural backgrounds than Caucasians and even within Asian countries. However, there is a scarcity of research on clinical features, treatment, and outcomes in multinational Asian populations. The authors aimed to review the current evidence about epidemiology, clinical characteristics and outcomes, and practice guidelines in Asia. Five observational studies and nine clinical practice guidelines across Asia were reviewed. The prevalence of hypertensive emergencies ranged from .1% to 1.5%. Stroke was the most common target organ involvement in Asians who presented with hypertensive emergencies. Although most hypertensive emergency patients required hospitalization, the mortality rate was low. Given the current lack of data among Asian countries, a multinational data repository and Asian guidelines on hypertensive emergency management are mandatory.

Regional differences in office and self-measured home heart rates in Asian hypertensive patients: AsiaBP@Home study.

Increased heart rate is a predictor of cardiovascular disease, heart failure, and all-cause mortality. In those with high heart rates, interventions for heart rate reduction have been associated with reductions in coronary events. Asia is a diverse continent, and the prevalences of hypertension and cardiovascular disease differ among its countries. The present analysis of AsiaBP@Home study data investigated differences among resting heart rates (RHRs) in 1443 hypertensive patients from three Asian regions: East Asia (N = 595), Southeast Asia (N = 680), and South Asia (N = 168). This is the first study to investigate self-measured RHR values in different Asian countries/regions using the same validated home BP monitoring device (Omron HEM-7130-AP/HEM-7131-E). Subjects in South Asia had higher RHR values compared with the other two regions, and the regional tendency found in RHR values was different from that found in BP values. Even after adjusting for age, sex, BMI, habitual alcohol consumption, current smoking habit, shift worker, hyperlipidemia, diabetes, chronic kidney disease, history of heart failure, and beta-blocker use, both office and home RHR values in South Asia were the highest among Asia (mean values ± SE of office: East Asia [E] 75.2 ± 1.5 bpm, Southeast Asia [Se] 76.7 ± 1.5 bpm, South Asia [S] 81.9 ± 1.4 bpm; home morning: [E] 69.0 ± 1.2 bpm, [Se] 72.9 ± 1.2 bpm, [S] 74.9 ± 1.1 bpm; home evening: [E] 74.6 ± 1.2 bpm, [Se] 78.3 ± 1.2 bpm, [S] 83.8 ± 1.1 bpm). Given what is known about the impact of RHR on heart disease, our findings suggest the possible benefit of regionally tailored clinical strategies for cardiovascular disease prevention.

The feasibility of polypill for cardiovascular disease prevention in Asian Population.

Polypill is a fixed-dose combination of medications with proven benefits for the prevention of cardiovascular disease (CVD). Its role in CVD prevention has been extensively debated since the inception of this concept in 2003. There are two major kinds of polypills in clinical studies. The first is polypill that combines multiple low-dose medications for controlling only one CVD risk factor (such as high blood pressure or high serum cholesterol). These "single-purpose" polypills were mostly developed from original producers and have higher cost. The polypill that combines 3-4 pharmaceutical components, each with potential to reduce one major cardiovascular risk factors is "multi-purpose" or "cardiovascular" polypill. Using data from various clinical trials and from meta-analysis, Wald and Law claimed that this "cardiovascular" polypill when administered to every individual older than 55 years could reduce the incidence of CVD by more than 80%. Several short and intermediate to long-term studies with different cardiovascular polypills in phase II and III trials showed that they could provide better adherence, equivalent, or better risk factor control and quality of life among users as compared to usual care. One recently published randomized controlled clinical trial demonstrated the effectiveness and safety of a four-component polypill for both primary and secondary CVD prevention with acceptable number needed to treat (NNT) to prevent one major cardiovascular event. Considering the slow achievement of CVD prevention in many poor- and middle-income Asian countries and also the need to further improve compliance of antihypertensive and lipid lowering medications in many high-income Asian countries, the concept of "cardiovascular polypill" could be very useful. With further support from ongoing polypill cardiovascular outcome trials, polypill could be the foundation of the population-based strategies for CVD prevention.

Angiotensin receptor neprilysin inhibitor as a novel antihypertensive drug: Evidence from Asia and around the globe.

Hypertension is a worldwide epidemic that continues to grow, with a subset of patients responding poorly to current treatment available. This is especially relevant in Asia, which constitutes 61% of the global population. Hypertension in Asia is a unique entity that is often salt-sensitive, nocturnal, and systolic predominant. Sacubitril/valsartan is a first-in-class angiotensin receptor neprilysin inhibitor that was first used in heart failure with reduced ejection fraction. Sacubitril inhibits neprilysin, a metallopeptidase that degrades natriuretic peptides (NPs). NPs exert sympatholytic, diuretic, natriuretic, vasodilatory, and insulin-sensitizing effects mostly via cyclic guanosine monophosphate (cGMP)-mediated pathways. As an antihypertensive agent, sacubitril/valsartan has outperformed angiotensin II receptor type 1 blockers (ARBs), with additional reductions of office systolic blood pressures ranging between 5 and 7 mmHg, in multiple studies in Asia and around the globe. The drug was well tolerated even in the elderly or those with chronic kidney disease. Its mechanisms of actions are particularly attractive for treatment of hypertension in Asia. Sacubitril/valsartan offers a novel, dual class, single-molecule property that may be considered as first-line antihypertensive therapy. Further investigations are needed to validate its safety for long-term use and to explore other potentials such as in the management of insulin resistance and obesity, which often coexist with hypertension in Asia.

Early morning-Best time window of hourly 24-hour ambulatory blood pressure in relation to hypertensive organ damage: The Japan Morning Surge-Home Blood Pressure study.

The correlations between organ damage and hourly ambulatory blood pressure (BP) have not been established. The patients were 1464 participants of the Japan Morning Surge-Home Blood Pressure (J-HOP) study participants who underwent ambulatory BP monitoring. The hourly systolic BP (SBP) at x o'clock was defined as the average of SBP values measured at times x - 30 minutes, x, and x + 30 minutes. The mean age was 64.8 ± 11.6 years. The percentage of male participants was 47.8%. The left ventricular mass index (LVMI) was significantly associated with SBP at 6 o'clock (r = 0.166, P < 0.001). The carotid intima-media thickness was significantly associated with SBP at 5 o'clock (r = 0.196, P < 0.001). After adjustment for age, sex, smoking, hyperlipidemia, diabetes mellitus, antihypertensive drug use, clinic SBP, and 24-hour ambulatory SBP, the correlations of the LVMI and hourly SBP at 6 o'clock remained significant (beta coefficient = 0.125, P < 0.01). In conclusion, morning ambulatory systolic BP especially at 5 and 6 o'clock was independently associated with organ damage.

Hypertension study among attendants at the Board of Investment Fair 2000.

To study the prevalence of hypertension, blood pressure (BP) controlled and cardiovascular risk factors in people who attended the Board of Investment 2002 Fair (BOI Fair). Altogether 1,774 participants aged more than 15 years old voluntarily participated in BP check-ups during the 3rd-17th February 2000 at the BOI Fair. Three hundred and fifty participants (19.7%) were known cases of hypertension (HT) and 340 participants (19.2%) were newly diagnosed hypertension cases (NHT). Of the HT group, 216 cases were under current treatment (61.7%) and only 69 cases (31.9%) had adequate BP control. Of the NHT group, cardiovascular risk factors were found more frequently than in normotensive participants. This study indicates the necessity of building up awareness in the population, improving in clinical detection, effectively controlling of the risk factors and the normalization of BP. This might prevent hypertension and reduce the cardiovascular disease.

Prevalence of erectile dysfunction among treated hypertensive males.

OBJECTIVE: Study the prevalence rate of erectile dysfunction (ED) in treated hypertensive males. MATERIAL AND METHOD: Four hundred and twenty nine patients attending the outpatient clinic at Siriraj Hospital between April 2001 and October 2002 were interviewed. The International Index of Erectile Function, a 5-item version (IIEF-5) questionnaire was used. All questions were carried out by a well-trained interviewer. RESULT: Of the 429 patients (mean age of 57.5 +/- 12.0 years) interviewed, 241 cases (56.2%) reported ED. The prevalence was found to increase with age: from 0% in men aged < 40 years, 47.4% in men aged 40-59 years, and 75.3% in men aged > 60 years. Risk of ED was significantly (p < 0. 01) associated with the elderly (OR = 4.7, 95%CI= 3.1-7.1), patients who suffered from hypertension longer than 5 years (OR = 4.0, 95%CI = 2.6-6.1), those with a history of back/pelvic surgery (OR = 2.8, 95%CI = 1.4-4.8), smoking (OR = 1.5, 95%CI = 1.0-2.2), alcohol ingestion (OR = 2.0, 95%CI = 1.3-3.0), diabetes mellitus (OR = 6.3, 95%CI = 3.5-11.2), diuretics (OR = 1.9, 95%CI = 1.3-2.8), and alpha-2 agonist (OR = 7.9, 95%CI = 2.3-26.1) usage. On multivariate regression analyses, the elderly (OR = 4.0, 95%CI = 2.5-6.4), diabetes mellitus (OR = 6.4, 95%CI = 3.5-11.8), the usage of diuretic (OR = 2.1, 95%CI = 1.3-3.4), and alpha-2 agonist (OR = 6.0, 95%CI = 1.7-21.3) predicted ED (p < 0.005 in all categories). Neither history of back/pelvic operation, smoking, alcohol ingestion, overweight (BMI > or = 30 kg/m2), or any other antihypertensive medications independently predicted ED. CONCLUSION: Our results indicated that ED in male hypertensive patients is common and the cause should be sought and avoided. Diabetic patients or those who have been using diuretic or alpha-2 agonists should receive much attention and be routinely evaluated for ED.