The Korean Society of Hypertension Guidelines for the Management of Hypertension in 2013: Its Essentials and Key Points

Abstract

The Korean Society of Hypertension published new guidelines for the management of hypertension in 2013 which fully revised the first Korean hypertension treatment guideline published in 2004. Due to shortage of Korean data, the Committee decided to establish the guideline in the form of an 'adaptation' of the recently released guidelines. The prevalence of hypertension was 28.5% in the recent Korean National Health and Nutrition Examination Survey in 2011, and the awareness, treatment, and control rates are generally improving. However, the risks for cerebrovascular disease and coronary artery disease which are attributable to hypertension were the highest in Korea. The classification of hypertension is the same as in other guidelines. The remarkable difference is that prehypertension is further classified as stage 1 and 2 prehypertension because the cardiovascular risk is significantly different within the prehypertensive range. Although the decision-making was based on office blood pressure (BP) measured by the auscultation method using a stethoscope, the importance of home BP measurement and ambulatory BP monitoring is also stressed. The Korean guideline does not recommend a drug therapy in patients within the prehypertensive range, even in patients with prediabetes, diabetes mellitus, stroke, or coronary artery disease. In an elderly population over 65 years old, drug therapy can be initiated when the systolic BP (SBP) is ≥ 160 mm Hg. The target BP is generally an SBP of <140 mm Hg and a diastolic BP (DBP) of <90 mm Hg regardless of previous cardiovascular events. However, in patients with hypertension and diabetes, the lower DBP control <85 mm Hg is recommended. Also, in patients with hypertension with prominent albuminuria, a more strict SBP control <130 mm Hg can be recommended. In lifestyle modification, sodium reduction is the most important factor in Korea. Five classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, β-blockers, calcium antagonists, and diuretics, are equally recommended as a first-line treatment, whereas a combination therapy chosen from renin-angiotensin system inhibitors, calcium antagonists, and diuretics is preferentially recommended.

Current status of home blood pressure monitoring in Asia: Statement from the HOPE Asia Network

“…Home systolic BP (SBP) <135 mm Hg and diastolic BP (DBP) <85 mm Hg are typically considered normal . In patients with hypertension and other risk factors, a more strict SBP level of <130 mm Hg can be recommended . In this article, the HOPE Asia (Hypertension Cardiovascular Outcome Prevention and Evidence in Asia) Network review the current evidence on HBPM in Asia, including but not limited to the key published literature from the region, data presented at congresses, and national hypertension management guidelines to determine the current utilization of HBPM in clinical practice in Asia.…”

High-Intensity Statin Therapy Is “Too Much,” Thus Not Indicated for Very Elderly Patients

“…Dyslipidemia is an important risk factor of cardiovascular disease [1, 2]. A 10 mg/dL increase of total cholesterol was associated with a 9% increase of 30-year cardiovascular death in the Framingham study [3].…”

Hypertension Guidelines: Timely New Initiatives from East Asia

“…This issue of Pulse brings together reviews of new or pending guidelines for the management of hypertension from China, Japan, Korea and Taiwan, covering the vast populations of East Asia [1,2,3,4,5,6,7,8,9]. This is a most timely and welcome initiative for many reasons.…”

“…The Japanese guidelines recommend a retention of the target of <130/80 mm Hg for patients with diabetes or chronic kidney disease and albuminuria [3,7], and the Taiwan guidelines advocate this same target for patients with diabetes and proteinuric renal disease, and additionally for those with coronary disease and those receiving antithrombotic drugs for stroke prevention [5,9]. The Korean guidelines recommend tighter targets for high-risk patients, specifically <140/85 mm Hg for patients with diabetes and <130/80 mm Hg for those with chronic renal disease and prominent albuminuria [4,8]. The Chinese guidelines from 2011 recommend a target of <130/80 mm Hg for patients with diabetes, chronic kidney disease, or coronary disease, but not for those with stroke [2,6].…”

“…In summary, these four sets of guidelines [2,3,4,5,6,7,8,9] make a very timely and substantial contribution to the management of hypertension in the vast populations of Asia that are increasingly burdened by hypertension, metabolic disorders and cardiovascular disease. The four guidelines apply to populations with great similarities in the characteristics of their hypertension and their cardiovascular disease burden.…”