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Original Article

Background
Similar to smoking, exposure to secondhand smoke is a risk factor for developing hypertension and cardiovascular diseases; however, there is no standardized method for measuring smoke exposure. Measuring urine cotinine levels is one possible means for determining the degree of exposure to secondhand smoke. This study investigated the association between urinary cotinine levels and blood pressure in Korean adults exposed to secondhand smoke.
Methods
Data from the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2018 were used. A total of 9,273 participants aged ≥19 years self-reported as current non-smokers, which was cotinine- verified. A complex sample general linear model regression analysis was performed to analyze the association between urine cotinine and blood pressure. A P-value of <0.05 was considered statistically significant.
Results
Corrected urine cotinine levels were positively associated with systolic and diastolic blood pressure in female participants (P<0.001 and P=0.040, respectively). Furthermore, a 10-fold increase in the corrected urine cotinine level of those in contact with secondhand smoke was independently associated with 2.085 mm Hg and 0.575 mm Hg increases in systolic and diastolic blood pressure, respectively. However, there was no association between systolic and diastolic blood pressure in male participants (P=0.226 and P=0.256, respectively).
Conclusion
Urinary cotinine levels were positively associated with increased blood pressure in females exposed to secondhand smoke. Therefore, urinary cotinine may be used as an indicator to quantify and monitor the effects of blood pressure elevation in females exposed to secondhand smoke.
  • 3,102 View
  • 156 Download

Review Article

Fruit Intake to Prevent and Control Hypertension and Diabetes
Hyun Ah Park
Korean J Fam Med 2021;42(1):9-16.   Published online January 20, 2021
DOI: https://doi.org/10.4082/kjfm.20.0225
Fruits are considered healthy because of their high antioxidant, vitamin, mineral, fiber, and phytochemical contents. However, their high sugar content is a concern for glucose, lipid, and uric acid metabolism. We reviewed related articles published in the last 10 years and summarized evidence that relates fruit intake to the prevention and control of hypertension and diabetes mellitus. Clinicians should familiarize themselves with appropriate fruit intake to counsel at-risk patients on hypertension and diabetes.

Citations

Citations to this article as recorded by  
  • Associations between the Global Diet Quality Score and risk of type 2 diabetes: Tehran lipid and glucose study
    Shahrzad Daei, Firoozeh Hosseini-Esfahani, Azam Ildarabadi, Parvin Mirmiran, Fereidoun Azizi, Meisam Akhlaghdoust
    PLOS ONE.2025; 20(1): e0313886.     CrossRef
  • Is breakfast consumption detrimental, unnecessary, or an opportunity for health promotion? A review of cardiometabolic outcomes and functional food choices
    Heitor O. Santos, Grant M. Tinsley
    Diabetes/Metabolism Research and Reviews.2024;[Epub]     CrossRef
  • Undiagnosed hypertension and associated factors among adult population in central zone of Tigray, Northern Ethiopia 2020: A cross‐sectional study
    Haftea Hagos Mekonen, Tsegu Hailu Gebru, Kbrom Gemechu Kiros, Tesfay Gebreslassie Gebrehiwot, Yohannes Ashebir Tesfamichael
    Health Science Reports.2024;[Epub]     CrossRef
  • Drug-related problems among type 2 diabetic patients in Sunwal Municipality of Western Nepal
    Sushma Chapagain, Nabin Pathak, Kushal Subedi, Prakash Ghimire, Bijay Adhikari, Niranjan Shrestha, Nim Bahadur Dangi, Naeem Mubarak
    PLOS ONE.2024; 19(11): e0309781.     CrossRef
  • The Diet Quality of Athletes as Measured by Diet Quality Indices: A Scoping Review
    Stella Dion, Gabriel Walker, Kelly Lambert, Anita Stefoska-Needham, Joel C. Craddock
    Nutrients.2024; 17(1): 89.     CrossRef
  • Ultrasound-assisted extraction and characteristics of maize polysaccharides from different sites
    Zongyan Song, Xiong Xiong, Gangliang Huang
    Ultrasonics Sonochemistry.2023; 95: 106416.     CrossRef
  • Prevalence and Factors Associated with Prehypertension and Hypertension Among Adults: Baseline Findings of PURE Malaysia Cohort Study
    Rosnah Ismail, Noor Hassim Ismail, Zaleha Md Isa, Azmi Mohd Tamil, Mohd Hasni Ja'afar, Nafiza Mat Nasir, Suraya Abdul-Razak, Najihah Zainol Abidin, Nurul Hafiza Ab Razak, Philip Joseph, Khairul Hazdi Yusof
    American Journal of Medicine Open.2023; 10: 100049.     CrossRef
  • Effects of fresh vs dried mango consumption on satiety and postprandial glucose in healthy adults
    Candice Stamper, Sama Safadi, Andrew Gehr, Pia Asuncion, Mee Young Hong
    Metabolism Open.2023; 19: 100253.     CrossRef
  • Revisiting Fruit Allergy: Prevalence across the Globe, Diagnosis, and Current Management
    Thanachit Krikeerati, Pongsawat Rodsaward, Jutamard Nawiboonwong, Kanokkarn Pinyopornpanish, Songwut Phusawang, Mongkhon Sompornrattanaphan
    Foods.2023; 12(22): 4083.     CrossRef
  • The effect of dietary patterns on mild cognitive impairment and dementia incidence among community-dwelling older adults
    Nurul Fatin Malek Rivan, Suzana Shahar, Nik Nur Izzati Nik Mohd Fakhruddin, Yee Xing You, Normah Che Din, Roslee Rajikan
    Frontiers in Nutrition.2022;[Epub]     CrossRef
  • Current status of health promotion in Korea
    Soo Young Kim
    Journal of the Korean Medical Association.2022; 65(12): 776.     CrossRef
  • Current status of nutrient intake in Korea: focused on macronutrients
    Seung-Won Oh
    Journal of the Korean Medical Association.2022; 65(12): 801.     CrossRef
  • Role of Indian Fruits in the Prevention and Management of Hypertension
    Pankaj Prabhakar
    Journal of the Practice of Cardiovascular Sciences.2022; 8(3): 135.     CrossRef
  • Caregiver Perceptions of Child Diet Quality: What Influenced Their Judgment
    Lijing Shao, Yan Ren, Yanming Li, Mei Yang, Bing Xiang, Liping Hao, Xuefeng Yang, Jing Zeng
    Nutrients.2021; 14(1): 125.     CrossRef
  • 8,939 View
  • 205 Download
  • 14 Web of Science
  • 14 Crossref

Original Articles

Association of Hand Grip Strength and Cardiometabolic Markers in Korean Adult Population: The Korea National Health and Nutrition Examination Survey 2015-2016
Hanul Chong, Young Eun Choi, Jin Young Kong, Joo Hyun Park, Hyun Jeong Yoo, Jeong Ho Byeon, Hye Jun Lee, Sang Hyun Lee
Korean J Fam Med 2020;41(5):291-298.   Published online May 8, 2020
DOI: https://doi.org/10.4082/kjfm.18.0129
Background
Muscle strength has been suggested as a cardiovascular marker. The aim of this study was to examine the associations between hand grip strength and biomarkers of cardiovascular disease in the Korean population.
Methods
A total of 9,083 participants aged 20–80 years from Korea National Health and Nutrition Examination Survey 2015–2016 were investigated.
Results
Among men, both relative and dominant hand grip strength showed a positive association with diastolic blood pressure in those aged 65–80 years (95% confidence interval, P-value of dominant and relative hand grip strength: β=0.06, 0.01; P<0.05). Among women, relative and dominant hand grip strength showed a positive relationship to diastolic blood pressure in those aged 20–64 years (β=0.06, 0.01; P<0.001). Body mass index was positively associated with dominant hand grip strength in younger women (β=0.18, P<0.05), whereas it was positively associated with relative hand grip strength in all sex and age groups. High-sensitivity C-reactive protein showed a negative association with relative and dominant hand grip strength in all women, although the same association was observed only in younger men. Diabetes was inversely related to hand grip strength in younger women and men.
Conclusion
Increased hand grip strength may be associated with lower C-reactive protein in women and with less risk of diabetes in the Korean adult population. Further prospective studies are needed for the determination of causality between cardiometabolic markers and hand grip strength.

Citations

Citations to this article as recorded by  
  • The impact of reduced muscular fitness on cardiometabolic risk factors in children aged 9–11 years
    Eva Rodríguez‐Gutiérrez, Ana Torres‐Costoso, Lidia Lucas‐de la Cruz, Arthur E. Mesas, Vicente Martínez‐Vizcaíno, Ana Díez‐Fernández
    Acta Paediatrica.2024; 113(6): 1364.     CrossRef
  • Association between handgrip strength and metabolic syndrome in relation to gender and adiposity among middle aged and older Saudi populations
    Shaea A. Alkahtani, Ghedeir M. Alshammari, Aishah Alzuwaydi, Abdulaziz Alfuhaid, Abeer A. Al-Masri, Rizwan Qaisar, Syed Shahid Habib
    The Aging Male.2024;[Epub]     CrossRef
  • Higher dietary methyl donor micronutrient consumption is associated with higher muscle strength in adults: a cross-sectional study
    Amin Mirrafiei, Parisa Radkhah, Mahla Chambari, Samira Davarzani, Nadia Babaee, Kurosh Djafarian, Sakineh Shab-Bidar
    British Journal of Nutrition.2024; 131(11): 1926.     CrossRef
  • The combined effect of handgrip strength and obesity phenotype on the risk of stroke in Chinese middle-aged and elderly: A cohort study
    Kai-jie Qi, Qiang Li, Gao-lei Lu, Min-jie Zhang, Min-zhe Zhang, Jia-min Yan, Qi-qiang He
    Archives of Gerontology and Geriatrics.2024; 124: 105481.     CrossRef
  • The Relationship Between Health Parameters, Body Size, Elements of Lifestyle, and Hand Grip Strength in a Group of Patients with Type 2 Diabetes, Aged 40–98, from Ulaanbaatar, Mongolia
    Myadagmaa Jaalkhorol, Agata Cieślik, Myagmartseren Dashtseren, Anya Khairat, Otgonbayar Damdinbazar, Gerelmaa Ochirdorj, Tsetsegsuren Khurelbaatar, Ganbayar Batmunkh, Ulemjjargal Ganzorig, Sławomir Kozieł
    Journal of Clinical Medicine.2024; 14(1): 102.     CrossRef
  • Relación entre adiposidad corporal y fuerza de prensión manual con la preocupación por la alimentación en deportistas universitarios
    Jorge Mendez-Cornejo, Ruben Vidal-Espinoza, Fernando Alvear-Vasquez, Ana Belen-Guzman, Rossana Gomez-Campos, Marco Cossio Bolaños
    Nutrición Clínica y Dietética Hospitalaria.2024;[Epub]     CrossRef
  • C-reactive protein and muscle-related measures over 14 years in Chinese community-dwelling older adults
    Suey S.Y. Yeung, Timothy Kwok, Jean Woo
    Archives of Gerontology and Geriatrics.2023; 106: 104878.     CrossRef
  • Increasing muscular strength to improve cardiometabolic risk factors
    Patricio Lopez-Jaramillo, Jose P. Lopez-Lopez, Maria Camila Tole, Daniel D. Cohen
    Clínica e Investigación en Arteriosclerosis.2023; 35(3): 144.     CrossRef
  • Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts
    Guochen Li, Yanqiang Lu, Liping Shao, Luying Wu, Yanan Qiao, Yi Ding, Chaofu Ke
    BMC Geriatrics.2023;[Epub]     CrossRef
  • Increasing muscular strength to improve cardiometabolic risk factors
    Patricio Lopez-Jaramillo, Jose P. Lopez-Lopez, Maria Camila Tole, Daniel D. Cohen
    Clínica e Investigación en Arteriosclerosis (English Edition).2023; 35(3): 144.     CrossRef
  • Lower handgrip strength levels probably precede triglyceride glucose index and associated with diabetes in men not in women
    Jia Zheng, Lu Zhang, Min Jiang
    Journal of Diabetes Investigation.2022; 13(1): 148.     CrossRef
  • Changes in high-sensitivity C-reactive protein levels and metabolic indices according to grip strength in Korean postmenopausal women
    Y. N. Kim, J.-h. Jung, S. B. Park
    Climacteric.2022; 25(3): 306.     CrossRef
  • Factors Associated with Handgrip Strength Among Older Adults in Malaysia
    Shamsul Azhar Shah, Nazarudin Safian, Zulkefley Mohammad, Siti Rohani Nurumal, Wan Abdul Hannan Wan Ibadullah, Juliana Mansor, Saharuddin Ahmad, Mohd Rohaizat Hassan, Yugo Shobugawa
    Journal of Multidisciplinary Healthcare.2022; Volume 15: 1023.     CrossRef
  • Associations of handgrip strength with morbidity and all-cause mortality of cardiometabolic multimorbidity
    Yanqiang Lu, Guochen Li, Pietro Ferrari, Heinz Freisling, Yanan Qiao, Luying Wu, Liping Shao, Chaofu Ke
    BMC Medicine.2022;[Epub]     CrossRef
  • Association between Grip Strength, Obesity, and Cardiometabolic Risk Factors among the Community-Dwelling Elderly Population in Taiwan
    Chun-Yung Chang, Nain-Feng Chu, Ming-Hsun Lin, Shu-Chuan Wang, Der-Min Wu, Ming-Kai Tsai, Chieh-Hua Lu
    International Journal of Environmental Research and Public Health.2022; 19(18): 11359.     CrossRef
  • Association of Absolute and Relative Handgrip Strength with Prevalent Metabolic Syndrome in Adults: Korea National Health and Nutrition Examination Survey 2014–2018
    Sunghyun Hong, Minsuk Oh, Youngwon Kim, Justin Y. Jeon
    International Journal of Environmental Research and Public Health.2022; 19(19): 12585.     CrossRef
  • Factors Influencing the Muscle Strength of the Elderly Without Activity Restrictions By Gender
    Myoungjin Kwon, Moonkyoung Park, Hyun Joo Kim, Jong Im Kim, Sun Ae Kim
    Journal of Korean Gerontological Nursing.2021; 23(1): 43.     CrossRef
  • Relationship Between Handgrip Strength and the Prevalence of Diabetes Mellitus Among Korean Adults: Korean National Health and Nutrition Examination Survey, 2014-2018
    Sung-hyun Hong, Ji-yong Byeon, Ji-hee Min, Dong-hyuk Park, Won-hee Cho, Justin Y. Jeon
    Exercise Science.2021; 30(1): 110.     CrossRef
  • Role of handgrip strength in predicting new-onset diabetes: findings from the survey of health, ageing and retirement in Europe
    Guochen Li, Yanan Qiao, Yanqiang Lu, Siyuan Liu, Yi Ding, Xing Chen, Chaofu Ke
    BMC Geriatrics.2021;[Epub]     CrossRef
  • Association between Adjusted Handgrip Strength and Metabolic Syndrome in Arab Men
    Shaea Alkahtani
    International Journal of Environmental Research and Public Health.2021; 18(20): 10898.     CrossRef
  • Association between relative handgrip strength and abdominal obesity, type-2 diabetes and hypertension in a Mexican population
    Iris Paola Guzmán-Guzmán, Pedro Delgado-Floody, Ilse Adriana Gutiérrez-Pérez, Felipe Caamaño-Navarrete, Daniel Jerez-Mayorga, Óscar Zaragoza-García, Isela Parra-Rojas
    Nutrición Hospitalaria.2021;[Epub]     CrossRef
  • Dietary Calcium Intake and Fat Mass in Spanish Young Adults: The Role of Muscle Strength
    Ana Torres-Costoso, Vicente Martínez-Vizcaíno, Rubén Fernández-Rodríguez, Irene Sequí-Dominguez, Sara Reina-Gutiérrez, Sergio Núñez de Arenas-Arroyo, Miriam Garrido-Miguel
    Nutrients.2021; 13(12): 4498.     CrossRef
  • Grip Strength as a Cardiometabolic Marker
    Jungun Lee
    Korean Journal of Family Medicine.2020; 41(5): 271.     CrossRef
  • 5,825 View
  • 128 Download
  • 21 Web of Science
  • 23 Crossref
Uncontrolled Blood Pressure in Hypertensive Patients with High Medication Adherence: A Korean Nationwide Population-Based Study
Jiwon Kwon, Chi-Yeon Lim, Minkyeong Kim
Korean J Fam Med 2020;41(1):28-37.   Published online January 8, 2020
DOI: https://doi.org/10.4082/kjfm.19.0051
Background
Uncontrolled blood pressure (BP) is relatively common despite treatment with antihypertensive medication. This study aimed to investigate factors associated with uncontrolled systolic BP (SBP) and diastolic BP (DBP) separately in hypertensive patients with high medication adherence in Korea.
Methods
This population-based cross-sectional study included 3,236 participants in the Korea National Health and Nutrition Examination Survey from 2013 to 2015. Hypertensive patients with high medication adherence were defined when they stated that they were taking antihypertensive medication daily. “Uncontrolled SBP and DBP” were defined as SBP ≥140 mm Hg and DBP ≥90 mm Hg, respectively. Data were analyzed using logistic regression to determine the association between uncontrolled SBP or DBP and various factors.
Results
The prevalence of uncontrolled SBP and uncontrolled DBP was 23.3%, and 9.0%, respectively. In multivariate analysis, uncontrolled SBP was positively associated with older age, female sex, blue-collar occupation or no work (vs. white-collar), presence of a spouse, short sleep duration, frequent heavy alcohol drinking, longer hypertension duration, diabetes, stroke, and missing antihypertensive medication on the examination day, but negatively associated with high stress. Uncontrolled DBP was positively associated with frequent heavy alcohol drinking, but negatively associated with older age, blue-collar occupation or no work (vs. white-collar), and diabetes.
Conclusion
After excluding low medication adherence, we identified various factors associated with uncontrolled SBP or DBP in Korean adults with treated hypertension. There were differences between factors associated with uncontrolled SBP or DBP. Separate analysis of SBP and DBP may help understand the factors involved in BP control.

Citations

Citations to this article as recorded by  
  • Factor associated with and risk of cardiovascular disease in people with uncontrolled hypertension
    Sara Ringwald-de Meyer, Roxane de La Harpe, Peter Vollenweider, Pedro Marques-Vidal, Julien Vaucher
    Scientific Reports.2025;[Epub]     CrossRef
  • Exploring the Influence of a Single Bout of Tahajjud Prayer on Acute Blood Pressure Response in Normotensive Young Adult Males with Varied Regularity of Tahajjud Practice
    Yusni Yusni, Hanifah Yusuf, Mustanir Yahya
    Islamic Guidance and Counseling Journal.2023;[Epub]     CrossRef
  • Adherence to Self-Care among Patients with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis
    Afework Edmealem, Sewunet Ademe, Sisay Gedamu, Tomohiro Katsuya
    International Journal of Hypertension.2022; 2022: 1.     CrossRef
  • Medication Adherence and Effective Management of Hypertension
    Seung-Won Oh
    Korean Journal of Family Medicine.2021; 42(2): 89.     CrossRef
  • A Modified Recommended Food Score Is Inversely Associated with High Blood Pressure in Korean Adults
    Kyuyoung Han, Yoon Jung Yang, Hyesook Kim, Oran Kwon
    Nutrients.2020; 12(11): 3479.     CrossRef
  • 6,624 View
  • 138 Download
  • 4 Web of Science
  • 5 Crossref
Home Blood Pressure Monitoring Has Similar Effects on Office Blood Pressure and Medication Compliance as Usual Care
Juliawati Muhammad, Muazah Mat Jamial, Azlina Ishak
Korean J Fam Med 2019;40(5):335-343.   Published online January 14, 2019
DOI: https://doi.org/10.4082/kjfm.18.0026
Background
Home blood pressure monitoring is recommended to achieve controlled blood pressure. This study evaluated home blood pressure monitoring-improvement of office blood pressure control and treatment compliance among hypertensive patients.
Methods
A randomized controlled trial was conducted from December 2014 to April 2015. The home blood pressure monitoring group used an automatic blood pressure device along with standard hypertension outpatient care. Patients were seen at baseline and after 2 months. Medication adherence was measured using a novel validated Medication Adherence Scale (MAS) questionnaire. Office blood pressure and MAS were recorded at both visits. The primary outcomes included evaluation of mean office blood pressure and MAS within groups and between groups at baseline and after 2 months.
Results
Mean changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) and MAS differed significantly within groups. The home blood pressure monitoring group showed greater mean changes (SBP 17.6 mm Hg, DBP 9.5 mm Hg, MAS 1.5 vs. SBP 14.3 mm Hg, DBP 6.4 mm Hg, MAS 1.3), while between group comparisons showed no significant differences across all variables. The adjusted mean difference for mean SBP was 4.74 (95% confidence interval [CI], -0.65 to 10.13 mm Hg; P=0.084), mean DBP was 1.41 (95% CI, -2.01 to 4.82 mm Hg; P=0.415), and mean MAS was 0.05 (95% CI, -0.29 to 0.40 mm Hg; P=0.768).
Conclusion
Short-term home blood pressure monitoring significantly reduced office blood pressure and improved medication adherence, albeit similarly to standard care.

Citations

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  • Comparative Different Interventions to Improve Medication Adherence in Patients with Hypertension
    Wei Yuan, Yu Zhang, LiHua MA
    Journal of Cardiovascular Nursing.2025; 40(1): E9.     CrossRef
  • Use of a blood pressure log is associated with improved blood pressure medication adherence in a predominately racial/ethnic minority sample
    Wing Hang Lau, Eric Lam, Joshua Fogel, Hanna Ghanayem, Chris Elsayad, Anjum Maqbool, Vas Vilma
    Blood Pressure Monitoring.2025;[Epub]     CrossRef
  • Metabolic Syndrome and Its Associated Factors Among Patients With Schizophrenia Treated With Second-Generation Antipsychotics at Amanuel Mental Specialized Hospital, Ethiopia
    Melak Gedamu Beyene, Solomon Teferra, Teferi G Fenta
    Cureus.2024;[Epub]     CrossRef
  • Biomarkers and Prevalence of Cardiometabolic Syndrome Among People Living With HIV/AIDS, Addis Ababa, Ethiopia: A Hospital-Based Study
    Minyahil Woldu, Omary Minzi, Workineh Shibeshi, Aster Shewaamare, Ephrem Engidawork
    Clinical Medicine Insights: Endocrinology and Diabetes.2022;[Epub]     CrossRef
  • Dyslipidemia and associated cardiovascular risk factors in HIV-positive and HIV-negative patients visiting ambulatory clinics: A hospital-based study
    Minyahil A. Woldu, Omary Minzi, Ephrem Engidawork
    JRSM Cardiovascular Disease.2022;[Epub]     CrossRef
  • Cardiometabolic syndrome in HIV-positive and HIV-negative patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: a comparative cohort study
    Minyahil Woldu, Omary Minzi, Workineh Shibeshi, Aster Shewaamare, Ephrem Engidawork
    Cardiovascular Endocrinology & Metabolism.2022;[Epub]     CrossRef
  • Improving medication adherence in hypertensive patients: A scoping review
    Simão Pinho, Mariana Cruz, Filipa Ferreira, André Ramalho, Rute Sampaio
    Preventive Medicine.2021; 146: 106467.     CrossRef
  • Medication Adherence and Effective Management of Hypertension
    Seung-Won Oh
    Korean Journal of Family Medicine.2021; 42(2): 89.     CrossRef
  • Evaluation of blood pressure through home monitoring in brazilian primary care: a feasibility study
    Jéssica Nunes Moreno, Welma Wildes Amorim, Sóstenes Mistro, Danielle Souto de Medeiros, Matheus Lopes Cortes, Daniela Arruda Soares, José Andrade Louzado, Clavdia Nicolaevna Kochergin, Kelle Oliveira Silva, Vanessa Moraes Bezerra, Marcio Galvão Oliveira
    Ciência & Saúde Coletiva.2021; 26(8): 2997.     CrossRef
  • Clinical applications for out-of-office blood pressure monitoring
    Hailan Zhu, Haoxiao Zheng, Xinyue Liu, Weiyi Mai, Yuli Huang
    Therapeutic Advances in Chronic Disease.2020;[Epub]     CrossRef
  • Strategies to Improve Adherence to Anti-Hypertensive Medications: a Narrative Review
    Chigozirim Izeogu, Jolaade Kalinowski, Antoinette Schoenthaler
    Current Hypertension Reports.2020;[Epub]     CrossRef
  • Can Home Blood Pressure Monitoring Help Control Blood Pressure and Increase Drug Compliance of Hypertensive Patients?
    Soo Young Kim
    Korean Journal of Family Medicine.2019; 40(5): 287.     CrossRef
  • 13,263 View
  • 189 Download
  • 11 Web of Science
  • 12 Crossref
Association between Parity and Blood Pressure in Korean Women: Korean National Health and Nutrition Examination Survey, 2010-2012
Miae Jang, Yeonji Lee, Jiho Choi, Beomseok Kim, Jayeon Kang, Yongchae Kim, Sewook Cho
Korean J Fam Med 2015;36(6):341-348.   Published online November 20, 2015
DOI: https://doi.org/10.4082/kjfm.2015.36.6.341
Background

Pregnancy considerably alters cardiovascular dynamics, and thereby affects the transition of blood pressure after delivery in women. We aimed to analyze the association between parity and blood pressure in Korean adult women.

Methods

We included 8,890 women who participated in Korean National Health and Nutrition Examination Survey between 2010 and 2012. We divided the population according to the menopause status and analyzed the association between parity and blood pressure by using multiple regression analysis, and on hypertension, by using logistic regression analysis.

Results

Systolic and diastolic blood pressures were significantly associated with parity in premenopausal women (β=-0.091 [P<0.001] and β=-0.069 [P<0.001], respectively). In the analysis that excluded women receiving antihypertensive medication, the systolic and diastolic blood pressure of postmenopausal women were significantly associated with parity (β=-0.059 [P=0.022] and β=-0.054 [P=0.044], respectively). Parity was found to prevent hypertension after adjustment for confounders in postmenopausal women (odds ratio, 0.55; 95% confidence interval, 0.310-0.985).

Conclusion

We found that parity prevented hypertension in Korean women.

Citations

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    Saravanakumar Murugesan, Lakshmi Saravanakumar, Sakthivel Sadayappan, Ramaswamy Kannappan, Rachel G. Sinkey, Michelle D. Tubinis, Alan N. Tita, Tamas Jilling, Dan E. Berkowitz
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    Nabilah Gulamhusein, Badal S B Pattar, Sandra M Dumanski, Tyrone G Harrison, Sonia Butalia, Magali Robert, Jane A Schulz, Sofia B Ahmed
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    Maryam Mousavi, Mina Amiri, Fereidoun Azizi, Fahimeh Ramezani Tehrani
    Clinical Hypertension.2025;[Epub]     CrossRef
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    Hongxin Wang, Noriyuki Iwama, Keiichi Yuwaki, You Nakamichi, Hirotaka Hamada, Hasumi Tomita, Kazuma Tagami, Rie Kudo, Natsumi Kumagai, Hirohito Metoki, Naoki Nakaya, Atsushi Hozawa, Shinichi Kuriyama, Nobuo Yaegashi, Masatoshi Saito
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    Yourong Feng, Sandy Lau, Qi Chen, Charlotte Oyston, Katie Groom, Carolyn J. Barrett, Lawrence W. Chamley
    American Journal of Obstetrics and Gynecology.2024; 231(3): 350.e1.     CrossRef
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    Allyson P. Bear, Wendy L. Bennett, Joanne Katz, Kyu Han Lee, Atique Iqbal Chowdhury, Sanwarul Bari, Shams El Arifeen, Emily S. Gurley, Sayedur Rahman
    PLOS ONE.2024; 19(7): e0287622.     CrossRef
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    Allyson P. Bear, Wendy L. Bennett, Joanne Katz, Kyu Han Lee, Atique Iqbal Chowdhury, Sanwarul Bari, Shams El Arifeen, Emily S. Gurley, Stephen J. McCall
    PLOS Global Public Health.2023; 3(9): e0002175.     CrossRef
  • The association of reproductive history with hypertension and obesity according to menopausal status: the J-MICC Study
    Mizuki Ohashi, Katsuyuki Miura, Naoyuki Takashima, Aya Kadota, Yoshino Saito, Shunichiro Tsuji, Takashi Murakami, Yuka Kadomatsu, Mako Nagayoshi, Megumi Hara, Keitaro Tanaka, Takashi Tamura, Asahi Hishida, Toshiro Takezaki, Ippei Shimoshikiryo, Etsuko Oza
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    Win Pa Pa Thu, Inger Sundström-Poromaa, Susan Logan, Michael S. Kramer, Eu-Leong Yong
    Hypertension Research.2021; 44(5): 561.     CrossRef
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    Felix Teufel, Pascal Geldsetzer, Nikkil Sudharsanan, Malavika Subramanyam, H Manisha Yapa, Jan-Walter De Neve, Sebastian Vollmer,, Till Bärnighausen
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Inter-arm Differences in Simultaneous Blood Pressure Measurements in Ambulatory Patients without Cardiovascular Diseases
Kyoung Bog Kim, Mi Kyeong Oh, Haa Gyoung Kim, Ji Hoon Ki, Soo Hee Lee, Su Min Kim
Korean J Fam Med 2013;34(2):98-106.   Published online March 20, 2013
DOI: https://doi.org/10.4082/kjfm.2013.34.2.98
Background

It has traditionally been known that there is normally a difference in blood pressure (BP) between the two arms; there is at least 20 mm Hg difference in the systolic blood pressure (SBP) and 10 mm Hg difference in the diastolic blood pressure (DBP). However, recent epidemiologic studies have shown that there are between-arm differences of < 5 mm Hg in simultaneous BP measurements. The purposes of this study is to examine whether there are between-arm differences in simultaneous BP measurements obtained from ambulatory patients without cardiovascular diseases and to identify the factors associated these differences.

Methods

We examined 464 patients who visited the outpatient clinic of Gangneung Asan Hospital clinical department. For the current analysis, we excluded patients with ischemic heart disease, stroke, arrhythmia, congestive heart failure, or hyperthyroidism. Simultaneous BP measurements were obtained using the Omron MX3 BP monitor in both arms. The inter-arm difference (IAD) in BP was expressed as the relative difference (right-arm BP [R] minus left-arm BP [L]: R - L) and the absolute difference (|R - L|).

Results

The mean absolute IAD in SBP and DBP were 3.19 ± 2.38 and 2.41 ± 1.59 mm Hg, respectively, in men and 2.61 ± 2.18 and 2.25 ± 2.01 mm Hg, respectively, in women. In men, there were 83.8% of patients with the IAD in SBP of ≤ 6 mm Hg, 98.1% with the IAD in SBP of ≤ 10 mm Hg, 96.5% with the IAD in DBP of ≤ 6 mm Hg and 0% with the IAD in DBP of > 10 mm Hg. In women, 89.6% of patients had IAD in SBP of ≤ 6 mm Hg, 92.1% with IAD in DBP of ≤ 6 mm Hg, and 0% with IAD in SBP of > 10 mm Hg or IAD in DBP of > 10 mm Hg. Gangneung Asan Hospital clinical series of patients showed that the absolute IAD in SBP had a significant correlation with cardiovascular risk factors such as the 10-year Framingham cardiac risk scores and higher BP in men and higher BP in women. However, the absolute IAD in SBP and DBP had no significant correlation with the age, obesity, smoking, drinking, hyperlipidemia, diabetes, metabolic syndrome, and renal function.

Conclusion

Our results showed that there were no significant between-arm differences in simultaneous BP measurements. It was also shown that most of the ambulatory patients without cardiovascular diseases had an IAD in SBP of < 10 mm Hg and an IAD in DBP of < 6 mm Hg.

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Background

According to the current guidelines for blood pressure monitoring, clinicians are recommended to measure blood pressure by completely exposing the upper arm. However, it is a common practice that blood pressure is measured with the cuff placed over the sleeve or with the sleeve rolled up. We therefore conducted this study to examine whether there are any differences in blood pressure measurements among the three different settings: the sleeve group, the rolled sleeve group, and the bare arm group.

Methods

We conducted the current study in 141 male and female adult patients who visited our clinical department. In these patients, we took repeatedly blood pressure measurements using the same automatic oscillometric device on three different settings. Then, we analyzed the results with the use of randomized block design analysis of variance.

Results

The mean values of systolic blood pressure (SBP) between the first reading and those of the second reading were 128.5 ± 10.6 mm Hg in the sleeve group, 128.3 ± 10.8 mm Hg in the rolled sleeve group, and 128.3 ± 10.7 mm Hg in the bare arm group. These results indicate that there were no significant differences among the three groups (P = 0.32). In addition, the mean values of diastolic blood pressure (DBP) between the first reading and those of the second reading were 80.7 ± 6.1 mm Hg in the sleeve group, 80.7 ± 6.1 mm Hg in the rolled sleeve group, and 80.6 ± 5.9 mm Hg in the bare arm group. These results indicate that there were no significant differences among the three groups (P = 0.77). In addition, based on the age, sex, past or current history of hypertension or diabetes mellitus, the thickness of sleeve, weight, a drinking history, and a smoking history, there were no significant differences in SBP and DBP among the three groups.

Conclusion

There were no significant differences in blood pressure measurements between the three different settings (the sleeve group, the rolled sleeve group, and the bare arm group).

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Review

Blood Pressure Variability and Its Management in Hypertensive Patients
Hee-Jeong Choi
Korean J Fam Med 2012;33(6):330-335.   Published online November 27, 2012
DOI: https://doi.org/10.4082/kjfm.2012.33.6.330

Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk.

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Brief Communication

The Impact of Bladder Distension on Blood Pressure in Middle Aged Women
Eun Jung Choi, Dong Wook Jeong, Jeong Gyu Lee, Sangyeoup Lee, Yun Jin Kim, Yu Hyone Yi, Young Hye Cho, Sun Ju Im, Mi Jin Bae
Korean J Fam Med 2011;32(5):306-310.   Published online July 28, 2011
DOI: https://doi.org/10.4082/kjfm.2011.32.5.306
Background

The purpose of the present study was to investigate the relation between the extent of bladder distention and the rise of blood pressure in middle aged women.

Methods

In a cross-sectional, descriptive observational study, we obtained data from 172 middle aged women at a health promotion center of Pusan National University Hospital. We measured duration of urine-holding as the degree of the extension of bladder distention. Blood pressure was measured twice while holding urine and immediately after urination. Urine holding with full bladder was confirmed by abdominal ultrasound.

Results

Difference in systolic blood pressure was 4.2 ± 10.7 (P < 0.001), and that in diastolic blood pressure was 2.8 ± 7.7 mm Hg (P < 0.001) between holding urine and immediately after urination. There was no significant correlation between the urine-holding duration and differences in systolic and diastolic blood pressure.

Conclusion

Our findings suggest that systolic and diastolic blood pressure is increased by urine-holding at least 3 hours after the last urination in middle aged women. Thus in practice, blood pressure should be measured after the bladder is emptied.

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Original Article

Changes in Blood Pressure, Blood Glucose, and Lipid Profile Caused by Changes of Weight, Percent Body Fat, and Waist Circumference in Adult Men with Normal Weight and Waist Circumference.
Ho Chun Choi, Hyun Jin Kim, Seong Jun Min, Kiheon Lee, Kyung Woo Kim, Seung Min Oh, Tae Woo Yoo
Korean J Fam Med 2010;31(6):430-436.   Published online June 20, 2010
DOI: https://doi.org/10.4082/kjfm.2010.31.6.430
Background
Metabolic indexes (blood pressure, blood glucose, and lipid) differ depending on lower or upper normal value of obesity indexes (weight, percent-body-fat, and waist circumference) despite normal value. Therefore, we examined metabolic indexes changes across obesity indexes changes. Methods: We analyzed 344 adult men who received routine-checkups with normal weight and waist circumference before and after follow-up. We used multiple-linear-regression to examine associations between changes of obesity indexes and metabolic indexes before and after follow-up. We examined differences of metabolic indexes by t-test and odds ratios of normal or abnormal metabolic indexes by multiple-logistic-regression in groups where obesity indexes were increased and decreased.Results: The mean follow-up was 1.38 ± 0.32 years and there were associations between weight change rate and changes in systolic-blood-pressure (SBP), diastolic-blood-pressure (DBP), triglyceride (TG), and high–density-lipoprotein (HDL) (P = 0.001, 0.03, 0.001, 0.01), associations between percent-body-fat change and changes in SBP, DBP, fasting-blood-glucose (FBG) and TG (P = 0.02, 0.002, < 0.001, 0.03), and associations between waist circumference change rate and changes in FBG, TG, HDL (P = 0.01, 0.01, 0.02). There were significant SBP and HDL differences in weight decrease and increase groups (P = 0.04, < 0.001), FBG difference in percent-body-fat decrease and increase groups (P = 0.01), and FBG and TG differences in waist circumference decrease/increase groups (P = 0.03, 0.03). As compared with percent-body-fat decrease group, percent-body-fat increase group had odds ratio of FBG ≥ 100 of 2.98 (95% confidential interval [CI], 1.18 to 7.51) with a significance on only FBG of initially normal metabolic components and conversely percent-body-fat decrease group had odds ratio of FBG < 100 of 3.22 (95% CI, 1.21 to 8.60) with a significance on only FBG of initially abnormal metabolic components. Conclusion: Increased obesity indexes even within normal range, could change metabolic indexes.
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Case Report

A Case of Successful Correction of Subclavian Steal Syndrome by Percutaneus Transluminal Angioplasty with Stenting Who Found Incidentally Significant Interarm Blood Pressure Difference.
Won Back Kim, Mi Kyeong Oh, Soo Hee Lee, Jin Roh, Haa Gyoung Kim, Jin Young Kim, Sang Sig Cheong, Seung Mun Jung
Korean J Fam Med 2009;30(12):979-984.   Published online December 20, 2009
DOI: https://doi.org/10.4082/kjfm.2009.30.12.979
A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally signifi cant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insuffi ciency symptoms due to reversal of blood fl ow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.

Citations

Citations to this article as recorded by  
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    Minho Han
    The Korean Journal of Clinical Laboratory Science.2018; 50(3): 370.     CrossRef
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    Minho Han, Bok Hee Jin, Hyo Suk Nam
    The Korean Journal of Clinical Laboratory Science.2017; 49(3): 316.     CrossRef
  • Inter-arm Differences in Simultaneous Blood Pressure Measurements in Ambulatory Patients without Cardiovascular Diseases
    Kyoung Bog Kim, Mi Kyeong Oh, Haa Gyoung Kim, Ji Hoon Ki, Soo Hee Lee, Su Min Kim
    Korean Journal of Family Medicine.2013; 34(2): 98.     CrossRef
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  • 3 Crossref
Original Articles
State of Diabetes Care in Korean Adults: According to the American Diabetes Association Recommendations.
Ji Eun Lee, Hyun Ah Park, Jae Heon Kang, Seong Hui Lee, Young Gyu Cho, Hye Ryoung Song, Seong Won Kim, Jung Sun Lee
J Korean Acad Fam Med 2008;29(9):658-667.   Published online September 10, 2008
Background: We assessed the state of diabetes control in Korean adults from the 2001 Korean National Health and Nutrition Survey. Methods: A total of 271 adult diabetes patients (125 males, 146 females) were identified from the health interview survey. Diabetes control status was assessed by the American Diabetic Association (ADA) recommendations. Socioeconomic characteristics and the health status were assessed by an interview and the health- related behavior was assessed by self-questionnaire. A one-day 24-hour recall was used for the dietary assessment. Blood pressure and anthropometric measurements were done. Fasting blood was drawn for glucose, HbA1c, and lipids profile. Results: The proportions of patients reaching the recommended goals for fasting plasma glucose (≤130 mg/dl), HbA1c (<7%), blood pressure (<130/80 mmHg), low density lipoprotein cholesterol (<100 mg/dl), triglyceride (<200 mg/dl), and high density lipoprotein cholesterol (>45 mg/dl for males, >55 mg/dl for females) were 57.2%, 19.9%, 24.4%, 27.8%, 64.5% and 20.7%, respectively. Body mass index, and smoking in males and age, and diabetes duration in females were associated with HbA1c level. Conclusion: This study shows that diabetes in Korean adult is not adequately controlled. National effort is needed to achieve the recommended treatment goals and to manage modifiable risk factors such as obesity and smoking. (J Korean Acad Fam Med 2008;29:658-667)
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Factors Related to Increase of Blood Pressure in Obese Children and Adolescents.
Sang Hyun Lee, Eunju Sung, Ho Cheol Shin, Yong Woo Park, Cheol Hwan Kim, Kyung Seop Soh
J Korean Acad Fam Med 2007;28(7):515-522.   Published online July 10, 2007
Background
As obese population is increasing nowadays, research on blood pressure of obese children is being performed more frequently. However, there are only few research related to factors about blood pressure among obese children in Korea. The purpose of this study was to analyze the factors affecting blood pressure of obese children and adolescents. Methods: The subjects were elementary and middle school students diagnosed with obesity (n=1716). Height, weight, waist circumstance, body fat percent, blood pressure were measured. Family history and sexual maturity were investigated through the questionnaire. The relationship between the factors and the increase of blood pressure was analyzed. Results: Body weight was the most powerful factor among to factors related to increase of blood pressure (male r=0.45, P<0.05, female r=0.37, P<0.05). Also, height, percentage weight for height (PWH), body mass index (BMI) and waist circumference was correlated with the blood pressure. In multiple regression analysis, family history of hypertension and the sexual maturity were significant determinants of blood pressure in males after adjusting for weight. However, body fat percent was a significant determinant in females. Conclusion: Body weight was the most important factor which increased the blood pressure in obese children and adolescents in both sexes. But males and females had different factors related to the increase of blood pressure with the exception of body weight. (J Korean Acad Fam Med 2007;28:515-522)
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Alteration of Circadian Diurnal Rhythms of Cardiovascular Parameters by Night Shift Work in 3 Shift Nurses.
Yun Jae Jung, Eun Ju Sa, Mi Na Kim, Dong Uk Lee, Ki Heum Park, Nak Jin Sung
J Korean Acad Fam Med 2007;28(3):187-194.   Published online March 10, 2007
Background
There are incoherent studies about the effect of night shift work on circadian diurnal rhythms of cardiovascular parameters. Our study aimed to assess the alteration of circadian diurnal rhythms of cardiovascular parameters by night shift work. Methods: We studied 26 healthy nurse volunteers engaged in 3 shift work. From March 16 to April 30, 2006, ABPM (ambulatory blood pressure monitoring) was performed to each nurse two times during the day and night shift. Three nurses were excluded due to pain omdiced by ABPM. Blood pressure and heart rate was monitored every 30 minutes. Paired T-test was used for statistical analysis. Results: The mean arterial pressure, the mean systolic pressure, the mean heart rate and the mean pulse pressure during the overall period were significantly higher in the night shift than the day shift (P-value: <0.05, <0.001, <0.05, and <0.001, respectively). The mean arterial pressure, the mean diastolic pressure and the mean heart rate during in-hospital working period were significantly higher in the day shift (P-value: <0.05, <0.001, and <0.05, respectively). All parameters during the daytime sleep period after the night shift were significantly higher than during the nighttime sleep period after the day shift (P-values: <0.001). Proportional percentile falls of 3 parameters (systolic pressure, diastolic pressure, and heart rate) during the daytime sleep period after the night shift were significantly less than during the nighttime sleep period after the day shift (P-values: <0.001). Conclusion: The night shift work caused significant alteration in homeostasis of autonomic nervous system associated with circadian diurnal rhythms of cardiovascular parameters. (J Korean Acad Fam Med 2007;28: 187-194)
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Factors Associated with Left Ventricular Hypertrophy on ECG in Middle-aged Normotensive Healthy Men.
Ju Hye Chung, Chan Hee Song
J Korean Acad Fam Med 2007;28(2):92-99.   Published online February 10, 2007
Background
This study was designed to elucidate which factors affected left ventricular hypertrophy (LVH) on ECG in middle-aged normotensive healthy men. Methods: A total of 436 normotensive office workers who visited the health examination center of St. Mary's Hospital of Catholic University in Korea from August 1 to October 30, 2002, were divided into two groups; 138 with LVH on ECG were grouped as LVH and 298 who showed no LVH on ECG were grouped as non-LVH. Questionnaires on history of smoking, drinking and exercise were filled out, and body fat, body mass index, blood pressure and biochemical markers were measured. Related factors with LVH on ECG were statistically analyzed with Chi-square test, t-test and logistic regression. Results: The mean systolic and diastolic blood pressure and mean alcohol intake (g/day) were significantly elevated in the LVH group (P<0.005). The non-LVH group had a tendency to show increased pulse rate (P=0.058), a higher percentage of people who did not exercise at all, and a lower percentage of people who exercised regularly (P=0.056). The smoking history, BMI and other biochemical markers showed no significant differences (P>0.1). On logistic regression analysis, there was a significant increase in odds ratio for LVH with increase in diastolic blood pressure (adjusted OR 1.048, 95% CI 1.019∼1.077), with exercise more than 3 times a week (adjusted OR 2.317, 95% CI 1.258∼4.269) and with increased alcohol intake (adjusted OR 1.010, 95% CI 1.001∼1.019). In contrast, odds ratio for LVH decreased as the pulse rate per minute increased (adjusted OR 0.974, 95% CI 0.952∼0.997). In detailed analysis comparing those who exercised regularly more than 3 times a week with those who exercised less than 3 times a week, the increase in diastolic blood pressure was a significant factor which increased the odds ratio for LVH in both groups. A significant increase in the odds ratio by mean alcohol intake per day was shown only in a group who exercised less than 3 times a week. Conclusion: As a result of this study, in normotensive middle-aged men with LVH on ECG, patients should be monitored for regular exercise and increase in diastolic blood pressure should be regarded as a risk factor for LVH on ECG irrespective of exercise. In those who do not do exercise regularly, diastolic blood pressure as well as alcohol intake should be evaluated as risk factors for LVH. (J Korean Acad Fam Med 2007;28:92-99)
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The Frequency and Related Factors of Masked Hypertension among Volunteers.
Hyuk Ga, Ho Young Pyoun, Hee Jeong Koh, Ji Ho Choi, Sung Ryul Kim, Jin Sung Han
J Korean Acad Fam Med 2007;28(1):24-31.   Published online January 10, 2007
Background
: 'Masked Hypertension' is a phenomenon of blood pressure that is normotensive by clinic measurement but proves to be hypertensive by 24 hour-AMBP and is associated with many cardiovascular complications and its clinical importance has become the center of public interest. However, in Korea no study concerning masked hypertension has ever been published so far. We investigated the frequency and the related factors of masked hypertension among Koreans.

Methods : Overall, 53 volunteers from Incheon and Seoul, Korea, who were 40 years old and abov were enrolled from August 2003 to August 2004. We checked their blood pressure and pulse rate every hour using an ambulatory blood pressure monitoring device [SpaceLabs 90207] for 24 hours. Masked hypertension was defined as office mean BP less than 140/90 mmHg and daytime mean BP over 135/85 mmHg.

Results : Among the total, 15 subjects met the criteria of masked hypertension (28.3%) Current smoking (P=0.021), higher clinic mean SBP (P=0.011) and DBP (P=0.027), and prehypertension (P=0.04) were identified as related factors. And when adjusted for sex by logistic regression, only current smoking was statistically significant (P=0.039) and prehypertension showed borderline significance (P=0.092) (CI=95%). Additionally, mean pulse pressures and mean standard deviation of individual mean SBP were higher in the masked hypertension group.

Conclusion : The frequency of masked hypertension was 28.3% the and related factors were current smoking and higher office BP, especially prehypertension that was introduced in JNC-7. The fact that the pulse pressure and the variability of individual SBP were higher in the masked hypertension group remains thought-provoking.
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Serum Homocysteine and Its Relevant Factors among Health Screeners in a University Hospital.
Dong Kuk Lee, Hyun Kook Choi, Jung Cheon Son, Yoo Ji Chung, Bom Taeck Kim, Kwang Min Kim
J Korean Acad Fam Med 2005;26(11):671-679.   Published online November 10, 2005
Background
: Elevated plasma total homocysteine is a risk factor for cardiovascular diseases. The authors investigated the parameters such as habit, body index, cardiovascular risk factors, nutrition relative to the plasma homocysteine concentration.

Methods : The subjects were 6,223 adults (3,377 males, 2,846 females) who were over 18 years of age and visited a health promotion center of a university hospital from March 2002 to January 2003. We assessed the relationship between the homocysteine level and the following parameters: sex, age, weight, body mass index, waist circumference, smoking, alcohol, systolic and diastolic blood pressure (BP), triglyceride, total cholesterol, high density lipoprotein cholesterol, creatinine, albumin and hemoglobin.

Results : The homocysteine levels was 10.5±5.9μmol/L in males, 7.3±2.6μmol/L in female. Thus it was significantly higher in males (P<0.001). After adjusting for variables that affect the homocysteine, the subjects over the age of 54 showed 10.7μmol/L (9.5, 12.0, 95% Confidence Interval), which was significantly (P=0.002) higher than the below the age of 38 groups 8.5μmol/L (7.8, 9.2, 95% CI). Non-smoking group showed 8.6μmol/L (8.4, 8.9, 95% CI), while over 28 pack-year group showed 9.6μmol/ L (9.2, 10.0, 95% CI), which was significantly (P<0.001) higher than the non-smoking groups. For the group with systolic BP over 132mmHg, it was 9.3μmol/L (8.8, 9.5, 95% CI). This was significantly (P=0.004) higher than 8.7μmol/L (8.4, 9.0, 95% CI) in the group whose systolic BP was less than 108 mmHg. The homocysteine was 10.4μmol/L (10.1, 11.7, 95% CI) for the group with creatinine over 1.0 mg/dL, which was significantly (P<0.001) higher than 7.9μmol/L (7.6, 8.2, 95% CI) in the group whose creatinine was less than 0.8 mg/dL.

Conclusion : After adjusting for variables that affect the homocysteine, significant difference in its values was found between males and females. The homocysteine was significantly increased in the group whose age, systolic BP, amount of smoking, and creatinine were higher.
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Evaluation of Primary Doctor's Knowledge on Target Level of Blood Pressure in Hypertensive Patients.
Dae Hyun Sung, Ki Bo Lim, Yang Hyun Cho, Eun Young Choi, Eal Whan Park, Yoo Seock Jung, Jae Hun Kim
J Korean Acad Fam Med 2005;26(8):464-469.   Published online August 10, 2005
Background
: The purpose of this study was to find out whether primary physicians know the new guidelines (JNC VII) of target BP (blood pressure) and whether they educate their patients properly or not.

Methods : We made calls to local clinicians (family medicine (FM), internal medicine (IM), oriental medicine (OM)) under the disguise of the patient's caretaker and asked them the target BP for patients with hypertension without any cardiovascular disease and those with hypertension and DM (diabetes mellitus). We categorized the participants according to sex, age and departments.

Results : Out of the 145 clinics, 88 clinics responded (28 clinicians of FM, 30 clinicians of IM, 30 clinicians of OM). Questions on systolic target BP for patients with hypertension without cardiovascular disease, 87 clinicians answered. Among them, 64 clinicians (73.6%) answered correctly to the target BP (≤140 mmHg), in the order of FM, IM, and OM. Questions on the diastolic pressure (≤90 mmHg), 78 clinicians answered and all of them answered correctly. On the question of the target BP for the patients and hypertension and DM, 55 clinicians (63.2%) answered correctly to the systolic target BP (≤130 mmHg) in the order of IM, FM, and OM. Only 19 clinicians (32.4%) answered correctly to the diastolic target BP (≤90 mmHg) in the order of FM, IM, and OM.

Conclusion : The clinicians have given less correct answers on the target BP in the patients and hypertension and DM than those with only essential hypertension. In conclusion, local clinicians should be fully aware of the target BP in patients with hypertension associated with cardiovascular disease or other complications. Also they should educate their patients properly.
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Plasma Lipid Concentrations and Blood Pressure in Women with Subclinical Hypothyroidism.
Kye Seon Park, Kuk Jin Oh, Dong Jin Kang, Kyung Che Park, Moon Jong Kim, Young Jin Lee
J Korean Acad Fam Med 2003;24(12):1110-1116.   Published online December 10, 2003
Background
: There are conflicting reports on the effect of subclinical hypothyroidism on plasma lipid concentrations and blood pressure. This may be due to lack of consideration for menopause status or hormone replacement therapy (HRT) in selecting the study subjects. Also, the reason may be that many subjects with transient abnormality were included in those studies. Therefore, we intended to include the subjects who satisfied the definition of subclinical hypothyroidism on repeated measures. Then, we investigated the difference of plasma lipid concentrations and blood pressure between subclinical hypothyroidism and normal control subjects.

Methods : This study involved the women above age 18, who visited a health promotion center in a general hospital and measured their serum TSH and free T4, from January 1997 to May 2003. The number patients who satisfied the definition of subclinical hypothyroidism on repeated measures, and who had no history of thyroid disease, herb medication or HRT, diabetes, abnormalities of liver and renal function were 30. Age, menopause, body mass index-matched people of 65 were selected as normal controls. Serum TSH, free T4 and plasma lipid concentrations were measured by chemiluminescent assay and enzyme method, respectively. Dyslipidemia were defined according to NCEP ATPIII guidelines.

Results : There was no significant difference of blood pressure and plasma lipid concentrations between subclinical hypothyroidism patients and normal controls irrespective of menopause. There was no significant difference of percentage of dyslipidemia and hypertension between the two groups.

Conclusion : There were no significant increase in plasma lipid concentrations and blood pressure in subclinical hypothyroidism patients despite more strict inclusion.
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Changes of Blood Pressure during Endoscopy.
Young In Lee, Hyun Ah Park, Yong Hyun An, Hyeong Jun Kim, Sang Keun Hahm
J Korean Acad Fam Med 2003;24(12):1099-1103.   Published online December 10, 2003
Background
: The burden of cardiac complications during endoscopy are growing due to increasing proportion of elderly in the endoscopy target population. This study was conducted to examine the blood pressure changes before and after the endoscopy and to seek better pre-treatments in minimizing cardiac complications.

Methods : One hundred subjects were chosen by consecutive sampling who visited a general hospital for physical examination. Basal, pre-endoscopic, immediate post-endoscopic blood pressure and blood pressure after 10 and 30 minutes were measured utilizing manual BP cuffs and recorded.

Results : The subjects included 34 hypertensive patients. Twelve subjects were on anti hypertensive medication. In 5 consecutive measurements, significant variations on blood pressure was noted (P<0.01). Blood pressure kept increasing until immediately after the procedure, followed by a gradual reduction. These changes were observed in both the normotensive and the hypertensive group, but the degree of changes were more pronounced in the hypertrensive group than the normotensive group (P<0.01). The difference between basal and after procedure was 17.6 mmHg for systolic, 13.5 mmHg for diastolic in the normotensive group. However in the hypertensive group, the difference was 21.4 mmHg for systolic, 14.8 mmHg for diastolic. In comparison of medicated and non-medicated group in the hypertensive patients, the degree of changes were marginally, but significantly lower in the treatment group than in the non-treatment group (systolic P=0.056, diastolic P=0.049).

Conclusion : The stress during endoscopy resulted in blood pressure changes, and the degree of changes was higher in the hypertensive group than the normotensive group. In the hypertensive group, the degree of changes was lower in patients treated with anti hypertensives than the non-treated patients. This sample size, however, was small.
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Knowledge and Skills in Blood Pressure Measurement Skills.
Seon Ho Min, Seung Yeon Lee, Hong Jun Cho
J Korean Acad Fam Med 2003;24(7):629-633.   Published online July 10, 2003
Background
: Errors during measurement of blood pressure can cause over diagnosis or under diagnosis of hypertension, which can result in inappropriate management of hypertension and follow up consultation. The aim of this study was to investigate the factors affecting the accuracy of blood pressure measurement, which may serve as means to improve the accuracy of blood pressure measurements.

Methods : Among the 123 interns who work at Asan Medical Center, we selected 90 persons who agreed to join the study. Three interns were excluded because of their incomplete response to the questionnaire. Questionnaire for the survey concerning blood pressure measurement was created by selecting 5 case problems from a total of 34 cases provided within the blood pressure measurement CD ROM, which apply the Korotkoff sound technique. The factors that might affect the measurement were analyzed by multiple logistic regression.

Results : Fifteen (17.2%) interns failed to accurately measure blood pressure provided by the CD program. They showed a difference of greater than 10 mmHg between the actual and the measured systolic blood pressure. A discrepancy of greater than 5 mmHg was noted in the measurement of diastolic blood pressure. From the total sample of 87 interns, 15 (16.1%) interns showed digit preference (0 or 5), when measuring blood pressure. The discrepancy between the measured and the actual blood pressure was greater among those who had a digit preference (95% CI 1.055∼17.770).

Conclusion : Digit preference was the most important factor that affected the accuracy of blood pressure measurement taken by conventional sphygmomanometry. Effort to correct digit preference would improve the quality of blood pressure measurements.
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The Association between Obesity Indices and Physical Fitness.
Yun Joo Jung, Jin Hee Shin, Keun Sang Yum, Chan Hee Song, Whan Seok Choi, Kyung Soo Kim, Jin Hee Park
J Korean Acad Fam Med 2003;24(3):271-278.   Published online March 10, 2003
Background
: Physical fitness is defined as the ability to carry out work necessary for muscle exercise satisfactorily. Generally, obese person have been considered to have low physical performance. In addition, obesity has been known to be a risk factor of cardiovascular disease such as hyperlipidemia, hypertension, and coronary arterial disease. Based on previous epidemiologic studies, abdominal obesity, especially, visceral obesity, is thought to be more important risk factor for cardiovascular disease rather than obesity itself. Therefore, the interest on assessment of abdominal visceral fat has been increasing. The aim of this study was to see the difference in physical fitness and blood pressure according to obesity degree assessed by BMI, and compare the anthropometric obesity indices with abdominal visceral fat accumulation measured by abdominal CT (Computed Tomogram).

Methods : Four hundred thirty-two subjects, who participated in the exercise program for more than one month duration at the 'Clinic for Obesity' in St. Mary's Hospital from November 1998 to June 2000, were included in the analysis. They were categorized into 4 groups [severe obesity group (BMI≥30), obesity group (25≤BMI<30), overweight group (23≤BMI<25), normal group (BMI<23)] according to their BMI. Blood pressure, anthropometric obesity indices and physical fitness (V02 max, back muscle strength, sit up, forward bending, vertical jump, side step, balance) were measured by one skillful exercise trainer. Among them, one hundred thirty-one subjects performed abdominal CT to assess visceral fatness. We compared anthropometric indices (waist to hip ratio, body mass index, abdominal circumference, skin foldness) with abdominal visceral fat accumulation measured by CT.

Results : Blood pressure, cardiovascular endurance, muscular endurance, muscle strength, speed and balance were significantly different among the four groups categorized by BMI in both sexes, but flexibility and agility were not significant. In women, the correlation coefficients between visceral fat area measured by abdominal CT and each of waist to hip ratio, BMI, abdominal circumference, and skin foldness adjusted for age were 0.487, 0.479, 0.464, 0.31, respectively (P<0.01). However in men, there were no significant correlations.

Conclusion : Obesity tended to increase blood pressure, and reduce physical performance. Only in women, obesity related indices reflected the abdominal visceral fat accumulation.
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Blood Pressure Difference between Right and Left Arms of Some College Freshmen.
Ha Jin Kim, Chang Won Won, Eun Suk Ann, Jung Ju Jung, Byung Sung Kim, Hyun Rim Choi
J Korean Acad Fam Med 2003;24(2):166-171.   Published online February 10, 2003
Background
: Hypertension is a main cause of heart blood vessel disease. To diagnose and treat hypertension, it is necessary to measure blood pressure accurately. There are various factors that influence blood pressure. According to real clinical demonstrators and some recent studies, blood pressure differences between right and left arms are often observed. This study was intended to know whether the differences are really found and wheather the correlation exists between mid-arm circumferences and the blood pressure differences according to right-handed or left-handed which were considered as an important factor in affecting blood pressures.

Methods : One hundred sixty nine college freshmen of year 2001 were chosen. Among them, 103 were right- handed and 66 left-handed. Which arms to be checked first were determined randomly. This sequence was repeated two times on each person. Their mid-arm circumferences were measured, also.

Results : For right-handed persons, systolic blood pressure in right arm (119.2±12.3 mmHg) was significantly higher than in left arm (118.0±12.0 mmHg) (P<0.005). But diastolic blood pressure differences between right arm (75.3±10.0 mmHg) and left arm (75.0±9.5 mmHg) was not significant statistically. For left-handed persons, systolic blood pressure was 120.3±9.9 mmHg in right arm and 120.0±10.3 mmHg in left arm. However, diastolic blood pressure in right arm (76.7±9.4 mmHg) was significantly higher than in left arm (75.0±8.6 mmHg) (P<0.005). For right handed persons, their arm circumferences (26.2±2.8 cm) were significantly thicker than left ones (25.9±2.9 cm). For left-handed, left arm circumference (25.9±2.7 cm) was significantly thicker than right one (25.5±2.6 cm). As for the blood pressure difference in arm tested order, the first measured systolic blood pressure (right arm; 120.9±11.7 mmHg, left arm; 120.0±11.9 mmHg) was significantly higher than the second measured one (right arm; 118.3±11.8 mmHg, left arm; 117.8±11.6 mmHg) (P<0.005). However, the first measured diastolic blood pressure (right arm; 76.3±10.5 mmHg, left arm; 75.5±9.4 mmHg) did not have more significance than the second measured one (right arm; 75.4±9.9 mmHg, left arm; 74.6±10.8 mmHg).

Conclusion : The right-handed person's blood pressure was higher in the right arm, but for the left-handed persons it was not significantly different in both arms. The second measurement of blood pressure was lower than the first measurement in both arms. The arm circumference depending on the right/left-handedness influenced the blood pressure, but clear correlation between them was not observed. Therefore, if possible, when the blood pressure is measured, it is advised to check blood pressure in both arms before diagnosing hypertension.
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The Self Blood Pressure Measurement by Hypertensive Patients: a Patient Survey.
Dong Ryul Lee, Woo Kyung Bae, Sang Min Park, Yoon Jung Chang, Kyu Nam Kim, Be Long Cho
J Korean Acad Fam Med 2003;24(1):45-50.   Published online January 10, 2003
Background
: This study was designed to compare the usual self-checked blood pressure measuring methods by hypertensive patients with standardized methods.

Methods : From May to August 2002, we surveyed 137 hypertensive patients who performed self blood pressure measurements with a self-administered questionnaire. We defined 14 standard methods from the six most frequently recommended guidelines. We asked patients how often they calibrated their sphygmomanometer, and how they learned to measure blood pressure. Also, their upper arm circumferences were measured.

Results : The percentage of correct preparations for BP measurement was over 80%, but that of correct technique was low. For example, 'reading from the arm with higher BP by more than 10 mmHg' (4.4%), 'placing midline of the bladder over the arterial pulsation' (21.5%), and 'waiting 2 or more minutes between readings' (21.9%). Only 11.2% of the patients have ever had calibrated their sphygmomanometers. In 20.2% of hypertensive subjects, upper arm circumferences were greater than 30 cm which made blood pressure measurement with a 24 cm-sized bladder incorrect.

Conclusion : As shown in previous studies, the methods of blood pressure measurement were incorrect in many aspects. Therefore, systematically educating hypertensive patients to measure blood pressure by correct methods and recommending to use a proper-sized cuff are essential.
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The Association between Blood Pressure and Bone Mineral Loss in Perimenopausal Women; A Cross Sectional Study.
Nam Wook Yoo, Sang Yeoup Lee, Young Joo Kim, Sang Han Choi, Yun Jin Kim
J Korean Acad Fam Med 2002;23(6):787-793.   Published online June 30, 2002
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The variability of blood pressure according to the number of measurement for diagnosis of hypertension.
Cang Ho Youn, Tae Jung Kwon, Dong Hyun Kim, Jung Bum Lee
J Korean Acad Fam Med 2002;23(1):33-39.   Published online January 1, 2002
Background
: Hypertension is a common, chronic disease that poses as a main risk factor of coronary artery disease. Therefore, it requires accurate diagnosis. This study attempted to examine the problem of misclassification and accurate diagnosis of hypertension in primary care settings and to consider the relationship between variability of blood pressure and number of measurements.

Methods : Among the 158 patients with initially high blood pressure who visited health screening center of one university hospital from May to November, 199,97 persons who corresponded to the following conditions were chosen for this study. We classified hypertension as stage 1 and 2. The subjects were not previously diagnosed as hypertensive and had no past history of use of antihypertensive medication. Blood pressure was measured according to 1999 WHO/ISH Hypertension Guideline, and two or more measures were performed at each visit on five separate occasions at one week intervals.

Results : The mean of initial blood pressure was 159.6 mmHg in systole, 95.3 mmHg in diastole. The mean of subsequent blood pressure was 155.6 mmHg, 146.1 mmHg, 143.4 mmHg, 138.7 mmHg in systole and 92.5 mmHg, 88.4mmHg, 87 mmHg, 85.1 mmHg in diastole, which showed the tendency to be lower. In both systole and diastole, the mean differences between first and second measurements, second and third measurements were significant, but insignificant between third and forth measurements, and forth and fifth measurements.
We divided systolic and diastolic pressures ito two subgroups according to stage 1, 2 classification of hypertension. In stage 1 subgroup, the means of blood pressures were lower from 151.3 mmHg to 135.4 mmHg in systole, from 95.1 mmHg to 85.3 mmHg in diastole, but there were not significant. In stage 2 subgroup, the mean blood pressure was lower from 169.7 mmHg to 142.5 mmHg in systole, form 105.4 mmHg to 87.8 mmHg in diastole, and the mean differences between first and second measurements, second and third measurements were significant, but not significant between third and forth measurements, and forth and fifth measurements.

Conclusion : Blood pressure tends to be checked significantly lower until subsequent third measurements, but not thereafter. We think that more studies to find out how many blood pressure measurements are needed for diagnosing hypertension in consideration of patient's blood pressure level and risk factors.
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Effects of changes in lifestyle and biological parameters on blood lipid levels in middle aged men.
Hoon Il Kang, Young Ho Youn, Jin Yi Kang, Jung Jin Cho
J Korean Acad Fam Med 2000;21(6):782-791.   Published online June 1, 2000
Background
: Death form coronary heart disease is increasing and this study is to evaluate the effect of longitudinal changes of lifestyle and biological parameters on the blood lipid levels, as the risk factor of the coronary heart disease.

Methods : Total cholesterol and total cholesterol to HDL-cholesterol ratio (atherosclerogenic index) as an indicator for risk of coronary heart disease were examined longitudinally in sample(n=463) of middle-aged men by 2 years. The independent variables were body mass index, smoking, alcohol, exercise, diastolic blood pressure, uric acid. All data was drawn form questionnaire, blood chemistry, and review of chart.

Results : ANOVA test according to categorized variables revealed that for total cholesterol, uric acid (P<0.01) and diastolic blood pressure (P<0.01), and for atherosclerogenic index, and body mass index (P<0.001) were significant. In correlation analysis, total cholesterol was associated with uric acid (r=0.20, P<0.001), diastolic blood pressure(r=0.15, P<0.001) and body mass index(r=0.30, P<0.05). and for atherosclerogenic index so was body mass index (r=0.18, P<0.001). In regression, uric acid(β=6.07, P<0.001), diastolic blood pressre(β=0.36, P<0.01) for total cholesterol, and body mass index(β=0.22, P<0.001) for atherosclerogenic index were significant. But changes in alcohol consumption, smoking, and exercise were not statistically significant.

Conclusion : In order to reduce risks of coronary heart disease, the more aggressive medical intervention for the uric acid, DBP, and BMI, would be essential. This study was done without medical intervention. So, further study with intervention, adequate duration and intensity for parameters modification is required.
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Seasonal variation of blood pressure in patients with hypertension.
Jai Jn Byeon, Dong Jin Kim
J Korean Acad Fam Med 1999;20(12):1770-1777.   Published online December 1, 1999
Background
: Seasonal variation of blood pressure(BP) is well documented. It means that season should be considered in diagnosis ad treatment of hypertension. This study was done to evaluate seasonal influence on blood pressure of hypertensive patients who had been taking the same antihypertensive medicine for a long time.

Methods : In medical records, we reviewed the blood pressure recordings of 328 hypertensive patients who had been taking the same medicines through the consecutive summer(June., Jul., & Sep.) and winter(Dec., Jan., & Feb.) period. We evaluated the blood pressure difference between summer and winter, and also evaluated influence of age, sex, BMI, smoking, alcohol drinking and exercise on seasonal difference of blood pressure.

Results : An average of four blood pressure readings per patient, two for summer and two for winter were recorded. Ambient temperature was over 22°C in summer and below 4°C in winter. The systolic blood pressure in summer and winter were 135.5mmHg ad 140.5mmHg, respectively, and the diastolic blood pressure in summer and winter were 85.0mmHg and 87.4mmHg, respectively. Both systolic and diastolic blood pressure increased significantly in winter. Both I systolic ad diastolic blood pressure, sex, smoking, alcohol drinking, exercise did not have an influence on seasonal difference. Age and BMI did not have an influence on seasonal difference of systolic blood pressure. But in diastolic blood pressure, age and BMI had an influence on seasonal difference and elderly patients had a greater seasonal difference in diastolic blood pressure than younger patients.

Conclusion : In hypertensive patients who had taken the same antihypertensive medicines for a long time, both systolic and diastolic blood pressure was significantly increased during the winter. Therefore season should be considered in the treatment of hypertension even though patients are stable with the same medicines.
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The effect of urine-holding on blood pressure.
Kwang Woo Bae, Jae Ho Choi, Seong Woong Jeong, Sang Yeoup Lee, Yun Jin Kim
J Korean Acad Fam Med 1999;20(10):1255-1259.   Published online October 1, 1999
Background
: For diagnosis of hypertension, prompt, blood pressure measurement is necessary. In a clinical setting, increased blood pressure is often recorded during urine-holding. The aim of this study was to assess the effect of urine-holding on blood pressure.

Methods : We analyzed 172 subjects who visited a hospital in Pusan for examination of pelvic ultrasonography. We measured urine-holding time, blood pressure in a urine-holding stat, and blood pressure immediately after urination when pelvic ultrasonography was examined. Paired t-test was performed to compare the pre-voiding blood pressure. The relationship between urine holding time and difference in blood pressure were assessed by Pearson's correlation coefficients.

Results : In subjects who held urine for no less than 3hours, mean pre-voiding systolic blood pressure was 124.2±20.8 mmHg, mean pre-voiding diastolic blood pressure was 78.3±13.3 mmHg. Mean difference in systolic blood pressure was 4.2±10.7 mmHg, and mean difference in diastolic blood pressure was 2.8±7.7 mmHg(P<0.05). The correlation between urine holding time and differences in systolic and diastolic blood pressure was not significant(P>0.05)

Conclusion : Urine-holding for no less than 3 hours made systolic and diastolic blood pressure rise. However, the rise in blood pressure was not proportional to urine-holding time.
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