Browsing by Author "Kario K."

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    Cognitive impairment in heart failure patients: association with abnormal circadian blood pressure rhythm: a review from the HOPE Asia Network
    (2023-01-01) Komori T.; Hoshide S.; Turana Y.; Sogunuru G.P.; Kario K.; Wang J.G.; Chia Y.C.; Buranakitjaroen P.; Chen C.H.; Cheng H.M.; Fujiwara T.; Li Y.; Van Huynh M.; Nagai M.; Nailes J.; Park S.; Schlaich M.; Shin J.; Siddique S.; Sison J.; Soenarta A.A.; Sukonthasarn A.; Tay J.C.; Teo B.W.; Tsoi K.; Turana Y.; Verma N.; Wang T.D.; Zhang Y.; Mahidol University
    Cognitive impairment (CI) is frequently a comorbid condition in heart failure (HF) patients, and is associated with increased cardiovascular events and death. Numerous factors contribute to CI in HF patients. Decreased cerebral blood flow, inflammation, and activation of neurohumoral factors are all thought to be factors that exacerbate CI. Hypoperfusion of the brain due to decreased systemic blood flow, cerebral venous congestion, and atherosclerosis are the main mechanism of CI in HF patients. Abnormal circadian BP rhythm is one of the other conditions associated with CI. The conditions in which BP does not decrease sufficiently or increases during the night are called non-dipper or riser BP patterns. Abnormal circadian BP rhythm worsens CI in HF patients through cerebral congestion during sleep and atherosclerosis due to pressure overload. Interventions for CI in HF patients include treatment for HF itself using cardiovascular drugs, and treatment for fluid retention, one of the causes of abnormal circadian rhythms. [Figure not available: see fulltext.]
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    Home blood pressure-centered approach – from digital health to medical practice: HOPE Asia Network consensus statement 2023
    (2023-01-01) Kario K.; Tomitani N.; Wang T.D.; Park S.; Li Y.; Shin J.; Tsoi K.; Chen C.H.; Cheng H.M.; Siddique S.; Turana Y.; Buranakitjaroen P.; Van Huynh M.; Nailes J.; Sison J.; Soenarta A.A.; Sogunuru G.P.; Sukonthasarn A.; Tay J.C.; Teo B.W.; Verma N.; Zhang Y.; Schlaich M.; Nagai M.; Fujiwara T.; Hoshide S.; Chia Y.C.; Wang J.G.; Mahidol University
    Recent innovations in digital technology have enabled the simultaneous accumulation, and the linking and analysis of time-series big data relating to several factors that influence blood pressure (BP), including biological indicators, physical activity, and environmental information. Various approaches can be used to monitor BP: in the office/clinic; at home; 24-h ambulatory recording; or with wearable and cuffless devices. Of these, home BP monitoring is a reliable and convenient method, and is recommended for hypertension management by current national and international guidelines. This recommendation is based on evidence showing that home BP is an important predictor of cardiovascular, cerebrovascular and kidney disease in patients with hypertension. In addition, lifetime personalized health record (PHR)-based home BP with telemonitoring combined with co-interventions has been shown to lower BP more effectively than the traditional approach based on office BP. Thus, home BP represents a key metric for personalized anticipation medicine, from digital healthcare to digital medicine. This paper summarizes the latest evidence on home BP monitoring and proposes a Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network consensus on a home BP-centered approach to the management of hypertension. [Figure not available: see fulltext.]
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    Hypertensive emergencies in Asia: A brief review
    (2022-09-01) Kotruchin P.; Tangpaisarn T.; Mitsungnern T.; Sukonthasarn A.; Hoshide S.; Turana Y.; Siddique S.; Buranakitjaroen P.; Van Huynh M.; Chia Y.C.; Park S.; Chen C.H.; Nailes J.; Tay J.C.; Wang J.G.; Kario K.; Mahidol University
    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.
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    Obstructive sleep apnea and non-dipper: epiphenomena or risks of Alzheimer’s disease?: a review from the HOPE Asia Network
    (2023-01-01) Nagai M.; Dote K.; Park S.; Turana Y.; Buranakitjaroen P.; Cheng H.M.; Soenarta A.A.; Li Y.; Kario K.; Mahidol University
    Obstructive sleep apnea (OSA) and associated nocturnal blood pressure (BP) surges is associated with non-dipper. On the other hand, the relationship between neurodegenerative diseases and non-dipper hypertension has been reported. To date, few studies have evaluated the relationships of nocturnal BP dipping patterns and OSA in relation to neurodegenerative diseases, particularly Alzheimer’s disease (AD). This review examines the etiology of the association between OSA and the non-dipper pattern of hypertension and how both are involved in the development of AD. To set the stage for this review, we first focus on the pathophysiology of AD, which is interrelated with sleep apnea and non-dipper through dysregulation of central autonomic network. [Figure not available: see fulltext.].
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    Renal Denervation in Asia: 2025 Asia Renal Denervation Consortium (ARDeC) Consensus Statement Endorsed by the Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network
    (2026-01-01) Kario K.; Alkatiri A.A.; Aoki J.; Wan Ahmad W.A.; Chia Y.C.; Cruz J.N.M.; Lee Y.H.; Lim S.T.; Lu C.; Nguyen Q.N.; Ong T.K.; Wander G.S.; Wang J.G.; Wong Y.T.A.; Wongpraparut N.; Wang T.D.; Kario K.; Mahidol University
    The second Asia Renal Denervation Consortium consensus conference shared information and developed updated recommendations for renal denervation (RDN). Current evidence confirms that RDN significantly reduces blood pressure across all metrics (office, home, and ambulatory) throughout 24 hours. Modern RDN approaches target the distal main renal artery and branches where nerves more closely approximate the vessel wall. Understanding renal artery anatomy is crucial; the main renal artery typically divides into anterior and posterior divisions as first-order branches, which further subdivide into second-order segmental arterial branches. Renal artery electrical stimulation shows promise as a procedural end point, with blood pressure response attenuation after successful RDN suggesting adequate denervation, though the optimal procedural end point remains to be established. The indication for RDN is resistant or uncontrolled hypertension, with high office, home, or 24-hour ambulatory blood pressure readings despite appropriate lifestyle modification and antihypertensive drug therapy. Preprocedure assessment includes comprehensive screening for secondary causes and detailed renal artery imaging. Checklists for preprocedure and postprocedure assessment are provided. Nocturnal hypertension and morning hypertension, which are common in Asia, are more closely associated with cardiovascular risk than daytime hypertension and are more difficult to control with current guideline-driven medication. Based on these Asian characteristics and RDN's long-term durability, RDN should be considered an effective option for facilitating optimal 24-hour blood pressure control. Future research through real-world data collection will help determine ethnic differences in RDN response between Asians and Westerners and identify optimal candidates. In addition, studies are needed to evaluate RDN's ability to prevent organ damage and cardiovascular events.
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    Role of dietary potassium and salt substitution in the prevention and management of hypertension
    (2024-01-01) Chia Y.C.; He F.J.; Cheng M.H.; Shin J.; Cheng H.M.; Sukonthasarn A.; Wang T.D.; Van Huynh M.; Buranakitjaroen P.; Sison J.; Siddique S.; Turana Y.; Verma N.; Tay J.C.; Schlaich M.P.; Wang J.G.; Kario K.; Kario K.; Schlaich M.; Verma N.; Siddique S.; Sison J.; Buranakitjaroen P.; Huynh M.; Wang T.D.; Sukonthasarn A.; Cheng H.M.; Chia Y.C.; Mahidol University
    Cardiovascular diseases (CVD) continue to be the leading cause of deaths and disability worldwide and the major contributor is hypertension. Despite all the improvements in detecting hypertension together with technological advances and affordable, efficacious and relatively free of adverse effects anti-hypertensive agents, we continue to struggle to prevent the onset of hypertension and to control blood pressure (BP) to acceptable targets. The poor control of hypertension is commonly due to non-adherence to medications. Another reason is the failure to adopt diet and lifestyle changes. Reduction of dietary salt intake is important for lowering BP but the role of potassium intake is also important. Globally the intake of sodium is double that of the recommended 2 gm per day (equivalent to 5 gm of sodium chloride/salt) and half that of the daily recommended intake of potassium of 3500 mg/day, giving a sodium-to-potassium ratio of >1, when ideally it should be <1. Many studies have shown that a higher potassium intake is associated with lower BPs, particularly when coupled concurrently with a lower sodium intake giving a lower sodium to potassium ratio. Most hypertension guidelines, while recommending reduction of salt intake to a set target, do not specifically recommend a target for potassium intake nor potassium supplementation. Here we review the role of potassium and salt substitution with potassium in the management of hypertension. Hence, the focus of dietary changes to lower BP and improve BP control should not be on reduction of salt intake alone but more importantly should include an increase in potassium intake. (Figure presented.)
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    Role of α1-blockers in the current management of hypertension
    (2022-09-01) Li H.; Xu T.Y.; Li Y.; Chia Y.C.; Buranakitjaroen P.; Cheng H.M.; Van Huynh M.; Sogunuru G.P.; Tay J.C.; Wang T.D.; Kario K.; Wang J.G.; Mahidol University
    There is emerging evidence that α1-blockers can be safely used in the treatment of hypertension. These drugs can be used in almost all hypertensive patients for blood pressure control. However, there are several special indications. Benign prostatic hyperplasia is a compelling indication of α1-blockers, because of the dual treatment effect on both high blood pressure and lower urinary tract symptoms. Many patients with resistant hypertension would require α1-blockers as add-on therapy. Primary aldosteronism screen is a rapidly increasing clinical demand in the management of hypertension, where α1-blockers are useful for blood pressure control in the preparation for the measurement of plasma aldosterone and renin. Nonetheless, α1-blockers have to be used under several considerations. Among the currently available agents, only long-acting α1-blockers, such as doxazosin gastrointestinal therapeutic system 4–8 mg daily and terazosin 2–4 mg daily, should be chosen. Orthostatic hypotension is a concern with the use of α1-blockers especially in the elderly, and requires careful initial bedtime dosing and avoiding overdosing. Fluid retention is potentially also a concern, which may be overcome by combining an α1-blocker with a diuretic.
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    Seven-action approaches for the management of hypertension in Asia – The HOPE Asia network
    (2022-03-01) Kario K.; Mahidol University
    Asia is a large continent and there is significant diversity between countries and regions. Over the last 30 years, absolute blood pressure (BP) levels in Asia have increased to a greater extent than those in other regions. In diverse Asia-Pacific populations, for choosing an Asia-specific approach to hypertension management is important to prevent target organ damage and cardiovascular diseases. In this consensus document of HOPE Asia Network, we introduce seven action approaches for management of hypertension in Asia.
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    The HOPE Asia network 2022 up-date consensus statement on morning hypertension management
    (2022-09-01) Kario K.; Wang J.G.; Chia Y.C.; Wang T.D.; Li Y.; Siddique S.; Shin J.; Turana Y.; Buranakitjaroen P.; Chen C.H.; Cheng H.M.; Van Huynh M.; Nailes J.; Sukonthasarn A.; Zhang Y.; Sison J.; Soenarta A.A.; Park S.; Sogunuru G.P.; Tay J.C.; Teo B.W.; Tsoi K.; Verma N.; Hoshide S.; Mahidol University
    Morning hypertension is an important clinical target in the management of hypertension for perfect 24-h blood pressure (BP) control. Morning hypertension is generally categorized into two types: “morning surge” type and “sustained nocturnal and morning hypertension” type. The “morning surge” type is characterized by an exaggerated morning blood pressure surge (MBPS), and the “sustained nocturnal and morning hypertension” type with continuous hypertension from nighttime to morning (non-dipper/riser type). They can be detected by home and ambulatory blood pressure measurements (HBPM and ABPM). These two forms of morning hypertension both increase the risk of cardiovascular and renal diseases, but may occur via different pathogenic mechanisms and are associated with different conditions. Morning hypertension should be treated to achieve a morning BP level of < 135/85 mmHg, regardless of the office BP. The second target morning BP levels is < 125/75 mmHg for high-risk patients with morning hypertension and concomitant diseases. Morning hypertension is more frequently found in Asians, than in Westerners. Thus, the management of morning hypertension is especially important in Asia. The detection of morning hypertension and the individual home BP-guided treatment approach targeting morning BP in combination with ABPM, and the optimal treatment of morning hypertension would reduce cardiovascular events in Asia.