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  1. Fulltext Correlation of Foot Bimalleolar Angle and Ultrasonography in Assessing the Severity of Club Foot in Neonates Treated by the Ponseti Method
    Bajaj V, Anshuman R, Verma N, Singh MP, Tandon A
    Malays Orthop J, 2018 Nov;12(3):14-18.
    PMID: 30555641 DOI: 10.5704/MOJ.1811.003
    Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method. Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression. Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05). Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.
  2. Fulltext Long sleep duration and cardiovascular disease: Associations with arterial stiffness and blood pressure variability
    Matsubayashi H, Nagai M, Dote K, Turana Y, Siddique S, Chia YC, et al.
    J Clin Hypertens (Greenwich), 2021 03;23(3):496-503.
    PMID: 33377597 DOI: 10.1111/jch.14163
    Although short and long sleep duration are both risk factors of cardiovascular disease (CVD), the recent meta-analyses have been shown that long sleep duration was closely associated with CVD mortality. While the specific mechanism underlying the association between long sleep duration and CVD remains unclear, long sleep duration was shown to be associated with arterial stiffness and blood pressure variability (BPV) in many Asian populations. This review article will focus on the pathophysiology of long sleep duration, arterial stiffness, BPV and their effects on CVD. To set the stage for this review, we first summarize the current insights for the relationship between long sleep duration and CVD in relation to arterial stiffness and BPV.
  3. Fulltext Standardized home blood pressure monitoring: Rationale behind the 722 protocol
    Lin HJ, Pan HY, Chen CH, Cheng HM, Chia YC, Sogunuru GP, et al.
    J Clin Hypertens (Greenwich), 2022 Sep;24(9):1161-1173.
    PMID: 36196472 DOI: 10.1111/jch.14549
    Home blood pressure (HBP) has been recognized as a prognostic predictor for cardiovascular events, and integrated into the diagnosis and management of hypertension. With increasing accessibility of oscillometric blood pressure devices, HBP monitoring is easy to perform, more likely to obtain reliable estimation of blood pressures, and feasible to document long-term blood pressure variations, compared to office and ambulatory blood pressures. To obtain reliable HBP estimates, a standardized HBP monitoring protocol is essential. A consensus regarding the optimal duration and frequency of HBP monitoring is yet to be established. Based on the current evidence, the "722" protocol, which stands for two measurements on one occasion, two occasions a day (morning and evening), and over a consecutive of 7 days, is most commonly used in clinical studies and recommended in relevant guidelines and consensus documents. HBP monitoring based on the "722" protocol fulfills the minimal requirement of blood pressure measurements to achieve agreement of blood pressure classifications defined by office blood pressures and to predict cardiovascular risks. In the Taiwan HBP consensus, the frequency of repeating the "722" protocol of HBP monitoring according to different scenarios of hypertension management, from every 2 weeks to 3 months, is recommended. It is reasonable to conclude that the "722" protocol for HBP monitoring is clinically justified and can serve as a basis for standardized HBP monitoring.
  4. Fulltext The role of renal nerve stimulation in percutaneous renal denervation for hypertension: A mini-review
    Huang HC, Cheng HM, Chia YC, Li Y, Van Minh H, Siddique S, et al.
    J Clin Hypertens (Greenwich), 2022 Sep;24(9):1187-1193.
    PMID: 36196464 DOI: 10.1111/jch.14554
    Recent trials have demonstrated the efficacy and safety of percutaneous renal sympathetic denervation (RDN) for blood pressure (BP)-lowering in patients with uncontrolled hypertension. Nevertheless, major challenges exist, such as the wide variation of BP-lowering responses following RDN (from strong response to no response) and lack of feasible and reproducible peri-procedural predictors for patient response. Both animal and human studies have demonstrated different patterns of BP responses following renal nerve stimulation (RNS), possibly related to varied regional proportions of sympathetic and parasympathetic nerve tissues along the renal arteries. Animal studies of RNS have shown that rapid electrical stimulation of the renal arteries caused renal artery vasoconstriction and increased norepinephrine secretion with a concomitant increase in BP, and the responses were attenuated after RDN. Moreover, selective RDN at sites with strong RNS-induced BP increases led to a more efficient BP-lowering effect. In human, when RNS was performed before and after RDN, blunted changes in RNS-induced BP responses were noted after RDN. The systolic BP response induced by RNS before RDN and blunted systolic BP response to RNS after RDN, at the site with maximal RNS-induced systolic BP response before RDN, both correlated with the 24-h ambulatory BP reductions 3-12 months following RDN. In summary, RNS-induced BP changes, before and after RDN, could be used to assess the immediate effect of RDN and predict BP reductions months following RDN. More comprehensive, large-scale and long term trials are needed to verify these findings.
  5. Fulltext Insights on home blood pressure monitoring in Asia: Expert perspectives from 10 countries/regions
    Wang JG, Bunyi ML, Chia YC, Kario K, Ohkubo T, Park S, et al.
    J Clin Hypertens (Greenwich), 2021 Jan;23(1):3-11.
    PMID: 33043574 DOI: 10.1111/jch.14074
    Hypertension is one of the most powerful modifiable risk factors for cardiovascular disease. It is usually asymptomatic and therefore essential to measure blood pressure regularly for the detection of hypertension. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to monitor blood pressure and facilitate effective diagnosis of hypertension. It is useful to identify the masked or white-coat hypertension. There is also increasing evidence that supports the role of HBPM in guiding antihypertensive treatment, and improving treatment compliance and hypertension control. In addition, HBPM has also shown prognostic value in predicting cardiovascular events. Despite these benefits, the use of HBPM in many parts of Asia has been reported to be low. An expert panel comprising 12 leading experts from 10 Asian countries/regions convened to share their perspectives on the realities of HBPM. This article provides an expert summary of the current status of HBPM and the key factors hindering its use. It also describes HBPM-related initiatives in the respective countries/regions and presents strategies that could be implemented to better support the use of HBPM in the management of hypertension.
  6. Fulltext Non-pharmacological management of hypertension
    Verma N, Rastogi S, Chia YC, Siddique S, Turana Y, Cheng HM, et al.
    J Clin Hypertens (Greenwich), 2021 Jul;23(7):1275-1283.
    PMID: 33738923 DOI: 10.1111/jch.14236
    Hypertension is an insidious disease which predisposes to cardiovascular complications and if not treated properly can lead to various serious complications. Economic limitations, having additional benefits with few or almost no side effects have made non-pharmacological management of hypertension an attractive approach for dealing with hypertension, in developed and developing countries alike. A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials, and meta-analyses for this review paper. Lifestyle modifications including changes in the dietary pattern, adopting special diets with low sodium, saturated fat and high calcium, magnesium and potassium and trying the new methods like time restricted meal intake which work in tandem with the circadian rhythm are opening new vistas in the field of non-pharmacological management of hypertension. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, relaxation techniques of Yoga, Acupuncture, Tai chi, mindfulness-based stress-reduction program, and Transcendental Meditation. Air pollution of the surrounding air is linked with poor health outcomes and is a major contributor to the global burden of disease. Fine particulate matter <2.5 μm in diameter (PM2.5) is strongly associated with cardiovascular morbidity and mortality. Short-term PM exposure (hours to weeks) increases the likelihood of adverse cardiovascular events including myocardial infarction, stroke, and heart failure, and longer-term exposure multiplies that risk. Non-pharmacological methods should be initiated early phase of disease and should be continued with medication.
  7. Fulltext An overview of hypertension and cardiac involvement in Asia: Focus on heart failure
    Soenarta AA, Buranakitjaroen P, Chia YC, Chen CH, Nailes J, Hoshide S, et al.
    J Clin Hypertens (Greenwich), 2020 03;22(3):423-430.
    PMID: 31955506 DOI: 10.1111/jch.13753
    Cardiovascular Disease (CVD) is the leading cause of deaths worldwide, contributing to about 30% of all deaths. Half of the cases of CVD are estimated in Asia, the world's most populous continent. Hypertension, a major modifiable risk factor for CVD, results in more deaths than any other CV risk factors in the Asian regions. The total number of patients with hypertension is likely to grow as the population ages. The proportion of the elderly population aged 65 years or more in Asia is expected to increase from 7.4% in 2015 to 10.9% in 2030. It is important to note that more than half (54%) of the world's population live in Asia. Aside of being the biggest single risk factor for global deaths, hypertension is also an important precursor and most common risk factor of heart failure (HF). An increase in HF prevalence is clearly related to the rapid epidemiological transition caused by changes in lifestyle in Asian countries. However, the availability of data on HF burden and health care delivery is limited in Asia compared with Europe and North America. This reality has driven the working group of Asian experts for example the HOPE Asia Network to concentrate on hypertension as risk factors for CVD, with the mission to improve the management of hypertension resulting in organ protection toward a goal of achieving "ZERO" CV event in Asia. This paper aims to give an overview regarding the heart problems caused by hypertension in Asia, focus on HF.
  8. Fulltext The feasibility of polypill for cardiovascular disease prevention in Asian Population
    Sukonthasarn A, Chia YC, Wang JG, Nailes J, Buranakitjaroen P, Van Minh H, et al.
    J Clin Hypertens (Greenwich), 2021 03;23(3):545-555.
    PMID: 33086429 DOI: 10.1111/jch.14075
    Polypill is a fixed-dose combination of medications with proven benefits for the prevention of cardiovascular disease (CVD). Its role in CVD prevention has been extensively debated since the inception of this concept in 2003. There are two major kinds of polypills in clinical studies. The first is polypill that combines multiple low-dose medications for controlling only one CVD risk factor (such as high blood pressure or high serum cholesterol). These "single-purpose" polypills were mostly developed from original producers and have higher cost. The polypill that combines 3-4 pharmaceutical components, each with potential to reduce one major cardiovascular risk factors is "multi-purpose" or "cardiovascular" polypill. Using data from various clinical trials and from meta-analysis, Wald and Law claimed that this "cardiovascular" polypill when administered to every individual older than 55 years could reduce the incidence of CVD by more than 80%. Several short and intermediate to long-term studies with different cardiovascular polypills in phase II and III trials showed that they could provide better adherence, equivalent, or better risk factor control and quality of life among users as compared to usual care. One recently published randomized controlled clinical trial demonstrated the effectiveness and safety of a four-component polypill for both primary and secondary CVD prevention with acceptable number needed to treat (NNT) to prevent one major cardiovascular event. Considering the slow achievement of CVD prevention in many poor- and middle-income Asian countries and also the need to further improve compliance of antihypertensive and lipid lowering medications in many high-income Asian countries, the concept of "cardiovascular polypill" could be very useful. With further support from ongoing polypill cardiovascular outcome trials, polypill could be the foundation of the population-based strategies for CVD prevention.
  9. Fulltext Clinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia
    Fujiwara T, Hoshide S, Tomitani N, Cheng HM, Soenarta AA, Turana Y, et al.
    J Clin Hypertens (Greenwich), 2021 03;23(3):457-466.
    PMID: 33591641 DOI: 10.1111/jch.14218
    Nocturnal home blood pressure (BP) monitoring has been used in clinical practice for ~20 years. The authors recently showed that nocturnal systolic BP (SBP) measured by a home BP monitoring (HBPM) device in a Japanese general practice population was a significant predictor of incident cardiovascular disease (CVD) events, independent of office and morning home SBP levels, and that masked nocturnal hypertension obtained by HBPM (defined as nocturnal home BP ≥ 120/70 mmHg and average morning and evening BP 
  10. Fulltext Office blood pressure measurement: A comprehensive review
    Siddique S, Hameed Khan A, Shahab H, Zhang YQ, Chin Tay J, Buranakitjaroen P, et al.
    J Clin Hypertens (Greenwich), 2021 03;23(3):440-449.
    PMID: 33420745 DOI: 10.1111/jch.14169
    The conventional auscultatory methods for measuring blood pressure have been used to screen, diagnose, and manage hypertension since long. However, these have been found to be prone to errors especially the white coat phenomena which cause falsely high blood pressure readings. The Mercury sphygmomanometer and the Aneroid variety are no longer recommended by WHO for varying reasons. The Oscillometric devices are now recommended with preference for the Automated Office Blood Pressure measurement device which was found to have readings nearest to the Awake Ambulatory Blood Pressure readings. The downside for this device is the cost barrier. The alternative is to use the simple oscillometric device, which is much cheaper, with the rest and isolation criteria of the SPRINT study. This too may be difficult due to space constraints and the post-clinic blood measurement is a new concept worth further exploration.
  11. Role of dietary potassium and salt substitution in the prevention and management of hypertension
    Chia YC, He FJ, Cheng MH, Shin J, Cheng HM, Sukonthasarn A, et al.
    Hypertens Res, 2025 Jan;48(1):301-313.
    PMID: 39472546 DOI: 10.1038/s41440-024-01862-w
    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.
  12. Unravelling the molecular mechanisms underlying chronic respiratory diseases for the development of novel therapeutics via in vitro experimental models
    Tan CL, Chan Y, Candasamy M, Chellian J, Madheswaran T, Sakthivel LP, et al.
    Eur J Pharmacol, 2022 Feb 11;919:174821.
    PMID: 35151643 DOI: 10.1016/j.ejphar.2022.174821
    Chronic respiratory diseases have collectively become a major public health concern and have now taken form as one of the leading causes of mortality worldwide. Most chronic respiratory diseases primarily occur due to prolonged airway inflammation. In addition, critical environmental factors such as cigarette smoke, industrial pollutants, farm dust, and pollens may also exacerbate such diseases. Moreover, alterations in the genetic sequence of an individual, abnormalities in the chromosomes or immunosuppression resulting from bacterial, fungal, and viral infections may also play a key role in the pathogenesis of respiratory diseases. Over the years, multiple in vitro models have been employed as the basis of existing as well as emerging advancements in chronic respiratory disease research. These include cell lines, gene expression techniques, single cell RNA sequencing, cytometry, culture techniques, as well as serum/sputum biomarkers that can be used to elucidate the molecular mechanisms underlying these diseases, and to identify novel diagnostic and management options for these diseases. This review summarizes the current understanding of the pathogenesis of various chronic respiratory diseases derived through in vitro experimental models, where the knowledge obtained from these studies can greatly benefit researchers in the discovery and development of novel screening techniques and advanced therapeutic strategies that could be translated into clinical use in the future.
  13. APASL-ACLF Research Consortium-Artificial Intelligence (AARC-AI) model precisely predicts outcomes in acute-on-chronic liver failure patients
    Verma N, Choudhury A, Singh V, Duseja A, Al-Mahtab M, Devarbhavi H, et al.
    Liver Int, 2023 Feb;43(2):442-451.
    PMID: 35797245 DOI: 10.1111/liv.15361
    BACKGROUND AND AIMS: We hypothesized that artificial intelligence (AI) models are more precise than standard models for predicting outcomes in acute-on-chronic liver failure (ACLF).

    METHODS: We recruited ACLF patients between 2009 and 2020 from APASL-ACLF Research Consortium (AARC). Their clinical data, investigations and organ involvement were serially noted for 90-days and utilized for AI modelling. Data were split randomly into train and validation sets. Multiple AI models, MELD and AARC-Model, were created/optimized on train set. Outcome prediction abilities were evaluated on validation sets through area under the curve (AUC), accuracy, sensitivity, specificity and class precision.

    RESULTS: Among 2481 ACLF patients, 1501 in train set and 980 in validation set, the extreme gradient boost-cross-validated model (XGB-CV) demonstrated the highest AUC in train (0.999), validation (0.907) and overall sets (0.976) for predicting 30-day outcomes. The AUC and accuracy of the XGB-CV model (%Δ) were 7.0% and 6.9% higher than the standard day-7 AARC model (p 

  14. Machine learning improves the prediction of significant fibrosis in Asian patients with metabolic dysfunction-associated steatotic liver disease - The Gut and Obesity in Asia (GO-ASIA) Study
    Verma N, Duseja A, Mehta M, De A, Lin H, Wong VW, et al.
    Aliment Pharmacol Ther, 2024 Mar;59(6):774-788.
    PMID: 38303507 DOI: 10.1111/apt.17891
    BACKGROUND: The precise estimation of cases with significant fibrosis (SF) is an unmet goal in non-alcoholic fatty liver disease (NAFLD/MASLD).

    AIMS: We evaluated the performance of machine learning (ML) and non-patented scores for ruling out SF among NAFLD/MASLD patients.

    METHODS: Twenty-one ML models were trained (N = 1153), tested (N = 283), and validated (N = 220) on clinical and biochemical parameters of histologically-proven NAFLD/MASLD patients (N = 1656) collected across 14 centres in 8 Asian countries. Their performance for detecting histological-SF (≥F2fibrosis) were evaluated with APRI, FIB4, NFS, BARD, and SAFE (NPV/F1-score as model-selection criteria).

    RESULTS: Patients aged 47 years (median), 54.6% males, 73.7% with metabolic syndrome, and 32.9% with histological-SF were included in the study. Patients with SFvs.no-SF had higher age, aminotransferases, fasting plasma glucose, metabolic syndrome, uncontrolled diabetes, and NAFLD activity score (p  140) was next best in ruling out SF (NPV of 0.757, 0.724 and 0.827 in overall, test and validation set).

    CONCLUSIONS: ML with clinical, anthropometric data and simple blood investigations perform better than FIB-4 for ruling out SF in biopsy-proven Asian NAFLD/MASLD patients.

  15. Agreement regarding overcoming hypertension in the Asian Hypertension Society Network 2022
    Hoshide S, Yamamoto K, Katsurada K, Yano Y, Nishiyama A, Wang JG, et al.
    Hypertens Res, 2023 Jan;46(1):3-8.
    PMID: 36229522 DOI: 10.1038/s41440-022-00994-1
  16. Fulltext The HOPE Asia network 2022 up-date consensus statement on morning hypertension management
    Kario K, Wang JG, Chia YC, Wang TD, Li Y, Siddique S, et al.
    J Clin Hypertens (Greenwich), 2022 Sep;24(9):1112-1120.
    PMID: 36196465 DOI: 10.1111/jch.14555
    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 
  17. Fulltext Diversity of and initiatives for hypertension management in Asia-Why we need the HOPE Asia Network
    Kario K, Chia YC, Sukonthasarn A, Turana Y, Shin J, Chen CH, et al.
    J Clin Hypertens (Greenwich), 2020 Mar;22(3):331-343.
    PMID: 31773883 DOI: 10.1111/jch.13733
    The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30 years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries. Identifying and treating masked hypertension is important to reduce cardiovascular risk. Abnormal patterns of blood pressure (BP) variability common in Asia include exaggerated early morning BP surge and nocturnal hypertension. These are also important cardiovascular risk factors that need to be managed. Home blood pressure monitoring (HBPM) is an important tool for detecting white-coat and masked hypertension, and monitoring BP variability, and practices in Asia are variable. Use of HBPM is important given the Asia-specific features of hypertension, and strategies are needed to improve and standardize HBPM usage. Development of HBPM devices capable of measuring nocturnal BP along with other information and communication technology-based strategies are key developments in the widespread implementation of anticipation medicine strategies to detect and prevent cardiovascular events in patients with hypertension. Region-wide differences in hypertension prevalence, control, and management practices in Asia highlight the importance of information sharing to facilitate best practices.
  18. Fulltext High blood pressure in dementia: How low can we go?
    Turana Y, Tengkawan J, Chia YC, Teo BW, Shin J, Sogunuru GP, et al.
    J Clin Hypertens (Greenwich), 2020 Mar;22(3):415-422.
    PMID: 31816178 DOI: 10.1111/jch.13752
    Hypertension is an important public health concern. The prevalence keeps increasing, and it is a risk factor for several adverse health outcomes including a decline in cognitive function. Recent data also show that the prevalence of hypertension and age-related dementia is rising in Asian countries, including in the oldest old group. This study aims to discuss possible treatments for high blood pressure in the elderly and propose an optimal target for BP relative to cognitive outcomes. This review discusses several studies on related blood pressure treatments that remain controversial and the consequences if the treatment target is too low or aggressive. Longitudinal, cross-sectional, and RCT studies were included in this review. An optimum systolic blood pressure of 120-130 mm Hg is recommended, especially in nondiabetic hypertensive patients with significant risk factors. In the oldest old group of patients, hypertension might have a protective effect. The use of calcium channel blockers (CCB) and angiotensin receptor blocker (ARB) is independently associated with a decreased risk of dementia in older people. However, personalized care for patients with hypertension, especially for patients who are frail or very old, is encouraged.
  19. Fulltext 2020 Consensus summary on the management of hypertension in Asia from the HOPE Asia Network
    Kario K, Park S, Chia YC, Sukonthasarn A, Turana Y, Shin J, et al.
    J Clin Hypertens (Greenwich), 2020 03;22(3):351-362.
    PMID: 31816164 DOI: 10.1111/jch.13751
    Hypertension professionals from Asia have been meeting together for the last decade to discuss how to improve the management of hypertension. Based on these education and research activities, the Hypertension, brain, cardiovascular and renal Outcome Prevention and Evidence in Asia (HOPE Asia) Network was officially established in June 2018 and includes experts from 12 countries/regions across Asia. Among the numerous research and review papers published by members of the HOPE Asia Network since 2017, publications in three key areas provide important guidance on the management of hypertension in Asia. This article highlights key consensus documents, which relate to the Asian characteristics of hypertension, home blood pressure monitoring (HBPM), and ambulatory blood pressure monitoring (ABPM). Hypertension and hypertension-related diseases are common in Asia, and their characteristics differ from those in other populations. It is essential that these are taken into consideration to provide the best opportunity for achieving "perfect 24-hour blood pressure control", guided by out-of-office (home and ambulatory) blood pressure monitoring. These region-specific consensus documents should contribute to optimizing individual and population-based hypertension management strategies in Asian country. In addition, the HOPE Asia Network model provides a good example of the local interpretation, modification, and dissemination of international best practice to benefit specific populations.
  20. Fulltext Central blood pressure for the management of hypertension: Is it a practical clinical tool in current practice?
    Cheng HM, Chuang SY, Wang TD, Kario K, Buranakitjaroen P, Chia YC, et al.
    J Clin Hypertens (Greenwich), 2020 03;22(3):391-406.
    PMID: 31841279 DOI: 10.1111/jch.13758
    Since noninvasive central blood pressure (BP) measuring devices are readily available, central BP has gained growing attention regarding its clinical application in the management of hypertension. The disagreement between central and peripheral BP has long been recognized. Some previous studies showed that noninvasive central BP may be better than the conventional brachial BP in association with target organ damages and long-term cardiovascular outcomes. Recent studies further suggest that the central BP strategy for confirming a diagnosis of hypertension may be more cost-effective than the conventional strategy, and guidance of hypertension management with central BP may result in less use of medications to achieve BP control. Despite the use of central BP being promising, more randomized controlled studies comparing central BP-guided therapeutic strategies with conventional care for cardiovascular events reduction are required because noninvasive central and brachial BP measures are conveniently available. In this brief review, the rationale supporting the utility of central BP in clinical practice and relating challenges are summarized.
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