Korean Circ J.  2019 Jun;49(6):514-527. 10.4070/kcj.2018.0358.

Temporal and Geospatial Trends of Hypertension Management in Korea: a Nationwide Study 2002–2016

• Lee H
• Park S
• Kim HC

• KMID: 2454047
• DOI: http://doi.org/10.4070/kcj.2018.0358

Abstract

BACKGROUND AND OBJECTIVES
Geographic distribution of hypertension management in Korea has never been reported. We investigated temporal and regional trends of hypertension management in Korea.
METHODS
For each calendar year from 2002 to 2016, we identified 2,423,245 to 7,549,989 persons aged ≥30 years treated for hypertension (total 80,564,109 cases). We calculated yearly age-sex standardized rates for medication adherence, combination therapy, blood test, and urine test according to geographic regions. We then used multivariate logistic regression to calculate odds ratios for hypertension management adjusted for individual-level sociodemographic factors.
RESULTS
Adherence rates have markedly increased from 24.4% (2002) to 71.6% (2016) nationwide. Regional difference was prominent in 2002 (highest, 31.7% in Seoul; lowest, 14.4% in Jeonbuk), but has become less noticeable over 15 years (highest, 73.1% in Daejeon; lowest, 69.0% in Jeonnam, 2016). Combination therapy rates increased from 42.8% (2002) to 61.0% (2011), but are in decreasing trend after 2011. Blood test rates were 58.8% in 2016, whereas urine test rates have been stagnant below 50% across all regions. Geographic variations of combination therapy and complication screening rates were not profound. Results from multivariable logistic regression, adjusted for age and sex, were in agreement with trends observed by standardized rates. The odds ratios remained unchanged when the models were further adjusted for employment status and household income.
CONCLUSIONS
Regional difference in hypertension management was evident in the past, but has become less apparent over the last 15 years in Korea.

Keyword

Hypertension; Medication adherence; Spatio-temporal analysis

MeSH Terms

Employment
Family Characteristics
Hematologic Tests
Humans
Hypertension*
Jeollanam-do
Korea*
Logistic Models
Mass Screening
Medication Adherence
Odds Ratio
Seoul
Spatio-Temporal Analysis

Figure

• 

  Figure 1 Age-sex standardized rates of hypertension management by regional characteristics and calendar year. All rates (%) are directly age-sex standardized to the 2016 population. (A, B) Adherence rates. (C, D) Combination therapy rates. (E, F) Blood test rates. (G, H) Urine test rates. (A, C, E, G) are stratified into capital or non-capital regions. (B, D, F, H) are stratified into metropolitan, urban, or rural area.

• 

  Figure 2 Map visualization of hypertension management by geographic region and calendar year. Yearly rates of adherence, combination therapy, blood test, and urine test are directly age-sex standardized to the 2016 population. Fill colors represent rates in percent. Crude and standardized rates in numeric forms are available in Supplementary Tables 3, 4, 5, 6.

Reference

1. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390:1345–1422.

2. Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol. 2008; 23:335–339.

3. Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013; 310:959–968.

4. Lloyd-Sherlock P, Beard J, Minicuci N, Ebrahim S, Chatterji S. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol. 2014; 43:116–128.

5. Reynolds K, Gu D, Muntner P, et al. Geographic variations in the prevalence, awareness, treatment and control of hypertension in China. J Hypertens. 2003; 21:1273–1281.

6. Mindell JS, Shelton NJ, Roth MA, Chaudhury M, Falaschetti E. Persistent regional variation in treatment of hypertension. Public Health. 2012; 126:317–323.

7. Marques-Vidal P, Paccaud F. Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland. BMC Public Health. 2012; 12:246.

8. Stöckl D, Rückert-Eheberg IM, Heier M, et al. Regional variability of lifestyle factors and hypertension with prediabetes and newly diagnosed type 2 diabetes mellitus: the population-based KORA-F4 and SHIP-TREND studies in Germany. PLoS One. 2016; 11:e0156736.

9. Yin M, Augustin B, Fu Z, Yan M, Fu A, Yin P. Geographic distributions in hypertension diagnosis, measurement, prevalence, awareness, treatment and control rates among middle-aged and older adults in China. Sci Rep. 2016; 6:37020.

10. Kauhl B, Maier W, Schweikart J, Keste A, Moskwyn M. Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany. BMC Public Health. 2018; 18:121.

11. OECD iLibrary. Doctors' Consultations. place unknown: OECD iLibrary;2018. DOI: 10.1787/1a1ac034-en.

12. National Health Insurance Service. 2016 National Health Screening Statistical Yearbook. Wonju: National Health Insurance Service;2017.

13. Korean Society Hypertension (KSH). Hypertension Epidemiology Research Working Group. Kim HC, Cho MC. Korea hypertension fact sheet 2018. Clin Hypertens. 2018; 24:13.

14. Seong SC, Kim YY, Khang YH, et al. Data resource profile: the national health information database of the national health insurance service in South Korea. Int J Epidemiol. 2017; 46:799–800.

15. ACCORD Study Group. Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1575–1585.

16. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013; 34:2159–2219.

17. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311:507–520.

18. SPRINT Research Group. Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373:2103–2116.

19. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; 71:e13–115.

20. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39:3021–3104.

21. Shin J, Park JB, Kim KI, et al. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology and diagnosis of hypertension. Clin Hypertens. 2015; 21:1.

22. Shin J, Park JB, Kim KI, et al. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part II-treatments of hypertension. Clin Hypertens. 2015; 21:2.

23. Halpern MT, Khan ZM, Schmier JK, et al. Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data. Hypertension. 2006; 47:1039–1048.

24. Pedigo A, Aldrich T, Odoi A. Neighborhood disparities in stroke and myocardial infarction mortality: a GIS and spatial scan statistics approach. BMC Public Health. 2011; 11:644.