Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Special Issue: Current evidence and perspectives for hypertension management in Asia
  • Published:

Asthma and increased risk of myocardial infarction and mortality among hypertensive Korean patients

Hypertension Research volume 46, pages 1694–1704 (2023)Cite this article

A Comment to this article was published on 25 May 2023

Abstract

This study aimed to evaluate the effects of asthma on cardiovascular disease incidence in patients with hypertension. A total of 639,784 patients with hypertension from the Korea National Health Insurance Service database were included, of whom 62,517 had history of asthma after propensity score matching. The risks of all-cause mortality, myocardial infarction (MI), stroke, and end-stage renal disease (ESRD) were assessed according to the presence of asthma, long-acting β2-agonist (LABA) inhaler usage, and/or systemic corticosteroid usage for up to 11 years. In addition, whether these risks were modified by average blood pressure (BP) levels during the follow-up period was examined. Asthma was associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.203; 95% confidence interval [CI], 1.165–1.241) and MI (HR, 1.244; 95% CI, 1.182–1.310) but not the risk of stroke or ESRD. LABA inhaler usage was associated with a higher risk of all-cause mortality and MI, and systemic corticosteroids usage showed a higher risk of ESRD as well as all-cause mortality and MI among hypertensive patients with asthma. Compared to patients without asthma, there was a graded increase in the risk of all-cause mortality and MI in those with asthma without LABA inhaler/systemic corticosteroid usage and in those with asthma with LABA inhaler/systemic corticosteroid usage. These associations were not significantly modified by BP levels. This nationwide population-based study supports that asthma may be a clinical factor that increases the risk of poor outcomes in patients with hypertension.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data underlying this article were provided by the NHIS of the Republic of Korea by permission and are available at the local server in the NHIS. Data will be shared on request to the corresponding author with the permission of the NHIS of the Republic of Korea.

References

  1. Stebbings JH Jr. Two observed associations between respiratory allergies and hypertension in nonsmokers. Am J Epidemiol. 1973;97:4–15.

    Article  PubMed  Google Scholar 

  2. Christiansen SC, Schatz M, Yang SJ, Ngor E, Chen W, Zuraw BL. Hypertension and asthma: a comorbid relationship. J Allergy Clin Immunol Pr. 2016;4:76–81.

    Article  Google Scholar 

  3. Ferguson S, Teodorescu MC, Gangnon RE, Peterson AG, Consens FB, Chervin RD, et al. Factors associated with systemic hypertension in asthma. Lung. 2014;192:675–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jacobs DR Jr, Yatsuya H, Hearst MO, Thyagarajan B, Kalhan R, Rosenberg S, et al. Rate of decline of forced vital capacity predicts future arterial hypertension: the Coronary Artery Risk Development in Young Adults Study. Hypertension. 2012;59:219–25.

    Article  CAS  PubMed  Google Scholar 

  5. Christiansen SC, Zuraw BL. Treatment of hypertension in patients with asthma. N Engl J Med. 2019;381:1046–57.

    Article  CAS  PubMed  Google Scholar 

  6. Cepelis A, Brumpton BM, Laugsand LE, Dalen H, Langhammer A, Janszky I, et al. asthma control and risk of acute myocardial infarction: HUNT study. Eur J Epidemiol. 2019;34:967–77.

    Article  CAS  PubMed  Google Scholar 

  7. Duong M, Islam S, Rangarajan S, Leong D, Kurmi O, Teo K, et al. Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV(1) (PURE): an international, community-based cohort study. Lancet Glob Health. 2019;7:e613–e623.

    Article  PubMed  Google Scholar 

  8. Strand LB, Tsai MK, Wen CP, Chang SS, Brumpton BM. Is having asthma associated with an increased risk of dying from cardiovascular disease? A prospective cohort study of 446346 Taiwanese adults. BMJ Open. 2018;8:e019992.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Xu M, Xu J, Yang X. Asthma and risk of cardiovascular disease or all-cause mortality: a meta-analysis. Ann Saudi Med. 2017;37:99–105.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Seong SC, Kim YY, Park SK, Khang YH, Kim HC, Park JH, et al. Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea. BMJ Open. 2017;7:e016640.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lee CJ, Hwang J, Oh J, Lee SH, Kang SM, Kim HC, et al. Relation between blood pressure and clinical outcome in hypertensive subjects with previous stroke. J Am Heart Assoc. 2017;6:e007102.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Shin JY, Sohn KH, Shin JE, Park M, Lim J, Lee JY, et al. Changing patterns of adult asthma incidence: results from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in Korea. Sci Rep. 2018;8:15052.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lee CJ, Hwang J, Lee YH, Oh J, Lee SH, Kang SM, et al. Blood pressure level associated with lowest cardiovascular event in hypertensive diabetic patients. J Hypertens. 2018;36:2434–43.

    Article  CAS  PubMed  Google Scholar 

  14. Lee CJ, Ryu J, Kim HC, Ryu DR, Ihm SH, Kim YJ, et al. Clinical benefit of treatment of stage-1, low-risk hypertension. Hypertension. 2018;72:1285–93.

    Article  CAS  PubMed  Google Scholar 

  15. Ko MJ, Jo AJ, Park CM, Kim HJ, Kim YJ, Park DW. Level of blood pressure control and cardiovascular events: SPRINT criteria versus the 2014 hypertension recommendations. J Am Coll Cardiol. 2016;67:2821–31.

    Article  PubMed  Google Scholar 

  16. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.

    Article  Google Scholar 

  17. Dogra S, Ardern CI, Baker J. The relationship between age of asthma onset and cardiovascular disease in Canadians. J Asthma. 2007;44:849–54.

    Article  PubMed  Google Scholar 

  18. Liu H, Fu Y, Wang K. Asthma and risk of coronary heart disease: a meta-analysis of cohort studies. Ann Allergy Asthma Immunol. 2017;118:689–95.

    Article  PubMed  Google Scholar 

  19. Bang DW, Wi CI, Kim EN, Hagan J, Roger V, Manemann S, et al. Asthma status and risk of incident myocardial infarction: a population-based case-control study. J Allergy Clin Immunol Pr. 2016;4:917–23.

    Article  Google Scholar 

  20. Raita Y, Camargo CA Jr, Faridi MK, Brown DFM, Shimada YJ, Hasegawa K. Risk of acute myocardial infarction and ischemic stroke in patients with asthma exacerbation: a population-based, self-controlled case series study. J Allergy Clin Immunol Pr. 2020;8:188–94.e188.

    Article  Google Scholar 

  21. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  PubMed  Google Scholar 

  22. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, 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. J Am Coll Cardiol. 2018;71:e127–e248.

    Article  PubMed  Google Scholar 

  23. Chung WS, Lin CL, Chen YF, Ho FM, Hsu WH, Kao CH. Increased stroke risk among adult asthmatic patients. Eur J Clin Invest. 2014;44:1025–33.

    Article  PubMed  Google Scholar 

  24. Kim SY, Lim H, Lim JS, Choi HG. Analysis of the relationship between adult asthma and stroke: a longitudinal follow-up study using the Korean national sample cohort. Biomed Res Int. 2019;2019:8919230.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fang ZH, Li ZF, An ZY, Huang SC, Hao MD, Zhang WX. Meta-analysis of the association between asthma and the risk of stroke. Front Neurol. 2022;13:900438.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kim HC, Oh SM. Noncommunicable diseases: current status of major modifiable risk factors in Korea. J Prev Med Public Health. 2013;46:165–72.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Spitzer WO, Suissa S, Ernst P, Horwitz RI, Habbick B, Cockcroft D, et al. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med. 1992;326:501–6.

    Article  CAS  PubMed  Google Scholar 

  28. Wang MT, Liou JT, Lin CW, Tsai CL, Wang YH, Hsu YJ, et al. Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: a nested case-control study. JAMA Intern Med. 2018;178:229–38.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Li C, Cheng W, Guo J, Guan W. Relationship of inhaled long-acting bronchodilators with cardiovascular outcomes among patients with stable COPD: a meta-analysis and systematic review of 43 randomized trials. Int J Chron Obstruct Pulmon Dis. 2019;14:799–808.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Ish P, Malhotra N, Gupta N. GINA 2020: what’s new and why? J Asthma. 2021;58:1273–7.

  31. Global Strategy for Asthma Management and Prevention. 2010. https://ginasthma.org/archived-reports/. Accessed 5 May 2020.

  32. Volmer T, Effenberger T, Trautner C, Buhl R. Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature. Eur Respir J. 2018;52:1800703.

    Article  PubMed  Google Scholar 

  33. Sweeney J, Patterson CC, Menzies-Gow A, Niven RM, Mansur AH, Bucknall C, et al. Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. Thorax. 2016;71:339–46.

    Article  PubMed  Google Scholar 

  34. Mebrahtu TF, Morgan AW, West RM, Stewart PM, Pujades-Rodriguez M. Oral glucocorticoids and incidence of hypertension in people with chronic inflammatory diseases: a population-based cohort study. CMAJ. 2020;192:E295–e301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014;30:96–102.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Lionaki S, Hogan SL, Jennette CE, Hu Y, Hamra JB, Jennette JC, et al. The clinical course of ANCA small-vessel vasculitis on chronic dialysis. Kidney Int. 2009;76:644–51.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Morales DR. LABA monotherapy in asthma: an avoidable problem. Br J Gen Pr. 2013;63:627–8.

    Article  Google Scholar 

  38. Iribarren C, Tolstykh IV, Miller MK, Sobel E, Eisner MD. Adult asthma and risk of coronary heart disease, cerebrovascular disease, and heart failure: a prospective study of 2 matched cohorts. Am J Epidemiol. 2012;176:1014–24.

    Article  PubMed  Google Scholar 

  39. Song WJ, Kang MG, Chang YS, Cho SH. Epidemiology of adult asthma in Asia: toward a better understanding. Asia Pac Allergy. 2014;4:75–85.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

In 2016, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Society of Cardiology to provide limited open access to its databases for investigating the past and current statuses of hypertension and its management. The National Health Information Database was provided by the NHIS of the Republic of Korea (NHIS-2021-1-210).

Funding

This work was supported by the National Institute of Health [grant number 2021-ER0903-02] and the National Research Foundation of Korea grant funded by the Korean government (MSIT) [grant number 2020R1C1C1013627].

Author information

Author notes

  1. These authors contributed equally: Chan Joo Lee, Jinseub Hwang

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Chan Joo Lee & Sungha Park

  2. Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea

    Jinseub Hwang, Chae Young Kang, Dayoung Kang & Do Hyang Kim

  3. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hye Jung Park

  4. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyeon-Chang Kim

  5. Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Sang-Hyun Ihm

  6. Division of Cardiology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Yong-Jin Kim

  7. Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea

    Jin-Ho Shin

  8. Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea

    Wook Bum Pyun

  9. Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

    Sungha Park

Authors
  1. Chan Joo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinseub Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chae Young Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dayoung Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Do Hyang Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hye Jung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyeon-Chang Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sang-Hyun Ihm
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yong-Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jin-Ho Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Wook Bum Pyun
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sungha Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. CJL and JH contributed equally to this study. Concept and design: CJL, JH, SP. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: CJL, JH. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: CJL, JH, CYK, DK, DHK. Obtained funding: CJL, SP. Administrative, technical, or material support: JH, HJP, SP. Supervision: SP.

Corresponding author

Correspondence to Sungha Park.

Ethics declarations

Conflict of interest

CJL has received lecture honoraria from Novartis, Hanmi Pharmaceutical, Yuhan, Boryung Pharmaceutical, and Daiichi Sankyo. SHI has received lecture honoraria from Daiichi Sankyo, Daewoong Pharmaceutical, Dong-A ST, Celltrion Pharmaceutical, Boryung Pharmaceutical, and Hanmi Pharmaceutical and a research grant from Dong-A ST. JS has received lecture honoraria from Pfizer, Hanmi Pharmaceutical, Yuhan, and Boryung Pharmaceutical, consulting fees from Hanmi Pharmaceutical, and research grants from Sanofi, and Hanmi Pharmaceutical. SP has received honorarium from Pfizer, Viatris, Boryoung, Hanmi, Daewoong, Donga, Celltrion, Servier, Daiichi Sankyo, Chong Kun Dang and Daewon. SP also has received research grant from Daiichi Sankyo.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, C.J., Hwang, J., Kang, C.Y. et al. Asthma and increased risk of myocardial infarction and mortality among hypertensive Korean patients. Hypertens Res 46, 1694–1704 (2023). https://doi.org/10.1038/s41440-023-01257-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-023-01257-3

Keywords

This article is cited by

Search

Advanced search

Quick links