Following antihypertensive treatment initiation, only 26.7% of patients achieved the target blood pressure of <130/<80 mmHg, with regional control rates positively associating with physician availability.
Cohort (n=1,318,437)
Yes
What is the rate of target blood pressure control (<130/<80 mmHg) after antihypertensive treatment initiation, and how does it vary regionally in Japan?
Substantial regional disparities in blood pressure control exist across Japan, which are significantly influenced by physician availability and correlate with stroke mortality.
This study assessed regional variations in blood pressure (BP) control after antihypertensive treatment and explored the associations with healthcare resource indicators across Japan. Using nationwide health check-up data from the Japan Health Insurance Association between 2015 and 2022, we analyzed 1,318,437 individuals aged 40-74 who initiated antihypertensive treatment based on consecutive health check-ups. We evaluated prefecture-level differences in post-treatment BP control rates (systolic BP SBP/diastolic BP DBP <130/<80 mmHg). Prefecture-level ecological analyses examined the associations between adjusted BP control rates and cerebrovascular disease mortality rates and six healthcare resource indicators, including the Physician Uneven Distribution Index (PUDI). Mean SBP/DBP decreased from 148.3/92.4 mmHg to 134.1/83.1 mmHg following treatment initiation. Only 26.7% of patients achieved the target BP (<130/<80 mmHg). This level is the universal target in the Japanese Society of Hypertension Guidelines for the Management of Elevated Blood Pressure and Hypertension 2025, highlighting a significant public health challenge. Unadjusted BP control rates varied by 10.2% across prefectures, narrowing to 7.4% after adjusting for individual-level patient characteristics. Pre-treatment SBP was the strongest predictor of post-treatment BP control. Ecological analysis revealed that each 1% increase in patients achieving the target BP of <130/<80 mmHg was associated with 3.5 fewer cerebrovascular disease deaths per 100,000 population in both sexes. PUDI showed a significant positive association with BP control rate (weighted Pearson's r = 0.47; p < 0.001). In conclusion, substantial regional disparities in BP control persist across Japan, which are significantly influenced by physician availability and associated with differences in stroke mortality. Using Japanese nationwide health check-up data from 1.3 million individuals initiating antihypertensive treatment, only 26.7% achieved the target BP (<130/<80 mmHg). Adjusted BP control rates varied by 7.4% across prefectures and were positively associated with physician availability and inversely with stroke mortality, indicating the impact of regional healthcare resource disparities.
Iwabe et al. (Tue,) conducted a cohort in Hypertension (n=1,318,437). Antihypertensive treatment was evaluated on Achievement of target blood pressure (<130/<80 mmHg). Following antihypertensive treatment initiation, only 26.7% of patients achieved the target blood pressure of <130/<80 mmHg, with regional control rates positively associating with physician availability.
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