Key result
Hypertension management in clinical practice achieved the overall target blood pressure according to the JSH 2014 guidelines in 68.1% of patients, with the highest rate (89.2%) in patients 75 years or older.
Cross-Sectional (n=1,105)
Yes
While overall blood pressure control was achieved in 68.1% of hypertensive patients in Kanagawa, control rates were alarmingly low in high-risk patients with diabetes (9.3%) and chronic kidney disease with proteinuria (11.9%).
Low control in diabetes and CKD subgroups signals need for targeted strategies; leaves open whether interventions improve outcomes in high-risk patients.
We performed a cross-sectional survey to investigate actual clinical practice concerning blood-pressure control among patients with hypertension in Kanagawa. The guidelines of the Japanese Society of Hypertension (JSH) for the management of patients with hypertension were revised in 2014. From October 1 to November 30, 2014, questionnaires on the care of patients with hypertension were sent via post to members of the Kanagawa Physicians Association in Kanagawa Prefecture, Japan. -Data on 1,105 patients (mean age: 68.4±12.3 years, 537 men and 568 women) were obtained. The overall mean systolic blood pressure (BP) of these patients was 128.7±12.1 mmHg for home monitoring and 132.9±12.6 mmHg for office monitoring; diastolic BP was 75.7±9.7 for home monitoring and 77.0±9.7 mmHg for office monitoring. According to the JSH 2014 guidelines, the target BP was achieved by 68.1% of all subjects; 89.2% of late-phase elderly patients (75 years or older); 69.1% of young, middle-aged, and early-phase elderly patients (younger than 75 years except in patients with diabetes mellitus [DM] or chronic kidney disease [CKD] with proteinuria); 9.3% of patients with DM except late-phase elderly patients; and 11.9% of CKD patients with proteinuria except DM. Cross-sectional analysis showed that the factors significantly associated with an increased likelihood of achieving the target BP were as follows: 1) good medication compliance even for a small number of antihypertensive agents at small amount of doses in patients 75 years and older; 2) good medication compliance in patients in younger than 75 years; 3) an older age, a larger proportion in the female-to-male ratio and a lower body mass index in patients with DM except late-phase elderly patients; and 4) usage of a large number of antihypertensive agents in CKD patients with proteinuria. Further follow-up surveys are necessary to investigate changes in clinical practice following the introduction of the revised guidelines.
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Hatori et al. (2016) conducted a cross-sectional in Hypertension (n=1,105). Hypertension management in clinical practice was evaluated on Achievement of target blood pressure according to JSH 2014 guidelines. Hypertension management in clinical practice achieved the overall target blood pressure according to the JSH 2014 guidelines in 68.1% of patients, with the highest rate (89.2%) in patients 75 years or older.
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