Association of hypertension specialist treatment with blood pressure control in Japanese primary care: The J-DOME study

Q: What are the key findings of this study?

Treatment by hypertension specialists was associated with lower odds of achieving office blood pressure <130/80 mmHg compared to non-specialists (30.8% vs 37.3%; OR 0.77), likely reflecting greater clinical complexity.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=2663). Intervention: Treatment by hypertension specialists vs. Treatment by non-specialists. Primary outcome: Achievement of office blood pressure < 130/80 mmHg (OR 0.77, 95% CI 0.61-0.96, p=0.0058).

Q: What does this research mean for the field?

Hypertensive patients managed by hypertension specialists in Japanese primary care have lower rates of target blood pressure achievement (<130/80 mmHg) and require more antihypertensive medications compared to those treated by non-specialists, likely reflecting referral bias toward difficult-to-control cases. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess real-world blood pressure control and determine clinical factors associated with reaching target office blood pressure among patients treated by certified hypertension specialists compared with non-specialists in primary care.

Daigoro Hirohama; Shigeru Shibata; Narumi Eguchi; Tsuguru Hatta; Kazuomi Kario; Tomohiro Katsuya; Kazuo Kobayashi; Akira Nishiyama; Mitsuhiko Noda; Yoichi Nozato; Kensuke Sasaki; Keisuke Shinohara; Emi Ushigome; K. Asayama

doi:10.1038/s41440-026-02833-z

October 2, 2026Hypertension ResearchOpen Access

Association of hypertension specialist treatment with blood pressure control in Japanese primary care: The J-DOME study

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Key result

Hypertension specialist care is linked to ~23% lower odds of target blood pressure control.

OR 0.77
95% CI 0.61-0.96
P=0.0058
n=2,663

Why the study?

Real-world blood pressure control in primary care and the role of hypertension specialists in Japan remain incompletely characterized.

Does treatment by hypertension specialists improve achievement of target BP (<130/80 mmHg) in patients with hypertension in Japanese primary care?

Key Points

To assess real-world blood pressure control and determine clinical factors associated with reaching target office blood pressure among patients treated by certified hypertension specialists compared with non-specialists in primary care.
Conducted a cross-sectional analysis of 2663 hypertensive patients (mean age 71.4 years; 43.6% women) across 80 primary care institutions in 2024 using the nationwide Japan Medical Association Database of Clinical Medicine (J-DOME).
Compared 545 patients managed by Japanese Society of Hypertension-certified specialists against 2118 patients managed by non-specialists.
Identified independent predictors of achieving office blood pressure < 130/80 mmHg using multivariable logistic regression models.
Target blood pressure (< 130/80 mmHg) achievement was significantly lower in the specialist group than the non-specialist group (30.8% vs. 37.3%; p = 0.0058), despite similar systolic blood pressure (135.1 vs. 134.2 mmHg; p = 0.28).
Patients treated by specialists had higher diastolic blood pressure (76.1 vs. 74.5 mmHg; p = 0.0060) and were prescribed more antihypertensive drugs (mean 1.9 vs. 1.6; p < 0.0001).
In multivariable analysis, specialist treatment (OR, 0.77; 95% CI, 0.61–0.96), overweight (OR, 0.70; 95% CI, 0.58–0.85), and obesity (OR, 0.57; 95% CI, 0.42–0.77) were associated with lower target achievement, whereas diabetes mellitus (OR, 1.32; 95% CI, 1.08–1.61) and each additional medication (OR, 1.12; 95% CI, 1.04–1.22) were associated with higher achievement.

Study Design

Type

Cross-Sectional (n=2,663)

Multicenter

Yes

Structured PICO

Does treatment by hypertension specialists improve achievement of target BP (<130/80 mmHg) in patients with hypertension in Japanese primary care?

P

Population

2,663 adults with hypertension (mean age 71.4 years, 43.6% female) managed in Japanese primary care institutions, evaluated cross-sectionally for blood pressure control.

E

Exposure

Treatment by a physician certified as a hypertension specialist by the Japanese Society of Hypertension.

C

Comparator

Treatment by non-specialists.

O

Outcome

Achievement of target BP defined as systolic/diastolic BP of <130/<80 mmHg.surrogate

Main Result

Odds Ratio: 0.77 (95% CI 0.61–0.96)

Absolute Event Rate: 30.8% vs 37.3%

p-value: p=0.0058

Office BP control remains suboptimal in Japanese primary care, with lower achievement among specialist-treated patients likely reflecting the concentration of difficult-to-control hypertension in specialist care.

Limitations

Cross-sectional design precludes causal inference.
Voluntary participation in J-DOME may not fully represent all primary care institutions in Japan.
Comorbidity patterns may have been influenced by the historical development of J-DOME from a diabetes-focused registry.
Office BP was used as the primary measure; self-measured home BP data were limited.
Data were collected before publication of the JSH 2025 Guidelines.
Information on cardiovascular disease history was based on physician diagnoses and not independently adjudicated.
Lack of information on medication doses, treatment adherence, secondary hypertension, treatment-resistant hypertension, frailty, orthostatic symptoms, and individualized BP targets.

Implication

Specialist referral patterns should not change based on this association; leaves open the impact of unmeasured case complexity on BP control.

Abstract

Although hypertension is a major contributor to cardiovascular complications, real-world blood pressure (BP) control in primary care and the role of hypertension specialists remain incompletely characterized. We evaluated BP control and associated factors using the Japan Medical Association Database of Clinical Medicine (J-DOME), a nationwide primary care registry. This cross-sectional study included patients with hypertension registered in 2024, categorized by treatment by specialists certified by the Japanese Society of Hypertension. Multivariable logistic regression identified factors associated with achieving office BP < 130/80 mmHg. Among 2663 patients (43.6% women; mean age, 71.4 years), 545 were treated by hypertension specialists. Mean BP was 134.4/74.8 mmHg, and the mean number of antihypertensive drugs was 1.6. Systolic BP was similar between specialist- and non-specialist-treated patients (135.1 vs . 134.2 mmHg; p = 0.28), whereas diastolic BP (76.1 vs . 74.5 mmHg; p = 0.0060) and the number of drugs (1.9 vs . 1.6; p < 0.0001) were higher in the specialist-treated group. Target BP achievement rate was lower in the specialist-treated group (30.8% vs . 37.3%; p = 0.0058), however, this difference was not observed among patients aged <75 years (33.2% vs. 35.4%; p = 0.55). The multivariable-adjusted model revealed that diabetes mellitus (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.08–1.61) and a higher number of drugs (OR per additional drug, 1.12; 95% CI, 1.04–1.22) were associated with higher target achievement, whereas overweight (OR, 0.70; 95% CI, 0.58–0.85), obesity (OR, 0.57; 95% CI, 0.42–0.77), and specialist treatment (OR, 0.77; 95% CI, 0.61–0.96) were associated with lower achievement. Office BP control remains suboptimal in Japanese primary care. Lower achievement among specialist-treated patients despite more drugs may reflect the concentration of difficult-to-control hypertension in specialist care. Continued efforts to improve hypertension management, particularly in patients with obesity, are warranted.

Discussion

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Cite This Study

Hirohama et al. (2026) conducted a cross-sectional in Hypertension (n=2,663). Treatment by hypertension specialists vs. Treatment by non-specialists was evaluated on Achievement of office blood pressure < 130/80 mmHg (OR 0.77, 95% CI 0.61-0.96, p=0.0058). Treatment by hypertension specialists was associated with lower odds of achieving office blood pressure <130/80 mmHg compared to non-specialists (30.8% vs 37.3%; OR 0.77), likely reflecting greater clinical complexity.

synapsesocial.com/papers/6ac1aba6cc6172083c928a63 https://doi.org/10.1038/s41440-026-02833-z

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Association of hypertension specialist treatment with blood pressure control in Japanese primary care: The J-DOME study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association of hypertension specialist treatment with blood pressure control in Japanese primary care: The J-DOME study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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