Abstract
We aimed to quantify the impact of inadequate pharmacological therapy on uncontrolled blood pressure (BP) using Japanese real-world data. This retrospective cohort study used databases provided by DeSC Healthcare, Inc (Tokyo, Japan). We identified 27,652 patients with hypertension (age, 60.7 ± 9.1 years; men, 56.4%) who were not receiving antihypertensive treatment at the initial visit (pre-treatment) and were under treatment at the next visit (post-treatment). Patients were classified into the following groups by the number of antihypertensive drug classes and defined daily dose (DDD): one antihypertensive drug class with a low dose (DDD < 1.0), one antihypertensive drug class with a moderate-to-high dose (DDD ≥ 1.0), two antihypertensive drug classes with a low dose (DDD < 2.0), two antihypertensive drug classes with a moderate-to-high dose (DDD ≥ 2.0), and ≥three antihypertensive drug classes. The pre-treatment systolic/diastolic BP was 157.7 ± 15.4/94.2 ± 11.5 mmHg. Overall, 43.0% of patients had uncontrolled BP (post-treatment BP ≥ 140/ ≥ 90 mmHg). High pre-treatment BP was a strong factor for uncontrolled BP. After adjustments for covariates, including the pre-treatment mean BP, the proportion of patients with uncontrolled BP was 2.08 times higher in the one antihypertensive drug class with a low dose group than in the ≥three antihypertensive drug classes group. The preventable fraction due to <three antihypertensive drug classes for uncontrolled BP was 40.6%. Only 9.9% of patients with the pre-treatment BP ≥ 180/ ≥ 110 mmHg were prescribed ≥ three antihypertensive drug classes. High pre-treatment BP and inadequate antihypertensive treatment were major factors contributing to uncontrolled BP. Adequate treatment intensification would resolve approximately 40% of uncontrolled BP cases among Japanese patients treated for hypertension.
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Acknowledgements
We thank Ms. Saki Sato and the staff at DeSC Healthcare, Inc. The present study used the database provided by DeSC Healthcare, Inc., under their academic research support program. The summary of this study was presented at the 59th Annual Meeting of the Japanese Society of Cardiovascular Disease Prevention, and Satoh M received first place in the Young Investigator’s Award.
Funding
This study was supported by Grants for Scientific Research (17K15853 and 21K10478) from the Ministry of Education, Culture, Sports, Science and Technology, Japan; the academic support from Bayer Yakuhin Co, Ltd; Health Care Science Institute Research Grant; and Foundation for Total Health Promotion. This study was awarded the Medical Research Encouragement Prize of the Japan Medical Association.
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MS received Academic support from Bayer Yakuhin Co, Ltd. KA, TO, YI and HM concurrently held the position of Director of the Tohoku Institute for Management of Blood Pressure, which was supported by Omron Healthcare Co, Ltd.
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Satoh, M., Muroya, T., Murakami, T. et al. The impact of clinical inertia on uncontrolled blood pressure in treated hypertension: real-world, longitudinal data from Japan. Hypertens Res 47, 598–607 (2024). https://doi.org/10.1038/s41440-023-01452-2
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DOI: https://doi.org/10.1038/s41440-023-01452-2
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