Differences in the epidemiology and phenotypes of hypertension in Japan compared with Western countries mean that optimal approaches to the pharmacological management of hypertension should be based on local data. Fortunately, there is a large body of evidence from studies conducted in Japanese populations to inform guidelines and treatment decisions. This article highlights treatment recommendations and BP targets for Japanese patients with hypertension, and summarizes key literature supporting these recommendations. The latest version of the Japanese Society of Hypertension (JSH) guidelines is consistent with US and European guidelines in recommending that the general BP target should be <130/80 mmHg for office blood pressure (BP) and <125/75 mmHg for home BP. There is good local evidence to support these targets. The JSH guidelines also strongly recommend that antihypertensive therapy is managed and monitored based on home BP, due to the closer association of this parameter with cardiovascular risk compared with office BP. Japan is a leader in out-of-office BP research, meaning that there is good evidence for the Japanese recommendations. Key features of antihypertensive agents for use in Japanese patients with hypertension include the ability to reduce stroke risk provide antihypertensive efficacy throughout the 24-h dosing period. Calcium channel blockers appear to be particularly effective in Asian populations, and are the most commonly prescribed agents in Japan. Again consistent with international recommendations, antihypertensive therapy should be started with a combination of agents to maximize the chances of achieving target BP.
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Medical writing assistance was provided by Nicola Ryan, independent medical writer, funded by Jichi Medical University.
Conflict of interest
KK has received independent principal investigator-initiated research grants from Omron Healthcare Inc., Fukuda Denshi Inc., A&D Inc., Taisho Pharmaceutical Co. Inc., and Sanwa Kagaku Kenkyusho Co. Inc. HR and KY have received independent principal investigator-initiated research grants from Astellas Pharma Inc., Daiichi Sankyo Co., Kyowa Hakko Kirin Co., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Takeda Pharmaceutical Company and Teijin Pharma. HR has received lecture fees from Daiichi Sankyo Co. and Takeda Pharmaceutical Company. SH has received research grants from Sanofi Co., Astellas Pharma Inc. and Novartis Pharma K.K. AO has no conflicts of interest to declare.
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Kario, K., Hoshide, S., Yamamoto, K. et al. Clinical studies on pharmacological treatment of hypertension in Japan. J Hum Hypertens (2021). https://doi.org/10.1038/s41371-021-00533-4