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Strategies for improving the treatment and control of hypertension in Japan

Journal of Human Hypertension (2022)Cite this article

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Abstract

Despite the significant advancements in the diagnosis and treatment of hypertension, the burden of hypertension remains a major global health care concern. In Japan, estimates show that more than two-thirds of the population have uncontrolled hypertension, regardless of whether they were taking antihypertensive medication. To improve hypertension management, hypertension guidelines have been developed and updated regularly by hypertension societies across various countries and regions. The Japanese Society of Hypertension (JSH) updated the Guidelines for the Management of Hypertension in 2019 (JSH 2019). The JSH 2019 aims to establish a standard management strategy for hypertension and provide evidence to all health care providers. One of its updated main features is its proposal for multidisciplinary team-based care (TBC) involving physicians, pharmacists, nurses, dietitians, and other health care providers. The TBC will help initiate and intensify the management of hypertension, as well as combat clinical inertia, which is expected to contribute to uncontrolled blood pressure and subsequent development of cardiovascular diseases. This is consistent with the recommendations from recent major guidelines on hypertension management. Moreover, to reduce the evidence–practice gap in hypertension management, it is essential to disseminate the essence of the guidelines and provide hypertension education programs for all health care providers and patients. This review summarizes the points of the JSH 2019-based strategy for improving hypertension management and discusses guidelines for its implementation into actual clinical practice.

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References

  1. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–82.

    Article  PubMed  Google Scholar 

  2. Fujiyoshi A, Ohkubo T, Miura K, Murakami Y, Nagasawa SY, Okamura T, et al. Blood pressure categories and long-term risk of cardiovascular disease according to age group in Japanese men and women. Hypertens Res. 2012;35:947–53.

    Article  PubMed  Google Scholar 

  3. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–724.

    Article  Google Scholar 

  4. Special Committee for Establishing the Next-Phase National Health Exercise Plan, Regional Health/Health Promotion Nutritional Section, Health Science Council, Ministry of Health, Labour, and Welfare. Reference Materials on the Promotion of Health Japan 21 (II). 2012. https://www.mhlw.go.jp/bunya/kenkou/dl/kenkounippon21_02.pdf.

  5. Ikeda N, Inoue M, Iso H, Ikeda S, Satoh T, Noda M, et al. Adult mortality attributable to preventable risk factors for noncommunicable diseases and injuries in Japan: a comparative risk assessment. PLoS Med. 2012;9:e1001160.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Miura K, Nagai M, Ohkubo T. Epidemiology of hypertension in Japan: where are we now? Circ J. 2013;77:2226–31.

    Article  PubMed  Google Scholar 

  7. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.

    Article  PubMed  Google Scholar 

  8. Hirawa N, Umemura S, Ito S. Viewpoint on guidelines for treatment of hypertension in Japan. Circ Res. 2019;124:981–3.

    Article  CAS  PubMed  Google Scholar 

  9. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71:e127–248.

    Article  PubMed  Google Scholar 

  10. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  PubMed  Google Scholar 

  11. Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, et al. Clinical inertia. Ann Intern Med. 2001;135:825–34.

    Article  CAS  PubMed  Google Scholar 

  12. Obara T, Ubeda SR, Ohkubo T, Matsuura H, Ishimitsu T, Takata M, et al. Awareness of the Japanese Society of Hypertension Guidelines for the management of hypertension and their use in clinical practices: 2009 survey results. Hypertens Res. 2015;38:400–4.

    Article  PubMed  Google Scholar 

  13. Mogi M, Hasebe N, Horiuchi M, Shimamoto K, Umemura S. The results of a survey of physicians about the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2014 and its clinical use. Hypertens Res. 2016;39:660–3.

    Article  PubMed  Google Scholar 

  14. Nishigaki N, Shimasaki Y, Yoshida T, Hasebe N. Physician and patient perspectives on hypertension management and factors associated with lifestyle modifications in Japan: results from an online survey. Hypertens Res. 2020;43:450–62.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yoshida T, Nishigaki N, Saita S, Shimasaki Y, Hasebe N. Perspectives of patients and physicians regarding hypertensive management from an online survey for excellence: a subanalysis of the PARADOX study by physician categories. Hypertens Res. 2020;43:431–41.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Carter BL, Rogers M, Daly J, Zheng S, James PA. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med. 2009;169:1748–55.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011;171:1441–53.

    Article  CAS  PubMed  Google Scholar 

  18. Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffé P, Burnier M, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3:e000718.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee JK, McCutcheon LRM, Fazel MT, Cooley JH, Slack MK. Assessment of interprofessional collaborative practices and outcomes in adults with diabetes and hypertension in primary care: a systematic review and meta-analysis. JAMA Netw Open. 2021;4:e2036725.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mills KT, Obst KM, Shen W, Molina S, Zhang HJ, He H, et al. Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis. Ann Intern Med. 2018;168:110–20.

    Article  PubMed  Google Scholar 

  21. Health Service Bureau, Ministry of Health, Labour and Welfare. Standard Health Checkup/Health Guidance Program. 2018. https://www.mhlw.go.jp/file/06-Seisakujouhou10900000-Kenkoukyoku/00_3.pdf.

  22. Kaplan NM. Anxiety-induced hyperventilation. A common cause of symptoms in patients with hypertension. Arch Intern Med. 1997;157:945–8.

    Article  CAS  PubMed  Google Scholar 

  23. Grimm RH Jr, Grandits GA, Cutler JA, Stewart AL, McDonald RH, Svendsen K, et al. Relationships of quality-of-life measures to long-term lifestyle and drug treatment in the Treatment of Mild Hypertension Study. Arch Intern Med. 1997;157:638–48.

    Article  PubMed  Google Scholar 

  24. Bremner AD. Antihypertensive medication and quality of life—silent treatment of a silent killer? Cardiovasc Drugs Ther. 2002;16:353–64.

    Article  PubMed  Google Scholar 

  25. Yoshida K, Matsuoka H, Omae T, Fujii J. Patient-hospital relationship and quality of life in elderly patients with hypertension. Hypertens Res. 1995;18:77–83.

    Article  CAS  PubMed  Google Scholar 

  26. Holt EW, Muntner P, Joyce CJ, Webber L, Krousel-Wood MA. Health-related quality of life and antihypertensive medication adherence among older adults. Age Ageing. 2010;39:481–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Peacock E, Joyce C, Craig LS, Lenane Z, Holt EW, Muntner P, et al. Low medication adherence is associated with decline in health-related quality of life: results of a longitudinal analysis among older women and men with hypertension. J Hypertens. 2021;39:153–61.

    Article  CAS  PubMed  Google Scholar 

  28. Isetts BJ, Buffington DE, Carter BL, Smith M, Polgreen LA, James PA. Evaluation of pharmacists’ work in a physician-pharmacist collaborative model for the management of hypertension. Pharmacotherapy. 2016;36:374–84.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hunt JS, Siemienczuk J, Pape G, Rozenfeld Y, MacKay J, LeBlanc BH, et al. A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. J Gen Intern Med. 2008;23:1966–72.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119:3028–35.

    Article  PubMed  Google Scholar 

  31. Kim S, Shin DW, Yun JM, Hwang Y, Park SK, Ko YJ, et al. Medication adherence and the risk of cardiovascular mortality and hospitalization among patients with newly prescribed antihypertensive medications. Hypertension. 2016;67:506–12.

    Article  CAS  PubMed  Google Scholar 

  32. Kronish IM, Woodward M, Sergie Z, Ogedegbe G, Falzon L, Mann DM. Meta-analysis: impact of drug class on adherence to antihypertensives. Circulation. 2011;123:1611–21.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schulz M, Krueger K, Schuessel K, Friedland K, Laufs U, Mueller WE, et al. Medication adherence and persistence according to different antihypertensive drug classes: a retrospective cohort study of 255,500 patients. Int J Cardiol. 2016;220:668–76.

    Article  PubMed  Google Scholar 

  34. Hedegaard U, Kjeldsen LJ, Pottegård A, Henriksen JE, Lambrechtsen J, Hangaard J, et al. Improving medication adherence in patients with hypertension: a randomized trial. Am J Med. 2015;128:1351–61.

    Article  PubMed  Google Scholar 

  35. Fletcher BR, Hartmann-Boyce J, Hinton L, McManus RJ. The effect of self-monitoring of blood pressure on medication adherence and lifestyle factors: a systematic review and meta-analysis. Am J Hypertens. 2015;28:1209–21.

    Article  PubMed  Google Scholar 

  36. Kim JY, Wineinger NE, Steinhubl SR. The influence of wireless self-monitoring program on the relationship between patient activation and health behaviors, medication adherence, and blood pressure levels in hypertensive patients: a substudy of a randomized controlled trial. J Med Internet Res. 2016;18:e116.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Albini F, Liu X, Torlasco C, Soranna D, Faini A, Ciminaghi R, et al. An ICT and mobile health integrated approach to optimize patients’ education on hypertension and its management by physicians: the Patients Optimal Strategy of Treatment (POST) pilot study. Conf Proc IEEE Eng Med Biol Soc. 2016;2016:517–20.

    Google Scholar 

  38. Kario K, Nomura A, Harada N, Okura A, Nakagawa K, Tanigawa T, et al. Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial. Eur Heart J. 2021;42:4111–22.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bane C, Hughes CM, Cupples ME, McElnay JC. The journey to concordance for patients with hypertension: a qualitative study in primary care. Pharm World Sci. 2007;29:534–40.

    Article  PubMed  Google Scholar 

  40. Tsuchihashi T, Ishimitsu T, Ando K, Kusaka M, Ichihara A, Miura K, et al. JSH statement: Tokyo declaration promoting salt reduction by the Japanese Society of Hypertension-the JSH Tokyo declaration. Hypertens Res. 2020;43:1133–4.

    Article  PubMed  Google Scholar 

  41. Tsuchihashi T. Dietary salt intake in Japan—past, present, and future. Hypertens Res. 2022. https://doi.org/10.1038/s41440-022-00888-2.

  42. Karppanen H, Mervaala E. Sodium intake and hypertension. Prog Cardiovasc Dis. 2006;49:59–75.

    Article  CAS  PubMed  Google Scholar 

  43. He FJ, Pombo-Rodrigues S, Macgregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open. 2014;4:e004549.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Morinaga Y, Tsuchihashi T, Ohta Y, Matsumura K. Salt intake in 3-year-old Japanese children. Hypertens Res. 2011;34:836–9.

    Article  CAS  PubMed  Google Scholar 

  45. Yasutake K, Nagafuchi M, Izu R, Kajiyama T, Imai K, Murata Y, et al. Sodium and potassium urinary excretion levels of preschool children: Individual, daily, and seasonal differences. Clin Exp Hypertens. 2017;19:577–83.

    Article  CAS  Google Scholar 

  46. Ohta Y, Iwayama K, Suzuki H, Sakata S, Hayashi S, Iwashima Y, et al. Salt intake and eating habits of school-aged children. Hypertens Res. 2016;39:812–7.

    Article  CAS  PubMed  Google Scholar 

  47. Asakura K, Mori S, Sasaki S, Nishiwaki Y. A school-based nutrition education program involving children and their guardians in Japan: facilitation of guardian-child communication and reduction of nutrition knowledge disparity. Nutr J. 2021;20:92.

    Article  PubMed  PubMed Central  Google Scholar 

  48. He FJ, Wu Y, Feng XX, Ma J, Ma Y, Wang H, et al. School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial. BMJ. 2015;350:h770.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Node K, Kishi T, Tanaka A, Itoh H, Rakugi H, Ohya Y, et al. JSH Future Plan Working Group and Executive Board Members. The Japanese Society of Hypertension-Digest of plan for the future. Hypertens Res. 2018;41:989–90.

    Article  PubMed  Google Scholar 

  50. Kario K, Wang JG. Could 130/80 mm Hg be adopted as the diagnostic threshold and management goal of hypertension in consideration of the characteristics of Asian populations? Hypertension. 2018;71:979–84.

    Article  CAS  PubMed  Google Scholar 

  51. Ito M, Ishimitsu T, Ichihara A, Itoh H, Ohishi M, Ohkubo T, et al. JSH statement: Kyoto declaration on hypertension research in Asia. Hypertens Res. 2019;42:759–60.

    Article  PubMed  Google Scholar 

  52. Nakamura S, Hasebe N, Yatabe M, Kishi T, Ishida M, Ichihara A, et al. JSH statement: Asahikawa declaration in promotion of diversity by the Japanese society of hypertension–the JSH Asahi kawa declaration. Hypertens Res. 2019;42:1483–4.

    Article  PubMed  Google Scholar 

  53. Ohya Y, Kario K, Itoh H, Nishiyama A, Ishimitsu T, Ichihara A, et al. Statement of the Asian Hypertension Society Network: the Okinawa Declaration on the unity of hypertension societies in Asian countries and regions to overcome hypertension and hypertension-related diseases. Hypertens Res. 2022;45:1–2.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Enago (www.enago.com) for the English Language review.

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Authors and Affiliations

  1. Health Administration Center, University of the Ryukyus, Okinawa, Japan

    Atsushi Sakima

  2. Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

    Tetsutaro Matayoshi

  3. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Hisatomi Arima

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All authors contributed to the conception and design of this manuscript. AS is the corresponding author and wrote this manuscript. HA supervised the manuscript preparation. All authors have read and approved the final manuscript.

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Correspondence to Atsushi Sakima.

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Sakima, A., Matayoshi, T. & Arima, H. Strategies for improving the treatment and control of hypertension in Japan. J Hum Hypertens (2022). https://doi.org/10.1038/s41371-022-00708-7

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