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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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The impact of clinical inertia on uncontrolled blood pressure in treated hypertension: real-world, longitudinal data from Japan

Hypertension Research volume 47, pages 598–607 (2024)Cite this article

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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References

  1. 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 

  2. 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. Hypertension. 2018;71:1269–1324.

    Article  CAS  PubMed  Google Scholar 

  3. 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: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.

    Article  CAS  PubMed  Google Scholar 

  4. Satoh M, Asayama K, Kikuya M, Inoue R, Metoki H, Hosaka M, et al. Long-term stroke risk due to partial white-coat or masked hypertension based on home and ambulatory blood pressure measurements: the Ohasama study. Hypertension. 2016;67:48–55.

    Article  CAS  PubMed  Google Scholar 

  5. SPRINT Research Group, Lewis CE, Fine LJ, Beddhu S, Cheung AK, Cushman WC, et al. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med. 2021;384:1921–30.

    Article  Google Scholar 

  6. Zhang W, Zhang S, Deng Y, Wu S, Ren J, Sun G, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385:1268–79.

    Article  CAS  PubMed  Google Scholar 

  7. 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 

  8. NCD Risk Factor Collaboration. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398:957–80.

    Article  Google Scholar 

  9. Hisamatsu T, Segawa H, Kadota A, Ohkubo T, Arima H, Miura K. Epidemiology of hypertension in Japan: beyond the new 2019 Japanese guidelines. Hypertens Res. 2020;43:1344–51.

    Article  CAS  PubMed  Google Scholar 

  10. Ohno K, Takase H, Sugiura T, Machii M, Nonaka D, Tokumaru M, et al. Current status and recent changes in blood pressure and dietary salt consumption in Japanese individuals. Clin Exp Hypertens. 2021;43:287–94.

    Article  CAS  PubMed  Google Scholar 

  11. Fujishima S, Kodama S, Tsuchihashi T. Achievement rate of blood pressure <140/90 mmHg and <130/80 mmHg in subjects with hypertension; findings from a Japanese health checkup in 2017. Clin Exp Hypertens. 2020;42:648–55.

    Article  PubMed  Google Scholar 

  12. Yokokawa H, Suzuki M, Aoki N, Sato Y, Naito T. Achievement of target blood pressure among community residents with hypertension and factors associated with therapeutic failure in the northern territory of Japan. J Int Med Res. 2022;50:3000605221126878.

    Article  PubMed  Google Scholar 

  13. Ali DH, Kilic B, Hart HE, Bots ML, Biermans MCJ, Spiering W, et al. Therapeutic inertia in the management of hypertension in primary care. J Hypertens. 2021;39:1238–45.

    Article  CAS  PubMed  Google Scholar 

  14. Khosravi A, Nazemipour M, Shinozaki T, Mansournia MA. Population attributable fraction in textbooks: time to revise. Global Epidemiol. 2021;3:100062.

    Article  Google Scholar 

  15. Satoh M, Murakami T, Obara T, Metoki H. Time-series analysis of blood pressure changes after the guideline update in 2019 and the coronavirus disease pandemic in 2020 using Japanese longitudinal data. Hypertens Res. 2022;45:1408–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Eba J, Nakamura K. Overview of the ethical guidelines for medical and biological research involving human subjects in Japan. Jpn J Clin Oncol. 2022;52:539–44.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Satoh M, Hirose T, Satoh H, Nakayama S, Obara T, Murakami T, et al. Actual impact of angiotensin II receptor blocker or calcium channel blocker monotherapy on renal function in real-world patients. J Hypertens. 2022;40:1564–76.

    Article  CAS  PubMed  Google Scholar 

  18. World Health Organization. World Health organization collaborating centre for drug statistics methodology system of defined daily doses. https://www.whocc.no/atc_ddd_index/. Accessed 15 Dec 2022.

  19. Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34:2940–8.

    Article  CAS  PubMed  Google Scholar 

  20. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083–107.

    Article  MathSciNet  PubMed  PubMed Central  Google Scholar 

  21. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Watabe D, Asayama K, Hanazawa T, Hosaka M, Satoh M, Yasui D, et al. Predictive power of home blood pressure indices at baseline and during follow-up in hypertensive patients: HOMED-BP study. Hypertens Res. 2018;41:622–8.

    Article  PubMed  Google Scholar 

  23. Asayama K, Ohkubo T, Metoki H, Obara T, Inoue R, Kikuya M, et al. Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure. Hypertens Res. 2012;35:1102–10.

    Article  PubMed  Google Scholar 

  24. Pickersgill SJ, Msemburi WT, Cobb L, Ide N, Moran AE, Su Y, et al. Modeling global 80-80-80 blood pressure targets and cardiovascular outcomes. Nat Med. 2022;28:1693–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122:290–300.

    Article  PubMed  Google Scholar 

  26. Hosaka M, Metoki H, Satoh M, Ohkubo T, Asayama K, Kikuya M, et al. Randomized trial comparing the velocities of the antihypertensive effects on home blood pressure of candesartan and candesartan with hydrochlorothiazide. Hypertens Res. 2015;38:701–7.

    Article  CAS  PubMed  Google Scholar 

  27. Metoki H, Ohkubo T, Kikuya M, Asayama K, Inoue R, Obara T, et al. The velocity of antihypertensive effect of losartan/hydrochlorothiazide and angiotensin II receptor blocker. J Hypertens. 2012;30:1478–86.

    Article  CAS  PubMed  Google Scholar 

  28. Ohishi M, Yoshida T, Oh A, Hiroi S, Takeshima T, Otsuka Y, et al. Analysis of antihypertensive treatment using real-world Japanese data-the retrospective study of antihypertensives for lowering blood pressure (REAL) study. Hypertens Res. 2019;42:1057–67.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Obara T, Ito K, Ohkubo T, Shibamiya T, Shinki T, Nakashita M, et al. Uncontrolled hypertension based on morning and evening home blood pressure measurements from the J-HOME study. Hypertens Res. 2009;32:1072–8.

    Article  PubMed  Google Scholar 

  30. Jiao T, Platt RW, Douros A, Filion KB. Prescription patterns for the use of antihypertensive drugs for primary prevention among patients with hypertension in the United Kingdom. Am J Hypertens. 2022;35:42–53.

    Article  CAS  PubMed  Google Scholar 

  31. Tajeu GS, Kent ST, Kronish IM, Huang L, Krousel-Wood M, Bress AP, et al. Trends in antihypertensive medication discontinuation and low adherence among medicare beneficiaries initiating treatment from 2007 to 2012. Hypertension. 2016;68:565–75.

    Article  CAS  PubMed  Google Scholar 

  32. Elnagar N, Satoh M, Hosaka M, Asayama K, Ishikura K, Obara T, et al. The velocity of home blood pressure reduction in response to low-dose eplerenone combined with other antihypertensive drugs determined by exponential decay function analysis. Clin Exp Hypertens. 2014;36:83–91.

    Article  CAS  PubMed  Google Scholar 

  33. Oikawa T, Obara T, Ohkubo T, Kikuya M, Asayama K, Metoki H, et al. Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study. J Hypertens. 2006;24:1737–43.

    Article  CAS  PubMed  Google Scholar 

  34. Waki T, Miura K, Tanaka-Mizuno S, Ohya Y, Node K, Itoh H, et al. Prevalence of hypertensive diseases and treated hypertensive patients in Japan: a nationwide administrative claims database study. Hypertens Res. 2022;45:1123–33.

    Article  PubMed  Google Scholar 

  35. Nishimura S, Kumamaru H, Shoji S, Sawano M, Kohsaka S, Miyata H. Adherence to antihypertensive medication and its predictors among non-elderly adults in Japan. Hypertens Res. 2020;43:705–14.

    Article  CAS  PubMed  Google Scholar 

  36. Ishida T, Oh A, Hiroi S, Shimasaki Y, Nishigaki N, Tsuchihashi T. Treatment patterns and adherence to antihypertensive combination therapies in Japan using a claims database. Hypertens Res. 2019;42:249–56.

    Article  CAS  PubMed  Google Scholar 

  37. Morgado M, Rolo S. Factors influencing medication adherence and hypertension management revisited: recent insights from cancer survivors. Hypertens Res. 2012;35:894–6.

    Article  PubMed  Google Scholar 

  38. Williams B, Shaw A, Durrant R, Crinson I, Pagliari C, de Lusignan S. Patient perspectives on multiple medications versus combined pills: a qualitative study. QJM. 2005;98:885–93.

    Article  CAS  PubMed  Google Scholar 

  39. Merlo J, Wessling A, Melander A. Comparison of dose standard units for drug utilisation studies. Eur J Clin Pharmacol. 1996;50:27–30.

    Article  CAS  PubMed  Google Scholar 

  40. Sano H, Hara A, Asayama K, Miyazaki S, Kikuya M, Imai Y, et al. Antihypertensive drug effects according to the pretreatment self-measured home blood pressure: the HOMED-BP study. BMJ Open. 2020;10:e040524.

    Article  PubMed  PubMed Central  Google Scholar 

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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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Authors and Affiliations

  1. Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Michihiro Satoh, Tomoko Muroya, Takahisa Murakami & Hirohito Metoki

  2. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan

    Michihiro Satoh, Takahisa Murakami, Taku Obara & Hirohito Metoki

  3. Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan

    Michihiro Satoh

  4. Division of Internal Medicine, Izumi Hospital, Sendai, Japan

    Tomoko Muroya

  5. Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan

    Takahisa Murakami

  6. Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan

    Taku Obara

  7. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

    Kei Asayama & Takayoshi Ohkubo

  8. Tohoku Institute for Management of Blood Pressure, Sendai, Japan

    Kei Asayama, Takayoshi Ohkubo, Yutaka Imai & Hirohito Metoki

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Correspondence to Michihiro Satoh.

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Conflict of interest

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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