Perspectives on the management of hypertension in Japan

ABSTRACT

Introduction

Hypertension is the most prevalent disease in Japan. However, it is estimated that only 50% of hypertensive patients receiving antihypertensive drug treatment achieve blood pressure of less than 140/90 mmHg. Consequently, hypertension is the leading cause of cardiovascular death in Japan. Innovative high-risk strategies are necessary to reduce hypertension-related morbidity and mortality in Japan.

Areas covered

This perspective summarizes the current prescription status of antihypertensive drug treatment, the clinical role of antihypertensive drug treatment in the management of hypertension and provides future perspectives in the management of hypertension in Japan.

Expert opinion

Earlier and lower blood pressure control throughout 24 h is currently recommended for the management of hypertension. Management of nighttime blood pressure is clinically important since nighttime blood pressure has been shown to be more closely associated than daytime blood pressure with cardiovascular events in patients receiving antihypertensive drug treatment. An appropriate selection of antihypertensive drugs and bedtime dosing of antihypertensive drugs may be effective for reducing nighttime blood pressure. The development and advancement of home blood pressure monitoring would enable tailor-made antihypertensive drug treatment.

KEYWORDS:

• Antihypertensive drug treatment
• home-blood pressure monitoring
• life style modifications/non-pharmacological interventions
• nigh-time blood pressure

Article highlights

• Despite the development of diagnostic methods and antihypertensive drugs in recent years, hypertension is the leading cause of cardiovascular death in Japan due to, in part, suboptimal rates of hypertension awareness, treatment, and control.

• The major antihypertensive drugs currently used in Japan include Ca channel blockers, renin-angiotensin system inhibitors (angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors), diuretics (thiazide-type diuretics, loop diuretics, and mineralocorticoid receptor antagonists), and β-blockers.

• Ca channel blockers (>60%) and angiotensin II receptor blockers (>50%) are the most frequently prescribed classes, whereas angiotensin-converting enzyme inhibitors (≒10%), diuretics (thiazide-type diuretics) (<20%), and β-blockers (<20%) are less frequently used in Japan.

• Antihypertensive drug treatment does not restore cardiovascular risk to the risk level of untreated individuals with similar blood pressure levels due to, in part, persistence of primary abnormalities of hypertension and higher cumulative exposure of blood pressure over time.

• A combination of lifestyle modifications/non-pharmacological interventions and antihypertensive drug treatment based on home blood pressure monitoring may be effective for reducing hypertension-related morbidity and mortality.

• The development and advancement of home blood pressure monitoring devices would enable tailor-made antihypertensive drug treatment to achieve earlier and lower blood pressure control throughout 24 h.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors have received Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology [18590815 and 21590898 to Y.Higashi] and a Grant-in-Aid from the Japanese Arteriosclerosis Prevention Fund (also to Y.Higashi).