Current status and recent changes in blood pressure and dietary salt consumption in Japanese individuals

Home blood pressure control and prescribing patterns of anti-hypertensive medications in a home blood pressure-based hypertension-specialized clinic in Japan: a sub-analysis of the Ohasama study

Although the benefits of anti-hypertensive treatment are well known, the proportion of hypertensive patients with controlled blood pressure (BP) remains suboptimal. The present study aimed to compare BP control conditions in a hypertension-specialized clinic and non-hypertension-specialized clinics. This cross-sectional study used data from 379 treated patients who measured home BP in the Ohasama study between 2016 and 2019 (men: 43.0%, age: 71.6 years). Of those, 172 patients were managed at the hypertension-specialized clinic where physicians distributed home BP devices to each patient, evaluated the home BP data, and adjusted medications to maintain home BP values according to the recent Japanese guidelines. When we set morning home systolic/diastolic BP of <135/ < 85 mmHg as controlled BP, 93.6% of patients fulfilled the controlled home BP range, compared to 43.0% in non-specialized clinics (n = 207). The proportion of the patients with home morning BP < 125/ < 75 mmHg was 73.3% in the hypertension-specialized clinic and 20.8% in the non-hypertension-specialized clinics. Hypertension-specialized clinics prescribed three or more anti-hypertensive drug classes to 41.9% of patients, compared to 15.2% in non-specialized clinics. In the hypertension-specialized clinic, angiotensin II receptor blockers were most commonly prescribed (86.6%), followed by dihydropyridine calcium channel blockers (77.9%), thiazide (including thiazide-like) diuretics (30.2%), mineralocorticoid receptor blockers (23.8%), and beta- and alpha-beta blockers (10.5%). In conclusion, the proportion of patients with controlled home BP was excellent in the hypertension-specialized clinic. Home BP-based hypertension practices, as recommended in the current Japanese guidelines, may be the key to achieving sufficient BP control.

The impact of clinical inertia on uncontrolled blood pressure in treated hypertension: real-world, longitudinal data from Japan

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 Collapse

Key Words

• Blood pressure
• Clinical inertia
• Cohort study
• Epidemiology

Collapse

MESH Headings

• Male
• Humans
• Middle Aged
• Aged
• Antihypertensive Agents/adverse effects
• Blood Pressure
• Japan
• Retrospective Studies
• Hypertension/drug therapy
• Hypertension/chemically induced

Collapse

Grants Collapse

Affiliation(s)

Michihiro Satoh Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan. Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.
Tomoko Muroya Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan Division of Internal Medicine, Izumi Hospital, Sendai, Japan
Takahisa Murakami Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
Taku Obara Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
Kei Asayama Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan Tohoku Institute for Management of Blood Pressure, Sendai, Japan
Takayoshi Ohkubo Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan Tohoku Institute for Management of Blood Pressure, Sendai, Japan
Yutaka Imai Tohoku Institute for Management of Blood Pressure, Sendai, Japan
Hirohito Metoki Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Tohoku Institute for Management of Blood Pressure, Sendai, Japan

Collapse

Dietary Patterns in Association With Hypertension: A Community-Based Study in Eastern China

Objective

This study aimed to explore the association between dietary patterns and hypertension based on a community–based survey in Suzhou, Eastern China.

Methods

This cross–sectional analysis was undertaken from the subset of the Suzhou Food Consumption and Health State Survey in 2018–2019. Adults aged ≥ 18 years were invited to participate in this survey. Dietary intake was collected by a 24–h dietary recall and a weighing method over three consecutive days (including two weekdays and one weekend day). Dietary patterns were defined using factor analysis. Association between the dietary patterns and hypertension was examined by multivariable logistic regression models with adjustment for covariates. Moreover, sensitivity analysis was used to reinforce our findings.

Results

A total of 2,718 participants were included in the final analysis. Rice-vegetable pattern, fast food pattern, fruit-dairy pattern, and wheat-meat pattern were identified. We observed that the fruit-dairy pattern was inversely associated with hypertension after adjustment for all the covariates (OR = 0.55; 95% CI: 0.40, 0.75; P = 0.002). The association between the wheat-meat pattern and hypertension was attenuated and became statistically nonsignificant in sensitivity analyses. The other two patterns were not significantly associated with hypertension (P &gt; 0.05).

Conclusion

The fruit-dairy pattern was inversely associated with the risk of hypertension among Chinese adults. Our findings further emphasize the important role of optimal diet combination in the prevention of hypertension.

Dietary salt intake increases with age in Japanese adults

Excess salt intake is linked to cardiovascular disease as well as hypertension, but whether individual salt intake increases with age has not been studied. The present study was designed to test the hypothesis that individual salt intake increases with age in Japanese adults. In this retrospective observational follow-up study, men and women age ≥30 years who participated in a baseline health checkup (2008-2009) at our center and had a health checkup 10 years later (n = 2598) were enrolled and salt intake was estimated by spot urine analysis. Yearly changes in salt intake were also assessed in participants with complete annual data over the course of 10 years from baseline (n = 1543). The follow-up study demonstrated increased salt intake (8.8 ± 2.0 to 9.3 ± 2.1 g/d, P < .001) with increasing age (54.0 ± 9.7 to 64.0 ± 9.8 years). Salt intake increased year over year in participants who had a health checkup annually for the 10-year follow-up period (n = 1543; analysis of variance, P < .001). Cross-sectional analyses using propensity-matched model revealed similar regional levels of salt intake in the baseline period (8.9 ± 2.0 g/d, 55.8 ± 11.4 years, n = 5018) and at 10 years (8.8 ± 2.0 g/d, P = .21; 55.9 ± 13.0 years, P = .65, n = 5105). These results suggest that dietary salt intake increases with age in Japanese adults, which should be considered in devising population-based strategies to lower dietary salt intake.