Health Administration Center, University of the Ryukyus, Okinawa, Japan.
Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Hypertens Res. 2023 Nov;46(11):2460-2469. doi: 10.1038/s41440-023-01362-3. Epub 2023 Jul 6.
Hypertension remains a major global healthcare issue. Considering that most Japanese patients with hypertension are managed by general practitioners, hypertension specialists should be involved in actual clinical practice. We investigated the blood pressure (BP), guidelines recommended for achievement rate of the target BP, and clinical variables of patients with hypertension treated by hypertension specialists and those treated by non-specialists in a real-world setting. Factors associated with the target BP achievement in this population were also investigated. Outpatients with hypertension from 12 medical facilities in Okinawa Prefecture were enrolled (n = 1469 [specialist group, 794; non-specialist group, 675]; mean age, 64.2 years; females, 45.8%). For all patients, BP and rate of the target BP achievement were 129.0 ± 15.5/74.6 ± 10.6 mmHg, and 51.8%, respectively. BP and the rate of target of BP achievement were 128.0 ± 15.1/73.4 ± 10.4 mmHg and 56.7% in the specialist group, and they were 130.1 ± 15.9/76.0 ± 10.8 mmHg and 46.1% in the non-specialist group. The urinary salt excretion and obesity rates were comparable between the specialist and non-specialist groups. Multivariable logistic analyses indicated that hypertension specialists and good medication adherence were positive factors, whereas obesity, chronic kidney disease, diabetes mellitus, and urinary salt excretion were inverse factors associated with target BP achievement in this population. Initiatives for salt reduction, medication adherence, and proper obesity management are crucial to improving BP management in patients with hypertension. Hypertension specialists are expected to play an essential role in them. For all patients, the target blood pressure (BP) achievement rate were 51.8%. Hypertension specialists and good medication adherence were positive factors in achieving target BP; conversely, obesity, diabetes mellitus, chronic kidney disease, and high urinary salt excretion were inverse factors in achieving target BP among patients with hypertension.
高血压仍然是一个主要的全球医疗保健问题。考虑到大多数日本高血压患者由全科医生管理，高血压专家应参与实际的临床实践。我们在真实环境中调查了高血压专家和非专家治疗的高血压患者的血压（BP）、目标 BP 达标率的指南推荐值和临床变量。还调查了该人群中与目标 BP 达标相关的因素。从冲绳县的 12 家医疗机构招募了高血压门诊患者（n=1469[专家组，794；非专家组，675]；平均年龄 64.2 岁；女性 45.8%）。对于所有患者，BP 和目标 BP 达标率分别为 129.0±15.5/74.6±10.6mmHg 和 51.8%。在专家组中，BP 和目标 BP 达标率分别为 128.0±15.1/73.4±10.4mmHg 和 56.7%，而非专家组中分别为 130.1±15.9/76.0±10.8mmHg 和 46.1%。专家组和非专家组的尿盐排泄率和肥胖率相当。多变量逻辑分析表明，高血压专家和良好的药物依从性是积极因素，而肥胖、慢性肾脏病、糖尿病和尿盐排泄是该人群中与目标 BP 达标相关的负性因素。减少盐摄入、提高药物依从性和适当控制肥胖是改善高血压患者血压管理的关键。高血压专家有望在其中发挥重要作用。对于所有患者，目标血压（BP）达标率为 51.8%。高血压专家和良好的药物依从性是达到目标 BP 的积极因素；相反，肥胖、糖尿病、慢性肾脏病和高尿盐排泄是高血压患者达到目标 BP 的负性因素。
