Satoh Michihiro, Metoki Hirohito, Murakami Takahisa, Tatsumi Yukako, Asayama Kei, Kikuya Masahiro, Ohkubo Takayoshi, Imai Yutaka
Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
Hypertens Res. 2025 Jan;48(1):26-36. doi: 10.1038/s41440-024-01954-7. Epub 2024 Oct 28.
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.
尽管抗高血压治疗的益处众所周知，但血压得到控制的高血压患者比例仍不尽人意。本研究旨在比较高血压专科诊所和非高血压专科诊所的血压控制情况。这项横断面研究使用了来自大岛研究中2016年至2019年间379例接受治疗并测量家庭血压的患者的数据（男性占43.0%，年龄71.6岁）。其中，172例患者在高血压专科诊所接受治疗，医生为每位患者分发家庭血压测量设备，评估家庭血压数据，并根据最新日本指南调整药物以维持家庭血压值。当我们将家庭清晨收缩压/舒张压<135/<85 mmHg设定为血压控制良好时，93.6%的患者达到了家庭血压控制范围，而非专科诊所的这一比例为43.0%（n = 207）。家庭清晨血压<125/<75 mmHg的患者比例在高血压专科诊所为73.3%，在非高血压专科诊所为20.8%。高血压专科诊所给41.9%的患者开具了三种或更多类别的抗高血压药物，而非专科诊所为15.2%。在高血压专科诊所，最常开具的药物是血管紧张素II受体阻滞剂（86.6%），其次是二氢吡啶类钙通道阻滞剂（77.9%）、噻嗪类（包括类噻嗪类）利尿剂（30.2%）、盐皮质激素受体阻滞剂（23.8%）以及β和α-β受体阻滞剂（10.5%）。总之，高血压专科诊所中家庭血压得到控制的患者比例很高。按照当前日本指南推荐的基于家庭血压的高血压治疗方法，可能是实现充分血压控制的关键。
