Kario Kazuomi
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Hypertens Res. 2025 Aug 28. doi: 10.1038/s41440-025-02355-0.
Recent updates to international hypertension guidelines have converged toward a therapeutic target of <130/80 mmHg, as reflected in the JSH2025, AHA/ACC2025, and ESC2024 recommendations. Strong evidence from major outcome trials such as SPRINT, STEP, BPROAD, and ESPRIT has consistently demonstrated the benefit of intensive blood pressure (BP) control, particularly systolic BP < 130 mmHg, across a wide spectrum of hypertensive populations, including the elderly and those with diabetes, CKD, or cardiovascular comorbidities. The JSH2025 guidelines further emphasize home BP management, setting a lower target of <125/75 mmHg, supported by prospective nationwide studies such as J-HOP and HONEST. However, despite these advances in evidence and recommendations, real-world BP control rates remain unsatisfactory, underscoring the critical need for effective implementation strategies. To address this gap, we propose the "achievement rate of BP control <130/80 mmHg" as a unified, core implementation metric for hypertension management. This target is consistent with both JSH2025 and AHA/ACC2025 guidelines, as well as with Japan's Asakatsu campaign. We further recommend a dual-layered evaluation framework: a macro-approach (spatial, population-level) using office BP or health-check BP to assess outcomes in the general hypertensive population, and a micro-approach (temporal, individual-level) using home BP to monitor the quality of daily management and treatment adherence. Adopting this integrated framework will enable the simultaneous assessment of both public health impact and individualized care quality, providing a practical and evidence-based index for bridging guidelines with daily clinical practice. Ultimately, widespread application of this unified implementation metric has the potential to accelerate progress toward improved global cardiovascular outcomes. Core metric 130/80 mmHg of implementation hypertension. BP, blood pressure.
国际高血压指南的最新更新都趋向于将<130/80 mmHg作为治疗目标，这在日本高血压学会2025版（JSH2025）、美国心脏协会/美国心脏病学会2025版（AHA/ACC2025）和欧洲心脏病学会2024版（ESC2024）的建议中都有体现。收缩压干预试验（SPRINT）、降压治疗预防心血管事件（STEP）、血压干预和心血管健康改善研究（BPROAD）以及欧洲收缩期高血压试验（ESPRIT）等主要结局试验的有力证据一致表明，强化血压控制有益，尤其是收缩压<130 mmHg，在广泛的高血压人群中，包括老年人以及患有糖尿病、慢性肾脏病（CKD）或心血管合并症的人群。JSH2025指南进一步强调家庭血压管理，设定了<125/75 mmHg的更低目标，这得到了诸如日本高血压前瞻性全国研究（J-HOP）和高血压家庭血压监测有效性和安全性研究（HONEST）等前瞻性全国性研究的支持。然而，尽管在证据和建议方面取得了这些进展，但实际的血压控制率仍然不尽人意，这突出表明迫切需要有效的实施策略。为了弥补这一差距，我们提议将“血压控制<130/80 mmHg的达标率”作为高血压管理统一的核心实施指标。这一目标与JSH2025和AHA/ACC2025指南以及日本的“朝食运动”一致。我们还建议采用双层评估框架：一种宏观方法（空间层面、人群层面），使用诊室血压或健康检查血压来评估一般高血压人群的治疗效果，以及一种微观方法（时间层面、个体层面），使用家庭血压来监测日常管理质量和治疗依从性。采用这种综合框架将能够同时评估公共卫生影响和个体化护理质量，为将指南与日常临床实践相衔接提供一个实用且基于证据的指标。最终，广泛应用这一统一的实施指标有可能加速在改善全球心血管结局方面取得进展。高血压实施的核心指标130/80 mmHg。BP，血压。
