Physician and patient perspectives on hypertension management and factors associated with lifestyle modifications in Japan: results from an online survey

Abstract

We conducted a survey to examine the gaps between Japanese physician and patient perspectives on hypertension management and to investigate important factors that may help solve the "hypertension paradox" in Japan. Web-based surveys of patients and physicians were conducted in Japan between October 19 and 31, 2017. The data collected included physician and patient perspectives on hypertension education, adherence to lifestyle modifications and antihypertensive medication, and reasons for treatment adherence/nonadherence. Factors relating to specific patient behaviors (e.g., monitoring their home blood pressure [BP] daily) were analyzed by multivariate logistic regression analysis. Of the 541 physicians and 881 patients included in the analyses, both groups recognized that the extent of lifestyle changes was insufficient. Approximately 80% of physicians reported that they fully or sufficiently provided education to patients about reasons for hypertension treatment and its associated risks, target BP levels, and lifestyle modifications. Only 40-50% of patients considered those topics having been fully or sufficiently discussed. Logistic regression analyses revealed that positive lifestyle modifications (daily home BP monitoring, salt intake <6 g/day, and daily aerobic exercise for ≥30 min) were positively associated with receiving feedback from physicians about specific lifestyle modifications and patient motivation for maintaining their target BP. In conclusion, perception of the amount of education provided by physicians on hypertension management was lower in patients than in physicians. In addition to effective regular follow-up regarding lifestyle modifications, patient motivation by physicians is an important factor for improving lifestyle modifications and achieving effective hypertension management in Japan.

Perspectives of patients and physicians regarding hypertensive management from an online survey for excellence: a subanalysis of the PARADOX study by physician categories

“…As shown in our previous analysis, the top three educational factors for hypertension treatment, which >80% of physicians felt that they fully or sufficiently explained at initial diagnosis, were adherence to treatment (82.3%), reasons for treating hypertension and its associated complications (80.4%), and target BP values (80.2%) [10]. Significant differences between specialist and nonspecialist physicians in patient education were observed in seven out of 14 topics (Fig.…”

“…Over 80% of all physicians reported that they fully or sufficiently assessed patients' home BP diaries, and~60% examined lifestyle changes at follow-up appointments, as demonstrated in the main analysis [10]. Similar to the results from the initial consultation, specialist physicians were significantly more likely than nonspecialists to fully or sufficiently discuss symptoms (88.1% vs 71.6%; P < 0.01), missed doses (79.7% vs 63.5%; P = 0.01), and lifestyle modifications (66.1-79.7% vs 38.8-57.9%; all P < 0.01, Fig.…”

“…As described in the PARADOX main analysis, the key patient-derived reasons for target BP not being achieved were patients' insufficient modification of their dietary habits, low treatment motivation due to lack of symptoms, and the presence of comorbidities and treatment-resistant hypertension [10]. In terms of physician subgroups, more specialist physicians than nonspecialist physicians strongly agreed on the patient-derived reasons for not achieving the target BP level ( Fig.…”

“…A web-based survey (PARADOX) was conducted in Japan between October 19 and 31, 2017 [10]. A subanalysis of data from the physician survey is presented here.…”

“…An online survey (PARADOX: Perspectives of patients And physicians RegArDing hypertensive management from an Online survey for eXcellence) has been undertaken in Japan to gain insight into the hypertension paradox [9]. The primary analysis, reported separately, evaluated differences between patients and physicians in their perceptions of hypertension diagnosis and management, specifically regarding the provision of education and guidance, and how patient guidance and motivation impacts adherence to lifestyle changes [10]. Here, we report results from a subanalysis of the PARADOX study, examining the differences in approaches to patient education and adherence to BP targets according to physician specialty (hypertension specialist [i.e., physicians who received certification from the JSH] vs nonspecialist), institution type (hospital-based physician vs general practitioner), gender, and age.…”