Trends in blood pressure control and medication use during 20 years in a hypertension clinic in Japan

Abstract

Guidelines for the management of hypertension have recommended strict control of blood pressure to help prevent cardiovascular disease. The aim of the present study was to evaluate the current status of blood pressure control and trends over the past two decades. Four hundred patients treated for hypertension at Kyushu University Hospital were included in the present study. Blood pressure levels and prescribed antihypertensive drugs were examined in 2011. The average blood pressure was 129/74 mmHg, and the number of prescribed antihypertensive drugs was 2.2. Angiotensin II receptor antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, alpha-blockers, and beta-blockers were prescribed in 66%, 5%, 78%, 21%, 12%, and 27% of the cases, respectively. Systolic blood pressure was significantly higher, and diastolic blood pressure was significantly lower in patients aged 80 years or older compared with the younger patients (<80 and ≥80 years, 128/75 mmHg and 133/68 mmHg, respectively). The number of prescribed antihypertensive drugs was similar between the two groups. Sixty-five patients were continuously treated for 20 years. The average blood pressure of these patients significantly decreased from 142/87 mmHg in 1991 to 128/71 mmHg in 2011, accompanied with an increase in the number of antihypertensive drugs from 1.6 in 1991 to 2.7 in 2011. These findings suggest that the revised guidelines for the management of hypertension may have contributed to increased awareness and better management of blood pressure levels.

Current use of antihypertensive drugs in Japanese patients with hypertension: Analysis by age group

“…Although the mean values did not differ appreciably among age groups, a trend was observed towards prescribing of more antihypertensive drugs with advancing age. A recent study of 400 patients attending a Japanese hypertension clinic reported that the number and classes of prescribed antihypertensive drugs were similar between patients aged <80 years and ≥80 years . In the present study, we observed a trend towards greater use of three or more antihypertensive drugs concomitantly in patients aged ≥75 years compared with their younger counterparts.…”

“…These were also the two most commonly prescribed antihypertensive drug classes in a large Japanese survey carried out from 2005 to 2011, although that study did not stratify patients by age . An analysis of 400 patients attending a Japanese hypertension clinic also reported that CCB (78%) and ARB (66%) were the most commonly prescribed antihypertensives . In the current study, it was notable that the prescription rate for ARB as monotherapy was relatively low in patients aged ≥75 years (11.0% vs 20.0% for CCB), suggesting that physicians were tailoring their prescribing choices according to patient age.…”

“…8 An analysis of 400 patients attending a Japanese hypertension clinic also reported that CCB (78%) and ARB (66%) were the most commonly prescribed antihypertensives. 7 In the current study, it was notable that the prescription rate for ARB as monotherapy was relatively low in patients aged ≥75 years (11.0% vs 20.0% for CCB), suggesting that physicians were tailoring their prescribing choices according to patient age. Older patients are generally presumed to have nephrosclerosis as a result of agingrelated physiological deterioration of renal function and a long-standing history of hypertension.…”

Current prescription status of antihypertensive drugs in Japanese patients with hypertension: Analysis by type of comorbidities

“…The prescription rate we observed for diuretics was somewhat higher than that reported in a previous large Japanese claims database study from 2011 (8), likely reflecting differences between the patient populations including a higher proportion of patients with heart disease in the current study. There is also some evidence to suggest that introduction of an FDC drug containing ARB+Diuretic may have increased the diuretic prescription rate at some centers in Japan (8)(9)(10).…”

Sex differences in antihypertensive drug use and blood pressure control

“…The prescription rate for DUs was lower than for other antihypertensive classes. This may be explained by concern about electrolyte disturbances 30. DUs block the electroneutral sodium chloride cotransporter to decrease BP, but the reduced cardiac output leads to stimulation of the renin-angiotensin-aldosterone and sympathetic systems in both males and females 31.…”