Abstract
BackgroundPatient journeys for hypertensive individuals after detection at screening have not been well examined in a general population. Thus, we aimed to assess the medical treatment status and subsequent longitudinal changes in blood pressure in a middle-aged Japanese population.MethodsWe conducted a cohort study using a nationwide Japanese health screening cohort, from April 2014 to March 2019. Among health screening participants aged 40–74 years who had not previously received treatment for hypertension, hypertensive patients were newly identified based on screening results, and their medical treatment status for hypertension during the year following their initial screening was assessed. The main outcomes were longitudinal changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over 4 years after initial screening.ResultsOf the 153,523 screening participants (mean age = 49.7 years), 16,720 (10.9%) and 4150 (2.7%) were newly detected as having hypertension, with baseline SBP of 140–159 mmHg (grade 1) and ≥ 160 mmHg (grade 2–3), respectively. Among them, 15.9% of the grade 1 hypertensive participants and 36.3% of the grade 2–3 hypertensive participants started receiving medical treatment during the year following initial screening. A linear generalised estimating equation with propensity score matching showed that receiving medical treatment was associated with 5.77 mmHg lower SBP (95% CI − 6.64 to − 4.90) and 3.82 mmHg lower DBP (95% CI − 4.47 to − 3.16) in the grade 1 hypertensive group, and 14.69 mmHg lower SBP (95% CI − 16.35 to − 13.04) and 8.42 mmHg lower DBP (95% CI − 9.49 to − 7.34) in the grade 2–3 hypertensive group.ConclusionsHealth screenings detected hypertension in a substantial percentage of the middle-aged population in this study. However, detection was often followed by insufficient medical treatment and inappropriate blood pressure management. These findings indicate an inadequate link between health screenings and medical treatments in patients with hypertension.
Highlights
Patient journeys for hypertensive individuals after detection at screening have not been well examined in a general population
We identified 16,720 (10.9%) grade 1 hypertensive participants (SBP 140–159 mmHg) and 4150 (2.7%) grade 2–3 hypertensive participants (SBP 160 mmHg or greater)
The prevalence of hypertension and the percentage of antihypertensive drug use was lower in the cohort when compared to the general Japanese population
Summary
Patient journeys for hypertensive individuals after detection at screening have not been well examined in a general population. Undiagnosed individuals lack the opportunity to receive appropriate treatment, and their disease management and long-term prognosis may deteriorate. A detailed analysis is necessary to determine the number of patients from the general population among whom these diseases can be detected during health screenings, what medical follow-up treatment they receive, and how they manage blood pressure. 29 million people (more than half of the eligible population) underwent screenings in Japan; whether these screenings are followed by appropriate medical treatment after detection has not been fully verified. Whether this system contributes to the appropriate management of hypertension is unknown. There is insufficient evidence and disagreement concerning the benefits of universal health screenings, such as those performed in Japan
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