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.
Highlights
High blood pressure (BP) is a major risk factor for cardiovascular and renal diseases [1, 2], the leading global risk
Of the patients who participated in this study, patients were excluded from the analysis set if they responded that they were prescribed over 30 types of drugs; their age and years with hypertension were the same; their initial or follow-up consultation was more than 90 min; their systolic BP was
A total of 565 physicians from all prefectures in Japan were surveyed during the study period, and 541 physician responses were included in the analyses
Summary
High blood pressure (BP) is a major risk factor for cardiovascular and renal diseases [1, 2], the leading global risk. Current guidelines issued by the Japanese Society of Hypertension (JSH) recommend lifestyle modifications as the initial treatment for hypertension, including decreased salt intake, weight loss, exercise, and restricted alcohol intake [8]. Cognitive-behavioral strategies including goal setting, BP self-monitoring, and adequate and frequent feedback from physicians have been suggested as key interventional components to change behavior regarding physical activity and dietary lifestyle modifications [13, 22] With these issues in mind, we conducted an online survey (Perspectives of Patients and Physicians Regarding Hypertensive Management from an Online Survey for Excellence; PARADOX study) to gain further insight into why a large proportion of Japanese patients with hypertension do not achieve the target BP levels, as defined by the JSH, despite receiving treatment (the so-called “hypertension paradox”) [8, 23]. Physicians were asked about their perspectives on hypertension diagnosis practices
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