S-14-5: JSH GUIDELINE FOR THE MANAGEMENT OF HYPERTENSION 2019 (JSH2019) ∼ CONCEPT AND SUBSEQUENT CHALLENGES ∼

Abstract

Hypertension Treatment Guidelines 2019 (JSH2019) is based on JSH2014 and complies with Minds’ clinical practice guideline creation manual, and adopts a policy of adding new evidence. For this reason, we have newly ‘ extracted clinical issues, raised them as clinical questions (CQ), conducted a comprehensive systematic review (SR), created a body of evidence, and made recommendations.’. Since conducting SR appropriately requires a huge amount of labor, we decided to form an SR team centered on young members of the Society and proceed with the work while receiving guidance from a support team of epidemiological experts. In particular, we hope that SR will lead to the development of young people who will lead the future, and we also aimed to submit the results of SR to Hypertens Res. In the end, we were able to create 17 CQs. Furthermore, in JSH2019, we calculated the absolute risk of CVD in Japanese people based on the JALS and Hisayama-town studies, and used it for risk stratification. Hypertension was defined as a blood pressure value of 140/90 mmHg or higher for which the efficacy of antihypertensive drugs has been proven in patients who are not at high risk. Evidence was also emphasized for blood pressure reduction goals. To the low-risk and the moderate-risk patients with elevated blood pressure, we recommended to achieve the target blood pressure control by modifying lifestyle habits without using antihypertensive drugs. We also asked patient groups to review the guidelines, aiming to reflect the values and wishes of patients. As we approach the third year since the publication of JSH2019, we would like to consider the remaining issues. There are still many patients whose blood pressure is not properly controlled, and many of whom are not aware that they have hypertension. Improvements in blood pressure control among the population are desired through countermeasures against clinical inertia and population tactics. This guideline was created with the aim of preventing CVD and improving patient prognosis, as described above. However, in a super-aging society, patients’ hopes are not necessarily to improve only the prognosis of life. There are many issues that need to be addressed in future guideline revisions, such as reconsidering recommendations for the elderly by appropriately understanding the ‘values and wishes of patients’ according to their age.