S-24-5: REAL WORLD DATA IN HYPERTENSION: DATA FROM JAPAN MEDICAL ASSOCIATION DATABASE OF CLINICAL MEDICINE (J-DOME) STUDY IN KANAGAWA

Abstract

Despite the ease of access for the diagnosis of hypertension and the progression of antihypertensive medications, the consultation for hypertension or the control of blood pressure (BP) is not sufficient, and hypertension remains the major cause of death due to cerebrovascular and cardiovascular diseases. The Japan Medical Association Database of Clinical Medicine (J-DOME) was established in 2018 with the aim of advancing the level of medical care for lifestyle-related diseases (diabetes and hypertension). To compare the results of previous studies and clarify the current problems, Kanagawa Physicians Associations collaborated with J-DOME to conduct the Kanagawa hypertension study 2021 featuring with J-DOME. We compared three studies: the 2011 study (n = 826); the 2014 study (n = 1098); and the 2021 study featuring with J-DOME (n = 830). The BP values at office (mmHg) were 132.9 ± 13.2/75.8 ± 9.3 in 2011, 133.1 ± 14.6/77.2 ± 10.7 in 2014, and 136.5 ± 17.4/76.9 ± 11.6 in 2021 study. Significantly high systolic and diastolic BP were observed in the 2021 study (p < 0.001) and the 2014 study (p = 0.02). The BP values at home (mmHg) were 128.6 ± 10.6/75.5 ± 8.7 in 2011, 129.4 ± 10.2/76.2 ± 8.9 in 2014, 128.0 ± 8.1/76.6 ± 8.3 in 2021 study. A significantly higher systolic BP was observed in the 2014 study (p = 0.03). Among patients whose target BP was < 140/90 mmHg at the office and < 135/85 mmHg at home, the achievement rates (at office/at home) were 72.5% and 75.8% in the 2011 study; 66.0%/68.5% in the 2014 study; and 46.7%/83.3% in the 2021 study. In contrast, among patients whose target BP was < 130/85 mmHg at office and < 125/75 mmHg at home, the achievement rates (at office/at home) were 31.6%/19.7% in 2011, 32.1%/16.9% in 2014, and 30.4%/19.1% in the 2021 study. Lower utilization of Ca-channel blockers, ARBs, alpha-blockers, and diuretics was observed in the 2021 study (all p < 0.001). Because JSH recommends that BP at home is given more importance than BP at the office, the improvement in the achievement of target BP by 135/85 mmHg at home is acceptable. However, efforts should be focused on the management of patients requiring strict BP control who showed extremely low achievement rates and did not show any improvement over the last decade. Furthermore, the low frequency of utilization of antihypertensive medications, despite the large number of diabetes patients, is also a major issue that general practitioners should address as soon as possible.