A nationwide study in Japan has highlighted continuing difficulties in controlling high blood pressure in everyday primary-care settings.
Researchers analysed data from the Japan Medical Association Database of Clinical Medicine, known as J-DOME. The study included 2,663 people with hypertension registered during the 2024 financial year, with an average age of approximately 71 years.
Around one-fifth of participants were being treated by physicians who were certified hypertension specialists. These patients generally received more antihypertensive medicines than those treated by non-specialists, reflecting the greater clinical complexity of many people referred to specialist care.
Overall, only 36% of participants achieved an office blood-pressure reading below 130/80 mmHg. The proportion was lower among patients receiving specialist hypertension care, although the researchers caution that this does not mean specialist treatment was less effective.
Patients managed by specialists tended to have more complicated health profiles and were prescribed a greater number of medicines. Among people younger than 75, there was no statistically significant difference in achieving the target between specialist and non-specialist groups.
The study also identified excess body weight as an important factor associated with poorer blood-pressure control. Obesity was associated with lower odds of reaching the study's target, reinforcing the importance of combining medication management with broader approaches to cardiovascular risk.
The researchers emphasised that the findings reflect real-world clinical practice rather than a controlled clinical trial. Information about medication adherence, individual treatment targets, frailty and some other clinical factors was not available.
The results nevertheless point to a continuing challenge for healthcare systems: achieving recommended blood-pressure levels in an ageing population with multiple health conditions. Better treatment optimisation and sustained attention to modifiable risk factors remain important elements of hypertension management.