LAUSR

R ecent guidelines [1–3] emphasize the importance of the early detection and initiation of antihypertensive drug treatment. Changed from the previous version [4], the target treated blood pressure should be set to below 130/below 80 mmHg for most patients when below 140/ below 90mmHg is well tolerated according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the management of arterial hypertension [1]. This target level is in line with the recent 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines [2], in which threshold target blood pressure level and diagnostic threshold for hypertension are both set at 130/80 mmHg. We previously reported that the blood pressure control in Japan is insufficient [5]. Among 20 769 participants who received antihypertensive medication in our pooled cohorts, more than 50% still had a blood pressure of at least 140/at least 90mmHg, irrespective of their age category, and only a quarter were controlled to below 130/below 85mmHg. In the same population, when we changed the threshold diastolic blood pressure to below 80mmHg according to the recent recommendations [1,2], the control rate declined by approximately three percentage points in comparison to when the conventional diastolic blood pressure threshold of 85mmHg was used (Table 1). This worsening of the blood pressure control rate occurred regardless of sex and was predominantly observed among the young population (Cochran-Armitage trend P < 0.0001), indicating that the impact of lowering target blood pressure range in the younger population would be greater than that in the older population. Only 12.6% of men of 49 years of age or less and 15.0% of men of 50–59 years of age met the revised blood pressure target (Table 1). Insufficient blood pressure control in young to middle age has the potential to result in high cardiovascular risk in later life due to the progression of atherosclerosis and target organ damage over long periods both before and during therapy [6,7]. Although data on the present analysis collected from 1999 to 2005 might not truly represent the current state of the Japanese population [8], there has been little improvement, because the major antihypertensive agents such as calcium channel blockers and angiotensin receptor blockers had already been marketed. In parallel with maintaining a healthy lifestyle, we need to increase efforts to achieve better control of systolic and – similarly important among young generations – diastolic blood pressure when we follow the recommendations of the revised guidelines [1,2]. The current study also accentuates the necessity of combination therapy among a majority of patients. Because reducing the number of daily antihypertensive agents improves adherence and increases the rate of blood pressure control [9,10], a single-pill combination therapy is a practical tool for achieving sufficient blood pressure control in the population as recommended in the 2018 ESC/ESH