Cross-sectional Survey of Hypertension Management among Patients Stratified by Chronic Kidney Disease in Japan.

Introduction: Despite progress in hypertension management, blood pressure (BP) control remains insufficient, and this so-called hypertension paradox is an urgent issue. Following the 2019 revision of the Guidelines for Hypertension Management, we reported that patients requiring stringent BP regulation highlight the unachieved goals of hypertension management. BP management is a basic and validated strategy for patients with chronic kidney disease (CKD) but its achievement rate has been under-reported. Methods: We collected and compared cross-sectional data of patients with hypertension in Kanagawa, Japan for 2011 and 2014 by accessing the Japan Medical Association Database of Clinical Medicine. Results: Patients with and without CKD were included as follows: 316/488 in 2011, 152/946 in 2014, and 396/385 in 2021, respectively. In the 2021 study, the target office BP (130/80 mmHg) and home BP (<125/75 mmHg) were achieved in 36.3% and 57.9% of patients with CKD, respectively, and this was a significant improvement over the results reported in the 2014 study (p < 0.05). In contrast, the 2021 study on patients without CKD had a significantly lower achievement rate for a stringent BP target compared to the 2014 study (p < 0.05), especially for patients without diabetes (p = 0.004). Unlike trends in patients without CKD, home BP control in patients with hypertension and CKD has improved over the past decade. Conclusions: The stringent BP target achievement rate remains insufficient in patients with CKD, indicating that CKD campaigns or resolution of clinical inertia resulting from an insufficient number of concomitant drugs is warranted.