Trends in Pharmacologic Management of Hypertension in Japan one year after the publication of the JS']JSH 2000 guidelines

Hypertension, a major risk factor for cerebrovascular disease and heart disease, often requires drug therapy. The First Japanese Society of Hypertension Guidelines for the Management of Hypertension were published in June 2000. In the present work, we surveyed 447 doctors who attended continuing medical education meetings between March and July 2001 to elucidate national anti hypertensive treatment patterns. A minimum level of 150/95 mmHg was selected by 60% and 140/90 mmHg by 19% of respondents as thresholds for initiating drug treatment, while 130/85 mmHg was selected by 26% of respondents as the goal blood pressure in middle-aged uncomplicated male patients. Sixty-nine percent of respondents selected a calcium antagonist as their previous drug of the first choice and 22% selected an ACE inhibitor. For their future first choice, 55% would prescribe an anglotensin II receptor antagonist (AIIA); 19% an ACE inhibitor; and 16% a calcium antagonist. Seventy-two percent selected a calcium antagonist + an ACE inhibitor and 17% selected a calcium antagonist + AIIA as their previous first-choice drug combinations. For their future drug combinations, 56% would select an AIIA + a calcium antagonist and 25% a calcium antagonist + an ACE inhibitor. Four weeks or less was selected by 69% of respondents as the period intended to reach the goal blood pressure. Eight weeks or more was selected by 28%. Overall, our data suggest that doctors in Japan are still cautious and conservative in controlling blood pressure levels but want rapid achievement of the goal blood pressure. Their first choice drug is shifting from calcium antagonists to AIIAs. These findings Indicate the need for continued effort to evaluate the diversity of clinical practice and assess the appropriateness of continuing medical education.