Modifiable factors to achieve target blood pressure in hypertensive participants

The management of hypertension is one of the most important public health issues. Many patients with untreated hypertension in Japan require urgent treatment. This retrospective cohort study in Hiratsuka city aimed to evaluate the proportion of participants achieving target blood pressure and identify modifiable factors affecting the achievement. We retrospectively analyzed data from a merged database of claims, specific health checkup (SHC), and national health insurance data in Hiratsuka City, Japan, from June 2016 to March 2023. The study participants were adults aged 40-74 years without a history of hypertension treatment and with blood pressure ≥140/90 mmHg at SHC. The primary outcome was the achievement of target blood pressure <140/90 mmHg at the next SHC. Furthermore, multivariable logistic regression was performed to explore factors influencing the achievement. Of 5428 participants, 43.6% were female. The median age was 69 years, and 58.4% (95% confidence interval 57.1-59.7) achieved target blood pressure <140/90 mmHg. Multivariable logistic regression results showed that achievement of target blood pressure was associated with younger age (50-69 years), mild hypertension (grade I), no hypertension at the previous SHC, no record of SHC in the previous year, and willingness to improve lifestyle. One-third of people reported that their hypertension at SHCs failed to achieve target blood pressure. For community-level hypertension management, people who have the influencing factors must be educated by public health nurses, which might be effective for lifestyle improvement. Additionally, the elderly and people with persistent hypertension or severe hypertension should seek medical advice.