Blood pressure status, JSH 2019-based control rate, and associated factors among community-dwelling adults: The NOSE...

The Japanese Society of Hypertension Guidelines (JSH 2019) introduce stricter blood pressure (BP) targets, but BP status (hypertension prevalence and treatment) and control rates under these criteria, particularly by home BP monitoring, remain limited. This study investigated BP status, guideline-based BP control rates, and associated factors in a community-dwelling population. We analyzed baseline data (2020-2021) from 623 participants (mean age 67.6 years; 37.4% men) in the NOSE Study. BP status and control were defined using JSH 2019 criteria, with thresholds modified by age and comorbidities and 5 mmHg lower for home BP. Office BP and 30-day mean morning and evening home BP values (≥14 days) were assessed. Multivariable regression analysis was used to identify factors associated with hypertension prevalence, treatment status, and poor BP control. Hypertension prevalence was 66.8% and was associated with older age and higher body mass index. Approximately half of adults with hypertension were untreated, despite having higher BP levels, and tended to be younger with fewer comorbidities. Among treated participants, BP control rates were 22.9% based on office BP and 7.3% based on morning home BP. Masked hypertension was frequent (24.8%). Monotherapy was common (59.2%), while diuretics (10.1%) and beta-blockers (4.1%) were underutilized. A higher number of anti-hypertensive medications was associated with better BP control. Community-dwelling adults showed high hypertension prevalence, substantial untreated BP, and very low control rates under guideline targets. Home BP monitoring is essential for detecting uncontrolled morning and masked hypertension, and current treatment patterns appear insufficient to meet JSH recommendations.