FEASIBILITY OF PERFECT 24-HOUR BP CONTROL IN ELDERLY FROM HI-JAMP STUDY

Objective: It is well known that the control rate of hypertension in clinical practice is poor, and one of the contributing factors is a condition referred to as ’treatment inertia.’ In elderly patients with hypertension, poor blood pressure control is often observed. This study aimed to investigate whether active management of this issue can achieve perfect 24-hour blood pressure control throughout the year. Design and method: Our institution participates in the nationwide multi-center HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) and continues to conduct 24-hour ambulatory blood pressure monitoring (ABPM) twice a year (in summer and winter) for blood pressure management. We retrospectively examined the blood pressure control status of 129 patients (mean age 82.4±6.5 years, 31% male) who were undergoing antihypertensive treatment and had data from two consecutive ABPMs without any changes in their antihypertensive medication during that period. Results: The usage rates of major antihypertensive medications were as follows: calcium channel blockers 94.5%, angiotensin II receptor antagonists 88.7%, angiotensin-converting enzyme inhibitors 3.6%, antihypertensive diuretics 60.1%, and beta-blockers 18.5%. Additionally, the usage rate of mineralocorticoid receptor antagonists was 7.1%. The average number of antihypertensive medications prescribed was 2.5, with 46.5% (60/129) of patients receiving three or more antihypertensive agents, among which the usage of antihypertensive diuretics was 93.3% (56/60). The average 24-hour blood pressure values in summer and winter were 112.5±10.1 mmHg and 115.2±9.7 mmHg, respectively. Regarding blood pressure control rates, in summer, the rates for 24-hour blood pressure (less than 130/80 mmHg), daytime blood pressure (less than 135/85 mmHg), and nighttime blood pressure (less than 120/70 mmHg) were 93.0%, 92.3%, and 85.3%, respectively. In winter, these rates were 90.7%, 89.2%, and 77.5%, respectively. Conclusions: In elderly hypertensive patients, actively addressing ’treatment inertia’ may nearly achieve perfect 24-hour blood pressure control throughout the year. The active use of antihypertensive diuretics plays a significant role in this achievement. However, challenges remain regarding nighttime blood pressure control.