ISH 2022 Kyoto Japan
Current Trend of Hypertension Practiceby Specialists and non-Specialists
in the Japanese Primary Care Settings— J-DOME Study
October 14, 2022
Narumi Eguchi1), Kei Asayama2), Tomohiro Katsuya3)
Yutaka Hatori4), Masaaki Miyakawa5), and Mitsuhiko Noda6)
1) Japan Medical Association Research Institute, 2) Teikyo University, 3) Katsuya Clinic, 4) Hatori Clinic,
5) Japan Medical Association, 6) International University of Health and Welfare Ichikawa Hospital

ISH 2022 Kyoto Japan
Disclosure of COI
Narumi Eguchi, Kei Asayama, Tomohiro Katsuya
Yutaka Hatori, Masaaki Miyakawa, and Mitsuhiko Noda

The authors have no Conflict of Interest for this presentation2

Background of J-DOME Registryl Japan is a super aged country with increasing chronic disease patientsl Role of primary care physicians is growingl Information on primary care practice was not readily available inJapanl Japan Medical Association１started J-DOME2, the first nationwide
primary care registry in Japan in 2018
1: Japan Medical Association (JMA) is the largest professional associationof licensed physicians in Japan with 174,000 membership
2: J-DOME : Japan Medical Association Database Of Clinical MEdicine

3Overview of J-DOME
Primary Care Physicians (PCPs)

with clinics & small to middle-sized hospitals

Register cases（J-DOME WEB registry system )Feedback
reportCertificate ofAppreciation

Case study(cross sectional & longtitudinal)

Databases by otherinstitutions （J-DREAMS)J-DOME
Hypertension
Type 2 diabetes
18,000 patient cases• Blood tests, prescription drugs
medical questionnaires,comorbidities• Register once a year (updateonce a year)• Patients’ oral consent required

l Provide the participating PCPs with feedback reportl Support and strengthen primary care practice using the data4

Objectives of This Studyl To understand the current hypertension practice by primarycare physiciansl To compare the patient cases by hypertension specialists※ withthose by non-specialists※hypertension specialists here are the specialists certified by the JapaneseSociety of Hypertension.
Patients’ background and acuity are different between them.

5DesignData:l A total of 3620 patients with either hypertension or Type 2
diabetes were registered in 2021
l Of those,
2304 are hypertension cases with office blood pressures (BPs)including 657 hypertension specialists’ cases and 1647 nonspecialists’ cases

6

DesignMethods：l Office BP and most recent self-measured home BP are usedl Other items including patient characteristics, blood test results,
medications, patient education and salt consumption are
analyzed and compared between the two groups （hypertension
specialists’ cases and hypertension non-specialists’ cases）

7

Results – Baselinel Average age: 70.5 years old in specialists’ cases
70.2 years old in non-specialists’ cases.
l The ratio of hypertension family history:56.5% in the specialists’ cases
35.3% in the non-specialists’ cases.
Hypertension
Specialists' Cases

Hypertension
Non-specialists' Cases

Average

SDnAverage

SDnAge(years)

70.5

12.33

657

70.2

11.16

1645

BMI(kg/m2)

25.1

4.17

657

25.1

4.03

1639

Duration of hypertension (years)

12.2

448

11.7

8.48%
42.9%

1073!"#$"%&'(")*+",-

10.07%
47.5%

Hypertention family history (%)

56.5%

35.3%

Smoking ratio (%)

9.4%

12.1%./01002&8Results – BPsl The average office BP :134.9/75.9 mmHg in the specialists’ cases
134.9/75.7 mmHg in the non-specialists’ casesl The average home BP:
125.6/74.5 mmHg in the specialists’ cases
128.0/75.9 mmHg in the non-specialists’ cases
Hypertension
Specialists' Cases

Hypertension
Non-specialists' Cases

AverageSDn

AverageSDn

Systolic Office BP(mmHg)

134.9

17.34

657

134.9

17.61

1647

Diastolic Office BP(mmHg)

75.9

12.10

657

75.7

11.80

1647

Systolic Home BP(mmHg)

125.6

11.89476

128.0

10.86761!"#$#%

Diastolic Home BP(mmHg)

74.5

9.7547675.9

9.83761!"#$#&HbA1c（%)

6.1

0.80559

6.5

1.031557!"#$##%'l The number of patient cases with home BPs is limited.

Results – BP Indicatorsl Ratio of office systolic BP ≥140 mmHg :36.1% in the specialists’ cases
33.6% in the non-specialists’ cases
Hypertension
Specialists' Cases

Hypertension
Non-specialists' Cases

Office Systolic BP≧140mmHg (%)

36.1%

33.6%

Office Diastolic BP≧90mmHg

14.0%11.9%(%)

10Results – Medications

Prescribed antihypertensive medications(seven categories)
Prescribed Antihyertensive Medication－Speciallists' cases and non-specialists' cases (n=2304)
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%

※※※
※※※

77.3%
70.3% 74.1%
64.9%

※※※
※※※

21.3%
18.0%
11.7%
10.4%
Ca
antagonists

ARBs

Diuretics
Specialists'cases

β blockers※※※

1.5% 3.6%

8.4% 4.9%

5.8% 3.7%

ACE
inhabitorsMR
antagonists

α blockers※※

Non-specialists' cases※※※ p<0.001※※ p<0.01※p<0.05

11Number of Prescribed Medications
l Number of prescribed medications :Average 2.1 medications in the specialists’ cases
Average 1.7 medications in the non-specialists’ cases&'()*+,-.,/0!*+1*2345*,!+*36+!14-23
Hypertension
Specialists' Cases

Hypertension
Non-specialists' Cases

AverageSDn

Average

SDn

2.1

1.01

657

1.7

0.88

1647!"#$##%

12

Sodium Education and Consumptionl Reducing sodium is expected to lower BPs
l Ratio of patients who received sodium education
91.7% – Patients with specialists 79.7% – Patients with non-specialists
l Average sodium consumption
9.0 g /day – Specialists’ cases

10.0 g/day – Non-specialists’ cases

Hypertension
Specialists' Cases

Hypertension
Non-specialists' Cases

Sodium education (% of Yes)

91.7%

n=590

79.7%

n=1476 !"#$##%

Sodium consumption (g/day)

9.0(±2.46)

n=178

10.0(±2.67)

n=67 !"#$#&

13

Information for PCPs – J-DOME Repoｒtl An annual report with the analyses of his/her practice is sent toevery participating physician
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Conclusionl Office BP and other essential characteristics are similar
between specialists’ and non-specialists’ casesl We have home BP but the number of registrations is still
limited. Further home BP promotion may be neededl There are evident differences in hypertensive medications
between the two groupsl Sodium education ratio and sodium consumption are also
different between the two groups
15

Conclusion (cont.)l Our study is still ongoing but it is the first attempt in theprimary care settingl We would expect providing analyses for both specialists
and non-specialists will be useful and informative for
their practice16

Acknowledgement
We would like to express our sincere gratitude tothe medical institutions and doctors
who are participating in the J-DOME study
during the repeating COVID-19 waves.

17

Thank you for your attention!

https://www.jdome.jp/