Physician and patient perspectives on hypertension management and factors associated with lifestyle modifications in Japan: results from an online survey

Abstract

We conducted a survey to examine the gaps between Japanese physician and patient perspectives on hypertension management and to investigate important factors that may help solve the "hypertension paradox" in Japan. Web-based surveys of patients and physicians were conducted in Japan between October 19 and 31, 2017. The data collected included physician and patient perspectives on hypertension education, adherence to lifestyle modifications and antihypertensive medication, and reasons for treatment adherence/nonadherence. Factors relating to specific patient behaviors (e.g., monitoring their home blood pressure [BP] daily) were analyzed by multivariate logistic regression analysis. Of the 541 physicians and 881 patients included in the analyses, both groups recognized that the extent of lifestyle changes was insufficient. Approximately 80% of physicians reported that they fully or sufficiently provided education to patients about reasons for hypertension treatment and its associated risks, target BP levels, and lifestyle modifications. Only 40-50% of patients considered those topics having been fully or sufficiently discussed. Logistic regression analyses revealed that positive lifestyle modifications (daily home BP monitoring, salt intake <6 g/day, and daily aerobic exercise for ≥30 min) were positively associated with receiving feedback from physicians about specific lifestyle modifications and patient motivation for maintaining their target BP. In conclusion, perception of the amount of education provided by physicians on hypertension management was lower in patients than in physicians. In addition to effective regular follow-up regarding lifestyle modifications, patient motivation by physicians is an important factor for improving lifestyle modifications and achieving effective hypertension management in Japan.

Keywords: Adherence; Education; Hypertension; Hypertension paradox; Lifestyle modification.

Fig. 1

Patient and physician beliefs, attitudes, and behaviors toward hypertension management. a Physician-reported factors contributing to patients’ failure to achieve blood pressure targets; b patients’ attitudes toward hypertension treatment and their associated behaviors; and c patient-reported lifestyle changes for blood pressure management. BP blood pressure, DBP diastolic blood pressure, MI myocardial infarction, SBP systolic blood pressure, TV television. ¹Percentage of physicians responding in each category with the answers “very significant” or “significant.” Based on physician question Q21 (Supplementary Document 2; to what extent do you think each of the following patient-derived and disease-related reasons are critical factors that prevent 100% of your patients from achieving the guideline-recommended target? Please select the most appropriate response for each of the following factors [scale ranging from “very significant” to “not significant at all”]). ²Percentage of patients who answered “very applicable” and “somewhat applicable” for each item. Based on the patient screening question SC13 (Supplementary Document 3; Please provide us your thoughts and actions or behaviors regarding antihypertensive treatment. Please select the most appropriate response for each of the following [scale ranging from “very applicable” to “not at all applicable”]). ³Percentage of patients who answered “yes” for each item. Based on patient question Q4 (Supplementary Document 4; what actions do you currently take to manage your blood pressure? Please select all the factors that apply to you from the following options)

Fig. 2

Physician and patient perspectives on the education and guidance on hypertension and its management. a Physician and patient perspectives on the education and guidance provided at the initial diagnosis, b patient-reported education regarding target blood pressure, and c physician and patient perspectives on the feedback or confirmations attained during follow-up assessments. BP blood pressure, BMI body mass index, DBP diastolic blood pressure, SBP systolic blood pressure. ¹Chronic kidney disease, myocardial infarction, stroke, etc. ²Percentage of patients and physicians who responded “firmly” or “to some extent.” Based on patient question Q2 (Supplementary Document 4; did you receive explanations regarding the following factors from your doctor at your initial consultation for hypertension? Please select the most appropriate response for each factor, and how thoroughly you received explanations from your doctor) and physician question Q3 (Supplementary Document 2; how thoroughly do you (the doctor) explain each of the following education and guidance factors to your patients? Please select the most appropriate response that applies to each patient education factor). Scale ranging from “very thoroughly” to “none” for both questions. ³Based on patient question Q11 (Supplementary Document 4; what kind of explanation did the doctor give you about your target blood pressure? Please provide the numerical target value if your doctor provided you with one). Figure depicts the sum of responses in which the patients reported “I was informed of the numerical value” and “I was informed of the numerical range.” Respondents were asked whether a specific value or a range was provided for both SBP and DBP. ⁴Based on patient question Q3 (Supplementary Document 4; did you receive feedback (or confirmation) regarding the following factors from your doctor during your follow-up consultation for the treatment of hypertension? Please select the most appropriate response for each factor, regarding how thoroughly you received feedback (or confirmation) from your doctor) and physician question Q5 (Supplementary Document 2; how thoroughly do you confirm (or feedback to the patient) each of the following symptom and lifestyle modification factors with your patients? Please select the most appropriate response that applies to each patient education factor). Scale ranging from “very thoroughly” to “none” for both questions

Fig. 3

Patient self-management. a Patient-reported frequency of home blood pressure measurement and b reasons cited by patients for continuing home blood pressure measurement. BP blood pressure, CV cardiovascular, TV television. ¹Based on patient question Q14 (Supplementary Document 4; how frequently do you measure your home blood pressure? Please choose the most appropriate out of the following options). Respondents chose from the seven options provided. ²Percentage of patients who answered “very applicable” and “somewhat applicable” for each item. Based on patient question Q16 (Supplementary Document 4; why do you continue to measure your home blood pressure?)

Fig. 4

Logistic regression analysis of factors relating to specific patient behaviors. a Measuring blood pressure daily, b decreasing salt intake to <6 g/day, and c undertaking aerobic exercise for ≥30 min per day. BP blood pressure, CI confidence interval. Multivariate logistic regression analysis adjusted for age, sex, region of residence in Japan, type of institution patient visited, employment status, and absence or presence of cardiovascular and renal complications in patients recording their home BP