The present study was a prospective cohort study carried out in Fukushima Prefecture, Japan, from July 2006 to May 2007. Fukushima Prefecture is located in the northern region of Japan, with a population of about 2 million. From March to April 2006, we called physician-members of the Fukushima Hypertension Conference to solicit participation in this study. The Fukushima Hypertension Conference was established in 1997 and there were 120 members as of April 2006.
Participants in our study had hypertension and had received antihypertensive medication for at least 3 months and visited a participating physician during the baseline survey period (July 2006). In the baseline survey, the physician enrolled the first 10 consecutive patients who were eligible and willing to participate in our study.28 The enrollment continued until the total number of registered patients reached 50 for each physician. Even if the number of enrolled patients did not reach 50, the recruitment was stopped on the last day of July 2006. The research date was not announced to patients prior to the survey, and appointments for medical consultation were made according to their requests as usual. Enrolled patients were monitored for 1 year in 3-month intervals.
In the baseline survey, the registered patient’s clinical data was copied from medical files to survey sheets. The data included the patient’s age, sex, height, weight, waist circumference, family histories (hypertension, diabetes mellitus, dyslipidemia, heart disease, stroke, renal disease, and premature CVD), alcohol consumption, current smoking habits, systolic and diastolic BPs, whether home BP measurement was instructed, duration of hypertension treatment, usage of antihypertensive drugs, and presence of metabolic disorders (diabetes mellitus, dyslipidemia), end-organ damage, and CVDs (brain, heart, kidney, blood vessel, hypertensive, and diabetic retinopathy). The status of renal disease and diabetes mellitus was obtained from physician reports. In Japan, diabetes mellitus is defined based on the Japan Diabetes Society, Diabetes Treatment Guideline 2008–2009.29 Renal disease is defined based on the Japanese Clinical Practice Guidebook for Diagnostic and Treatment of Chronic Kidney Disease.16 As for methods to measure BP, we asked physicians to maintain their usual practices and report BP measurements on each day the patients were surveyed. Follow-up surveys (October 2006, January 2007, and April 2007) collected hypertension-related information. As for physicians’ characteristics, the following information was collected in the baseline survey: age, sex, place of employment, main specialty, number of hypertensive patients (per month), and measurer, timing, place, and method of BP measurement. The present report used data from the baseline survey and conducted analyses on achievement toward treatment goals and its associated factors.
All data were entered into a computer and analyzed using SPSS version 14 (SPSS Inc, Chicago, IL). We classified participants into 3 groups according to the JSH 2004: elderly patients 65 years and older without diabetes mellitus or renal disease, young or middle-aged patients without diabetes mellitus or renal disease, and patients with diabetes mellitus or renal disease. The success rates were calculated following treatment goals for each group indicated in JSH 2004: <140/90 mm Hg for elderly patients without diabetes mellitus or renal disease, <130/80 mm Hg for patients with the diseases, and <130/85 mm Hg for young or middle-aged patients without the diseases. For the analysis of factors associated with failure to achieve the treatment goals, we computed odds ratios (ORs) and 95% confidence intervals (CIs) for each item using univariate logistic regression. Significant factors in the univariate analysis (P<.05) were then entered into a multivariate logistic regression analysis.
With regard to the analysis of physicians’ characteristics and the success rates of their patients, we divided participating physicians into 2 groups using a median split of overall patient success rates (<45% vs ≥45%). The 2 groups were compared using the chi-square test and Fisher exact test for categoric items and Mann–Whitney test for continuous items.