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JSH 2004) 4Ii 3 Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004) 4ii Guidelines Subcommittee Chair Takao SARUTA Keio University Members Tanenao ETO Miyazaki University Toshiro FUJITA The University of Tokyo Yutaka IMAI Tohoku University Tsutomu IMAIZUMI Kurume University Sadayoshi ITO Tohoku University Kenjiro KIKUCHI Asahikawa Medical College Masayasu MATSUMOTO Hiroshima University Hiroaki MATSUOKA Dokkyo Medical University Toshio OGIHARA Osaka University Kazuyuki SHIMADA Jichi Medical University School of Medicine Kazuaki SHIMAMOTO Sapporo Medical University Hiromichi SUZUKI Saitama Medical University Shuichi TAKISHITA University of the Ryukyus Hisaichiro TSUKIYAMA International University of Health and Welfare Makoto UCHIYAMA Niigata University Hirotsugu UESHIMA Shiga University of Medical Science Reviewers Keishi ABE Tohoku University Kikuo ARAKAWA Fukuoka University Masatoshi FUJISHIMA Kyushu University Koshiro FUKIYAMA University of the Ryukyus Toshihiko HASEGAWA National Institute of Public Health Kunio HIWADA Ehime University Osamu IIMURA Sapporo Medical University Masao ISHII Yokohama City University Yoshihiro KANEKO Yokohama City University Teruo OMAE National Cardiovascular Center Akira TAKESHITA Kyushu University Yoshio YAZAKI National Hospital Organization Kaoru YOSHINAGA Tohoku University Secretary Ikuo SAITO Keio University Support staff Isao ABE Kitakyushu Wakamatsu Hospital Katsuyuki ANDO The University of Tokyo Naoyuki HASEBE Asahikawa Medical College Hiroshi HIROSE Keio University Toshihiro KITA Miyazaki University Tatsuo SHIMOSAWA The University of Tokyo (in alphabetical order) iii5 Volume 29, Supplement, August, 2006 CONTENTS 1. Epidemiology of Hypertension S1 1) Changes in the Average Blood Pressure of the Japanese S1 2) Hypertension and Occurrence of Cardiovascular Diseases and Its Prognosis S1 a. High Incidence of Stroke Due to Hypertension S1 b. Development of Heart Diseases Due to Hypertension S1 c. Prognosis of Stroke and Heart Disease S2 3) Characteristics of Hypertension in the Japanese S2 a. High Salt Intake S2 b. Obesity S5 c. Untreated Hypertensive Patients and Poor Management of Hypertension S5 4) Preventive Measures against Hypertension from the Viewpoint of Public Health S5 Summary S6 2. Measurement and Clinical Evaluation of the Blood Pressure S7 1) Measurement of Blood Pressure S7 a. Measurement of Blood Pressure at the Clinical Setting S7 b. Home Blood Pressure Measurement S7 c. Ambulatory Blood Pressure Monitoring S8 d. Information Obtained by the Home Blood Pressure Measurement and Ambulatory Blood Pressure Monitoring S9 2) Classification of Blood Pressure Values and Evaluation of Risk Factors S10 a. Classification of Blood Pressure Values S10 b. Risk Factors for Cardiovascular Diseases S11 c. Stratification of Risk for Evaluation of the Prognosis S11 d. Types of Hypertension S12 3) Examination and Diagnosis S12 a. History S12 b. Examination (Physical Findings) S13 c. Laboratory Examinations S13 d. Diagnosis of Hypertensive Target Organ Damage S13 4) Planning for the Control of Hypertension at the Initial Examination S14 Summary S14 3. Basic Principles of Treatment S15 1) Objectives of Treatment S15 2) Patients to Be Treated and Target Levels of Blood Pressure S16 a. Patients to Be Treated S16 b. Target Levels of Blood Pressure S16 3) Selection of Treatments S17 a. Lifestyle Modifications S17 b. Time to Start Antihypertensive Drug Treatment S17 c. Antihypertensive Drug Treatment S17 4) Other Points of Attention S18 a. Initial Treatment S18 b. Long-Term Treatment (Continuous Treatment) S18 c. Attention to the Quality of Life S18 Summary S19 4. Lifestyle Modifications S21 1) Restriction of the Salt Intake (Reduced-Salt Diet) S21 2) Increases in the Intake of Vegetables and Fruits and Restriction of the Intake of Cholesterol and Saturated Fatty Acids S22 3) Maintaining a Proper Body Weight (Weight Control) S24 4) Exercise Therapy S24 5) Restriction of Alcohol Intake (Moderation in Drinking) S24 6) No Smoking S24 6iv 7) Other Cautions about Daily Living S25 8) Comprehensive Lifestyle Modifications S25 Summary S25 5. Treatment with Antihypertensive Drugs S27 1) Basic Principles for Choice of Antihypertensive Drugs S27 a. Choice of Antihypertensive Drugs S27 b. Use of Antihypertensive Drugs S27 c. Drug Interactions S28 d. Dose Reduction and Withdrawal of Antihypertensive Drugs S28 2) Characteristics and Major Adverse Effects of Various Antihypertensive Drugs S28 a. Ca Antagonists S28 b. Angiotensin II Receptor Blockers S29 c. Angiotensin-Converting Enzyme Inhibitors S29 d. Diuretics S30 e. β-Blockers (Including αβ-Blockers) S31 f. α-Blockers S31 g. Other Sympatholytic Agents—Centrally and Peripherally Acting Drugs S31 h. Classic Vasodilators S32 3) Designated Health-Promoting Foods S32 Summary S32 6. Hypertension Associated with Organ Damage S33 1) Cerebrovascular Disease S33 a. Acute Phase S33 b. Chronic Phase S34 c. Asymptomatic Phase S35 2) Heart Diseases S36 a. Ischemic Heart Disease S36 b. Treatment for Heart Failure Using Antihypertensive Drugs S37 c. Cardiac Hypertrophy S38 3) Kidney Diseases S38 a. Renal Function and Blood Pressure S38 b. Chronic Kidney Diseases and Cardiovascular Diseases S39 c. Lifestyle Modifications S39 d. Antihypertensive Drug Treatment S39 e. Patients Undergoing Dialysis S41 4) Vascular Diseases S42 a. Aortic Aneurysm S42 b. Atherosclerotic Peripheral Arterial Obstruction S42 Summary S42 7. Hypertension Complicated by Other Diseases S45 1) Diabetes Mellitus S45 2) Hyperlipidemia S47 3) Obesity S47 4) Metabolic Syndrome S47 5) Bronchial Asthma and Chronic Obstructive Pulmonary Disease S48 6) Gout and Hyperuricemia S48 7) Liver Diseases S49 Summary S49 8. Hypertension in the Elderly S51 1) Characteristics of Hypertension in the Elderly S51 2) Criteria and Diagnosis of Hypertension in the Elderly S51 3) Treatment S52 a. Effects of Antihypertensive Therapy in the Elderly S52 b. Indications for Antihypertensive Therapy and Target Levels of Blood Pressure S54 c. Lifestyle Modifications S55 d. Choice of Antihypertensive Drugs S56 Summary S58 7v 9. Hypertension under Special Conditions S59 1) Refractory Hypertension S59 a. Definition and Frequency S59 b. Causes and Preventive Measures S59 2) Hypertensive Emergency and Urgency S60 a. Definitions and Classification S60 b. Principles of Treatment S61 c. Hypertensive Encephalopathy S61 d. Cerebrovascular Diseases S62 e. Acute Left Ventricular Failure and Pulmonary Edema S62 f. Severe Hypertension Complicating Acute Coronary Syndrome, Acute Myocardial Infarction, or Unstable Angina S62 g. Pheochromocytoma Crisis S62 h. Accelerated/Malignant Hypertension S63 i. Cases with Increases in Blood Pressure Other than Hypertensive Emergency S64 3) Blood Pressure Management at Pre- and Post-Surgery S64 4) Hypertension in Women S65 a. Hypertension in Pregnancy S65 b. Hypertension Related to the Use of Oral Contraceptives and Estrogen Replacement Therapy S67 c. Hypertension in Postmenopausal Women S67 Summary S67 10. Hypertension in Children S69 1) Characteristics of Hypertension in Children and High School Students S69 2) Measurement of Blood Pressure and Diagnostic Criteria of Hypertension for Children S69 3) Problems with Essential Hypertension in Children and High School Students S69 4) Lifestyle Modifications in Childhood (Primary Prevention of Hypertension) S69 a. Dietary Therapy S71 b. Exercise Therapy S71 5) Management of Hypertension S71 6) Antihypertensive Drug Treatment S71 Summary S72 11. Secondary Hypertension S73 1) Prevalence of Secondary Hypertension S73 2) Renal Parenchymal Hypertension S73 a. Diabetic Nephropathy S73 b. Chronic Glomerulonephritis S74 c. Polycystic Kidney Disease S74 3) Renovascular Hypertension S74 a. Diagnostic Clues S76 b. Examinations for the Diagnosis S76 c. Treatments S76 4) Endocrine Hypertension S77 a. Primary Aldosteronism and Similar Diseases S77 b. Cushing’s Syndrome S78 c. Pheochromocytoma S79 d. Thyroid Diseases S79 e. Hyperparathyroidism (Primary) S80 f. Acromegaly S80 5) Vascular Hypertension S80 a. Aortitis Syndrome S80 b. Other Angitis S80 c. Coarctation of Aorta S80 d. Vascular Hypertension Accompanied by an Increase in the Cardiac Output S81 6) Hypertension Due to Diseases of the Brain or the Central Nervous System S81 7) Drug-Induced Hypertension S81 a. Non-Steroidal Anti-Inflammatory Drugs S81 b. Licorice (Glycyrrhizin) S81 c. Glucocorticoids S82 8vi d. Cyclosporine S82 e. Erythropoietin S82 f. Drugs with Sympathomimetic Actions S82 g. Others S83 Summary S83 References S85 Main Antihypertensive Drugs S103 Hypertension Research (ISSN 0916-9636) has been published monthly since 2003 by the Japanese Society of Hypertension. The Journal succeeds the Japanese Journal of Hypertension which had been published since 1978 in Japanese edition and has been renewed in 1992, from Volume 15. Correspondence Kazuyuki Shimada, M.D. (Editor-in-Chief Hypertension Research) Division of Cardiovascular Medicine, Jichi Medical University School of Medicine 3311–1 Yakushiji, Shimotsuke 329–0498, Japan Tel: +81 (0)285-58-7538 Fax: +81 (0)285-44-4311 E-mail: [email protected] Subscription Rates Annual subscription is accepted at any time. These list prices are effective since 2000. In Japan: For individuals subscription rate is ¥15,000/year. For institution: ¥20,000/year. All orders must be sent to the Japanese Society of Hypertension. Members of the Japanese Society of Hypertension are eligible for a reduced rate. Contact the Japanese Society of Hypertension [Rm4F,
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