JSH2023 and fast-track publications in 'Hypertension Research'

Hypertension is the major risk factor for cardiovascular disease and is a global burden. In Japan, more than 100,000 people die annually from hypertension-related diseases [1]. Dr. Chobanian used the term 'hypertension paradox' to describe the problematic situation of poor blood pressure control despite the availability of excellent antihypertensive drugs [2]. This situation is still a major problem in Japan today. To solve this problem, it is necessary not only to increase awareness of appropriate antihypertensive treatment but also to develop strategies to reduce the number of patients with an inadequate antihypertensive treatment. In 2018, the Japan Society of Hypertension (JSH) announced 'The JSH Future Plan' with the slogan 'Good Blood Pressure for Lively 100 Years' [3]. The plan aims to 'Decrease the number of hypertensive individuals by seven million over the next decade, thereby extending the healthy life expectancy'. Many Japanese hypertension researchers and practitioners are working towards this goal, and the Society holds an annual meeting to present the progress of their work. Although the COVID-19 pandemic is now over, this was the first time in four years that we held a face-to-face meeting in Osaka, and it was a great success. A total of 236 abstracts were accepted from the public, 104 designated as symposia, and 35 as sponsored seminars and public lectures, for a total of 404 abstracts. As Chairman, I realised that there are still many scientific issues to be addressed in hypertension research and that many people are involved in different types of hypertension research.

At the suggestion of the Editorial Board of Hypertension Research, we encouraged conference speakers to submit manuscripts for publication in Hypertension Research, and some articles were published online on the day of presentation at the conference. The manuscripts were peer-reviewed on a fast-track basis, and we received 41 submissions and were able to publish 22 articles in this special issue. Five manuscripts are still under review. Although the acceptance rate is higher than usual, we are pleased that the quality of the presentations at the Annual Meeting was such high that the best of them have been submitted for publication.

Trends in hypertension research in Japan

The titles of the articles published in this special issue provide an overview of the current direction of interest in hypertension research in Japan. Specifically, there is one study on the pathogenesis of hypertension, one epidemiological study on hypertension and cancer, two on home blood pressure management and its application, two on hypertension in adolescents, four on the risk of lifestyle-related conditions such as defection, smoking, and sodium/potassium, and four on hypertension complications such as defection, smoking, and sodium/potassium. Two studies on hypertension in adolescents, four on the risk of lifestyle-related conditions such as defection, smoking, and sodium/potassium, four reports on hypertension complications such as atrial fibrillation, and chronic kidney disease, and one on the epidemiology of hypertension and cancer, six studies on hypertension complications such as atrial fibrillation, chronic kidney disease and cognitive dysfunction, and three reports on clinical and basic research on the effects of two sodium-glucose transport protein inhibitors, two on primary aldosteronism. In addition, the Editorial Board members have compiled an update on the field of hypertension research in 2023 into a full-length review article, providing information on trends in hypertension research worldwide [4]. These research streams are in line with the following three strategies proposed by the JSH to implement the 'Future Plan' [3].

  1. (1)

    Establishment of a lifetime-care system for individuals with hypertension,

  2. (2)

    Promotion of academic research in hypertension and embodiment of 'Future Medicine',

  3. (3)

    Promotion of social awareness by creating a society where the public takes ownership of blood pressure management.

Some of the results in which the Society has been involved will be presented at this year’s Annual Meeting, and this special issue includes some of the other results achieved by individual researchers. We look forward to more detailed discussions at next year’s JSH in Fukuoka, which will be organised by President Koichi Node.

Inter-academic solidarity among hypertension societies in Asia

At the 45th Annual Scientific Meeting of the JSH, we held an Asian International Exchange Session to discuss various topics with Asian participants both on-site and via the Internet. In the past, the JSH had deepened international exchanges through events such as the Japan-China Hypertension Symposium and the Japan-China-Korea Hypertension Symposium, which were held alternately in each other’s countries. Subsequently, we succeeded in attracting the 29th Scientific Meeting of the International Society of Hypertension 2022 in Kyoto (ISH2022 Kyoto) and decided to further promote international exchange, especially in Asia. The International Exchange Committee (chaired by Prof Akira Nishiyama) led this effort. It set up a web session as the Asian Hypertension Society Network at the 43rd Annual Meeting of the JSH in Okinawa, Japan in 2021 [5].

To continue our international exchange activities in Asia, we are organising an international exchange programme at the 45th JSH Annual Meeting in collaboration with the Hypertension Cardiovascular Outcome Prevention and Evidence in Asia Network (HOPE Asia Network), which is continuing its exchange activities in Asia, the JSH International Exchange Committee and the Hypertension Research Editorial Committee (Chaired by Prof Kazuomi Kario). I am grateful to the many Asian researchers who travelled to Osaka, Japan.

Hypertension and a healthy 100-year life

The '100-year life span' has become a trend symbolising longevity in Japan. The theme of the 45th JSH meeting was 'Promoting the JSH Future Plan' to Support a Healthy 100-Year Life. The reason I included the phrase 'a healthy 100-year life' in the conference theme is that I wanted to express my wish for a vibrant 100-year life in this age of 100-year life spans. Japan is the country with the longest life expectancy in the world, with 81.05 years for men and 87.09 years for women in 2022, and the old-age population index, the ratio of the population aged 65 and over to the total population, is 29.0%, forming a super-aged society [6, 7]. The median life expectancy that half of the people born each year are expected to reach is 83.93 years for men and 89.96 years for women, and the population over 100 years old is over ten thousand men and ninety thousand women. Many Japanese now realise that they will live to be 100. In our daily medical practice, we have many opportunities to see patients over 80. The average life expectancy of an 80-year-old is 8.89 years for men and 11.74 years for women, so it is necessary to develop medical care that takes into account maintaining health over such a long period.

The theme of this year’s conference was how we treat hypertension to achieve this goal. The primary goal of hypertension treatment is to prevent cerebrovascular complications, which is achieved by actively lowering blood pressure according to guideline recommendations. In Japan, it is no longer unusual to have very old people, as we have entered the era of 100-year life expectancy. As the population ages, the goals of hypertension treatment have changed, and hypertension treatment strategies are needed to ensure that each generation can live a healthy life in their own way for the 100 years of their lives. For example, adolescents and young adults with disordered lifestyles, advanced maternal age, very old people with health conditions ranging from robust health to nursing care, older people with dementia, people undergoing cancer treatment, cancer survivors and older workers are difficult to treat on the basis of previous randomised controlled trials, so we need new strategies. In these situations, it is often not enough to prescribe lifestyle changes and antihypertensive drugs to control high blood pressure.

As the population ages, one in five people will develop dementia. Treating high blood pressure to help people with dementia and prevent the disease has become an emerging issue. There is also a lack of data on how to deal with sudden increases in blood pressure in older people during physical activity, whether they are at risk of cardiovascular disease or how to manage it. Treatment of hypertension to manage the condition and achieve individual well-being is the real care needed for hypertension. The main aim of such treatment is not only to cure the disease, but also to maintain quality of life and activities of daily living. In addition to current treatment methods, multidisciplinary cooperation and telemedicine are expected to be introduced, as well as new technologies such as software as a medical device and artificial intelligence. In the search for environmental risk factors for hypertension, it is also necessary to improve the food and living environment in society as a whole.

Fig. 1 summarises the new strategies for overcoming hypertension in Japan, a super-aged society. The 'ISH2022Kyoto Hypertension Zero Declaration' has proposed a similar approach [8]. Achieving the goal of hypertension control has passed the stage where lowering blood pressure is enough, and we need to take on new challenges. Japan has not yet overcome the hypertension paradox. However, we hope that the basic and clinical perspectives of researchers such as those presented in this special issue will be further deepened and broadened, leading to the real conquest of hypertension.

Fig. 1
figure 1

New strategies to overcome hypertension in Japan, a super-aged society. Japan is at the forefront of the world’s ageing societies. As the aging population is accompanied by changes in morbidity patterns and problems in daily life, new strategies for hypertension management are needed. We need to move beyond the primary goal of hypertension treatment, which is the control of CV events, to a new goal of well-being into old age. Several new strategies will achieve active, appropriate, and safe blood pressure lowering. BP blood pressure, SaMD Software as medical device, AI artificial intelligence, CV cardiovascular, CVD cardiovascular disease, ESRD end-stage renal disease, QOL quality of life, ADL activities of daily living

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