Open Journal Systems

Diagnosis and control of hypertension in the elderly populations of Japan and the United States

Yasuhiko Saito, Shieva Davarian, Atsuhiko Takahashi, Edward Schneider, Eileen M. Crimmins

Article ID: 34
Vol 1, Issue 1, 2015, Article identifier:19-28

VIEWS - 2791 (Abstract) 2107 (PDF)


The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system con-tributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in se-niors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years old or older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n = 2,309) and the U.S. Health and Retirement (HRS) Study (n = 3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hyperten-sion is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medi-cation is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S.


control; diagnosis; hypertension; public health; older adults

Full Text:



Benetos A, Safar M, Rudnichi A, et al. (1997). Pulse pressure: Apredictor of long-term cardiovascular mortality in a French male population. Hypertension, 30(6): 1410–1415.

Coresh J, Selvin E, Stevens LA, et al. (2007). Prevalence of chronic kidney disease in the United States. Journal of the American Medical Association, 298(17): 2038–2047.

Crimmins E M, Garcia K and Kim J K. (2010). Are international differences in health similar to interna-tional differences in life expectancy?, in International Difference in Mortality at Older Ages: Dimen-sions and Sources, Crimmins EM, Preston SH, Cohen B, The National Academies Press, Washington DC, 64–104.

Crimmins E M, Vasunilashorn S, Kim J K, et al. (2008). A comparison of biological risk factors in two populations: The United States and Japan. Population and Development Review, 34(3): 457–482.

Cushman W C and Basile J. (2006). Achieving blood pressure goals: Why aren't we? Journal of Clinical Hypertension, 8(12): 865–872.

Cutler J A, Sorlie P D, Wolz M, et al. (2008). Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension, 52(5): 818–827.

Davarian S, Crimmins E, Takahashi A, et al. (2013). Sociodemographic correlates of four indices of blood pressure and hypertension among older persons in Japan. Gerontology, 59(5): 392–400.

DiGiovanna A G. (1999). The cardiovascular system, in Human aging: biological perspectives, DiGi-ovanna AG, McGraw-Hill, San Francisco, 68–92.

Franklin S S, Larson M G, Khan S A, et al. (2001). Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham heart study. Circulation, 103(9): 1245–1249.

Glei D A, Mesle F and Vallin J. (2010). Diverging trends in life expectancy at age 50: A look at causes of death, in International Difference in Mortality at Older Ages: Dimensions and Sources, Crimmins EM, Preston

SH, Cohen B, The National Academies Press, Washington DC, 17–67.

Hajjar I and Kotchen T A. (2003). Trends in prevalence, awareness, treatment, and control of hyperten-sion in the United States, 1988–2000. Journal of the American Medical Association, 290(2): 199–206.

Hozawa A, Ohkubo T, Kikuya M, et al. (2002). Blood pressure control assessed by home, ambulatory and conventional blood pressure measurements in the Japanese general population: The Ohasama study. Hypertension Research, 25(1): 57–63.

Ikeda N, Gakidou E, Hasegawa T, et al. (2008). Understanding the decline of mean systolic blood pres-sure in Japan: An analysis of pooled data from the national nutrition survey, 1986–2002. Bulletin of the World Health Organization, 86(12): 978–988. 10.2471/BLT/07.050195

Kanzen Shuroku Dai 5ji Junkannki Shikkan Kiso Chosa Kekka (Report of the 5th Japanese National Survey of Circulatory Disorders), viewed August 30 2015, , Japanese

Liu J E, Roman M J, Pini R, et al. (1999). Cardiac and arterial target organ damage in adults with ele-vated ambulatory and normal office blood pressure. Annals of Internal Medicine, 131(8): 564–572.

Ma J, Lee K V and Stafford R S. (2006). Changes in antihypertensive prescribing during US outpatient visits for uncomplicated hypertension between 1993 and 2004. Hypertension, 48(5): 846–852.

MacMahon S, Peto R, Cutler J, et al. (1990). Blood pressure, stroke, and coronary heart disease. Part I, prolonged differences in blood pressure: prospective observational studies corrected for the regres-sion dilution bias. The Lancet, 335(8692): 765–774.

Marmot M, Syme S, Kagan A, et al. (1975). Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Prevalence of coronary and hypertensive heart disease and associated risk factors. American Journal of Epidemiology, 102(6): 514–525.

Murray C. (2011).Why is Japanese life expectancy so high? The Lancet, 378(9797): 1124–1125.

Ministry of Health, Labor and Welfare 2009, Heisei 18 Nen Kokumin Kenko Eiyo Chosa Hokoku (Report on the National Health Nutritional Survey 2006), viewed February 1 2013, , Japanese

Mori H, Ukai H, Yamamoto H, et al. (2006). Current status of antihypertensive prescription and asso-ciated blood pressure control in Japan. Hypertension Research, 29(3): 143–151.

Nihon University Japanese Longitudinal Study of Aging home page. (n.d.). Retrieved on August 30 2015,

Obara T, Ohkubo T, Funahashi J, et al. (2005). Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the JHOME study. Journal of Hypertension, 23(9): 1653–1660.

Ohkubo T, Obara T, Funahashi J, et al. (2004). Control of blood pressure as measured at home and office, and comparison with physicians' assessment of control among treated hypertensive patients in Japan: First report of the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) study. Hypertension Research, 27(10): 755–763.

Oliveria S A, Lapuerta P, McCarthy B D, et al. (2002). Physician-related barriers to the effective man-agement of uncontrolled hypertension. Archives of Internal Medicine, 162(4): 413–420.

Selenta C, Hogan B E and Linden W. (2000) How often do office blood pressure measurements fail to identify true hypertension? An exploration of white-coat normotension. Archives of Family Medicine, 9(6): 533–540.

Shirasaki O, Asou Y and Takahashi Y. (2007). New clinical validation method for automated sphygmo-manometer: a proposal by Japan ISO-WG for sphygmomanometer standard, Blood Pressure Moni-toring, 12(6): 381–383.

Singer G M, Izhar M and Black H R. (2002). Goal-oriented hypertension management: Translating clini-cal trials to practice. Hypertension, 40: 464–469.

Wing L M, Brown M A, Beilin L J, et al. (2002) Reverse white-coat hypertension' in older hypertensives. Journal of Hypertension, 20(4): 639–644.

(2791 Abstract Views, 2107 PDF Downloads)


  • There are currently no refbacks.

Copyright (c) 2015 Yasuhiko Saito, Shieva Davarian, Atsuhiko Takahashi, Edward Schneider, Eileen M. Crimmins

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.