Hypertension treatment at our clinic

What is high blood pressure?

Hypertension can increase the risk of stroke, heart disease and kidney disease even when it causes few symptoms. We review home readings, test results, other conditions and your daily routine to plan treatment you can continue.

• Clinic blood pressure: systolic pressure of 140 or higher, or diastolic pressure of 90 or higher.
• Home blood pressure: systolic pressure of 135 or higher, or diastolic pressure of 85 or higher.

All values are in mmHg. Diagnosis is based on repeated measurements and home readings, not a single result.

Sometimes another condition causes high blood pressure

Hormonal disorders, kidney disease and sleep apnea can cause secondary hypertension. Identifying a cause may allow treatment of that condition alongside blood pressure control.

Primary aldosteronism

This condition involves excessive aldosterone production by the adrenal glands. It is especially important to consider in people with hypertension from a young age, blood pressure that remains high despite several medicines, or low blood potassium. Normal potassium does not rule it out.

We review medical history, current medicines and test results before considering aldosterone and renin blood tests. Medicines can affect the results; do not stop them on your own.

Our director’s research

Dr. Koshiro Nishimoto has published research on primary aldosteronism and how the adrenal glands produce aldosterone. This research background informs our attention to possible causes as well as the blood pressure reading.

About our doctors / Research profile (Japanese)

Related publications: adrenal aldosterone production (2010) and aldosterone-producing cells and gene mutations (2015).

Assessing future health risks

People with the same blood pressure can have different risks depending on age, smoking, cholesterol, diabetes, kidney disease and previous stroke or heart disease. Guidelines combine these findings with blood pressure to classify risk as low, moderate or high. Low risk does not mean hypertension should be left untreated.

We use a clinic decision-support tool to organize recorded blood pressure and medical history. The doctor checks measurement conditions and any missing information, then discusses lifestyle changes, medication and follow-up. We can provide a written explanation of the assessment and care plan. The doctor makes the final decision for each patient.

Treatment according to risk

Lifestyle changes matter at every risk level. For people not yet taking blood pressure medicines and without previous stroke or heart disease, the following is a general guide.

• Elevated blood pressure with low or moderate risk: review lifestyle and reassess within about three months; strengthen lifestyle measures if improvement is insufficient.
• Hypertension with low or moderate risk, or elevated blood pressure with high risk: reassess within about one month and consider medication if the target is not reached.
• Hypertension with high risk: start appropriate medication promptly alongside lifestyle changes.

“Elevated blood pressure” means clinic systolic pressure of 130–139 or diastolic pressure of 80–89 mmHg without reaching the hypertension threshold. People who have already made lifestyle changes or have previous stroke or heart disease may need medication from the start. We decide individually using home readings and overall health.

If you already take medication, we continue to review home readings, dizziness, adherence and kidney function. Lower readings during treatment do not by themselves mean your original risk has disappeared or that medication is no longer needed. Discuss changes or stopping treatment with your doctor.

Treatment targets and lifestyle

The guideline’s general targets are:

• Clinic blood pressure: systolic below 130 and diastolic below 80 mmHg.
• Home blood pressure: systolic below 125 and diastolic below 75 mmHg.

Diagnostic thresholds and treatment targets are different. We also monitor symptoms caused by excessive lowering and changes in kidney function. Targets are individualized, including for patients receiving dialysis.

We support salt reduction toward less than 6 g of salt per day, weight management, suitable physical activity and reviewing alcohol intake. Lifestyle measures continue after medication starts and are adapted to your health and routine.

CureApp HT at our clinic

We use the prescribed CureApp HT therapeutic app to support home blood pressure recording and changes in salt intake, weight management and activity. It is intended for adults with essential hypertension, in which several factors such as predisposition and lifestyle contribute.

The doctor checks previous lifestyle counseling, your health and smartphone use before deciding whether it is appropriate. It may be combined with blood pressure medicines according to your condition. Regular visits assess progress; app use should not delay necessary medication or lead you to stop medicine on your own.