Although the control rate of hypertension has gradually improved over the last 40 years in Japan, it is still unsatisfactory low at only around 48% of male and 50% of female patients. Despite remarkable advances in the diagnosis and treatment of hypertension, countermeasures against hypertension are still insufficient. This hypertension paradox is a recent serious clinical issue in Japan. I named this unfortunate clinical condition of neglecting uncontrolled hypertension as feigning ignorance of hypertension. The feigning ignorance of hypertension is caused by patients who don’t want to listen to their doctor's negative comments, is exacerbated by doctors or medical providers who don’t want to say what their patients don’t want to hear. More than 70% of causal factors of hypertension paradox may be attributed to feigning ignorance.
We conducted a web-based survey, named PARADOX and studied patients (n = 881) and physicians (n = 541) involved in hypertension treatment. Approximately 80% of physicians reported that they fully or sufficiently provided education to patients about hypertension treatment. In contrast, only 40 to 50% of patients considered those topics to have been fully or sufficiently covered by doctors at the initial consultation. The largest discrepancy was observed in the topic of target blood pressure and its reason. About 80% of physicians believed that they sufficiently provided guidance on target blood pressure to their patients, but only 38% of patients felt their doctors actually did so. This is a simple but critical discrepancy, which doctors should seriously consider. We asked about the important actions required to achieve target blood pressure in the future. Approximately 30% of doctors cited providing a target blood pressure value and its reasons. We must reassess and focus again on guiding patients toward a target blood pressure.
Finally, we understand Japanese doctors want to have more time, opportunities, and better conditions to talk and listen to their patients about hypertension management. Japanese doctors are too busy to complete the process of improvement of hypertension management by themselves. Therefore, multidisciplinary and multilateral cooperation with patients’ families, medical nurses, public health nurses, pharmacists, engineers, office workers, SNS, newspapers, TV and mass media is essential for better management of hypertension.