In October 2024, I succeeded Dr. Koichi Node as the 13th President of the Japanese Society of Hypertension (JSH). Hypertension remains a leading risk factor for stroke, cardiovascular disease and kidney disease, and the JSH has made significant contributions to controlling this condition. Recently, under the slogan ‘Healthy 100-year life in hypertensive patients’, we have been actively advancing the ‘JSH Future Plan’ (Fig. 1) [1, 2]. To accelerate these efforts, the JSH plans to focus on three main pillars: digital hypertension research, implementation science in hypertension, and internationalization (Fig. 2). Each of these pillars is described in detail below.

Fig. 1
Fig. 1
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Japanese Society of Hypertension Future Plan. Reproduced, with permission, from Node et al. Hypertens Res 2018; 41: 989–990 [1]

Fig. 2
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Three pillars of JSH activity 2024–2026 in the information network era. AI artificial intelligence, BP blood pressure, HOPE Asia Network Hypertension Cardiovascular Outcome Prevention and Evidence in Asia Network, JSH Japanese Society of Hypertension, ICT information and communication technology, J-DOME Japan Medical Association Database of Clinical Medicine

Digital hypertension research

Digital hypertension is an emerging research field that leverages blood pressure (BP) as a master biomarker, evolving rapidly within the digital information era [3]. By capturing all relevant biological data—genetic, environmental, behavioral, and habitual—utilizing interconnected networks and synchronizing these data with BP fluctuations over time, we can generate evidence for personalized anticipation medicine and add value to the comprehensive prevention of hypertension and healthcare in general. Key research themes include: (1) the research and development of wearable BP monitors and vascular function assessment devices; (2) collaborative engineering and medical research on information and communication technology (ICT)-linked information systems; (3) data science research utilizing artificial intelligence (AI); and (4) the development of BP data management systems and digital therapeutics via apps [4,5,6,7,8,9]. Additionally, the JSH will focus on establishing guidelines and standardizing the new devices and ICT systems that are required for societal implementation of effective initiatives, taking into account consideration of international harmonization [10].

Implementation science in hypertension

Hypertension treatment guidelines were released by the European Society of Hypertension (ESH) in 2023 [11] and by the European Society of Cardiology (ESC) in 2024 [12]. The JSH plans to publish updated guidelines on the management of hypertension in 2025 (JSH2025), and this document is expected to include a strong emphasis on societal implementation of the included recommendations. The JSH 2025 guideline will provide a comprehensive overview of the latest, evidence-based insights regarding the diagnosis and treatment of hypertension, accumulated over decades of research. However, the challenge lies in achieving effective real-world implementation of these recommendations [13].

In the Japanese population, BP control remains sub-optimal compared with global standards. Despite efforts by the JSH to address risky morning hypertension over more than two decades [14,15,16], more than half of all patients being treated for hypertension still fail to achieve adequate BP control (Fig. 3) [17, 18]. To intensify efforts in this regard, the JSH is launching a ‘Morning Hypertension Control Program’, which is designed to ensure stricter home BP management, targeting morning hypertension in particular. In addition, this implementation program project will facilitate the use of home BP monitoring and salt restriction in healthcare and medical fields around the world. The JSH contributes to the Japan Medical Association Database of Clinical Medicine (J-DOME), an ongoing nationwide real-world registry aimed at elucidating current evidence on BP control in Japan.

Fig. 3
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Prevalence of uncontrolled hypertension defined by office, home, and ambulatory blood pressure (BP) values in medicated patients with hypertension (n = 2731) – baseline data from the HI-JAMP study. Reproduced, with permission, from Kario et al. Hypertens Res 2023; 46: 357–367 [15]. A higher number of medications was associated with a lower rate of uncontrolled office BP but the proportion of patients with uncontrolled morning BP remained at ≈55% even during treatment with ≥2 antihypertensive medications

We encourage JSH members to address unresolved issues such as clinical inertia and adherence to antihypertensive therapy. In this context, they are urged to promote appropriate lifestyle guidance on salt reduction, exercise and sleep duration, and to consider the use of recently introduced antihypertensive medications and new drug combinations. Furthermore, evaluating the clinical adoption of novel non-pharmacological treatments, such as digital therapeutics [6, 7] and renal denervation [19, 20], are recommended. We expect that new findings relating to these approaches and their use in clinical practice will be presented and discussed at JSH annual scientific meetings. In addition, we look forward to multi-disciplinary collaboration across sectors – industry, government, and academia –to advance a diverse array of research efforts.

Notably, the ‘Zero Hypertension City’ community-wide initiatives to hypertension prevention and management of model projects and salt reduction activities using sodium-to-potassium ratios as a guide [21], and the promotion of hypertension management based on home BP monitoring [13, 14] are achieving measurable success in collaboration with local communities. These activities serve as a global model of practical implementation science in hypertension from Japan, and the continued advancement of these initiatives is planned.

Internationalization

To date, the International Society of Hypertension (ISH) has taken the lead in fostering communication and academic collaboration between hypertension societies worldwide [8, 22,23,24]. The JSH has been an active contributor to the ISH, advancing unique and pioneering basic, epidemiological and clinical research, to establish the organization on the global stage. Notably, after the COVID-19 pandemic, JSH hosted the 2022 ISH conference in Kyoto, and the ‘ISH2022 KYOTO Hypertension Zero Declaration’ was issued [25]. This represents a successful and invaluable international meeting experience for the JSH.

As the official journal of JSH, Hypertension Research has solidified its status as an international English-language publication with an impact factor of 4.3 and over 1200 submissions annually. Moving forward, we will continue to strengthen our alliances with the ISH, American Heart Association (AHA), ESH, ESC, and Latin American Society of Hypertension (LASH) to remain at the forefront of global hypertension advancements. Furthermore, in collaboration with the Asian Pacific Society of Hypertension (APSH), the Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, and other Asian societies, the JSH aims to showcase distinctive research and effective implementation cases from Asia published in Hypertension Research, thereby accelerating our contributions to the global hypertension community [26,27,28].

Perspectives

Modern hypertension science is rapidly evolving due to a variety of advancements, where the development and innovative application of digital technology aims to address clinical challenges, yielding outcomes that prompt new research questions. In this era of information networks, we anticipate that hypertension research will continue to expand in both breadth and depth. The resulting findings should make a significant contribution to the control of hypertension, both in Japan and globally. By continuing to build on Japan’s unique expertise and advancing evidence-based practice, we aim to make significant strides in hypertension prevention and management worldwide. We look forward to the invaluable support and contributions from JSH members to facilitate the achievement of these goals.