Takase et al. examined risk factors for hypertension using data from the Tohoku Medical Megabank cohort study, and found that body mass index, salt intake, urinary Na/K ratio, γ-GTP level, and alcohol intake were associated with risk factors for elevated systolic blood pressure [1]. Aida et al. examined the relationship between income and blood pressure using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, and found that the lowest income group had 15.3% more hypertension than the highest income group in men and 18.7% in women, and the effects of lifestyle habits such as smoking, alcohol consumption, and obesity were considered [2]. In a similar report, Gupta et al. looked at the incidence of hypertension in India by region and attributed the increase in hypertension among the younger generation in the less developed rural areas to a lack of knowledge and adequate treatment for hypertension via inequalities [3]. Using data on 920,000 individuals from the Japan Health Insurance Association, Mori et al. examined the association between excessive antihypertensive treatment and cardiovascular events in patients at low risk for cardiovascular disease and reported that the incidence of events increases when diastolic blood pressure falls below 60 mmHg, sounding the alarm against excessive diastolic blood pressure reduction [4]. Sleep apnea in obese individuals is a known risk factor for hypertension. However, Inoue et al. found that the 3% oxygen desaturation index (3% ODI) obtained by polysomnography correlated with the presence of hypertension even in non-obese individuals, and the possibility of sleep disorders should be considered in hypertensive patients, even in non-obese individuals [5]. In addition, because women who experience gestational hypertension are at higher risk for future cardiovascular disease and metabolic syndrome, postpartum care is needed. Ushida et al. include a review article on the importance and methods of such care [6]. Detailed risk management in women who experience hypertension during pregnancy is desirable. Moreover, Yan et al. reported that a follow-up study of 330 very elderly hypertensive patients aged 80 years or older with a mean follow-up of 3.8 years showed a U-shaped relationship between baseline systolic blood pressure and pulse pressure values and the development of future frailty, with nadir values of systolic blood pressure 140 mmHg, pulse pressure was 77 mmHg [7]. Furthermore, as biomarkers of risk factors for cardiovascular disease, An et al. reported high uric acid levels as a risk factor for elevated arterial stiffness [8], and Ding et al. reported the importance of serum total homocysteine levels in relation to renal function [9].

In addition, two studies on atrial fibrillation are reported in this month’s issue. The first examined the presence of atrial fibrillation in 4161 hypertensive patients aged 65 years or older in Shanghai and found that the incidence was 2.21 times higher in newly hypertensive patients than in those who were already hypertensive, suggesting the need to be aware of the development of atrial fibrillation in newly hypertensive patients [10]. The second, from Chichareon et al. in Thailand, showed that in 3172 patients with atrial fibrillation, the higher the blood pressure variability, the higher the risk of stroke, cerebral hemorrhage, and death [11].

In short, this month’s Special Issue - Asian Studies is a reminder of the dangers of hypertension and the need for meticulous hypertension care.