A limitation of this study is that the definition of aTRH does not include 24-hour blood pressure measurements or home blood pressure measurements. These measurements would allow for a more accurate diagnosis of aTRH. In addition, specific interventions to improve medication adherence are a future challenge. A multifaceted approach, including the use of digital health technology and the development of patient education programs, will be necessary.

This is a valuable study that clearly demonstrates the prognosis of aTRH and the importance of medication adherence in an Asian population. In the Japanese hypertension practice, we need to focus more on early detection and appropriate management of aTRH and improvement of medication adherence.

adherence

Number of patients (%)

Hazard ratio (95% CI) for the composite primary outcome

Optimal (PDC ≥ 80%)

51,879 (77.0%)

1.00 (Ref.)

Inadequate (60 ≤ PDC < 80%)

11,667 (17.3%)

1.20 (1.15–1.25)

Failure (PDC < 60%)

3852 (5.7%)

1.49 (1.36–1.63)

This table straightforwardly illustrates the importance of medication adherence in patients with aTRH. It clearly shows that the risk of the composite primary outcome increases with poor adherence (key result from ref. [4]).