In the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) study, we examined the current situation with respect to the prescription of
diuretics, including the prevalence of
diuretic treatment and the dosages used for patients with
essential hypertension in primary care settings. Of the 3,400 hypertensive patients included in the study, 315 (9.3%) patients (mean age: 66.9+/-10.4 years; males: 43.5%) were prescribed
diuretics. Compared with patients who were not using
diuretics, those who were using
diuretics were more obese and had more complications. The most commonly prescribed
diuretic among the 331 prescriptions in the 315
diuretic users was
trichlormethiazide (44%), followed by
indapamide (15%) and
spironolactone (14%). Among patients being treated with
diuretics, monotherapy was used in only 5% of patients; in the majority of patients combination
therapy including
diuretics (95%) was used. Relatively low dosages of
diuretics were generally used. There was a difference between the actual dosages prescribed and those recommended by the Japanese Society of
Hypertension (JSH) guidelines or the product information approved in Japan. Compared with previous estimates of the prevalence of
diuretic use in hypertensives in Japan (4.0-5.4%), the rate in the J-HOME study (9.3%) was higher. This may be attributable at least in part to the results of the many published, large-scale intervention trials confirming the clinical significance of
diuretics. Although a relatively high dosage is recommended in the
diuretic product information and in the JSH guidelines, dosages of
diuretics should be reconsidered in Japan.