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Consensus Document on Improving Hypertension Management in Asian Patients, Taking Into Account Asian Characteristics

Hypertension is the major cause of mortality and the leading cause of cardiovascular disease worldwide. Blood pressure (BP) lowering either by lifestyle modification or medication leads to a reduction in cardiovascular events. However, there are significant ethnic differences in the determinants of hypertension and in the risk of hypertension-related demographics of cardiovascular disease.1–4 In Asian countries, stroke, especially hemorrhagic stroke, and nonischemic heart failure (HF) are more common than in Western countries. Stroke and HF are more closely related to hypertension than coronary artery disease or renal disease. In addition, data from the Asia Pacific Cohort Studies Collaboration show that the association between BP and cardiovascular disease is stronger in Asian patients than in white patients from Australia and New Zealand.5,6 In terms of the characteristics of determinants of hypertension, Asians are more likely to have higher salt sensitivity and salt intake than Western populations. Genetically, Asians are likely to have factors relating to salt-sensitive gene polymorphism of the renin–angiotensin system (RAS).7 In fact, Japanese people are more likely to develop pre-hypertension and hypertension even with a small increase in body mass index, and the body mass index associated with pre-hypertension was lower than that in Western countries.8

A previous survey of senior doctors in Asia demonstrated a need for Asian guidelines that take into account Asian characteristics of cardiovascular disease.9 Here, we have developed a consensus document for more optimal management of hypertension in East Asian people, which takes into consideration ethnic-specific characteristics.

### Consensus Statements

1. Stroke, especially hemorrhagic stroke, and nonischemic HF are common outcomes of hypertension-related cardiovascular disease in Asia.

2. The association between BP and cardiovascular disease is stronger in Asia than in the West.

3. Higher salt sensitivity, even with mild obesity and higher salt intake, is an Asian characteristic of …