Predicting failure to follow-up screened high blood pressure in Japan: a cohort study

BACKGROUND: This study aimed to determine the prevalence and predictors of working-age individuals who did not follow-up for possible hypertension that was detected in the population-based screening. METHODS: We conducted a retrospective cohort study, using the database of health insurance claims and health checkups from several health insurance societies for employees in Japan. Screened participants aged ≥20 years, with possible hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) and without known antihypertensive treatment, were included. The outcome was lack of clinical follow-up for possible hypertension within 6 months of the latest screening. Multivariate logistic regression analysis was performed to identify predictors. RESULTS: Among 17,173 participants (15,793 males and 1380 females) who were identified as possible hypertensives, 89.7 and 82.3% of them, respectively, did not consult physicians for screened possible hypertension. Predictors of no clinical follow-up for males included younger age, lower body mass index (BMI), lower hemoglobin A1c and milder hypertension. Predictors for females included younger age, lower BMI and being insured. CONCLUSIONS: Approximately 80% of participants failed to consult physicians even with positive screening results. Younger individuals with lower BMI are at high risk of no clinical follow-up.