Achievement rate of blood pressure control <130/80 mmHg as the core metric of implementation hypertension, based on the new JSH2025 and AHA/ACC2025 guidelines

Recent updates to international hypertension guidelines have converged toward a therapeutic target of <130/80 mmHg, as reflected in the JSH2025, AHA/ACC2025, and ESC2024 recommendations. Strong evidence from major outcome trials such as SPRINT, STEP, BPROAD, and ESPRIT has consistently demonstrated the benefit of intensive blood pressure (BP) control, particularly systolic BP < 130 mmHg, across a wide spectrum of hypertensive populations, including the elderly and those with diabetes, CKD, or cardiovascular comorbidities. The JSH2025 guidelines further emphasize home BP management, setting a lower target of <125/75 mmHg, supported by prospective nationwide studies such as J-HOP and HONEST. However, despite these advances in evidence and recommendations, real-world BP control rates remain unsatisfactory, underscoring the critical need for effective implementation strategies. To address this gap, we propose the “achievement rate of BP control <130/80 mmHg” as a unified, core implementation metric for hypertension management. This target is consistent with both JSH2025 and AHA/ACC2025 guidelines, as well as with Japan’s Asakatsu campaign. We further recommend a dual-layered evaluation framework: a macro-approach (spatial, population-level) using office BP or health-check BP to assess outcomes in the general hypertensive population, and a micro-approach (temporal, individual-level) using home BP to monitor the quality of daily management and treatment adherence. Adopting this integrated framework will enable the simultaneous assessment of both public health impact and individualized care quality, providing a practical and evidence-based index for bridging guidelines with daily clinical practice. Ultimately, widespread application of this unified implementation metric has the potential to accelerate progress toward improved global cardiovascular outcomes.