Hypertension is the most common lifestyle-related disease among the Japanese population and the leading risk factor for major cardiovascular diseases such as stroke, myocardial infarction, heart failure, and aortic dissection. Recent reports indicate that hypertension is the most lifestyle-related cause of death in Japan, and among the estimated 43 million people with hypertension, only 27% have their blood pressure well controlled [1]. Furthermore, about one-third of hypertensive individuals are unaware of their condition.

In response to this alarming situation, the Japanese Society of Hypertension (JSH) launched two major initiatives in 2025: the publication of a new clinical guideline titled The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (hereinafter “JSH2025 Guidelines”) [1]. Simultaneously, we released the Declaration for the Eradication of Morning Hypertension [2], and initiated a nationwide The JSH Morning Hypertension Eradication Program Project [3], centered on “Asakatsu Blood Pressure” action plan - Morning Blood Pressure 130 Campaign [3]. This article discusses the significance of implementing these two initiatives concurrently and how their synergistic effects can enhance blood pressure control at the societal level (Fig. 1).

Fig. 1
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Synergy of the Japanese Society of Hypertension (JSH) 2025 Guidelines for the management of hypertension and “Asakatsu” Blood Pressure Campaign to achieve the goal blood pressure of 130 / 80 mmHg

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Structure and innovations of JSH2025 Guidelines

The JSH2025 Guidelines were issued on July 25, 2025 [1]. Building on the foundation of the 2019 version (JSH2019), the most notable feature of the new guidelines is their emphasis on “implementation.” JSH2025 Guidelines adopt a three-tiered structure:

  • Part 1: For the general public and general practitioners

  • Part 2: For primary care physicians

  • Part 3: For specialists

This structure clearly defines “who” should manage hypertension, “for whom,” and “how,” all within the context of clinical practice.

Key elements include a focus on home blood pressure monitoring, strategies to address blood pressure variability and morning hypertension, and the promotion of precision management—individualized treatment plans tailored to patient-specific risks and conditions. The development of the guidelines involved 20 critical clinical questions (CQs), with systematic reviews (including meta-analyses), and a transparent, bias-reducing recommendation process, establishing a clinical standard applicable both domestically and internationally.

JSH2025 Guidelines are not merely a clinical manual—it is positioned as a “compass for action,” providing clear guidance on blood pressure control for healthcare professionals, policymakers, and the public alike.

“Asakatsu BP” action – Morning Blood Pressure 130 Campaign

The “Asakatsu BP” action - Morning Blood Pressure 130 Campaign is a society-wide awareness initiative spearheaded by JSH, with full participation from its members. It focuses on morning hypertension, which is a high-risk time window for cardiovascular events such as stroke and heart attacks [4,5,6]. The importance of identifying and managing morning hypertension through home blood pressure monitoring is internationally recognized [7].

Under the clear slogan, “130 mmHg or higher is a risky morning blood pressure,” the campaign promotes self-monitoring in diverse settings such as homes, workplaces, pharmacies, gyms, and public facilities [3]. This “visualization of blood pressure” encourages behavior change. If high readings are observed, individuals are encouraged to improve lifestyle habits (salt reduction, exercise, smoking cessation, sleep hygiene, etc.) and consult healthcare providers in accordance with JSH2025 Guidelines [1]. In this way, the campaign acts as a bridge connecting healthcare with everyday life.

Importantly, Morning Blood Pressure 130 Campaign is not a top-down initiative led solely by healthcare providers, but a self-management–based hypertension prevention strategy led by individuals themselves. This citizen-centered approach aligns well with JSH2025 guidelines’ implementation philosophy and reinforces the mutual complementarity of both efforts.

Why now? The structural complementarity of guidelines and Morning BP campain

While both JSH2025 Guidelines and the Morning BP campaign are independently meaningful, launching them simultaneously creates a powerful synergistic effect. The guidelines provide the scientific and policy foundation for the campaign, while the campaign serves as the real-world action plan for implementing the guidelines. Together, they reinforce each other’s value.

From the perspective of implementation science, this integration represents the process of converting evidence (JSH2025 Guidelines) into field implementation (Morning BP campaign)—an approach that integrates medicine with public health. Moreover, this initiative lays the groundwork for establishing a new academic field called Implementation Hypertension, making it highly significant both scientifically and socially [8].

Looking ahead to the digital era

Digital health technology plays a vital role in implementing both the campaign and the guidelines. The use of AI-enabled wearable blood pressure monitors, home IoT devices, and BP tracking apps allows for Time-Space Network Hypertension management [9]—visualizing individual risk and enabling timely medical intervention.

The JSH has also officially proposed the concept of Digital Hypertension, signaling future directions for digital integration in hypertension care [10].

In 2025, the JSH launched a dual initiative combining the JSH2025 Guidelines and the Morning BP 130 Campaign—an integrated approach of system and behavior to combat the national burden of hypertension. The former provides the scientific and institutional foundation, while the latter enables behavioral and societal implementation. Together, they have the potential to drastically improve blood pressure control at both individual and societal levels.

In conclusion, the synergistic implementation of these initiatives can help embed hypertension control within both healthcare and everyday life. This “JSH2025 Guidelines × Morning BP” movement represents a promising new model for medical implementation, with the potential to be exported from Japan to the world.