The '100-year life span' has become a trend symbolising longevity in Japan. The theme of the 45th JSH meeting was 'Promoting the JSH Future Plan' to Support a Healthy 100-Year Life. The reason I included the phrase 'a healthy 100-year life' in the conference theme is that I wanted to express my wish for a vibrant 100-year life in this age of 100-year life spans. Japan is the country with the longest life expectancy in the world, with 81.05 years for men and 87.09 years for women in 2022, and the old-age population index, the ratio of the population aged 65 and over to the total population, is 29.0%, forming a super-aged society [6, 7]. The median life expectancy that half of the people born each year are expected to reach is 83.93 years for men and 89.96 years for women, and the population over 100 years old is over ten thousand men and ninety thousand women. Many Japanese now realise that they will live to be 100. In our daily medical practice, we have many opportunities to see patients over 80. The average life expectancy of an 80-year-old is 8.89 years for men and 11.74 years for women, so it is necessary to develop medical care that takes into account maintaining health over such a long period.

The theme of this year’s conference was how we treat hypertension to achieve this goal. The primary goal of hypertension treatment is to prevent cerebrovascular complications, which is achieved by actively lowering blood pressure according to guideline recommendations. In Japan, it is no longer unusual to have very old people, as we have entered the era of 100-year life expectancy. As the population ages, the goals of hypertension treatment have changed, and hypertension treatment strategies are needed to ensure that each generation can live a healthy life in their own way for the 100 years of their lives. For example, adolescents and young adults with disordered lifestyles, advanced maternal age, very old people with health conditions ranging from robust health to nursing care, older people with dementia, people undergoing cancer treatment, cancer survivors and older workers are difficult to treat on the basis of previous randomised controlled trials, so we need new strategies. In these situations, it is often not enough to prescribe lifestyle changes and antihypertensive drugs to control high blood pressure.

As the population ages, one in five people will develop dementia. Treating high blood pressure to help people with dementia and prevent the disease has become an emerging issue. There is also a lack of data on how to deal with sudden increases in blood pressure in older people during physical activity, whether they are at risk of cardiovascular disease or how to manage it. Treatment of hypertension to manage the condition and achieve individual well-being is the real care needed for hypertension. The main aim of such treatment is not only to cure the disease, but also to maintain quality of life and activities of daily living. In addition to current treatment methods, multidisciplinary cooperation and telemedicine are expected to be introduced, as well as new technologies such as software as a medical device and artificial intelligence. In the search for environmental risk factors for hypertension, it is also necessary to improve the food and living environment in society as a whole.

Fig. 1 summarises the new strategies for overcoming hypertension in Japan, a super-aged society. The 'ISH2022Kyoto Hypertension Zero Declaration' has proposed a similar approach [8]. Achieving the goal of hypertension control has passed the stage where lowering blood pressure is enough, and we need to take on new challenges. Japan has not yet overcome the hypertension paradox. However, we hope that the basic and clinical perspectives of researchers such as those presented in this special issue will be further deepened and broadened, leading to the real conquest of hypertension.

New strategies to overcome hypertension in Japan, a super-aged society. Japan is at the forefront of the world’s ageing societies. As the aging population is accompanied by changes in morbidity patterns and problems in daily life, new strategies for hypertension management are needed. We need to move beyond the primary goal of hypertension treatment, which is the control of CV events, to a new goal of well-being into old age. Several new strategies will achieve active, appropriate, and safe blood pressure lowering. BP blood pressure, SaMD Software as medical device, AI artificial intelligence, CV cardiovascular, CVD cardiovascular disease, ESRD end-stage renal disease, QOL quality of life, ADL activities of daily living