How well are we managing and monitoring high blood pressure?

Abstract

Purpose of review: We will summarize the latest available data on hypertension control levels in different populations throughout the world, and review the factors that appear to contribute to the widespread lack of blood pressure control in identified hypertensive patients.

Recent findings: Population surveys throughout the world indicate that the proportion of hypertensive patients with blood pressure controlled to below 140/90 mmHg ranges from 5% in Taiwan to 25% in the United States. Studies in the US have shown that the majority of hypertensive patients classified as uncontrolled have diastolic pressure below 90 mmHg with mild systolic elevation in the 140-160 mmHg range, and that these blood pressure levels rarely elicit a treatment intensification action by the physician. The results of the Antihypertensive and Lipid Lowering to Prevent Heart Attack Trial indicate that it is feasible to maintain average blood pressures on treatment to levels well below 140/90 mmHg in elderly hypertensive patients in primary care settings. Although the literature on automated blood pressure measurement and comparisons between office blood pressure and home blood pressure continues to grow, there has been little attention paid to practicing physicians' attitudes and beliefs about different blood pressure measurement methods, or to the feasibility of standardizing blood pressure measurement in typical practice settings.

Summary: The experience in the US indicates that widely publicized treatment guidelines recommending blood pressure control targets and choice of first-line agents may have little influence on practicing physicians, even when based on solid evidence from clinical trials. Controversies in the literature regarding treatment targets, appropriate drug choices, and blood pressure monitoring methods are likely to delay improvements in overall population control.