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Review
. 2006 Dec;8(12):865-72.
doi: 10.1111/j.1524-6175.2006.05789.x.

Achieving blood pressure goals: why aren't we?

William C Cushman  1 , Jan Basile
Affiliations
Review

Achieving blood pressure goals: why aren't we?

William C Cushman et al. J Clin Hypertens (Greenwich). 2006 Dec.

Abstract

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends a blood pressure (BP) goal of <140/90 mm Hg in patients with hypertension and <130/80 mm Hg in those with diabetes or chronic kidney disease. Achievement of BP goals is associated with significant benefits in cardiovascular morbidity and mortality. Although evidence suggests these goals are attainable, only about one third of patients are meeting them. There is a significant gap between treatment guideline recommendations and their implementation in clinical practice. Many clinicians appear satisfied with modest BP reductions and do not make the necessary treatment adjustments to achieve BP goals. Patient nonadherence is another important reason for lack of BP control. For the success of clinical trials to be reproduced in clinical practice, clinicians must recognize the importance of treating BP to goal, emphasize to patients the need to adhere to treatments, and provide persistent, goal-targeted therapy.

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Figures

Figure 1
Figure 1
Proportions of patients with hypertension diagnosis, treatment, and control in 2000 and the incremental increases in these proportions required by 2010 to meet the Healthy People 2010 goal of controlling hypertension in 50% of affected patients.
Figure 2
Figure 2
Cumulative percentage of patients achieving blood pressure goal (<140/90 mm Hg) in relation to the number of antihypertensive agents used in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) at 5 years. Derived from Cushman et al. 10
Figure 3
Figure 3
Mean number of antihypertensive agents required to achieve a range of blood pressure (BP) goals in major trials. 10, 18, 27, 28, 29, 30 ABCD indicates Appropriate Blood Pressure Control in Diabetes 28 ; MDRD, Modification of Diet in Renal Disease 29 ; AASK, African American Study of Kidney Disease and Hypertension ; pts, patients; DBP, diastolic BP; NR, not reported; and MAP, mean arterial pressure; other trial acronyms are expanded in the text. Adapted from Bakris et al, 31 with permission from Elsevier
See this image and copyright information in PMC

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