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. 2023 Jan 11;30(1):48-60.
doi: 10.1093/eurjpc/zwac203.

New perspectives for hypertension management: progress in methodological and technological developments

Gianfranco Parati  1   2 , Alexandra Goncalves  3 , David Soergel  4 , Rosa Maria Bruno  5 , Enrico Gianluca Caiani  6 , Eva Gerdts  7 , Felix Mahfoud  8 , Lorenzo Mantovani  9 , Richard J McManus  10 , Paola Santalucia  11 , Thomas Kahan  12   13
Affiliations

New perspectives for hypertension management: progress in methodological and technological developments

Gianfranco Parati et al. Eur J Prev Cardiol. .

Abstract

Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.

Keywords: Adherence; Control; Education; Inertia; Lifestyle; Screening.

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Conflict of interest statement

Conflict of interest: G.P.: honoraria for lectures from Omron, Servier, Merck, and Bayer; A.G. Employee of Philips; D.S.: Employee of Novartis; R.S.B.: grants for InSiDe (Integrated Silicon photonics for Cardiovascular Disease monitoring; H2020-ICT-871547); E.G.C.: consulting fees from Medtronic and Summeet Srl; honoraria from Novartis Farma SpA, Havas PR Milan Srl, Servier, and Aim Italy Srl; support for meeting attendance from the European Society of Cardiology (ESC); advisory board participation for Medtronic; and positions on the ESC Advocacy, Regulatory Affairs, and Digital Health Committees; F.M.: support from Deutsche Gesellschaft für Kardiologie (DGK) and Deutsche Forschungsgemeinschaft (SFB TRR219); scientific support and speaker honoraria from Bayer, Boehringer Ingelheim, Medtronic, and ReCor Medical; R.J.M.: Programme grants and funding from the NIHR; institutional licensing fees from Omron and Sensyne; and institutional consulting fees from Omron; P.S.: Leadership role (President-elect) of the Italian Stroke Association-ISA; T.K.: Institutional research contracts from Medtronic and ReCor. The other others report no conflict of interest.

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