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Does the evidence from clinical trials justify the treatment of hypertension?
1Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
Insights
Hypertension affects millions, with control rates far below US goals. Evidence-based medicine requires reviewing clinical trials to determine if current blood pressure targets are sufficient.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Hypertension is a prevalent condition, a leading reason for physician visits in the US.
- Affects 43-50 million Americans, with prevalence increasing significantly in older adults.
- Current blood pressure control rates are substantially below the US Public Health Services (USPHS) Year 2000 goal.
Purpose of the Study:
- To evaluate the adequacy of current hypertension control goals.
- To determine if existing blood pressure targets are justified based on evidence.
- To inform decisions on whether to intensify hypertension management efforts.
Main Methods:
- Review of large-scale, prospective, well-controlled, long-term clinical trials.
- Analysis of data from the past three decades.
- Application of evidence-based medicine principles.
Main Results:
- In the early 1990s, only 27% of hypertensive adults aged 18-74 and 20% of those over 75 had achieved blood pressure control (<140/90 mm Hg).
- These rates indicate a significant shortfall in meeting the USPHS goal.
- The data suggests a need to critically assess the established hypertension control targets.
Conclusions:
- Current evidence suggests that existing hypertension control rates are insufficient to meet public health goals.
- Further review of clinical trial data is necessary to determine if current blood pressure targets are optimal.
- The findings underscore the importance of evidence-based strategies in managing hypertension effectively.
Abstract:
Hypertension is the most common reason for physician office visits. An estimated 43 to 50 million people in the United States have elevated blood pressure (BP). The prevalence of hypertension varies from a small percentage among individuals in their teens and 20s to more than 70% of the elderly (those > 75 years of age). The US Public Health Services (USPHS) has set a goal of having 50% of individuals with hypertension "under control"--that is, reducing their BP to < 140 mm Hg systolic and < 90 mm Hg diastolic--by the year 2000. Current information suggests that we will fall far short of reaching that goal. In the early 1990s, such levels had been achieved by only 27% of hypertensive Americans 18 to 74 years old and by only 20% of those > 75 years old. Is this a cause for concern? Is the goal defined by the USPHS justified? Should we push even harder to reach that goal, should we strive to do even better, or should we be satisfied? Since we are now in the era of evidence-based medicine, the only way to answer these questions is to review what we have learned from the many large, prospective, well-controlled, long-term clinical trials that have addressed these questions over the past 3 decades.