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Management of difficult-to-control hypertension
1Division of Hypertension and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clinic Proceedings
|March 22, 2000
Summary
Many hypertension patients struggle to reach blood pressure goals. Understanding difficult hypertension and resistant cases is key to improving treatment outcomes and reducing risks for heart disease and stroke.
Area of Science:
- Cardiology
- Public Health
- Nephrology
Background:
- Hypertension significantly increases risks for heart disease and stroke, leading causes of death in the U.S.
- While hypertension awareness and treatment rates have risen, achieving blood pressure goals remains a challenge for many.
- Over 70% of hypertensive individuals do not reach target blood pressure levels, classifying them as 'difficult hypertensives'.
Purpose of the Study:
- To analyze the challenges in achieving blood pressure control in difficult hypertensive patients.
- To highlight the importance of understanding resistant hypertension and its contributing factors.
- To explore practical management strategies for improving outcomes in difficult-to-treat hypertension.
Main Methods:
- Analysis of National Health and Nutrition Examination Survey (NHANES) data from 1976-1980 and 1988-1991.
- Review of factors contributing to uncontrolled hypertension, including resistant hypertension, secondary causes, and patient adherence.
- Examination of pathophysiological mechanisms and screening techniques for secondary hypertension.
Main Results:
- Hypertension awareness increased from 51% to 73%, and treatment rates rose from 31% to 55% between NHANES-II and NHANES-III.
- Despite increased treatment, only 29% of hypertensive individuals achieved goal blood pressure (< 140/90 mm Hg) in NHANES-III, up from 10% in NHANES-II.
- A significant majority of patients remain 'difficult hypertensives' due to various factors hindering blood pressure control.
Conclusions:
- Effective management of difficult hypertension requires a comprehensive approach.
- Understanding the pathophysiology of resistant hypertension and screening for secondary causes are crucial.
- Implementing practical management strategies can help achieve treatment goals in most difficult hypertensive patients, reducing cardiovascular risks.