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The problem of uncontrolled hypertension
1Department of Public Health and Clinical Medicine, Norrlands University Hospital, Umeå, Sweden. larsh.lindholm@fammed.umu.se
Insights
High blood pressure significantly increases cardiovascular risks. Angiotensin II type 1 receptor blockers may improve adherence and control of hypertension due to their tolerability.
Area of Science:
- Cardiology
- Hypertension Management
- Pharmacology
Background:
- Elevated blood pressure is a continuous risk factor for cardiovascular and cerebrovascular diseases.
- Systolic blood pressure is a more significant predictor of risk than diastolic pressure.
- Current guidelines recommend blood pressure targets below 140/90 mm Hg.
Purpose of the Study:
- To highlight the issue of inadequately controlled hypertension in clinical practice.
- To identify factors contributing to poor hypertension control.
- To explore the potential role of Angiotensin II type 1 (AT(1))-receptor blockers in improving treatment adherence.
Main Methods:
- Review of established medical literature on hypertension and cardiovascular risk.
- Analysis of population survey data on hypertension control rates.
- Examination of factors influencing patient adherence to antihypertensive therapy.
Main Results:
- Despite clear evidence, hypertension control rates are often low, with some surveys showing achievement rates of 20% or less.
- Physician focus on diastolic rather than systolic pressure and poor patient adherence contribute to inadequate control.
- Angiotensin II type 1 (AT(1))-receptor blockers exhibit favorable tolerability, potentially improving patient adherence.
Conclusions:
- Inadequate control of hypertension remains a significant clinical challenge.
- Improving patient adherence through well-tolerated medications like AT(1)-receptor blockers is crucial.
- AT(1)-receptor blockers may offer a valuable strategy to improve overall hypertension management and reduce cardiovascular events.
Abstract:
It is well established that there is a continuous relationship between raised blood pressure and the risk of cardiovascular or cerebrovascular disease. Both systolic and diastolic hypertension are associated with increased risk, but systolic blood pressure appears to be a more important determinant of risk than diastolic blood pressure. Randomised controlled trials have clearly shown that lowering blood pressure results in significant reductions in cardiovascular mortality and morbidity, and hence current hypertension management guidelines recommend target blood pressures of below 140/90 mm Hg (135/85 mm Hg in the case of the WHO/ISH guidelines). Despite the clear evidence for the benefits of antihypertensive therapy, however, blood pressure is often not adequately controlled in clinical practice. Population surveys indicate that the proportion of patients achieving even conservative blood pressure targets may be only 20% or lower. A number of factors contribute to poor control of hypertension, including a focus by the physician on diastolic blood pressure, rather than the prognostically more important systolic pressure, and poor adherence to therapy by patients. Poor adherence may be largely attributable to adverse events, and there is evidence that the excellent tolerability profile of angiotensin II type 1 (AT(1))-receptor blockers may help to increase the proportion of patients remaining on therapy. AT(1)-receptor blockers could thus make a potentially important contribution to solving the problem of uncontrolled hypertension.