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Clinical situations associated with difficult-to-control hypertension

Anna Oliveras1, Roland E Schmieder

  • 1Unit of Hypertension, Nephrology Department, Hospital Universitari del Mar, Barcelona, Spain. aoliveras@hospitaldelmar.cat

Journal of Hypertension
|February 8, 2013
PubMed

Insights

Uncontrolled high blood pressure (hypertension) significantly increases cardiovascular risk. Factors like poor adherence, therapeutic inertia, and comorbidities contribute to difficult-to-treat hypertension.

Area of Science:

  • Cardiology
  • Epidemiology
  • Internal Medicine

Background:

  • Hypertension poses a significant cardiovascular and mortality risk.
  • Over 50% of hypertensive patients have uncontrolled blood pressure (BP).
  • Suboptimal BP control is a major public health concern.

Purpose of the Study:

  • To review the epidemiology of poorly controlled hypertension.
  • To identify conditions associated with difficult-to-treat hypertension.
  • To explain the multifactorial reasons behind uncontrolled BP.

Main Methods:

  • Literature review of epidemiological surveys on hypertension control.
  • Analysis of patient-related factors (e.g., adherence).
  • Examination of physician-related factors (e.g., therapeutic inertia).
  • Assessment of drug efficacy and adverse effects.
  • Investigation of comorbidities and specific hypertension types (e.g., resistant hypertension).

Main Results:

  • Numerous factors contribute to uncontrolled hypertension.
  • Patient adherence and physician inertia are key issues.
  • Comorbidities like diabetes, obesity, CKD, and OSA complicate BP management.
  • Drug-related hypertension and resistant hypertension present unique challenges.

Conclusions:

  • Poorly controlled hypertension is multifactorial, involving patient, physician, and treatment-related elements.
  • Comorbidities and specific hypertension types significantly impact treatment outcomes.
  • Addressing these factors is crucial for improving hypertension management and reducing cardiovascular risk.

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