C O M M E N T A R Y Barriers to and strategies for effective blood pressure control David Siegel1,2 1Medical Service, Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA; 2Department of Medicine, University of California, Davis, CA, USA Correspondence: David Siegel Medical Service (111), Department of Veterans Affairs NCHCS, 10535 Hospital Way, Mather, CA 95655, USA Tel +1 916 843 7096 Fax + 1 916 366 5475 Email david.siegel@med.va.gov Abstract: There are major differences between the current knowledge of the treatment of cardiac conditions derived from evidence-based medicine and the widespread application of this knowledge. This is particularly true in the treatment of hypertension. Hypertension is the most common chronic cardiovascular condition, affecting more than 50 million Americans and approximately 1 billion individuals worldwide. However, many hypertensive patients are not receiving treatment, and of those that are, many are not adequately controlled. There is evidence that there are methods to improve blood pressure control and improve compliance with expert recommendations for the treatment of hypertension. These methods range from local initiatives such as academic detailing to national performance measures as have been developed by the US Department of Veterans Affairs. A challenge for the future will be to identify and broadly apply these and other programs to improve the quality and efficiency of hypertensive treatment. Keywords: academic detailing, antihypertensives, hypertension, medication prescribing Over the past 60 years, the treatment of cardiovascular diseases has made revolutionary progress. The development of cardiopulmonary bypass, angioplasty, and the use of lasers are just a few of the technological innovations that are available for the treatment of patients suffering from cardiac disease. Equally impressive are findings from well controlled and executed clinical trials that have established medical treatments for many cardiac conditions. Yet, many of these treatments are underutilized. This has been particularly true for hypertension in many different clinical settings (Goldstein et al 1994; Berlowitz et al 1998; Hyman and Pavlik 2001; Jackson et al 2002). Blood pressure control Hypertension is the most common chronic cardiovascular condition, affecting more than 50 million Americans and approximately 1 billion individuals worldwide (NHLBI 2003). The benefits of lowering blood pressure in hypertensive individuals on the morbidity and mortality associated with cardiovascular and renal disease has been established in many randomized controlled trials (SHEP Cooperative Research Group 1991; The ALLHAT 2002; Blood Pressure Lowering Treatment Trialists’ Collaboration 2003), including the seminal Department of Veterans Affairs (VA) study published in 1970 (Veterans Administration Cooperative Study Group on Antihypertensive Agents 1970). However, data from the National Health and Nutrition Survey (NHANES) III indicate that only 46% of men and 65% of women with blood pressure ≥ 140/90 mmHg are currently receiving antihypertensive treatment in the US (Burt et al 1995). Of those under treatment, only 50% of men and 58% of women are adequately controlled. This includes patients 65 years of age and older as well as younger patients (Glynn et al 1995). Strategies to improve blood pressure control as well as decisions concerning Vascular Health and Risk Management 2005:1(1) 9 –14 © 2005 Dove Medical Press Limited. All rights reserved 9