Blood Pressure Control: Missed Opportunity or Potential Holy Grail?
Authors: Liam G. Glynn, Richard J. McManus
Journal: Annals of Internal Medicine (2017)

Editorials16 January 2018Blood Pressure Control: Missed Opportunity or Potential Holy Grail?Liam G. Glynn, MD, MMSc and Richard J. McManus, PhDLiam G. Glynn, MD, MMScUniversity of Limerick, Limerick, Ireland (L.G.G.)Search for more papers by this author and Richard J. McManus, PhDUniversity of Oxford, Oxford, United Kingdom (R.J.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3036 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Blood pressure control is a key public health challenge in terms of morbidity and mortality from stroke and cardiovascular events and associated health care costs. Extensive epidemiologic data have strengthened the well-recognized relationship between blood pressure and cardiovascular disease risk and have confirmed the importance of blood pressure as a determinant of risk (1). However, blood pressure goals are achieved in only 25% to 40% of patients who receive antihypertensive drug treatment (2), a percentage that has remained unchanged for the past 40 years (3). This situation may worsen with the recent publication of new, lower blood pressure targets (4), ...References1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-13. [PMID: 12493255] CrossrefMedlineGoogle Scholar2. Wang YR, Alexander GC, Stafford RS. Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. Arch Intern Med. 2007;167:141-7. [PMID: 17242314] CrossrefMedlineGoogle Scholar3. Wilber JA, Barrow JG. Hypertension—a community problem. Am J Med. 1972;52:653-63. [PMID: 5027555] CrossrefMedlineGoogle Scholar4. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017. [PMID: 29133356] doi:10.1161/HYP.0000000000000065 CrossrefMedlineGoogle Scholar5. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224-60. [PMID: 23245609] doi:10.1016/S0140-6736(12)61766-8 CrossrefMedlineGoogle Scholar6. Mills KT, Obst KM, Shen W, Molina S, Zhang HJ, He H, et al. Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients. A systematic review and meta-analysis. Ann Intern Med. 2018;168:110-20. doi:10.7326/M17-1805 LinkGoogle Scholar7. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group. JAMA. 1979;242:2562-71. [PMID: 490882] CrossrefMedlineGoogle Scholar8. Khanna RR, Victor RG, Bibbins-Domingo K, Shapiro MF, Pletcher MJ. Missed opportunities for treatment of uncontrolled hypertension at physician office visits in the United States, 2005 through 2009. Arch Intern Med. 2012;172:1344-5. [PMID: 22869238] doi:10.1001/archinternmed.2012.2749 CrossrefMedlineGoogle Scholar9. Tucker KL, Sheppard JP, Stevens R, Bosworth HB, Bove A, Bray EP, et al. Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med. 2017;14:e1002389. [PMID: 28926573] doi:10.1371/journal.pmed.1002389 CrossrefMedlineGoogle Scholar10. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D; American Heart Association. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society Of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:10-29. [PMID: 18497370] doi:10.1161/HYPERTENSIONAHA.107.189010 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Limerick, Limerick, Ireland (L.G.G.)University of Oxford, Oxford, United Kingdom (R.J.M.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3036.Corresponding Author: Liam G. Glynn, MD, MMSc, Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland; e-mail, liam.[email protected]ie.Current Author Addresses: Prof. Glynn: Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland.Prof. McManus: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom.This article was published at Annals.org on 26 December 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients Katherine T. Mills , Katherine M. Obst , Wei Shen , Sandra Molina , Hui-Jie Zhang , Hua He , Lisa A. Cooper , and Jiang He Metrics 16 January 2018Volume 168, Issue 2Page: 147-148KeywordsAntihypertensive drug therapyBlood pressureDisclosureGraduate medical educationHealth careHealth care providersHypertensionMortalityPatientsSystolic pressure ePublished: 26 December 2017 Issue Published: 16 January 2018 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...