The problem of uncontrolled hypertension

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 (AT₁)-receptor blockers may help to increase the proportion of patients remaining on therapy. AT₁-receptor blockers could thus make a potentially important contribution to solving the problem of uncontrolled hypertension.