Moving beyond guidelines: are report cards the answer to high rates of uncontrolled hypertension?
Hypertension control rates remain alarmingly low worldwide despite the extensive evidence for decreased rates of cardiovascular, cerebrovascular, and renal events in response to blood pressure (BP) lowering to recommended targets. Several classes of antihypertensive drugs are available, which in combination can produce major decreases in BP, with minimal side effects. Moreover, most patients only have mild hypertension and, in general, can be controlled to < 140/90 mm Hg by proper combinations of two antihypertensive drugs. Although patient-related factors clearly contribute to poor control of hypertension, physician-related factors, particularly "passive" therapeutic inertia, are as responsible if not more so. Recent studies clearly indicate that monitoring performance of individual physicians and providing feedback on the care delivered by them can move treatment of hypertension to BP control rates in the 60% to 70% range. If health care organizations would implement this approach, enormous benefits could be expected for the prevention of cardiovascular and cerebrovascular disease.
Ruzicka
Marcel
M
Hypertension Unit, University of Ottawa Heart Institute, 40 Ruskin Street, Room H360, Ottawa, Ontario, Canada K1Y 4W7. fleenen@ottawaheart.ca
Leenen
Frans H H
FH
D000959:Antihypertensive Agents / Q000592:standards / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D011307:Drug Prescriptions / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors
D000959:Antihypertensive Agents