State of hypertension management in the United States: confluence of risk factors and the prevalence of resistant hypertension.
An improvement in the awareness and treatment of hypertension in the United States has occurred, resulting in the best control rates in the world, which unfortunately are far below the goals of Healthy People 2000 or 2010. This failure to achieve blood pressure (BP) goals is attributed to many factors, including an aging population, higher prevalence of kidney disease and obesity, high salt intake, physician inertia to increase dose and number of antihypertensive medications prescribed, and patient nonadherence with medication regimens. Resistant hypertension is defined as a failure to achieve goal BP in patients who adhere to full doses of an appropriate antihypertensive regimen of 3 drugs that includes a diuretic. The problem of resistant hypertension is projected to increase as the population ages. Efforts on the part of the Veterans Administration hospitals and others clearly indicate that a system can be implemented to help increase the percentage of persons in whom BP goal is achieved and reduce the prevalence of resistant hypertension. Medications specific to the problem of resistant hypertension are also under development. This review analyzes the status of hypertension control in the United States, the frequency of associated diseases, and adherence to guidelines; it further discusses strategies to reduce the prevalence of resistant hypertension.
Sarafidis
Pantelis A
PA
Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece.
Bakris
George L
GL
D000367:Age Factors; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001364:Awareness; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D010349:Patient Compliance; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016312:Treatment Refusal; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents