Is it time to celebrate a century of blood pressure management?

BACKGROUND: Even after a century of hypertension management, several trivial issues have remained unsolved and still result in inadequate control of blood pressure in many patients. METHODS: We have performed a critical literature review on topics pertaining the assessment and management of hypertension, focusing on the gaps in knowledge and pitfalls of hypertension management in clinical practice. RESULTS: Physicians are often not capable of adequately measuring blood pressure themselves; the office blood pressure recordings are not sufficiently reliable and the timing of the start of the treatment is often not satisfactory. However, much progress has been made in the past century. Research in this field not only expanded the potential of blood pressure measurements for risk stratification and risk management but also identified many erroneous assumptions and technical mistakes. An important step forward may be the development of affordable 'high tech' blood pressure measuring devices that continuously monitor the intra-arterial pressure in a noninvasive way to eliminate human factors and equipment errors. Technological advances will also provide adequate data storage and software allowing management on an international scale. CONCLUSIONS: Hypertension management can almost be celebrated; however, the pressure is still on!