Hypertension, society, and public policy

There is plentiful evidence of the threat to public health of uncontrolled hypertension, and ample professional knowledge of how to prevent the condition. Yet failure to achieve adequate prevention in practice is widely acknowledged across Europe and North America. The lack of success of well-intentioned public policy initiatives in the past is linked with problems of changing lifestyles, improving patients' adherence, doctor-patient communications, inadequate public sector budgets for prevention as distinct from treatment, and reliance on top-down programmes instead of involving patients or their organizations directly. Current promising methods of tackling these problems are described.