Key result
Pharmacotherapy and guidelines dominate top-cited primary care hypertension literature, comprising ~40% of articles vs. 16% lifestyle.
Why the study?
Hypertension control rates are declining due to complex guidance and variable targets, prompting this evaluation of adult management trends and gaps affecting clinical outcomes in primary care.
A bibliometric analysis of the 50 most-cited articles on primary care hypertension management reveals a heavy reliance on pharmacologic therapy and major guidelines, with significant underutilization of lifestyle interventions and notable geographic and gender disparities in research output.
Answers are grounded in this paper and cite their sources.
Indicates substantial guideline presence among highly cited hypertension articles; leaves open needs for expanded primary research on non-pharmacologic approaches.
A BSTRACT Background: Hypertension is a leading global risk factor for cardiovascular disease and premature death. In Canada, nearly one in four adults is affected, yet control rates are declining due to complex guidance and variable targets. The 2025 Canadian guidelines, aligned with the World Health Organization’s (WHO) HEARTS, define hypertension as ≥130/80 mm Hg, emphasizing practical primary care. This review evaluates adult management trends and identifies gaps affecting clinical outcomes. Methods: A systematic Web of Science search used “hypertension,” “high blood pressure,” or “elevated blood pressure” combined with “management” or “treatment.” Eligible studies were English, human-based, and had no year limits. Four reviewers independently extracted data on study design, demographics, management strategies, and outcomes. Descriptive statistics analyzed citation trends and emerging research areas. Results: The review included 50 highly cited studies (2002–2018), primarily from North America and Europe. Guidelines and consensus papers comprised 40% of the data. Pharmacologic therapy dominated—focusing on angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and diuretics—while lifestyle interventions appeared in only 16%. Citation counts ranged from 120 to over 6,000, with major guideline reports being the most referenced. Common adverse effects included peripheral edema and electrolyte imbalances. Notable gaps included limited geographic diversity, low female authorship, and a lack of research on non-pharmacologic care. Conclusion: Primary care relies heavily on medications, leaving lifestyle strategies underutilized despite proven efficacy. Citation impact reveals regional and institutional disparities in research output. Future efforts should prioritize region-specific studies, digital health tools, personalized treatments, and multidisciplinary care to improve long-term blood pressure control and global health equity.
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Alotaibi et al. (2026) conducted a review in Hypertension. Pharmacologic and lifestyle hypertension management strategies was evaluated on Citation trends, study types, and management strategy distribution among top 50 cited articles. Pharmacologic therapy and guidelines (40%) dominated the 50 most-cited primary care hypertension articles (120 to >6,000 citations), whereas lifestyle interventions appeared in only 16%.
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