Overcoming barriers to effective blood pressure control in patients with hypertension

BACKGROUND: Patients with hypertension remain at increased risk of micro- and macrovascular complications unless their elevated blood pressure (BP) can be adequately controlled. However, helping patients with hypertension to get to, and stay at, target BP goals can be difficult in everyday clinical practice. SCOPE: The present study describes the magnitude of this problem in various regions and attempts to analyse possible underlying reasons. For this purpose, a non-systematic literature review using Medline database was performed. FINDINGS: Reasons for suboptimal blood pressure control include factors under the control of the physician, such as insufficient education and motivation of the patient, reluctance to initiate lifestyle changes or drug treatment; overlooking the importance of controlling systolic BP (especially in the elderly) and failure to modify and expand therapy when it is indicated (e.g. use of combination therapy if monotherapy is proving inadequate for BP lowering). Patient-related factors that may give rise to inadequate BP control include a lack of awareness of the relevance of hypertension, failure to comply with recommended lifestyle modifications and poor medication compliance (e.g. because of forgetfulness, tolerability problems, or incomplete understanding of the long-term nature of therapy). CONCLUSIONS: These issues can be addressed by ensuring that doctors adhere more closely to national or international guidelines and that patients are well-informed about the need for long-term therapy. Further approaches include simplifying the treatment regimen (e.g. use of well-tolerated, fixed-dose combinations) and using various measures to reduce forgetfulness. With properly directed therapy and consideration of potential physician- and patient-related barriers to poor BP control, more hypertensive patients in everyday clinical practice can achieve target BP goals and thereby realise the proven benefits of antihypertensive therapy for decreasing their cardiovascular risk.