Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension

Author:

Mancia G.1,Cappuccio F. P.2,Burnier M.3,Coca A.4,Persu A.5,Borghi C.6,Kreutz R.7,Sanner B.8

Affiliation:

1. University of Milano‐Bicocca Milan Italy

2. University of Warwick Warwick Medical School University Hospitals Coventry & Warwickshire NHS Trust Coventry UK

3. Service of Nephrology and Hypertension Department of Medicine Centre Hospitalier Universitaire Vaudois Lausanne Switzerland

4. Hypertension and Vascular Risk Unit, Department of Internal Medicine Hospital Clinic University of Barcelona Barcelona Spain

5. Division of Cardiology Cliniques Universitaires Saint‐Luc and Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium

6. Medical and Surgical Sciences Department University of Bologna Bologna Italy

7. Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin and Berlin Institute of Health Institut für Klinische Pharmakologie und Toxikologie Berlin Germany

8. Department of Internal Medicine Agaplesion Bethesda Wuppertal Germany

Abstract

AbstractThe clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long‐term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient‐, physician‐ and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single‐pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient‐focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long‐term improvements in population health and cost‐efficiency for healthcare systems.

Publisher

Wiley

Subject

Internal Medicine

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