Hypertension Control Rate Should be Defined Consistently and Used to Motivate Action to Improve
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Hypertension Control Rate Should be Defined Consistently and Used to Motivate Action to Improve Arthur P. DeMarzo1 Received: 12 September 2019 / Accepted: 11 November 2019 © Italian Society of Hypertension 2019
Abstract Hypertension has been poorly controlled with the old target of less than 140/90 (mmHg). Currently, the average control rate in the United States is about 50% with the old goal of 140/90. If the new goal of 130/80 is used, the control rate would dramatically decrease. For hypertension management, the traditional stepped-care method needs to be replaced with new approaches using single-pill combination pharmacotherapy (polypill) or using hemodynamic data for drug selection and titration to target underlying cardiovascular abnormalities when cardiovascular disease is present. With the old goal of 140/90, these new approaches have achieved a control rate of 90%. The evidence indicates that new models of therapy and patient support can dramatically improve control rate. However, a key requirement is the will to act. Standardizing and publishing the control rate per medical group could motivate clinicians to implement best practices and expedite a rapid shift to better hypertension management. Keywords Control rate · Cardiovascular disease · Hypertension · Risk factors · Hemodynamics · Blood pressure Improvement in the hypertension control rate has been slow and disappointing. Hypertension has been poorly controlled even with the old target of less than 140/90 (mmHg) specified by the seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) [1]. The JNC7 reported that only 34% of hypertensive patients in the United States were at goal. In November 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) released new guidelines for hypertension that lowered the goal to less than 130/80 [2]. The new guidelines have been endorsed by the American College of Preventive Medicine, American Society of Preventive Cardiology, American Society of Hypertension, American Geriatrics Society, American Pharmacists Association, American Academy of Physician Assistants, Association of Black Cardiologists, National Medical Association, and Preventive Cardiovascular Nurses Association. However, the acceptance of the lower blood pressure goal has not been universal. The American Academy of * Arthur P. DeMarzo [email protected] 1
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Family Physicians and the American College of Physicians have refused to give their support claiming that the harms, cost, and complexity of care associated with the new target do not justify the presumed benefits. If there is controversy concerning the target blood pressure, how should the control rate be defined? If the current average control rate in the United States is slightly above 50% with the old goal [3], then lowering the blood pressure goal to 130/80 will dramatically lower the control rat
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