World Hypertension League calls for urgent action to get more hypertensive patients to goal
International survey identifies important gaps in clinical practice that must be addressed to ensure more patients reach blood pressure goalThis World Hypertension Day, the results of a global survey are being announced, uncovering alarming gaps between current and recommended hypertension management, and important insights into physician awareness of the importance of blood pressure goal achievement.
In response to the Close The Gap survey findings, the World Hypertension League is supporting a call for better awareness of the importance of high blood pressure patients reaching the internationally-recognised goal of 140/90mmHg or lower.
At the moment, around 50-70% of the one billion people with high blood pressure worldwide remain above this goal, leaving them at significant risk of coronary artery disease, heart failure, stroke, vascular and kidney damage1,2.
Dr Claude Lenfant, President of the World Hypertension League, commented on the survey findings, "Viewed simply, for every 20/10mmHg rise in blood pressure above this level, the risk of death from cardiovascular problems doubles3. International guidelines have set a clear goal - every patient with hypertension needs to have their blood pressure reduced to 140mmHg or below".
The Close The Gap survey, conducted with 1,259 primary care physicians across 17 countries, compared physicians' perceptions against the reality of current hypertension management.
Encouragingly, the findings confirmed that most physicians are aware of the recommended blood pressure goal for hypertension patients (140/90mmHg), and that the vast majority (96%) know treating patients to blood pressure goal significantly reduces their risk of cardiovascular disease4.
However, the survey also showed that over 40% of physicians would be satisfied to reduce patients' blood pressure to an "acceptable level" only, rather than fully to the recommended goal4. Further, surveyed physicians overestimated the proportion of their patients reaching blood pressure goal. Over half believed 70% of their hypertension patients are at their blood pressure goal,4 when epidemiological data show that worldwide only 30-50% of hypertension patients are actually at goal 2.
Examining physician views on treatment options, the survey revealed that physicians believe combination therapy would get more of their patients to goal, with 71% indicating they would give patients combination therapy if not reaching goal on monotherapy4. However, recent studies show that fewer than 20% of uncontrolled monotherapy patients are switched to combination therapy during follow-up visits5,6.
Additionally, whilst the vast majority of physicians (96%) recognised hypertension is one of the most important cardiovascular conditions, only 54% cited it as one of the most challenging cardiovascular conditions to manage. This suggests that some physicians may currently underestimate what is involved in successfully getting all hypertension patients to goal,4 and may help explain why the number of patients not at goal worldwide is so high.
Respondents identified a need for better patient education, so that patients can take a shared role in achieving blood pressure goal. 83% confirmed that more patients would successfully reach goal if they were more aware of their current blood pressure and their goal.
Dr Lenfant, World Hypertension League, concludes, "The Close The Gap survey has identified key areas where current hypertension management differs from international guideline recommendations. We recognise that hypertension is a very complex and difficult condition to manage, and we welcome the survey in helping to identify areas in which we can work with and support physicians, to get more hypertension patients to goal."
The Close the Gap survey was undertaken as part of the i-Control to Goal campaign. The campaign is a joint initiative to reduce the burden of hypertension, supported by the World Hypertension League in partnership with Bristol-Myers Squibb and sanofi-aventis.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
Published on PsychCentral.com. All rights reserved.