State of hypertension management in the united states: confluence of risk factors and the prevalence of resistant hypertension

Abstract

An improvement in the awareness and treatmentof hypertension in the United States has occurred, resulting in the best control rates in the world, which unfortunately are far below the goals ofHealthy People 2000 or 2010. This failure toachieve blood pressure (BP) goals is attributedto many factors, including an aging population, higher prevalence of kidney disease and obesity, high salt intake, physician inertia to increasedose and number of antihypertensive medicationsprescribed, and patient nonadherence withmedication regimens. Resistant hypertension isdefined as a failure to achieve goal BP in patientswho adhere to full doses of an appropriate antihypertensiveregimen of 3 drugs that includes adiuretic. The problem of resistant hypertensionis projected to increase as the population ages.Efforts on the part of the Veterans Administrationhospitals and others clearly indicate that a systemcan be implemented to help increase the percentageof persons in whom BP goal is achieved andreduce the prevalence of resistant hypertension.Medications specific to the problem of resistanthypertension are also under development.This review analyzes the status of hypertensioncontrol in the United States, the frequency ofassociated diseases, and adherence to guidelines;it further discusses strategies to reduce the prevalenceof resistant hypertension. © 2008 Le Jacq.