Control of hypertension: is the goal reached?

Hypertension is one of the most prevalent risk factors in the development of cardiovascular diseases and events, and on the bright side it can perfectly be controlled in the vast majority of patients. Physicians for years have taken action to control it by instituting several means to decrease blood pressure in hypertensive patients and the population at large. Initially, this effort was successful from what can be observed by comparing the data from the 1970s and those available in the 1990s. Surprisingly, physicians’ interest in the topic dropped thereafter and as a consequence, the figures of blood pressure control hardly showed any further improvement. Interest rose again when after some time, surveys like EuroAspire sent out alarming new information; the investigators had checked the existing risk factors and their control in patients who had a coronary event. Results showed a surprisingly high prevalence of all risk factors and particularly, hypertension was found in ≈50% of the patients. In hopes to obtain an improvement of these disappointing findings, results were made public and advices were clearly given. Yet, in the next survey, using the same protocol, no significant improvement was found, even not for hypertension; only cholesterol level clearly decreased. This lack of pressure control may have had far reaching consequences as reports came out describing sustained high prevalence and even increases in cerebrovascular events in several countries worldwide. In reality, we are facing here a remarkable contradiction. On one hand, we have seen an encouraging increase in the available means of improving on blood pressure control such as lifestyle correction, which includes better food habits with the accent made on reduction of calories and salt, also we could witness a booming increase in new and effective antihypertensive drugs and research in this area. On the other hand, there is clearly less improvement in the control of high blood pressure in both hypertensive patients and at population level, which the new available means of controlling hypertension would have warranted us to expect! The results of the National Health and Nutrition Examination Survey study published in this issue are therefore encouraging.