State of Hypertension Management in the United States: Confluence of Risk Factors and the Prevalence of Resistant Hypertension

Authors

  • Pantelis A. Sarafidis MD, PhD,

    1. From the Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;1 and the Hypertensive Diseases Unit, Department of Medicine, Section of Endocrinology Diabetes and Metabolism, University of Chicago Pritzker School of Medicine, Chicago, IL2
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  • and 1 George L. Bakris MD 2

    1. From the Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece;1 and the Hypertensive Diseases Unit, Department of Medicine, Section of Endocrinology Diabetes and Metabolism, University of Chicago Pritzker School of Medicine, Chicago, IL2
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George L. Bakris, MD, Hypertensive Diseases Unit, University of Chicago Pritzker School of Medicine, 5841 South Maryland Avenue, Chicago, IL 60637
E-mail: gbakris@earthlink.net

Abstract

An improvement in the awareness and treatment of hypertension in the United States has occurred, resulting in the best control rates in the world, which unfortunately are far below the goals of Healthy People 2000 or 2010. This failure to achieve blood pressure (BP) goals is attributed to many factors, including an aging population, higher prevalence of kidney disease and obesity, high salt intake, physician inertia to increase dose and number of antihypertensive medications prescribed, and patient nonadherence with medication regimens. Resistant hypertension is defined as a failure to achieve goal BP in patients who adhere to full doses of an appropriate antihypertensive regimen of 3 drugs that includes a diuretic. The problem of resistant hypertension is projected to increase as the population ages. Efforts on the part of the Veterans Administration hospitals and others clearly indicate that a system can be implemented to help increase the percentage of persons in whom BP goal is achieved and reduce the prevalence of resistant hypertension. Medications specific to the problem of resistant hypertension are also under development. This review analyzes the status of hypertension control in the United States, the frequency of associated diseases, and adherence to guidelines; it further discusses strategies to reduce the prevalence of resistant hypertension.

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