Hypertension

Abstract

The field of hypertension has enjoyed some remarkable successes in recent years. Better blood pressure management has been an important contributor to the recent rapid decline in the age-adjusted death rates for coronary heart disease (CHD) and stroke.1 Yet, there is yet so much more that could be accomplished through better blood pressure management. CHD and stroke remain the first and third leading causes of death in the United States.2 And only slightly more than a third of those with hypertension in the United States achieve recommended treatment goal blood pressure levels.3 Control rates are even worse in most other countries.4 Better blood pressure management can save many lives. Here, some pathways to success are considered. Few measurements in medicine are done as poorly and inconsistently as blood pressure measurement. Methods used today in clinical practice and in clinical trials are little changed from the earliest days of measurement.5 Though there is a clear recognition of biological variability, we continue to make decisions largely on measurements taken at random times under poorly controlled conditions. The measurement process is less regulated than measurement of most other major risk factors. Just compare the quality control process for glucose or cholesterol measurement with that for blood pressure measurement in your own local setting. There are not readily available solutions for this issue. Substantial investments in research in this area should be made by government and commercial entities. We must have reliable, reproducible, convenient, and precise measurement tools for blood pressure. These tools should allow for measurement of the important components of blood pressure and mechanisms for integrating and interpreting influence of time of day, activity, …