Current challenges for hypertension management: From better hypertension diagnosis to improved patients' adherence and blood pressure control. (15th May 2021)

• Record Type: Journal Article
• Authors: Parati, Gianfranco; Lombardi, Carolina; Pengo, Martino; Bilo, Grzegorz; Ochoa, Juan Eugenio
• Is Part Of: International journal of cardiology. Volume 331(2021)
• Page Start: 262
• Page End: 269
• Publication Date: 2021-05-15
• Subjects: Hypertension diagnosis and treatment -- Blood pressure control -- Home blood pressure monitoring -- Ambulatory blood pressure monitoring -- Treatment adherence -- BP telemonitoring -- Mobile health technologies; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.01.070
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Hypertension control still remains a largely unmet challenge for public health systems. Despite the progress in blood pressure (BP) measurement techniques, and the availability of effective and safe antihypertensive drugs, a large number of hypertensive patients are not properly identified, and a significant proportion of those who receive antihypertensive treatment fail to achieve satisfactory control of their BP levels. It is thus not surprising that hypertension is still a major contributor to disease burden and disability worlwide, even in developed countries. This paper will address current challenges in hypertension management and potential strategies for an improvement in this field. In its first part relevant issues related to hypertension diagnosis will be addressed, in particular how to improve identification of sustained BP elevation and specific BP phenotypes such as white coat and masked hypertension trough the combined use of office and out-of-office BP monitoring techniques. In its second part focus will be on how to improve achievement of hypertension control in treated patients by optimization and simplification of medication regimens, including more efficient selection and titration of antihypertensive drugs and their combinations, aimed at achieving a more consistent 24hBP control; and by favoring a more active patients' and physicians' involvement in hypertension management also through BP telemonitoring and mobile health technologies. Highlights: Hypertension control still remains a largely unmet challenge for public health systems even in developed countries. BP measurement techniques and antihypertensive drugs are not always optimally used in clinical practice Identification of WCH and MH is possible through the combined use of office and out-of-office BP monitoring (ABPM and HBPM). Hypertension diagnosis may be improved by detection of sustained BP elevation, WCH and MH. Consistent 24h-BP control is favored by proper selection, titration and single pill combination of antihypertensive drugs. Home BP telemonitoring and mobile health technologies may improve patients' adherence/ compliance to antihypertensive treatment.