, Volume 2, Issue 3, pp 192-197
Date: 14 Oct 2008

Underuse of antihypertensive therapies in at-risk populations

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Abstract

Effective control of elevated blood pressure (BP) levels over the long term substantially lowers the likelihood of premature mortality, microvascular and macrovascular diseases, and pressure-sensitive organ failure (eg, heart failure). High-risk hypertensive patients, such as those with concomitant cardiovascular-renal conditions (eg, diabetes, dyslipidemia), vascular disease, depressed heart/kidney function, or even just severe BP elevations, are at high risk for pressure-sensitive complications. African Americans are another high-risk demographic group but, arguably, because diet and lifestyle attributes lead to high levels of cardiovascular-renal conditions. Although high-risk hypertensive patients accrue the largest absolute risk reductions when treated effectively, they are least likely to attain goal BP levels below recommended targets. This is significantly attributable to resistance to antihypertensive treatment. Undertreatment of high-risk hypertensive patients occurs because of factors related to the patient, physician, the patient-physician interface, and the system (or typically lack thereof) of care delivery.