Epidemiology and unmet needs in hypertension

BACKGROUND: The persistent control of blood pressure (BP) to levels below current recommended levels is an important but often elusive goal for patients with hypertension. OBJECTIVE: To provide an overview of unmet needs in contemporary hypertension treatment. SUMMARY: The rationale for BP normalization is very persuasive. Incrementally higher BP levels predict higher rates of microvascular (e.g., retinopathy, stroke, nephropathy) and macrovascular disease (e.g., myocardial infarction), as well as organ (e.g., heart) failure. Accordingly, the pharmacologic reduction of BP levels with a broad range of mechanistically dissimilar agents reduces the risk of these BP-related complications. The primary prevention of BP-related complications has been closely linked to the magnitude of decreases in BP brought about pharmacologically, but some modest disease-specific differences have been noted between drug classes. However, pharmacologic blockade of the renin-angiotensin aldosterone system in high-risk patients (e.g., patients with diabetic nephropathy) reduces the risk of BP-related renal end points more than treatment strategies that do not include these agents, even when BP levels are lowered to similar degrees. CONCLUSION: Despite the large number of antihypertensive agents available, the majority of patients with hypertension who are treated with drugs do not attain goal BP levels. Though the reasons for this are complex and relate to various factors for patients, providers, and systems of medical care delivery, new pharmacologic treatments hold the potential to augment the reduction of BP levels while minimizing class-specific side effects.