Overcoming the Global Hypertension Crisis: Challenges and Modern Treatment Goals

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• Hypertension Global Prevalence and Control Rates
• The Silent Killer Problem in Hypertension
• Medication Side Effects and Tolerability Issues
• Patient Noncompliance with Hypertension Treatment
• New Blood Pressure Targets and Control Challenges
• The Critical Importance of Patient Education
• Full Transcript

Hypertension Global Prevalence and Control Rates

Hypertension is a massive global health problem. Dr. Ehud Grossman, MD, cites alarming statistics from the United States. Approximately one-third of the population has high blood pressure. Another one-third of individuals have hypertension but remain completely unaware of their condition.

Dr. Ehud Grossman, MD, notes that almost half of all people with hypertension do not achieve good blood pressure control. Data from the United Kingdom is even more concerning. It shows nearly 90% of patients fail to reach the traditional target of 140/90 mmHg.

The Silent Killer Problem in Hypertension

Hypertension is often called the "silent killer" for a critical reason. Patients frequently feel no symptoms even when their blood pressure is dangerously high. Dr. Ehud Grossman, MD, explains this lack of sensation is a primary barrier to care.

Because they feel well, individuals see no reason to visit a doctor. This absence of physical cues makes it difficult to convince someone they need lifelong treatment. The organ damage from uncontrolled hypertension happens gradually and without warning.

Medication Side Effects and Tolerability Issues

Modern medicine has a robust arsenal of antihypertensive drugs. Dr. Grossman confirms there are enough medications available to effectively lower blood pressure. However, a significant treatment challenge involves drug tolerability.

Many patients experience side effects from their blood pressure medications. Not all individuals can tolerate the specific anti-hypertension drugs prescribed to them. These adverse effects become a major reason for discontinuing therapy, leading to poor control.

Patient Noncompliance with Hypertension Treatment

The core issue in hypertension control is patient noncompliance. Dr. Ehud Grossman, MD, defines this as not taking drugs as prescribed. This problem is compounded when a patient feels perfectly healthy.

Remembering to take three or four different medications daily is difficult. Forgetting doses is common when there are no immediate physical reminders of illness. Side effects further contribute to this nonadherence, creating a complex barrier to successful treatment.

New Blood Pressure Targets and Control Challenges

Recent American Heart Association guidelines have intensified treatment goals. The new blood pressure target is now 130/80 mmHg, lower than the previous 140/90 standard. Dr. Ehud Grossman, MD, discusses the profound implications of this change.

He believes this stricter target means over 50% of hypertensive patients will be uncontrolled. Despite available medications, achieving this new goal on a population level is a monumental task. This highlights the escalating challenge clinicians and patients face together.

The Critical Importance of Patient Education

Dr. Ehud Grossman, MD, concludes that patient education is a major goal. Combating the misconception that "feeling fine" equals healthy blood pressure is essential. He stresses that hypertension remains the number one modifiable risk factor for stroke, heart attack, and kidney disease.

Effective treatment prevents devastating future health problems. Dr. Grossman and Dr. Anton Titov, MD, agree on the need to educate people about the dangers of high blood pressure. The first step is regular blood pressure measurement to know one's true numbers, regardless of how one feels.

Full Transcript

Dr. Ehud Grossman, MD: Hypertension is a global problem. In the US, one-third of people have hypertension. One-third of people have hypertension and don't know about it, and almost half of the people do not have good control of hypertension.

In fact, there is UK data that shows that almost 90% of people do not have control of hypertension to the 140 over 90 recommended target.

Why does hypertension continue to be such a global problem today? Hypertension is called the "silent killer" because you don't feel when your blood pressure is high, and it causes all the damage to the organs.

If you don't feel bad, you don't go to the doctor, and you may not be convinced to get treatment for high blood pressure. So this is problem number one with hypertension.

Problem number two is that we have enough medications to lower blood pressure, but then people have side effects and not all tolerate the anti-hypertension drugs.

Number three, even if you are convinced that you have to take the medications, if you don't suffer from hypertension symptoms, you forget to take medications.

If you have to take every day three or four drugs to lower blood pressure and you don't feel something is wrong with you, then you forget to take the medications.

The main problem with control of blood pressure is what we call "noncompliance," which means that you don't take the drugs as requested, or you may have side effects and that's why you don't take medications.

So we still have a problem treating hypertension. We haven't found a good solution for all patients.

I believe that if a patient complies with the treatment and you know how to treat hypertension, you can control 90% of the patients.

Now the main problem is that recent American guidelines for hypertension define a lower blood pressure target than 140 over 90, which is now 130 over 80.

If we go to this target, I believe that at least 50% of people with hypertension, if not more, will not have good blood pressure control despite anti-hypertensive medications.

Hypertension is still the number one killer, and the main point is that hypertension is a modifiable risk factor.

If you treat high blood pressure well, you can prevent many problems in the future.

That's why we have to fight, explain, and convince people how important it is to lower blood pressure.

Patient education continues perhaps to be one of the major goals—educating people how serious and how dangerous it is to have high blood pressure even though they don't feel it.

People say, "I don't feel bad, so I probably have no high blood pressure." But it is not true. You can have very high blood pressure levels and feel nothing.

It is very important to measure blood pressure in order to know what your real blood pressure is.