Nephrol Dial Transplant (2002) 17: 1547-1550
© 2002 European Renal Association-European Dialysis and Transplant Association
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Why is blood pressure control unsatisfactory—or is it?
Institute of Epidemiology and Social Medicine, Clinical Epidemiology Unit, University Hospital, Münster, Germany
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Introduction
Arterial hypertension is a strong risk factor for cardiovascular and renal disease. There are several aspects that make the management of hypertension almost unique. Hypertension is common, i.e. there is a high prevalence of the condition in most industrialized countries; it is simple to detect, i.e. ubiquitously available office brachial manometry and/or ambulatory blood-pressure measurement ensure a rapid and valid diagnosis; it is treatable, i.e. there is a great choice and diversity of highly tolerable medications with proven blood pressure (BP)-lowering effects; and antihypertensive therapy is efficacious, i.e. there is a wealth of clinical trial data proving beyond doubt that treatment effectively reduces the risk of subsequent disease of heart, brain, and kidneys. In hardly any other field of internal medicine is the evidence base as sound as it is for the management of hypertension.
Nevertheless, recent population surveys from various
Population surveys exaggerate poor hypertension control
Control of systolic BP is worse than control of diastolic BP
The age dynamics of systolic and diastolic BP
Control of systolic vs diastolic BP: the trial evidence
Control of systolic BP—wishful thinking?
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