We read with interest the Cohen1 editorial in a recent issue of the ARCHIVES. Despite a better understanding of the benefits of controlling hypertension, both the second2 and third3 National Health and Nutrition Examination Surveys show that blood pressure (BP) control in over 70% of patients remains inadequate. It is widely recognized that strict control of BP is closely related to the prevention of long-term complications of hypertension. More than 3 years ago, the researchers of the Hypertension Optimal Treatment (HOT) trial4 involving 19 000 patients concluded that the greatest benefit in reducing adverse events was seen in patients whose BP was reduced to 130 mm Hg systolic and 83 mm Hg diastolic. The problem of inadequate BP control has been highlighted by several studies. In the Treatment of Mild Hypertension Study (TOMHS),5 only 72% of patients reached a diastolic BP goal of 90 mm Hg. At the initial enrollment of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT),6 only 28% of patients had adequate BP control (<140/90 mm Hg). In the the Systolic Hypertension in Europe (Syst-Eur) Study,7 over 55% of patients were noted to have a systolic BP higher than 140 mm Hg.
Gupta K, Gupta S. Undertreatment of Hypertension: A Dozen Reasons. Arch Intern Med. 2002;162(19):2246-2248. doi: