The thoughtful letter from the Guptas is appreciated and highlights important reasons why hypertension is undertreated. Since the publication of my editorial,1 several reports have shed more light on this issue.
A study from France showed that the problems that we encounter in the United States are not unique.2 The BP, primarily the systolic BP, in 85% of 4714 men with hypertension was not controlled by drug treatment. The importance of undertreatment is shown by the linear relationship between systolic BP levels of patients undergoing treatment and risk of cardiovascular disease. For those with a systolic BP of 140 to 159 mm Hg or 160 mm Hg or higher, the risks were 70% or 250% higher, respectively, than those with systolic BP lower than 140 mm Hg (after adjustment for age and associated risk factors). The level of diastolic BP was not significantly related to risk of cardiovascular disease after adjustment for systolic BP.
Cohen JD. Undertreatment of Hypertension: A Dozen Reasons—Reply. Arch Intern Med. 2002;162(19):2246-2248. doi: