Dr Miller's paper presents the unhappiness of many physicians. We are distressed about our responsibility for failure to maintain reduction of blood pressure in hypertensive people, and we worry that inefficiency as teachers of patients may indeed be responsible for lack of persistent success.
Dr Miller presents the following reasons for failure to maintain reduced blood pressure: (1) disagreement about when to begin antihypertensive therapy; (2) inability to prevent some of the complications of hypertension, eg, myocardial infarction, by lowering blood pressure; (3) lack of clarity about goals for blood pressure; ie, how far it should be reduced; (4) the complexity of drug regimens; and (5) significant ill effects of drugs.
Most of the criticism of physicians has come from physicians who suspect that it is quicker and easier to change one's own behavior than that of others, be they patients or inventors of drugs. The first four of
Richardson DW. Can Physicians Effect Persistent Control of Blood Pressure?. Arch Intern Med. 1977;137(11):1598-1599. doi:10.1001/archinte.1977.03630230074019