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August 19, 2019

Time for Neurologists to Drop the Reflex Hammer on Hypertension

Author Affiliations
  • 1Department of Neurology, University of California, San Francisco
  • 2Web Editor, JAMA Neurology
  • 3Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, Division of General Internal Medicine, University of California, San Francisco
JAMA Neurol. Published online August 19, 2019. doi:10.1001/jamaneurol.2019.2588

Despite decades of research and widely available treatments, hypertension remains a leading cause of death and disability worldwide and is a growing public health problem. Randomized clinical trial data1 demonstrates that in specific patients, targeting a systolic blood pressure of less than 120 mm Hg (compared with 140 mm Hg) resulted in lower rates of fatal and nonfatal cardiovascular events and all-cause mortality. Accordingly, the updated American College of Cardiology/American Heart Association Guideline has incorporated new, lower blood pressure levels defining hypertension and recommended initiating antihypertensive medications for systolic blood pressure of 130 mm Hg or greater for patients at high cardiovascular risk or patients 65 years and older.2 Applying these new recommendations, the prevalence of hypertension is now estimated to be 45.5% in US adults, with antihypertensive medications recommended for 36.2% of US adults.3 These numbers are already staggering, and as the population continues to grow and age, the consequences of hypertension will undoubtedly increase. Novel strategies focused on consistent, sustainable early intervention are critically important to prevent hypertension-associated morbidity and mortality and combat this growing epidemic.