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Comment & Response
March 2, 2020

We Dropped the Reflex Hammer on Hypertension 20 Years Ago

Author Affiliations
  • 1Stroke Unit, Sanatorio Guemes, Buenos Aires, Argentina
JAMA Neurol. 2020;77(4):526. doi:10.1001/jamaneurol.2020.0070

The hardest lessons to learn are those that are the most obvious.

Theodore Roosevelt

To the Editor The authors of this Viewpoint1 should be commended for calling attention to the overdue and under-recognized importance of hypertension, which accounts for 13% of total deaths, as a major treatable cause of cognitive decline and cardiovascular mortality and morbidity. For the last 20 years, we have studied hypertension at our neurology clinic in Argentina where we teach young neurologists that blood pressure (BP) measurement is the most valuable medical procedure and found that 59% of patients had a BP greater than 140/90 mm Hg during their first visit.2 Hypertension was not previously diagnosed in 50%, and in 80% of those treated, BP was uncontrolled. The prevalence of hypertension ranged from 40% to 80% in patients with headache, neuromuscular disease, Parkinson disease, dementia, and stroke. We referred patients with hypertension to their primary physician to find that when they returned to our clinic they still had hypertension. In a second part of the study, we initiated and adjusted hypertension treatment at the neurology clinic.3 Of 1464 neurology consults, 1009 patients (69%) had hypertension at the first visit. Only 76 of 508 known patients with hypertension (15%) were controlled. Among 544 patients with hypertension who returned for follow-up, BP decreased from an average 155/93 mm Hg to 143/86 and in 222 (40%) reached normal values. There was a significant difference in the rate of patients with controlled hypertension favoring those treated at the neurology clinic compared with those treated elsewhere.

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