Update on the management of hypertension in 2023
DOI:
https://doi.org/10.58931/cpct.2023.1212Abstract
Hypertension is the most common condition managed in the primary care setting. It is a potent but modifiable risk factor for cardiovascular disease (CVD) and premature mortality. Currently, approximately 25% of Canadian adults have a diagnosis of hypertension. However, the global community is experiencing challenges with optimizing hypertension management; it is estimated that at least 23% of individuals globally have effectively managed hypertension. Furthermore, if clinicians were able to identify and adequately intervene in these cases, we could prevent 10.8 million deaths per year. This statistic is extremely relevant to Canadian practitioners as our most recent Canadian data suggest that 34% of adults with hypertension are not achieving target blood pressure (BP) due to undertreatment or lack of awareness.
The undertreatment of hypertension is complex. There are a number of structural and environmental drivers of CV risk, and there is increasing recognition that if we are going to be effective at CV risk reduction, we must acknowledge the significant role that social determinants play in the development of risk factors including hypertension, smoking, obesity and diabetes.
The clinical guidance concerning hypertension may inadvertently contribute to the challenges we are seeing globally with hypertension management. There are numerous guidelines available to inform clinicians about how to provide supportive care for individuals with hypertension, and discordance between guidelines and the granularity of guidelines make implementation challenging. While there is disparity between guidelines, as well as differences regarding hypertension nomenclature, there is unanimous agreement that accurate BP measurement, risk-based thresholds for intervention, simplified approaches to pharmacotherapy, and well-structured care are the foundations of effective hypertension management.
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