Hypertension continues as the "silent killer," particularly in developed countries, despite decades of awareness and numerous medications that can effectively treat the condition. An editorial in August's medical publication Lancet points out that the risk of having high blood pressure during one's lifetimes exceeds 90% in developed countries. Recent studies published in both Circulation and JAMA indicate that the prevalence of pre-hypertension and hypertension in children is increasing but the diagnosis is often missed. Of 507 children with hypertension, only 26% had the diagnosis documented in their medical chart and 41% had undiagnosed stage II hypertension.

Contributing factors include the fact that screening for hypertension is not done systematically, so the diagnosis is often made at a late stage when organ damage has already started. Another problem is that treatment is often not aggressive enough. A physician may start treating a patient with relatively high blood pressure and may be satisfied with improvement that does not reach target goals. According to research, newly diagnosed patients may not receive drug treatment for a year after diagnosis, during which lifestyle modifications are tried. Experts in hypertension recommend that drug therapy be started if lifestyle modifications do not accomplish goals after 2 to 3 months.

Taking medication as directed, or compliance, is a major problem even for educated patients. Noncompliance is common among patients who have reached target blood pressure levels and believe that the medication is no longer needed. In most cases there is no cure for hypertension; medications must continue to be taken to control blood pressure. Unpleasant medication side effects can contribute to noncompliance. Patients should report side effects to their physician so they can work together to select the most effective and least bothersome medication treatment. Cost can also be a factor in noncompliance. Insurances and other third party payers will usually only pay for certain drugs within a class. Again, patients and physicians should work together to achieve an acceptable treatment plan.

Another complication is that different guidelines for the classification and treatment of hypertension have been issued by various medical groups. One of the most widely accepted sets of guidelines are those issued in the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in 2003. In this report, normal blood pressure is defined as systolic pressure less than 120 and diastolic less than 80. Prehypertension is systolic of 120-139 or diastolic of 80-89. Stage I hypertension as systolic of 140-159 or diastolic of 90-99 and Stage II hypertension with systolic over 160 or diastolic over 100. Lifestyle modifications are indicated as part of treatment for all classes of hypertension. Specifically, these include maintaining a normal body weight (BMI 18-24.9). Blood pressure can be reduced by 5-20 points for every 20 pounds lost. Eating a diet rich in fruits, vegetables, and low-fat dairy and low in saturated and total fats can lower BP by 8-14 points. Reducing dietary sodium to less than 2.4 gm per day can lower BP 2-8 points. Regular physical activity of 30 minutes per day 5 days per week can lower BP another 4-9 points. Limiting alcohol consumption to less than 2 drinks per day for men and 1 drink per day for women can lower BP 2-4 points.

References: http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf, http://www.drugtopics.com/drugtopics/Pharmacy/Hypertension-So-many-treatments-yet-so-undermanage/ArticleStandard/Article/detail/484451.

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