Physician-Related Barriers to the Effective Management of Uncontrolled Hypertension

Abstract

IMPROVING THE QUALITY of hypertension care is a priority. Studies have shown that most patients with hypertension have inadequate blood pressure (BP) control,^1-7 resulting in excess cases of coronary artery disease, congestive heart failure, renal insufficiency, peripheral vascular disease, and stroke.^2,8-11 Safe and effective therapies for hypertension are readily available, and the importance of obtaining optimal BP control through the use of these therapies is increasingly recognized. Efforts to understand poor BP control have usually focused on patient adherence with therapy and patient characteristics associated with nonadherence. Recently, it has been shown that clinician practices are very important and that physicians may not be aggressive enough in their management of hypertension.^2,5,12-18 Further, despite the demonstrated positive association between systolic BP and cardiovascular disease, there is uncertainty among physicians about the importance of systolic BP.^19,20 These results suggest the need for studies on patient-clinician interaction and that better define how clinicians make decisions about therapy for the hypertensive patient.