Uncontrolled hypertension may lead to heart and kidney disease and stroke and may increase vulnerability to COVID-19, according to an article published June 7 in the Journal of the American College of Cardiology. In the article, William J. Oetgen, MD, MBA, MACC, and Janet S. Wright, MD, FACC, urge the cardiology community to prioritize hypertension control on a national scale.

Oetgen and Wright explain that almost half of adults in the U.S. have hypertension, and the control rate has fallen from 53.8% in 2013 to 43.7% in 2014. In October 2020, the U.S. surgeon general released a Call to Action to Control Hypertension that outlined three goals to improve hypertension control across the U.S.: 1) make hypertension control a national priority; 2) ensure that the places where people live, learn, work and play support hypertension control; and 3) optimize patient care for hypertension. They note that the call to action is particularly relevant to practicing cardiologists due to the link between uncontrolled hypertension and cardiovascular health threats, including heart failure, stroke, kidney disease, ischemic heart and peripheral vascular disease, and pregnancy complications.

Oetgen and Wright cite data from ACC and Veradigm's PINNACLE Registry that showed the percentage of patients in cardiovascular practices with controlled blood pressure is "substantially higher" than in the population as a whole (72.3% vs. 42.7%). In addition, "beta blockers in heart failure, ACE inhibitors in heart failure, statins in ischemic disease and oral anticoagulants in atrial fibrillation improved during the period of observation (all trends p<0.001), while blood pressure (an outcome measure) was flat."

The authors note that unclear roles of responsibility between cardiologists and primary care providers and a lack of focus on hypertension in therapeutic advancements may be among the reasons for suboptimal hypertension care. However, they explain that national initiatives such as Million Hearts have achieved significant success with hypertension control for patients of varying risk profiles in private practices, community health care centers, academic groups and more.

Moving forward, they recommend that cardiologists can improve health outcomes for patients with cardiovascular disease by raising awareness of the consequences of uncontrolled hypertension, highlighting and eliminating disparities in hypertension treatment, advocating for individualized blood pressure monitoring, and more.

"Contemporary data show that, even with a broad definition of hypertension, cardiology practices averaged 72.4% control over a recent five-year period. When we were in school, a grade of 72.4% was a D+, and that was never satisfactory. Our cardiology practices can do a better job," Oetgen and Wright conclude.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, COVID-19 Hub, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Hypertension

Keywords: Blood Pressure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiovascular Diseases, Atrial Fibrillation, Angiotensin-Converting Enzyme Inhibitors, COVID-19, Blood Pressure Determination, Hypertension, Heart Failure, Stroke, Anticoagulants, Registries, Peripheral Vascular Diseases, Kidney Diseases, Patient Care, Outcome Assessment, Health Care, Private Practice, Pregnancy Complications, Primary Health Care, Community Health Services, National Cardiovascular Data Registries, PINNACLE Registry

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