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Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution.
Am J Hypertens 2017; 30(9):857-860AJ

Abstract

BACKGROUND

About one-half of all hypertensive adults do not have their blood pressure controlled. They are often prescribed medications that conform to national guidelines but they continue to have elevated blood pressure. This public health problem might be improved by applying plasma renin guided therapy.

RESULTS

A contributor to the public health problem of unsuccessfully treated hypertension is that the circulating renin-angiotensin system (RAS) is not recognized in treatment guidelines as clinically relevant for the treatment of hypertension or as important as the body salt status for determining blood pressure levels. Another contributor to the problem is the lack of specificity in the package inserts for antihypertensive drugs. They do not specifically state under the heading "Indications" that RAS blockers are primarily most effective in hypertensive subjects with medium and high plasma renin levels; by contrast, natriuretic drugs are most effective in those with low plasma renin levels.

METHODS

Literature review.

CONCLUSIONS

To address the problem of unsuccessfully treated hypertension, we recommend that the "Indications" section of package inserts for antihypertensive drugs be more specific. The primary indication for RAS blockers ought to be hypertension with medium and high plasma renin levels, and natriuretic agents for those with low plasma renin levels. Similar language ought to be added to treatment guidelines. Additionally, 3 other reasons for lack of blood pressure control also need to be addressed-failure to prescribe antihypertensive drugs to hypertensive subjects, failure of patients to fill prescriptions, and low drug adherence.

Authors+Show Affiliations

Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.Department of Medicine, Weill Cornell Medical College, New York, New York, USA.Department of Medicine, Weill Cornell Medical College, New York, New York, USA. The Rogosin Institute, New York, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28482060

Citation

Furberg, Curt D., et al. "Unsuccessfully Treated Hypertension: a Major Public Health Problem With a Potential Solution." American Journal of Hypertension, vol. 30, no. 9, 2017, pp. 857-860.
Furberg CD, Sealey JE, Blumenfeld JD. Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution. Am J Hypertens. 2017;30(9):857-860.
Furberg, C. D., Sealey, J. E., & Blumenfeld, J. D. (2017). Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution. American Journal of Hypertension, 30(9), pp. 857-860. doi:10.1093/ajh/hpx068.
Furberg CD, Sealey JE, Blumenfeld JD. Unsuccessfully Treated Hypertension: a Major Public Health Problem With a Potential Solution. Am J Hypertens. 2017 Sep 1;30(9):857-860. PubMed PMID: 28482060.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution. AU - Furberg,Curt D, AU - Sealey,Jean E, AU - Blumenfeld,Jon D, PY - 2017/02/10/received PY - 2017/04/13/accepted PY - 2017/5/10/pubmed PY - 2018/5/8/medline PY - 2017/5/9/entrez KW - anti-renin treatment KW - anti-volume treatment KW - blood pressure KW - high blood pressure KW - hypertension, plasma renin activity, PRA SP - 857 EP - 860 JF - American journal of hypertension JO - Am. J. Hypertens. VL - 30 IS - 9 N2 - BACKGROUND: About one-half of all hypertensive adults do not have their blood pressure controlled. They are often prescribed medications that conform to national guidelines but they continue to have elevated blood pressure. This public health problem might be improved by applying plasma renin guided therapy. RESULTS: A contributor to the public health problem of unsuccessfully treated hypertension is that the circulating renin-angiotensin system (RAS) is not recognized in treatment guidelines as clinically relevant for the treatment of hypertension or as important as the body salt status for determining blood pressure levels. Another contributor to the problem is the lack of specificity in the package inserts for antihypertensive drugs. They do not specifically state under the heading "Indications" that RAS blockers are primarily most effective in hypertensive subjects with medium and high plasma renin levels; by contrast, natriuretic drugs are most effective in those with low plasma renin levels. METHODS: Literature review. CONCLUSIONS: To address the problem of unsuccessfully treated hypertension, we recommend that the "Indications" section of package inserts for antihypertensive drugs be more specific. The primary indication for RAS blockers ought to be hypertension with medium and high plasma renin levels, and natriuretic agents for those with low plasma renin levels. Similar language ought to be added to treatment guidelines. Additionally, 3 other reasons for lack of blood pressure control also need to be addressed-failure to prescribe antihypertensive drugs to hypertensive subjects, failure of patients to fill prescriptions, and low drug adherence. SN - 1941-7225 UR - https://www.unboundmedicine.com/medline/citation/28482060/Unsuccessfully_Treated_Hypertension:_A_Major_Public_Health_Problem_With_a_Potential_Solution_ L2 - https://academic.oup.com/ajh/article-lookup/doi/10.1093/ajh/hpx068 DB - PRIME DP - Unbound Medicine ER -