Current status of hypertensive disease treatment: results from the Evaluation and Interventions for Systolic Blood pressure Elevation: Regional and Global (EISBERG) project

Conclusive evidence has shown the benefits of antihypertensive treatment, T he systematic review of end-point trials has indicated that for a reduction of 10-12 mmHg in systolic blood pressure or 5-6 mmHg in diastolic blood pr essure, the incidence of stroke is reduced by 38% and ischaemic heart disea se by 16%, Despite this, studies on the effectiveness of treatment - carrie d out both in specialist hypertension clinics and in the community - have a ll shown that patients receiving treatment for hypertension continue to be at increased risk of cardiovascular disease, Failure to control blood press ure to recommended guidelines contributes substantially to this excess risk . Some reasons for this failure are outlined below. Socioeconomic factors and lack of professional and patient compliance appea r to be of considerable importance in the failure to control blood pressure . The Evaluation and Interventions for Systolic Blood pressure Elevation: R egional and Global (EISBERG) project investigated both the quantitative and qualitative aspects of the current treatment of hypertension international ly. The quantitative study indicated major shortcomings in blood pressure c ontrol, and in particular, poor control of elevated systolic pressure, whic h accounted for 90% of treatment failures. The qualitative research was bas ed upon semi-structured interviews with professionals, patients and their c are-givers, These interviews indicated that there were misconceptions among physicians regarding the relative importance of systolic and diastolic blo od pressure, the need for more aggressive treatment in the elderly, and the need for improved physician-patient interactions. If the therapeutic advan ces emerging from medical research are to be translated into clinical benef its, both the understanding and communication of the need for effective blo od pressure control must be improved. J Hypertens 17 (suppl 2):S15-S19 (C) 1999 Lippincott Williams & Wilkins.