Current clinical practice in hypertension: The EISBERG (Evaluation and interventions for systolic blood pressure elevation - Regional and global) project

Hypertension is one of the major treatable factors contributing to the burd en of disease worldwide. However, despite national programs to encourage de tection and treatment, there are still shortcomings in hypertension managem ent. A large proportion of these can be attributed to socioeconomic factors , professional shortcomings, and patient noncompliance with management regi mens. The Evaluation and interventions for Systolic Blood pressure Elevatio n-Regional and Global (EISBERG) project was conceived to examine the reason s for suboptimal management of hypertension in more detail. Emphasis was pl aced on control of elevated systolic blood pressure because this is often n eglected despite evidence that it is more important than diastolic pressure in predicting cardiovascular risk. The goals of the project include analys is of the relative importance of systolic and diastolic blood pressure as c ardiovascular risk factors, identification of any necessary changes in prac tice, and the development and implementation of programs to promote appropr iate changes in practice or attitudes. The three components of the initiati ve are a formal collection of epidemiologic evidence to examine the relatio n between systolic blood pressure and outcome; a cross-sectional, quantitat ive database (CardioMonitor) providing information on the treatment of pati ents with cardiovascular diseases including hypertension in seven countries , and qualitative research into hypertension management to assess attitudes , awareness, and knowledge among primary care physicians, patients and thei r carers. The study showed more effort was directed toward control of diast olic than systolic blood pressure. Adequate control of systolic blood press ure was seldom achieved. Blood pressure targets tended to be raised in elde rly patients in conflict with recommendations and evidence that there is gr eater benefit in treating hypertension more aggressively in this population . Despite awareness of guidelines for treating hypertension, doctors were u nsuccessful in practice.