The urgent need to improve hypertension care

Hypertension is the most prevalent health problem among adult primary care patients, but its recognition and treatment are suboptimal. Although there is ample evidence from several large-scale randomized, controlled studies t hat treatment of hypertension reduces morbidity and mortality, current mana gement of hypertension is characterized by underdiagnosis, misdiagnosis, un dertreatment, overtreatment, and misuse of medications. As a result, roughl y 75% of the estimated 50 million adults with hypertension in the United St ates are at increased risk for vascular complications. Optimal therapy requ ires careful attention to patients' age, sex, race, diet, exercise, tobacco use, comorbid conditions, choice of antihypertensive drug treatment, compl iance with treatment, and achievement of blood pressure control. Other issu es that deserve scrutiny are accuracy of the initial diagnosis, self-monito ring of blood pressure, and the advisability of attempting reduction of dos age or possible withdrawal from administration of antihypertensive drug tre atment in patients whose blood pressures have been controlled for 1 year or more. Physicians' knowledge and use of the Sixth Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure report are d eficient. Several responses to this current crisis in care of hypertensive patients are reviewed, including computer-aided management, medical chart a udit, academic detailing, and a nurse case manager using prepared algorithm s in consultation with the physician.