Hypertension is a common, dangerous, expensive, time consuming, ailment. Depending on the cutoff Blood Pressure definition (140/90 or 130/90), Hypertension (HTN) affects 30 to 46% of the population. It causes 18% of the heart attacks, 35% of the strokes, 39% of heart failure in men and 59% of heart failure in women and 23% of renal failure. It contributes to 500,000 deaths each year from cardiovascular disease. It costs $76 Billion dollars of the $351 Billion we spend yearly on cardiovascular disease. It consumes 42 million office visits per year. Despite its high prevalence, significant morbidity and mortality, and excessive cost, it is poorly managed. Only 48.3% are controlled.
If the Blood Pressure (BP) is above goal in the office (130/80 or 140/90), patients come back for 2 more office visits. If the BP remains elevated, the diagnosis of Primary or Essential HTN is made, and doctors recommend lifestyle changes.
After that fails, most providers start a diuretic (Are they the same? NO). If that fails, one of four classes of drugs (ACE, ARB, CCB, diuretics) are added in any order using a trial and error methodology. Meds are adjusted every few months. They are increased to maximally tolerated doses, following specialty guidelines. HTN is treated as a singular disease and there is no systematic workup for potential secondary causes.
This approach fails in over half the patients. Only 48.3% are controlled to goal BP.