Hypertension

Abstract

Despite widespread efforts to improve education and enhance public awareness, up to 33% of persons with hypertension remain undiagnosed, and only about 50% of those known to have hypertension are adequately controlled. The percentages of patients who are aware that they have hypertension, who are treated, and who are controlled have increased since the 1970s (Table 8.1). Most have stage 1 hypertension, and controversy still exists concerning the appropriate approach to these patients. Nonpharmacologic therapy is often the first choice, and this approach continues to evolve.¹ Of the 20 to 30 million hypertensives who receive pharmacologic therapy, fewer than 50% adhere to their therapeutic regimen for more than 1 year, and 60% of these patients reduce the dosage of their drug owing to adverse effects. A negative impact on the patient’s quality-of-life may occur as a result of just making the diagnosis. Effects such as increased absenteeism, sickness behavior, hypochondria, and decreased self-esteem have been noted in cohorts of previously well individuals who have been told they were hypertensive.² A 1987 survey of physicians revealed that they regarded quality-of-life changes to be the primary impediment to effective pharmacologic treatment of hypertension.