The ultimate goal of hypertension management is to minimize the economic, medical, and human costs of cardiovascular and renal morbidity and mortality. If untreated, about one half of all hypertensive patients will develop heart failure, and most will die prematurely of cardiovascular or renal disease. Yet, success at achieving individual‐ and population‐level blood pressure control appears elusive. This unsolved problem is not the result of a knowledge deficit. We are now aware that even small elevations above optimal blood pressure values (<120/80 mm Hg) increase the likelihood of target organ damage. Numerous randomized controlled clinical trials have demonstrated that the incidence of stroke, heart failure, and end‐stage renal disease can be reduced by lowering blood pressure to levels as close to normal as possible. Even the public is becoming increasingly aware that chronic high blood pressure, if left untreated, results in disabling heart and kidney disease. While the barriers to achieving blood pressure control in the general population are multifaceted, it appears that a key obstacle is suboptimal clinical management of hypertension.
In this special supplement of The Journal of Clinical Hypertension, an expert panel presents convincing arguments regarding the urgent need to manage blood pressure at the population level. William J. Elliott, MD, PhD, presents a useful framework for optimizing hypertension treatment through the use of pharmacoeconomic analyses to identify potential ways to reduce health care expenditures. William C. Cushman, MD, cautions us that a current understanding of the pathophysiology of hypertension is critical to its appropriate management. I will address major paradigm shifts in optimal clinical management of high blood pressure, including increasing the use of low‐dose combination therapy to achieve blood pressure goals.
But how do we translate this knowledge into clinical success? To date, relatively few programs have been evaluated that were designed to affect the clinical practice patterns of primary care physicians who treat the majority of patients with hypertension. Susan K. Maue, PhD, and colleagues describe a large‐scale populationbased program—the Hypertension Management Program—designed to change physician prescribing practices within managed care settings. This program represents an excellent example of a fruitful partnership between managed care and the pharmaceutical industry with the common goal of improving clinical outcomes. Preliminary data from this project are presented here, based on a current database of over 1.9 million individuals enrolled in eight health care plans. We look forward to future publications describing the outcomes of this major program.