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(Hypertension. 2007;49:17.)
© 2007 American Heart Association, Inc.

Editorial Commentaries

Effective Ambulatory Blood Pressure Control in Medical Practice

Good News To Be Taken With Caution

Giuseppe Mancia

From the Clinica Medica, Dipartimento di Medicina Clinica e Prevenzione and Dipartimento di Statistica, Università Milano-Bicocca, Ospedale San Gerardo, Monza (Milan); Istituto Auxologico Italiano, Milan, Italy and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università di Milano, Milano-Bicocca and Pavia, Italy.

Correspondence to Giuseppe Mancia, Clinica Medica, Ospedale San Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy. E-mail giuseppe.mancia@unimib.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A large number of studies has addressed the question of how effective is blood pressure (BP) control in the hypertensive population,^1–3 with a consistent and unequivocal answer. That is, BP control is disappointingly low, because only a small fraction of patients diagnosed as having a BP elevation show on-treatment BPs <140 mm Hg systolic and 90 mm Hg diastolic, which are the target values for treatment recommended by international guidelines.^4,5 This is the case regardless of whether patients are followed by general practitioners or specialists^6,7 and have a low or high cardiovascular risk profile,^8–10 the latter condition making the need of BP control even more compelling given the imminent risk of a cardiovascular event. Reality is obviously even worse when the lower BP targets that have been shown to be additionally protective in high-risk hypertensive patients, that is, <130/80 mm Hg, are considered.^4,5 In a recent study performed in Italy, for example, we have shown that in diabetic (and, thus, high risk) hypertensive patients followed by general practitioners, an on-treatment BP <130/80 mm Hg was achieved in only 3% of the sample,⁷ the conclusion being that in the clinical practice these targets are, at present, no more than a "mirage."

Evidence is available that hypertensive patients in whom BP is uncontrolled by treatment have a cardiovascular risk only modestly less than that of untreated individuals,¹¹ possibly also because in several instances treated BP levels remain quite high, that is, patients are frequently not barely but badly uncontrolled.^6,7,9,12 This has led . . . [Full Text of this Article]

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Effectiveness of Blood Pressure Control Outside the Medical Setting

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Hypertension 2007 49: 62-68. [Abstract] [Full Text] [PDF]

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				G. Mancia, M. Bombelli, R. Facchetti, F. Madotto, F. Quarti-Trevano, H. P. Friz, G. Grassi, and R. Sega Response to Long-Term Risk in Subjects With White-Coat Hypertension Hypertension, November 1, 2009; 54(5): e134 - e134. [Full Text] [PDF]

				E. O'Brien Ambulatory Blood Pressure Measurement: The Case for Implementation in Primary Care Hypertension, June 1, 2008; 51(6): 1435 - 1441. [Full Text] [PDF]