CLINICAL CHALLENGES
IN HYPERTENSION

Hypertension is the most common form of cardiovascular disease in economically developed and developing countries, afflicting over 73 million persons in the US and over one
billion worldwide. Left uncontrolled, it is a major contributor to death and disability due to
stroke, coronary artery disease and chronic kidney disease. While blood pressure reduction
has been shown in randomized controlled trials to be highly effective in preventing acute
cardiovascular events and death, attainment of guideline specified blood pressure goals in
the practice setting has proved difficult. Much of the difficulty experienced by primary care
providers and hypertension specialists alike in managing blood pressure comes from conflicting information about the relative efficacy of various antihypertensive measures, both
pharmacologic and nonpharmacologic (lifestyle modification). Further, there is a paucity of
authoritative information about how to approach blood pressure management in patients
with comorbidities that may be driving blood pressure elevation (anxiety and panic disorders, sleep disorders, athletic activities) or that may limit therapeutic choices (acute and
chronic stroke, coronary artery disease) and in special patient populations (adolescents and
young adults, the very elderly).