Barriers to BP Control

“Failure to titrate or combine medications and to reinforce lifestyle modifications despite knowing that the patient is not at goal BP represents clinical inertia that must be overcome.” ¹
- Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

Clinical inertia contributes to low blood pressure control rates

JNC 7 report identifies "clinical inertia" as the root of the problem in many cases. Clinical inertia may be due in part to clinicians’ focus on relieving symptoms, a lack of familiarity with clinical guidelines, or discomfort in titrating to goal

Although attainment of blood pressure goals may be limited by lack of access to healthcare, cost, and patient non-adherence, in many cases the root of the problem is clinical inertia.¹

Barriers to blood pressure control

Despite an increase in available antihypertensive medications and greater evidence for the beneficial effects of blood pressure control, the percentage of people with controlled hypertension remains low. Proposed reasons for this are⁴:

Healthcare providers
- Studies have shown a gap between national guidelines and common clinical practice
- Acceptance of suboptimal BP management
Patients with hypertension
- Low adherence to lifestyle interventions
- Low adherence with medications
- Lack of access to healthcare
- Lack of healthcare insurance

Multiple antihypertensive agents are often needed to achieve target BP

Another reason that hypertension is such a widespread problem is that multiple antihypertensive agents are often needed to achieve desired target blood pressure goals.¹

In seven large, double-blind, placebo-controlled studies, more than one agent was required to achieve desired target blood pressure goals.^6-12 Target blood pressure varied from study to study.^6-12

Trial Results with Multiple Antihypertensive

6. UK Prospective Diabetes Study. BMJ. 1998;317:703-713.
7. Estacio RO et al. Am J Cardiol. 1998;82:9R-14R.
8. Lazarus JM et al. Hypertension. 1997;29:641-650.
9. Hansson L et al. Lancet. 1998;351:1755-1762.
10. Kusek JW et al. Control Clin Trials. 1996;16:40S-46S.
11. Lewis EJ et al. N Engl J Med. 2001;345:851-860.
12. ALLHAT. JAMA. 2002;288:2981-2997.

At the end of the Hypertension Optimal Treatment (HOT) study, for example, 78% of patients were still taking felodipine as baseline therapy, usually together with an angiotensin-converting enzyme inhibitor (41%) or a β-blocker (28%).⁹

In the United Kingdom Prospective Diabetes Study (UKPDS), 29% of patients required three or more agents to achieve a mean BP of 144/82 mm Hg after nine years of follow-up.⁶

WARNING: USE IN PREGNANCY When pregnancy is detected, discontinue AVAPRO or AVALIDE as soon as possible. When used in pregnancy during the second and third trimesters, drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus. [See Warnings and Precautions: Fetal/Neonatal Morbidity and Mortality in the full Prescribing Information.]

Please see Indications and Important Safety Information.

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