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January 23, 2007

USA #1 — in Treating Hypertension

Doctors in the US are quicker than those in other countries to treat hypertension. This approach may actually save money...
Ready for some good news about American public health?

Doctors in the United States do a much better job of treating hypertension than their counterparts in Western Europe, according to a new study.

Their secret: starting treatment earlier and being more aggressive.

By treating sooner and more aggressively, U.S. physicians may actually save money by reducing the overall economic burden of cardiovascular disease...

Looking at more than 21,000 people with hypertension, researchers from Temple, the University of Chicago, and Stanford found that 63 percent of U.S. patients had their blood pressure under control, compared to between 31 percent and 46 percent in Italy, the United Kingdom, Germany, Spain and France.

"Under control' was defined as less than 140/90 mm Hg.

The study authors caution, however, that the United States effort "should not be too quickly praised." Even there, they note, nearly half of all hypertension patients did not achieve blood pressure levels that meet current guidelines. "Substantial potential for better hypertension control and future costs savings," they say, "exists in both Europe and the United States."

"We found that U.S. physicians tended to have a lower threshold for beginning treatment and were more willing to increase the dose or add other medications when patients did not respond," said lead author, Richard Wang, M.D., Ph.D., of Temple University Hospital.

"We also found vast room for improvement, here and abroad," said co-author G. Caleb Alexander, M.D., assistant professor of medicine at the University of Chicago. "Overall, less than two-thirds of the patients reached the goals set by expert guidelines."

These deficiencies are important, he added, and suggest that "we need to find ways to overcome clinical inertia, the tendency of physicians and patients to rationalize the causes of elevated blood pressure and to delay stepping up treatment."

The research was reported in the Jan. 22, 2007 issue of the Archives of Internal Medicine.

By treating sooner and more aggressively, U.S. physicians may actually save money by reducing the overall economic burden of cardiovascular disease associated with hypertension, the authors suggest. One concern about more aggressive treatment is that some people might receive medications they don't need.

"This is a serious concern," said Alexander. "However, even in the U.S., average blood pressure before treatment was fairly high. This study confirms our impression that late treatment is common, under-treatment is not uncommon and we know there are millions of people with undiagnosed hypertension. This is an area where we can do better, with very little risk from trying harder.
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