Nontraditional problems of antihypertensive management

Problems with patient screening, disease labeling, diagnosis confirmation, patient compliance and physician adherence continue to undermine efforts to control hypertension and prevent its complications.Simple screening involves patient selection bias, limited new diagnosis, arterial pressure lability, ambiguous disease definition, complex measurement imprecision and deficient patient follow-through. Case finding may improve some of these deficiencies. Recent data suggest that labeling a person as hypertensive may produce impaired self-concept, marital dissatisfaction and absence from work. Newer series confirm the low prevalence of curable, secondary hypertension among unselected patients and strongly argue for restricting extensive hypertensive evaluations to selected subpopulations. Patient noncompliance is highly prevalent, poorly predicted and imprecisely measured. Based on successful trials, specific suggestions can be made to achieve maximum patient compliance and physician adherence to diagnostic and therapeutic guidelines.