A call to action for more aggressive treatment of hypertension.

During the past three decades, tremendous progress has been made in the USA and many other nations in detecting and controlling hypertension. Health education efforts increased public knowledge of the benefits of treating hypertension, and rates of blood pressure control improved. Despite improvements in the past, however, more recent information has shown some disturbing trends; we are not as healthy a nation as we could be. Hypertension control rates are no longer improving, and are likely to fall short of the US Healthy People 2000 goal of blood pressure control in 50% of all hypertensive patients. Overwhelming data from clinical trials underscore the need to control hypertension, especially in the elderly, for whom hypertension control rates are lower than they are for the total US population. Data from the Framingham Study indicate that the incidence of heart failure increases with age and is greater in hypertensive patients than in normotensive patients. Hypertension precedes heart failure in 90% of all cases, and the prevalence of heart failure, greater today than it was a decade ago, is now the largest component of the Medicare budget (Medicare is the US health insurance and standards for medical participation program for those aged 65 years and older). Hypertension is also associated with an increase in the incidence of end-stage renal disease, and stroke and coronary heart disease may be increasing again. Such alarming trends are a call to action for the public, patients, and health professionals. Strong evidence supports the need for better blood pressure control, with an emphasis on the elderly and other difficult-to-treat populations.