Current status of hypertensive disease treatment: results from the Evaluation and Interventions for Systolic Blood pressure Elevation: Regional and Global (EISBERG) project.

Conclusive evidence has shown the benefits of antihypertensive treatment The systematic review of end-point trials has indicated that for a reduction of 10-12 mmHg in systolic blood pressure or 5-6 mmHg in diastolic blood pressure, the incidence of stroke is reduced by 38% and ischaemic heart disease by 16%. Despite this, studies on the effectiveness of treatment - carried out both in specialist hypertension clinics and in the community - have all shown that patients receiving treatment for hypertension continue to be at increased risk of cardiovascular disease. Failure to control blood pressure to recommended guidelines contributes substantially to this excess risk. Some reasons for this failure are outlined below. Socioeconomic factors and lack of professional and patient compliance appear to be of considerable importance in the failure to control blood pressure. The Evaluation and Interventions for Systolic Blood pressure Elevation: Regional and Global (EISBERG) project investigated both the quantitative and qualitative aspects of the current treatment of hypertension internationally. The quantitative study indicated major shortcomings in blood pressure control, and in particular, poor control of elevated systolic pressure, which accounted for 90% of treatment failures. The qualitative research was based upon semi-structured interviews with professionals, patients and their care-givers. These interviews indicated that there were misconceptions among physicians regarding the relative importance of systolic and diastolic blood pressure, the need for more aggressive treatment in the elderly, and the need for improved physician-patient interactions. If the therapeutic advances emerging from medical research are to be translated into clinical benefits, both the understanding and communication of the need for effective blood pressure control must be improved.