Control of blood pressure in the community: an unsolved problem.

Available data indicate that blood pressure (BP) is reduced below 140-90 mmHg in less than 30% of hypertensive patients. This poor control of BP derives from lack of diagnosis (unawareness of hypertension), lack of treatment of aware hypertensive patients and lack of efficacy of treatment. Systolic BP (SBP) is now considered as the most important parameter for diagnosis and stadiation of hypertension, above all in elderly patients, and the most frequent cause of unsatisfactory control of BP in the population. Lack of SBP control is caused both by physicians' attitude and difficulty in reducing SBP. Physicians are more prone to consider diastolic BP as the most important parameter for diagnosis and stadiation of hypertension, decision to treat and intensification of treatment and therefore SBP is often forgotten and-or misinterpreted in this decision making process. On the other hand, since current antihypertensive drugs are equally effective in lowering SBP and DBP and-or less effective in lowering SBP more than DBP, SBP is often uncontrolled in treated patients with isolated systolic hypertension or prevalent increase in SBP. The possibility of obtaining better control of SBP in the future is linked to better education of physicians, who need to pay greater attention to SBP as a parameter for diagnosing, treating and intensifying treatment, and to the development of new drugs more active in reducing SBP.