Factors underlying superior hypertension control in the us

Wang YR _ et al_. (2007) Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. _Arch Intern Med_ 167: 141–147 Guidelines for the

treatment of hypertension are more aggressive in the US than elsewhere. To determine whether differences in guidelines translate into differences in clinical variables, Wang _ et al_.

analyzed data for the year 2004 from CardioMonitor—an ongoing, nationally representative survey of physician visits made by patients with cardiovascular diseases. The data set included

21,053 adults with hypertension who had visited 1,284 primary care physicians and 291 cardiologists in France, Germany, Italy, Spain, the UK or the US. A minimum of 92% of patients received

drug treatment for hypertension in each country. Average pretreatment blood pressure was lower in the US than in the European countries (161/94 mmHg vs 167–173/96–99 mmHg), while concomitant

use of antihypertensive drugs from two or more classes was more common in the US (64% vs 44–59% of patients). The authors defined 'controlled hypertension' as a most-recent blood

pressure reading of less than 140/90 mmHg. Multivariate analyses showed that hypertension was less likely to be controlled in the European countries (odds ratios 0.27–0.50; _P_ <0.001 for

all). The likelihood of a dose escalation or medication change in response to inadequately controlled hypertension was also lower in Europe (odds ratios 0.29–0.65; _P_ <0.001 for all).

The better rates of hypertension control in the US seem, therefore, to be attributable to lower thresholds for initiating treatment, and more-intensive drug regimens. RIGHTS AND PERMISSIONS

Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Factors underlying superior hypertension control in the US. _Nat Rev Cardiol_ 4, 297 (2007).

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