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CE: Swati; JH-D-16-00347; Total nos of Pages: 9;

JH-D-16-00347

Editorial

Why in 2016 are patients with hypertension not 100%
controlled? A call to action
Josep Redon a, Jean-Jacques Mourad b, Roland E. Schmieder c, Massimo Volpe d,e,
and Thomas W. Weiss f

The objective is to consider the problem of high blood
pressure (BP), a leading global risk factor, associated with
substantial morbidity and mortality. Despite the availability
of treatment guidelines and a wide range of therapies, BP
control is suboptimal in many countries. Recent data
indicate that only around 40% of patients manage to
achieve an adequate level of BP control. A group of
international experts in the field of hypertension met in
2008 to consider this problem. The resulting white paper
delivered an urgent call to action and identified six key
issues for improving BP control. In 2015, a working group
of investigators spontaneously undertook an action with
the primary aim of considering the current hypertension
management situation in Europe, to discuss whether the
situation had changed since 2008 and to determine what
can be learnt from the projects in other continents, such
as the Canadian Hypertension Education Program, which
has shown that higher levels of BP control can be achieved
across a general population. The working group identified
the main challenges affecting the improvement of BP
control today and suggests five key actions: identify the BP
treatment target of less than 140/90 mmHg for the
majority of patients, simplify treatment strategies and
encourage pill reduction, decrease therapeutic inertia,
improve patient empowerment, and involve healthcare
systems and reduce the prevailing focus on drug costs in
many healthcare systems. Implementing key actions
identified by the working group may help to improve
achievement of better BP control across Europe.
Keywords: blood pressure, call to action, hypertension
Abbreviations: BP, blood pressure; CHEP, Canadian
Hypertension Education Program; ESC, European Society of
Cardiology; ESH, European Society of Hypertension

INTRODUCTION

O

ver the last two decades, the status of high blood
pressure (BP) has increased from being the fourth
risk factor for global disease burden in 1990 to the
first in 2010 [1]. Consequently, the increase in annual
mortality over the time period accounted for more than
2 million deaths [1].
Improvement in BP control rates is probably one of the
most beneficial steps that can improve life expectancy and
the quality of life for millions of people with immediate and

Journal of Hypertension

measurable results. Over the last few years, developments
in hypertension management have included new interventions (e.g. renal denervation and carotid baroreceptor
stimulation), novel treatments like direct renin inhibitors,
new treatment modalities such as fixed-dose combinations,
and increasing use of out-of-office BP measurement.
Despite these developments, the lifetime burden of hypertension remains substantial and highlights the need for new
strategies [2]. In terms of the number needed to treat, the 5year rate to prevent one death is 125 in hypertension [3].
Besides the high BP per se, the clustering of chronic diseases
is also of concern, particularly as life expectancy increases
and consequently the coexistence of multimorbidity [4,5].
In 2008, an urgent call to action that aimed to address the
inadequate control of hypertension and the toll it places on
patients in Europe was published as a white paper by an
international group of physicians [6]. The group identified
the following six key challenges to the treatment of hypertension, and suggested straightforward actions to improve
the management of hypertension:
1.
2.
3.
4.
5.
6.

Inadequate primary prevention
Faulty awareness of risk
Lack of simplicity in the treatments
Therapeutic inertia
Insufficient patient empowerment
Unsupportive healthcare systems.

In 2016, these six key challenges remain and BP control
is still suboptimal with only 39% of hypertensive patients
achieving a BP target of less than 140/90 mmHg; therefore, a
challenge for physicians is to get patients to goal and
increase the BP control rates [7,8]. On this basis, a working

Journal of Hypertension 2016, 34:000–000
a
INCLIVA Research Institute, University of Valencia and CIBERObn ISCIII, Valencia,
Spain, bUnite Me´decine Interne – HTA and CHU Avicenne, Paris, France, cUniversity
Hospital of the Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen,
Germany, dUniversity of Rome ‘Sapienza’, Rome, eIRCCS Neuromed, Pozzilli, Italy
and f3rd Medical Department, Wilhelminenhospital, Vienna, Austria

Correspondence to Professor Josep Redon, INCLIVA Research Institute, University of
Valencia and CIBERObn ISCIII, Avenida de Mene´ndez y Pelayo, 4, 46010 Valencia,
Spain. Tel: +34 961 97 35 17; e-mail: josep.redon@uv.es
Received 11 April 2016 Revised 19 April 2016 Accepted 4 May 2016
J Hypertens 34:000–000 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights
reserved.
DOI:10.1097/HJH.0000000000000988

www.jhypertension.com

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JH-D-16-00347

Redon et al.

group of investigators convened to consider and discuss the
following objectives:
1. To assess the current situation in hypertension management in Europe, identify areas where progress has
been made, and appreciate the scale and nature of
the unmet need that remains.
2. To determine what can be learned from experience in
other continents, such as the Canadian Hypertension
Education Program (CHEP) and what has been
learned from the ‘70% treated to BP goal or 70%
objective’ initiatives in France and Italy.
3. To identify the challenges that stand in the way of
improving rates of BP control across Europe.
4. To provide key actions on the most effective ways to
improve BP control levels across Europe over the
next few years.
The current study presents the outcome of these discussions.

CURRENT SITUATION
Worldwide, only a modest fall in the proportion of the
population with high BP was observed between 1980 and
2008 [9]. In 2010, the European Study on Cardiovascular
Risk Prevention and Management in Usual Daily Practice
(EURIKA), a cross-sectional study of the status of primary
cardiovascular disease prevention, identified that 38.8% of
patients achieved a target BP (Fig. 1) [7]. The continuing
need to improve the control of high BP has been highlighted in a report from the WHO [10] and a fact sheet issued
by the World Hypertension League and the International
Society of Hypertension [11].
To determine how the hypertension landscape in European countries has evolved since publication of the white
paper in 2008, in particular the changes in BP control rates,

a review of the published literature was conducted. The
PubMed database was searched from 1 January 2006 to 31
March 2015, using the following terms: prevalence, incidence, control, hypertension, and European countries. A
total of 72 studies were identified and, of those, only 20
reported BP control rates in European countries. A summary of the methodology and results are presented in Table
1. BP control was defined as DBP/SBP less than 140/
90 mmHg (<130/80 mmHg in patients with comorbid conditions) or being treated for high BP.
A wide variation in BP control rates is observed in all
hypertensive patients: ranging from 9.1% in White-Dutch
patients to 55.1% in Germany [12,13]. For those patients
receiving treatment, the BP control rates range from 15.8%
in Hungary [14] to 63% in England [15]. A higher control
rate of 70% was observed in the United Kingdom when
BP control was defined as less than 150/90 mmHg [16].
The results from studies in the Czech Republic [17],
Denmark [18], England [15,19], and Spain [20] highlight
an improvement in BP control in all patients and those
receiving treatment over various time periods. Poor BP
control is also evident in older patients, such as observed in
France [21] and Dutch-African and Dutch-South Asians
[12].
Results from a review of the prevalence, awareness,
treatment, and control of hypertension in Germany for
1998 and 2008–2011, published after our literature review,
confirm an increase in control between these time periods
(55 vs. 72%) [32].
Overall, an improvement in BP control is observed in
treated patients; however, there is still an urgent need to
improve BP control rates in untreated and treated populations. It is clear that various sources of inertia exist which
need to be resisted at different levels and that the responsibility for improving BP control rates is shared (Fig. 2) with
all players having some power and responsibility.

Norway 34.6%

Germany 36.3%
Sweden 33.6%
UK 42.8%
Austria 35.9%
Belgium 4.3.7%
France 45.5%
Turkey 32.1%
Spain 41%

Greece 47.5%
FIGURE 1 Proportion (%) of primary care patients with SBP/DBP less than 140/90 mmHg (<130/80 mmHg for patients with diabetes) in Europe in 2010. Adapted from [7].

2

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A call to action to control hypertension in 2016
TABLE 1. Summary of the methodology and blood pressure control results from the literature in European patients with hypertension
(published between 2008 and 2015)
Patients with BP controla (%)
Reference

Country

Methodology

Cı´fkova´ et al. [17]

Czech Republic

Paulsen et al. [18]

Denmark

Falaschetti et al. [19]

England

Falaschetti et al. [15]

England

Wagner et al. [21]

France

Six independent cross-sectional
population surveys from
1985 to 2007/2008
Danish General Practice
Database from 2009 to 2011
Two cross-sectional, nationally
representative, random
samples (HSE) of
noninstitutionalized adults in
2003 and 2006
Five cross-sectional, nationally
representative, random
samples (HSE) of
noninstitutionalized adults
between 1994 and 2011
Epidemiological, cross-sectional,
population-based survey
between 2005 and 2007
(MONA LISA)

Labeit et al. [22]

Germany

In der Schmitten
et al. [13]

Germany

Ninios et al. [23]

Greece

Triantafyllou et al. [24]

Greece

Sonkodi et al. [25]

Hungary

Steiner et al. [14]

Hungary

Tocci et al. [26]

Italy

Agyemang et al. [12]

The Netherlands
The United Kingdom

Agyemang et al. [27]

The Netherlands

Rodrı´guez-Roca et al.
Spain
[28]
Catala´-Lo´pez et al. [29] Spain

Escobar et al. [20]

Spain

Rodrı´guez-Roca et al.
[30]
Serumaga et al. [16]

Spain
The United Kingdom

Journal of Hypertension

Cross-sectional DETECT study
in 2003
Cross-sectional data from
general practice (CRISTOPH)
in 2006
Population-based study in
patients at least 65 years old
between 2002 and 2004
Cross-sectional survey in
patients aged at least 65
years old in 2006
BP screening in blue and whitecollar employees in 2005
BP screening project in whitecollar employees in 2005
Observational studies and
clinical surveys published
between 2005 and 2011
Secondary analyses of
population-based studies
between 1990 and 2006

Cross-sectional study of
Ghanaian adults in
Amsterdam in 2010
PRESCAP 2006 in patients at
least 80 years old
Systematic review and metaanalysis of epidemiological
studies since 2000
Three cross-section surveys
(PRESCAP) in primary care
setting in 2002, 2006, and
2010
PRESCAP 2010 in patients at
least 80 years old
Interrupted time series analysis
in primary care using THIN
database (2000–2007)

Number of
patients

All

Treated

13 972

1985: 3.9
2007/2008: 24.6

1985: 13.2
2007/2008: 42.1

37 651

2009–2011: 33.2



2003: 8834
2006: 7478

2003: 22
2006: 28

2003: 46
2006: 52

1994: 12 117
2011: 4466

1994: 11
2011: 37

1994: 33
2011: 63

4825



55 518

Men aged
35–64 years: 26.5
35–74 years: 24.1
Women aged
35–64 years: 45.8
35–74 years: 38.9


2003: 21.4%

3355

55.1



720



2004: 42.5

171

32.8

36.9

2012



18.5

1000



15.8

158 876



37.0

13 999

212

White-Dutch: 9.1
White-Dutch: 40.9
White-English: 11.1
White-English: 45.3
Dutch-African: 10.5
Dutch-African: 30.9
English-African: 26.2
English-African: 56.7
English-Caribbean: 23.8 English-Caribbean: 50.3
Dutch-South Asian:
Dutch-South Asian:
16.1
34.4
English-Indian: 17.9
English-Indian: 44.5
English-Pakistani: 29.5 English-Pakistani: 65.8
English-Bangladeshi:
English-Bangladeshi:
31.7
57.9
15
33

923



35.6

341 632



33

2002: 12 754
2006: 10 520
2010: 12 961



2002: 31.1
2006: 41.4
2010: 46.3

13 420



40.8

470 725



70b

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Redon et al.
TABLE 1 (Continued)
Patients with BP controla (%)
Number of
patients

Reference

Country

Methodology

Ferrari et al. [31]

Western, Central, and
Eastern Europe

Western/Central Europe: 15 388
5-year observational
Eastern Europe: 3026
longitudinal cohort study
(CLARIFY) in outpatients with
stable CAD recruited in
2009/2010

All

Treated



Western/Central
Europe: 55
Eastern Europe: 47

a

Defined as at least 140/90 mmHg (<130/80 mmHg in patients with comorbid conditions) or being treated for high BP, unless specified.
b
BP less than 150/90 mmHg.
BP, blood pressure; CAD, coronary artery disease; CLARIFY, the prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease; CRISTOPH,
Cardiovascular Risk Intervention Study to Optimise Treatment in Patients with Hypertension; DETECT, Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for
Commitment of Treatment; HSE, Health Survey for England; PRESCAP, PRESio´n arterial en la poblacio´n Espan˜ola en los Centros de Atencio´n Primaria; THIN, The Health Improvement
Network.

INITIATIVES TO IMPROVE BLOOD
PRESSURE CONTROL
Experiences in different countries have demonstrated that
large improvements can be achieved by applying adequate
actions. Before considering European hypertension management initiatives to improve BP control, it is important to
consider the CHEP, an initiative launched in 1999, to
improve hypertension control rates. Canada has one of
the highest rates of awareness, treatment, and control of
BP in the world [33–35]. CHEP is a professional education
programme which provides annually updated simple
recommendations and clinical practice guidelines for the
detection, treatment, and control of hypertension [34,36].
Dramatic increases have been observed in the diagnosis
and treatment of hypertension, especially in the first 4 years
after the initiation of CHEP [37]. It has been estimated that
there was a 77% increase in the number of individuals
diagnosed with hypertension in Canada from 1996 to
2003 [37]. An increase of 106.8% was observed for antihypertensive prescriptions between 1996 and 2006 [38].
These improvements in hypertension management have
been associated with major benefits in terms of reduction in
cardiovascular deaths and hospitalization rates [37].
Recently, there have been a number of initiatives in
Europe to improve hypertension management, and some
examples for Austria, France, and Italy are summarized
here.
Track nonadherence

Fight against
inertia

Promote
adherence

More potent
treatments
Better evaluation of
BP level

Primary prevention
of HT

Simple and implementable
recommendations

Caregivers

Authorities

Pharmacists
Scientific societies

Patients
Pharma industry

FIGURE 2 Illustration of the shared responsibility concept for improving
blood pressure control illustrating how everyone has a little power and some
responsibility.

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To improve the understanding of hypertension management in primary care, a cross-sectional study of 20 000
patients is currently being conducted in collaboration with
the Pharmacists’ College in Vienna and lower Austria. In
total, 554 pharmacies in two Austrian provinces (rural
lower Austria and urban Vienna) will be enrolled to obtain
data on demographics, control rates, and awareness in
consecutive individuals approaching the respective
pharmacies with a prescription filled for antihypertensive
medication.
The study will evaluate the proportion of patients with
adequately controlled hypertension, using a BP threshold
of less than 140/90 mmHg. Prespecified secondary outcomes are control rates according to age, sex, socioeconomic status, rural or urban residence, specialty of the
treating physician, disease awareness, and number of
drugs taken.
A phase IV study on BP lowering is currently being
conducted in primary care in Vienna [39]. The aim of this
prospective randomized, open-label, multicentre study is to
enhance BP control in primary care by introducing a standardized and simplified titration regimen with single-pill
combinations, comprising an angiotensin receptor blocker,
calcium channel blocker, and the thiazide diuretic hydrochlorothiazide. The primary endpoint will be the proportion of patients achieving the target office BP after 6
months’ follow-up. This study primarily aims toward overcoming physician inertia.

France

Preserve/organize
access to care

Physicians

Austria

Although there have been improvements in BP control in
France, from 31% of treated patients (aged 65 years) in the
Three-City study [40], conducted in 1999–2001, to 42.5% of
treated patients (aged 65–74 years) in the National Health
Nutrition Study, conducted in 2006–2007 [41], there has
been a plateauing in rates [42]. In particular, there has been
an overreliance on monotherapy [41,43].
In 2012, the French League against Hypertension and
The French Society of Hypertension, with the support of the
French Ministry of Health, made BP control a priority with
the goal of achieving 70% of treated and controlled hypertensive patients in 2015 [42]. A simplified algorithm was
proposed with seven key points dedicated to general
practice:
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A call to action to control hypertension in 2016

1. Confirmation of high BP outside the office
2. Screening for poor adherence
3. Switching from monotherapy to fixed combination
therapy in case of lack of control after initial treatment
4. Proposing a prescription of three-drug therapy of
hypertension in patients not controlled by a twodrug therapy
5. Screening for signs in support of a cause of
uncontrolled hypertension
6. Organizing a healthcare course for hypertensive
study participants and access to specialists
7. Evaluating the performance of management [42].
With regard to confirmation of high BP outside the office,
improvements in the perception (45 vs. 66%) and use (70 vs.
92%) of home BP measurement have been observed among
French general practitioners between 2004 and 2009 [44].
In 2013, the French Society of Hypertension issued new
practical guidelines on the management of hypertension
[45]. These simple guidelines, referred to as the appointments of the hypertensive patient, include 15 recommendations divided into three time points: prior to treatment
initiation (diagnosis), initial treatment plan (first 6 months),
and long-term plan (beyond 6 months). These three treatment visit time points have been identified as critical in
improving BP control. It is important to highlight that the
primary objective of the second time point, the initial
treatment plan, is to obtain BP control within the first
6 months (SBP: 130–139 mmHg and DBP <90 mmHg).
The guidelines focus on aspects of BP control, such as
confirmation of diagnosis outside the doctor’s office, use of
fixed-dose combinations, screening for poor adherence,
and encouraging home BP monitoring.
Although these guidelines have been well received and
facilitate the progressive implementation of the national
recommendations, there are still a number of barriers to
improving BP control. For example, fixed triple therapies
are not reimbursed and there is no further discussion for full
coverage of patients with severe (resistant) hypertension.
Also, industrial promotion is rare and there are recurrent
negative messages in the media concerning the overtreatment of hypertension. Results from the PASSAGE registry,
conducted in 1000 French general practitioners in 2014,
demonstrated that only 54.4% of patients met the BP control
criteria of 140/90 mmHg in patients less than 80 years old
and SBP less than 150 mmHg in patients more than 80 years
old [43].

Italy
The Italian Society of Hypertension also published guidance on improving BP control in 2012, with the aim of
achieving BP control in 70% of treated patients with hypertension by 2015 [46].
In 2011, BP control rates of 37% were observed in the
treated hypertensive population [26], whereas more recent
analyses of large databases derived from the general population and outpatient clinics have reported BP control rates
toward 60% of treated patients with hypertension at the end
of 2013 [47]. These included analysis of an Italian Health
Search general practice database, based on more than
900 000 outpatients, and a population survey on World
Journal of Hypertension

Hypertension Day, based on more than 10 000 adult individuals, who had their BP measured free of charge in open
access points promoted by the Italian Red Cross and Italian
Society of Hypertension [48]. A recent survey has also
highlighted an imbalance in the distribution of hypertension centres in Italy, with the majority located in the north of
the country, which may contribute to poor BP control in
other regions [49].
Several educational and interventional activities were
planned and adopted in the last few years. A diagnostic
and therapeutic algorithm was developed with the aim of
improving the awareness and the behaviour of general
practitioners and guiding their choice of antihypertensive
treatment (www.siia.it). The algorithm has been endorsed
by the Italian Society of Hypertension and developed by the
‘Agenzia Italiana per il Farmaco’ [50]. Other tools published
by the Italian Society of Hypertension include a consensus
document which provides simple and easy-to-use guidance
on the more effective use of combination therapies in
treated uncontrolled hypertension [51], and practical
recommendations on the diagnosis and management of
patients with resistant hypertension [52]. Finally, with the
participation of experts from France, Germany, Greece, and
Spain, a practical treatment platform based upon angiotensin receptor blocker-based single-pill therapy approach has
been developed in an attempt to identify the most appropriate approach for individual patients [53].

CURRENT CHALLENGES
The working group identified five key challenges to controlling BP, which overlap with those identified by the
working group in 2008 [6], highlighting the continued failure to control hypertension. These challenges are recognized as barriers not only for physicians and healthcare
providers but also for patients and payers. Although
inadequate primary prevention was identified by the
2008 working group as the first challenge, this is beyond
the scope of this study; however, this present working
group noted that dietary changes are still needed, especially
a reduction in salt intake.

Controversy over blood pressure goals
The European guidelines [54] are long and somewhat
complicated document for physicians and general practitioners, although they reflect best available knowledge
and evidence rather than provide guidance for clinical
practice. The European Society of Hypertension (ESH)/
European Society of Cardiology (ESC) 2007 guidelines
[55] recommended two distinct BP targets: less than 140/
90 mmHg in low–moderate-risk patients with hypertension
and less than 130/80 mmHg in high-risk patients. Furthermore, in 2012, the European Association for Cardiovascular
Prevention and Rehabilitation [56] recommended a target of
less than 140/80 mmHg for patients with diabetes. As such,
reappraisal of the ESH/ESC 2007 recommendations led to
further stratification of the BP targets according to risk in the
2013 guidelines [54].
These multiple targets may be confusing for physicians
and less direct and effective than the message that the
universally agreed minimum BP target is less than 140/
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90 mmHg to reduce the risk of significant morbidity or
mortality [6]. A large meta-analysis on the use of BP-lowering drugs in the prevention of cardiovascular disease
concluded that treatment should not be limited to those
patients with hypertension, and that guidelines could be
simplified enabling drugs to be given to study participants
with all BP levels [57].
The present working group agreed that a simplification
of BP treatment targets is required, suggesting that a BP
strictly below 140/90 mmHg should be the goal for the vast
majority of patients, including the elderly. Individualized
treatment could be considered and discussed with specific
groups of patients, for example, patients with diabetes and
the frail elderly.
The situation may be further complicated by the recent
Systolic Blood Pressure Intervention Trial (SPRINT). This
large study ( 9000 hypertensive patients aged 50 years
with increased cardiovascular risk or reduced renal function, including 25% of patients aged >75 years) has shown
that treating patients to an SBP target less than 120 mmHg
was associated with a substantial reduction in the rate of
cardiovascular events and death compared with treating
patients to the widely used SBP target less than 140 mmHg
[58]. If confirmed, these findings may lead to calls for
treatment guidelines to be revised and for a new SBP target
to be introduced in specific populations. However, some
characteristics of Systolic Blood Pressure Intervention Trial
such as the BP measurement being unblinded and unobserved introduce some words of caution. Careful considerations are required as the beauty of existing guidelines is its
clear, simple message: control BP less than 140/90 mmHg.

Treatment complexity
As highlighted previously, there has been an overreliance
on monotherapy, particularly in France [41,43]. Importantly, the ESH/ESC guidelines note that most patients will
need two or more medications to control BP, and provide
recommendations on possible combinations [54]. The
working group advised that the development of educational materials have a valuable role to play in supporting
physicians. Moreover, reducing the number of pills by
using fixed-dose combinations is advisable [59].

Physician inertia
Physician inertia has been documented as a major reason
for lack of uptitration of treatment (and BP control) in large
randomized controlled trials in hypertension, such as
Losartan Intervention For Endpoint reduction in hypertension study (LIFE), VAlsartan Longterm Use Evaluation
trial (VALUE), the Anglo-Scandinavian Cardiac Outcomes
Trial (ASCOT), and the Avoiding Cardiovascular Events
through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) [60]. There is often a
reluctance to change or increase antihypertensive treatment
in patients presenting with uncontrolled BP. Results from a
European survey of physicians’ attitudes have revealed that
they may lack confidence in BP measurements or hesitate to
reduce high SBP [8]. Nevertheless, inactivity and failure to
increase the therapeutic efforts is unacceptable without
good reason on an individual basis.

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Increasing physicians’ and other healthcare professionals’ (e.g. nurses, pharmacists, and nutritionists)
awareness of increased risk in those patients not achieving
a minimum BP target within the first year of treatment is
important in overcoming therapeutic inactivity/inertia.
Enrolling patients into healthcare programmes or registries,
with standardized written feedback about BP control
achievement rates may be an important tool to remind
physicians at each visit whether the BP goal has been
achieved [61].

Poor patient education
There was a wide consensus among the working group of
the importance of the active participation of the individual
in the prevention and treatment of hypertension. Empowerment requires the patient to accept responsibility for their
own health and commit to making lifestyle changes and
adhering to treatment.
There are a number of solutions to improving patients’
empowerment, including the provision of information and
easy-to-use decision tools, which may take the form of a
mobile app, and participation in hypertensive patient
associations. In some countries, a multidisciplinary team
approach, including the delivery of education programmes
by nurses and pharmacists, may help with patient engagement.
Integration of self-assessment controls, such as home BP
monitoring, not only provides valuable treatment information for the physician but also encourages patients to
adhere to treatment.

Short-term economic objectives
The public health implications of uncontrolled BP are
widely recognized [62]; however, there is insufficient
perception of the challenges related to the management
of hypertension by payers. The working group identified
the need to rebuild the reputation of hypertension with
payers and shift the focus away from cost to also consider
overcoming inertia, promoting adherence, improving
evaluation of BP levels, and simplifying treatment recommendations [62].

KEY ACTIONS
On the basis of these challenges, the working group identified the following five key actions:
1. Simplify the BP treatment target to less than 140/
90 mmHg for the majority of patients
2. Simplify treatment options
3. Decrease therapeutic inactivity/inertia
4. Improve patient empowerment
5. Involve healthcare systems and shift the focus away
from cost.
These simple key actions should form the basis of
hypertension management in Europe going forward,
ensuring that more patients are achieving BP control in
the future, and thereby reducing cardiovascular morbidity
and mortality.

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ACKNOWLEDGEMENTS
Funding for this meeting and for editorial assistance, provided by Vicky Hinstridge, of inScience Communications,
Springer Healthcare, came from Daiichi Sankyo Europe
GmbH. The funding provider played no part in the meeting
other than providing logistical and editorial support. The
decision to develop an article based upon discussions held
during the meeting was taken by the authors who carried
out literature searches, developed the outline, provided
detailed requests for editorial assistance, and reviewed the
manuscript at each stage of development.

8.

9.
10.

11.

Conflicts of interest
J.R.: received advisor fees for Daichii Sankyo GmBH, the
Menarini group, GSK, and Boehringer Ingelheim. Lecturer
for Daichii Sankyo GmBH, the Menarini group, GSK, and
Boehringer Ingelheim, MSD.
J.M.: consultancy and lecturing fees from Daiichi Sankyo
GmBH, the Menarini group, Servier, BMS, Pfizer, and Bayer.
R.E.S.: received speaker and advisor fees from Daiichi
Sankyo GmBH and his institution received a grant from
Daiichi Sankyo GmBH.
T.W.W.: received lecture fees from AstraZeneca, Bayer,
Boehringer-Ingelheim, Daiichi Sankyo GmBH, Eli-Lilly,
Medronic, the Menarini group, Novartis, Servier, and Vifor
Pharma; advisory board and consultation fees from AstraZeneca, Boston Scientific, Daiichi Sankyo GmBH, Eli-Lilly,
Medtronic, and Sanofi Aventis; and research grants from
AstraZeneca, the Austrian Science Fund, the Austrian
Cardiology Society, the Austrian Hypertension League,
Boehringer-Ingelheim,
Bristol-Meyer-Squibb,
Daiichi
Sankyo GmBH, and the Menarini group.
M.V.: received consultancy fees from Takeda International, Daiichi Sankyo GmBH, Actelion, Novartis Pharma,
and lecturing fees from Daiichi Sankyo GmBH, the Menarini group, Servier, BMS, Pfizer, and Bayer.

12.

13.

14.

15.
16.

17.

18.

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Volume 34 Number 1 Month 2016

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JH-D-16-00347

A call to action to control hypertension in 2016

Reviewers’ Summary Evaluation
Reviewer 1
An independent working group has identified the main
challenges affecting the improvement of BP control today
and suggests five key actions: identify the BP treatment
target of <140/90 mmHg for the majority of patients,
simplify treatment strategies and encourage pill reduction,

Journal of Hypertension

decrease therapeutic inertia, improve patient empowerment, involve healthcare systems and reduce the prevailing
focus on drug costs in many healthcare systems. Thus, we
should stop blaming the patients, and we should not blame
the drugs, as these five items mostly identify what the
treating physicians can do to improve the care for people
with hypertension.

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