Published in the Journal of Hypertension, the paper is led by Irakli Todua, MD an internal medicine doctor and researcher at Tufts Medical Center and Assistant Professor at Tufts University School of Medicine, and Deeb N. Salem, MD, Senior Vice President, Academic Integration at Tufts Medicine and Sheldon M. Wolff Professor at Tufts University School of Medicine.
Together, they take a comprehensive look at the persistent challenge of uncontrolled hypertension and outline practical, evidence-based strategies that could help improve care and outcomes.
A common condition with serious consequences
High blood pressure affects more than 1.4 billion people globally and is a leading risk factor for heart disease, stroke and kidney disease. Yet even with effective treatments available, many patients do not reach recommended blood pressure goals.
One of the most concerning findings highlighted in the review is how often hypertension goes unrecognized. Many individuals with uncontrolled blood pressure are unaware of their condition—even after interacting with the healthcare system—while others face barriers that make ongoing management difficult.
Understanding the gaps in care
Todua and Salem point to several interconnected reasons why blood pressure control remains a challenge. These include limited patient awareness, difficulty adhering to medication regimens and "therapeutic inertia," when treatment plans are not adjusted despite elevated readings.
They also highlight the underuse of tools like ambulatory blood pressure monitoring as well as broader social and economic factors that can affect access to care and consistency in treatment. Improving adherence—even modestly—could have a meaningful impact on reducing cardiovascular events and deaths.
Aligning goals with the latest evidence
Another key takeaway from the review is the need for greater alignment between clinical guidelines and performance measures.
Organizations such as the American College of Cardiology and American Heart Association recommend a blood pressure target of less than 130/80 mmHg for many patients. However, current Medicare quality measures still use a higher threshold.
The authors suggest that adopting lower targets more consistently could help improve cardiovascular outcomes, particularly for patients at higher risk.
New and emerging treatment approaches
The review also highlights a number of evolving strategies that could help address resistant or difficult-to-control hypertension.
These include newer medications that target different biological pathways as well as polypill approaches that combine multiple therapies into a single dose to simplify treatment. In addition, renal denervation—a minimally invasive procedure—continues to show promise for select patients whose blood pressure remains elevated despite multiple medications.
Moving toward more personalized care
Ultimately, the authors emphasize the importance of a more proactive and individualized approach to hypertension management.
That means earlier detection, more consistent monitoring outside of the clinic and timely adjustments to treatment plans. It also means recognizing and addressing the real-world challenges patients face, from medication complexity to access and affordability.
Advancing care through research
With hypertension-related healthcare costs in the United States projected to exceed $220 billion annually by 2035, improving blood pressure control is both a clinical priority and a public health imperative.
Clinician researchers at Tufts Medicine are helping to identify practical solutions that can be applied in everyday care—bringing us closer to better outcomes for patients living with high blood pressure.
