Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Treating hypertension: who speaks for the patient?

Journal of Human Hypertension volume 35, pages 1057–1058 (2021)Cite this article

Subjects

The dissemination of medical knowledge traditionally has followed a hierarchical pattern. It starts with the rigorous work of researchers and experts in a particular field, and proceeds through the processes of creating publications, analyses of valid sources of relevant evidence, and the writing of clinical practice guidelines. Then, through a variety of written, in-person, and on-line educational programs, clinicians are advised about best practices, and in turn guide their patients into understanding and dealing with their own health issues.

An article in this issue of the Journal of Human Hypertension cites an instance where failure to follow this well-established pathway of care can result in a troubling outcome [1]. Tobe et al., who have personally contributed to the highly respected Canadian Hypertension Education Program make the argument that the success of the guideline has depended not simply on writing a learned statement and hoping that others might read it, but rather on a proactive process managed by an Implementation and Dissemination Task Force [2]. The strength of that effort lay in the participation across Canada of large numbers of hypertension experts who set up major educational meetings and formed local committees of volunteers committed to teaching the key elements of the national program [3, 4]. These authors also note that those strategies created a remarkable 80% treatment rate and about 70% control rates among hypertension patients in Canada, a performance unmatched by any other country [5].

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Tobe SW, Campbell NRC, Padwal RS, Kahn NA, Singer J. Change in education strategy associated with slippage in Canadian hypertension awareness, treatment and control rates.

  2. Tobe SW, Touyz RM, Campbell N. The Canadian Hypertension Education Program—a unique Canadian knowledge translation program. Can J Cardiol. 2007;23:551–5.

    Article  Google Scholar 

  3. Hua D, Carter S, Bellerive S, Allu SO, Reid T, Tremblay G, et al. Bridging the gap: innovative knowledge translation and the Canadian Hypertension Education Program. Can J Cardiol. 2012;28:258–61.

    Article  Google Scholar 

  4. Onysko J, Maxwell C, Eliasziw M, Zhang JX, Johansen H, Campbell NR. Large increases in hypertension diagnosis and treatment in Canada after a healthcare professional education program. Hypertension. 2006;48:853–60.

    Article  CAS  Google Scholar 

  5. Schiffrin EL, Campbell NR, Feldman RD, Kaczorowski J, Lewanczuk R, Padwal R, et al. Hypertension in Canada: past, present and future. Ann Glob Health. 2016;82:288–99.

    Article  Google Scholar 

  6. Leung AA, Williams JVA, McAlister FA, Campbell NRC, Padwal RS, Hypertension Canada’s Research and Evaluation Committee. Worsening hypertension awareness, treatment, and control rates in Canadian women between 2007 and 2017. Can J Cardiol. 2020;36:732–9.

    Article  Google Scholar 

  7. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.

    Article  CAS  Google Scholar 

  8. Wright JT Jr, Fine LJ, Lackland DT, Ogedegbe G, Dennison, Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014;160:499–503.

    Article  Google Scholar 

  9. Gibbons GH, Shurin SB, Mensah GA, Lauer MS. Refocusing the agenda on cardiovascular guidelines: an announcement from the National Heart, Lung, and Blood Institute. Circulation. 2013;128:1713–5.

    Article  Google Scholar 

  10. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA, Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430–7.

    Article  Google Scholar 

  11. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255–64.

    Article  Google Scholar 

  12. Messerli FH, Hofstetter L, Agabiti-Rosei E, Burnier M, Elliott WJ, Franklin SS, et al. Expertise: no longer a sine qua non for guideline authors? J Hypertens. 2017;35:1564–6.

    Article  CAS  Google Scholar 

  13. Messerli FH, Hofstetter L, Agabiti-Rosei E, Burnier M, Elliott WJ, Franklin SS, et al. Expertise: no longer a sine qua non for guideline authors? Hypertension. 2017;70:235–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, State University of New York Downstate Medical College, New York, NY, USA

    Michael A. Weber

  2. Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA

    Daniel T. Lackland

Authors
  1. Michael A. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel T. Lackland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Weber.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weber, M.A., Lackland, D.T. Treating hypertension: who speaks for the patient?. J Hum Hypertens 35, 1057–1058 (2021). https://doi.org/10.1038/s41371-021-00564-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-021-00564-x

Search

Advanced search

Quick links