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YOU JUST MIGHT HAVE HYPERTENSION AND NOT KNOW IT
FLORENCE, Italy- The 2025 European Congress of Internal Medicine (March 5-8) featured a collaborative session with the European Society of Hypertension that reviewed current guidelines, global hypertension prevalence, and management challenges in specific patient populations.
Professor Dragan Lovic from Singidunum University Medical School and ESH Scientific Council member presented troubling data indicating that global hypertension control efforts have largely failed. According to World Health Organization statistics, hypertension affects 1.3 billion people globally, with 46% unaware of their condition. While 42% of hypertensive individuals receive diagnosis and treatment, only 21% achieve adequate blood pressure control.
This persistent public health challenge continues to be a primary cause of death worldwide, with prevalence rates steadily climbing over decades and affecting all genders equally. These findings underscore the urgent need for improved hypertension detection, treatment adherence, and management strategies to address this widespread cardiovascular risk factor.
Despite the availability of diverse medications and combination therapies, hypertension treatment outcomes remain inadequate. Across Europe, although 78% of patients with hypertension receive treatment, only 49% achieve proper blood pressure control, with substantial differences observed between nations.
Additional inconsistencies exist in medication combination preferences between primary care physicians and heart specialists.
“We’re dealing with a complicated situation,” explained Lovic in a conversation with Univadis Italy, a Medscape Network publication. “While an interdisciplinary approach would ideally address hypertension management effectively, we encounter a practical challenge: Primary care physicians must treat numerous conditions beyond hypertension, making it difficult to maintain current knowledge and adjust prescriptions appropriately.”
Despite these obstacles, Lovic stressed that continued education and professional development remain essential for improving global hypertension management practices.
Why are hypertension control rates so poor then? Multiple factors contribute, but medication adherence is a critical issue. Clinical guidelines specifically include sections addressing compliance problems and strategies to overcome them.
Research shows a clear correlation: as prescription complexity increases, patient adherence decreases. Developing individualized treatment approaches that go beyond standard guideline recommendations can significantly improve blood pressure management success rates.
Role of Guidelines
Medical guidelines help doctors treat high blood pressure better. During the meeting, experts shared the ESH 2023 guidelines and the newer 2024 practical guidelines.
The discussion was led by Dr. Thomas Weber from Austria, who is the current ESH President and helped write both sets of guidelines. Unlike before, the European Society of Cardiology (ESC) and ESH now publish separate guidelines on high blood pressure treatment. Dr. Weber explained the differences between the ESH 2023 and ESC 2024 guidelines.
One important topic was how to measure blood pressure. The ESH recommends using electronic arm monitors in clinics and at home. They don’t recommend devices without cuffs because there’s not enough proof they work well, even though research continues.
The guidelines don’t make big changes to how measurements should be taken in doctors’ offices. They confirm that high blood pressure should be diagnosed based on readings taken at the doctor’s office, since current research is based on this method.
“Home measurements are still important and give useful extra information,” said Dr. Weber.
The experts stressed that the link between heart disease risk and high blood pressure is gradual, not sudden at a certain point. But for practical reasons, they need to set a specific number to diagnose high blood pressure. Both the ESH and ESC keep the diagnosis level at 140/90 mm Hg.
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