Why results remain disappointing despite available therapies

Answer: Despite the availability of effective pharmacological and non-pharmacological strategies for the treatment of high blood pressure, blood pressure control in the general population remains suboptimal in many areas of the world, including high-income countries such as ours. This paradox, i.e. the discrepancy between theoretical effectiveness of therapies and actual control of the disease, is one of the main obstacles in preventing cardiovascular complications.

If we look at data from the World Health Organisation (WHO), hypertension affects about 1.28 billion adults worldwide. However, it is estimated that more than 40 per cent of hypertensive adults are unaware of their condition, and only a fraction of those on treatment reach the recommended blood pressure targets.

If we move to Italia, the most recent data from the Istituto Superiore di Sanità show us that in 2022-2023, the Italian population aged 18-69 years had an arterial hypertension prevalence of 18%. Data from a recent monitoring conducted by the Thea Group show that the Istat 2025 data point in this direction.

It should be emphasised that the older the age, the more hypertensive individuals can be found: between 35-44 years of age they are only 3.9%, becoming 33.2% at 60-64 years of age and 55.7% over 75. A large proportion of these individuals also fail to achieve blood pressure control. A dramatic fact is that from 2014 to the present day, even with increased medical knowledge and increasingly well-known, safe and effective prevention strategies and therapies, this has not changed.

Several factors contribute to this situation, despite the wide availability of effective drugs:

1. Lack of awareness of the disease: hypertension is often asymptomatic and is called the 'silent killer'. Many patients do not know they are hypertensive until they undergo check-ups, often late. Moreover, patients are very often unaware of the blood pressure values they need to achieve.

2. Delay in diagnosis and care: limited access to preventive services and screening programmes contributes to the diagnostic delay.

3. Lack of self-monitoring ability: Despite the presence of automatic arm devices, which have been validated in all clinical trials for many years now, some patients are not trained in adequate self-monitoring of blood pressure. This particularly limits the ability for long-term blood pressure control.

4. Insufficient adherence to therapy: studies show that up to 50% of patients abandon therapy within the first year.

5. Therapeutic inertia: sometimes, especially in certain types of patients (such as the elderly), there is a tendency not to intensify therapy even when we should, based on the patient's excellent performance and life expectancy.

There is still a long way to go and the disconnect between what can be achieved with current therapies and what happens in daily clinical practice is still too wide. Improving blood pressure control requires multilevel action: more attention to early diagnosis, promotion of healthy lifestyles, simplification of therapy, improved adherence, and more active involvement of both the patient and the treating physician.