The Role of the Specialist In Clinical Hypertension

Successful treatment of hypertension is among the most effective means to prevent cardiovascular morbidity and mortality. Unfortunately, nearly 70% of all hypertensive persons in the United States do not achieve the goal of <140/90 mmHg. This substantial gap between the potential benefit of effective hypertensive care and actual results is even more prominent in medically underserved communities.

Hypertension is highly prevalent in adult populations yet, all too often, considered a simple problem for physicians and other health care providers. Most hypertensive patients can be effectively managed by primary care providers: internists, family practitioners and other providers (i.e. supervised nurse clinicians and physician assistants). Nonetheless, a fraction of the hypertensive population requires specialized expertise for optimal care due to a variety of conditions; this is now recognized in national and international guidelines (JNC-7, WHO-ISH) developed for the care of hypertensive patients. It has become apparent that the increasingly overburdened primary care practitioner, facing a broad variety of medical problems in daily practice, can be helped by experts functioning as a resource for advice.

Reference: Saint Peter, R.F., Reed, M.C., Kemper, P., and Blumenthal, D. Changes in the scope of care provided by primary care physicians. N Engl J Med 341:1980-1985, 1999

Some Indications for Considering Consultation by a Hypertension Expert for Individual Patients