Improving Care of Patients With Hypertension-Reply

William B. Kannel, MD, MPH
JAMA. 1996;276(13):1037. doi:10.1001/jama.1996.03540130035022.
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In Reply.  —I agree with Dr Black's assertions about the state of physicians' control of existing hypertension in the general population. Hypertension is one of the most easily detected and corrected of the major risk factors for cardiovascular disease. Therefore, it is disappointing that we have not been able to bring the blood pressure of hypertensive patients under better control. However, in addition to correcting the barriers of poor understanding of the hazards and need for better long-term compliance in taking medications, there is an urgent need to implement more effective primary preventive measures. The incidence of new onset of hypertension remains unacceptably high. As monitored by the Framingham Study, hypertension incidence and prevalence have not shown any tendency to decline over decades of follow-up of the cohort.1 Few diseases have been eradicated from populations by detecting and treating all those who already have it. We must attempt to shift


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