Factors that appear as obstacles to the control of high blood pressure.

Blood pressure control at the population level is not what it should be, given the results of therapeutic trials and the current knowledge on risk factors for hypertension. Awareness and treatment of hypertension, as well as blood pressure control under treatment, are low, whether looking at results in the general population or in groups of people with little education, lower socioeconomic status or of ethnic origin. Financial and cultural obstacles have been described in the literature in relation to patient characteristics. Considering the poor blood pressure control achieved among treated hypertensive subjects, the interaction between health professionals and patients also needs to be better understood. From a primary prevention perspective, a non-drug approach seems moderately successful, particularly among lower socioeconomic groups and ethnic minorities. However, a contradiction between individual counseling and societal economic values placed on food seems to create an obstacle to this approach. To achieve good blood pressure control in the entire population and particularly underprivileged groups, policies on public health approaches (including nutrition) to combat risk factors for hypertension are necessary.