ASH 2013: Post Script

In the recent “Reflections on ASH 2013” commentary, I top-lined the topics I felt are most important to improving the quality of treatment for hypertension in primary care practice. There were many other hypertension topics of note that also deserve mention.

The trio of obesity, hypertension, and cardiometabolic risk was discussed. Endothelin antagonists were summarized. Targets for numerous clinical situations (eg, diabetes, renal disease) were reviewed and they may be a prominent part of JNC 2013. Ambulatory blood pressure monitoring made the agenda as well. It is reimbursed in England by the National Institute of Clinical Excellence. That’s not the case in the US. All this content was solid and evidence-based, but I chose, in the preceding commentaries, to highlight the portions most relevant to primary care.

Speakers observed that there are not enough hypertension specialists.

I viewed this demographic paucity as a challenge to primary care: It is in our practices that the “hypertensive rubber” meets the road, so to speak. I do not think that titrating a primary regimen to 3 well-dosed agents (ACEI or ARB + calcium channel blocker + a diuretic appropriate to GFR and potassium metabolism) requires a specialist. Identifying resistant patients is also straightforward. Further treatment (spironolactone and chlorthalidone if the patient isn’t on them already) is a reasonable primary care responsibility. The meeting reminded us that in addition to strokes and myocardial infarcts, dementia lurks in persons with hypertension not lowered to goal.

Now is primary care’s time to step up. Lowering blood pressure saves lives and adds quality years.