Michael Miedema, MD, is the director of cardiovascular prevention at the Allina Health Minneapolis Heart Institute.

Michael Miedema, MD

Addressing the Manifold Barriers in Hypertension, With Michael Miedema, MD

Despite the prevalence of antihypertensive therapies and widespread awareness campaigns, half of the US population has hypertension. Among these patients, roughly 4 out of 5 adults in the US with 

 have blood pressure well above the guideline-recommended goal of <130/80 mmHg. In 2023, hypertension was noted as the primary cause or a contributing factor in nearly 664,000 deaths in the US.

There has been a longstanding debate regarding the best path forward to solve this ongoing crisis, particularly in an era of rapid advancement in both treatments and technologies available. Recent research has uncovered that only 2 in 3 US adults suffering from hypertension actually receive medical treatment.

“It’s a multifactorial issue. Multiple readings are needed at multiple different times in multiple different settings to come up with a formal diagnosis, and that takes time, money, and effort,” Michael Miedema, MD, director of cardiovascular prevention at the Allina Health Minneapolis Heart Institute, told 

 in an exclusive interview. “I think our treatment agents could also be a little bit better – we have better evidence that using a low dose combination of several agents is more effective than a high dose of 1 agent, but most of our patients don’t want to take multiple pills.”

Miedema points out 3 major components that need to be overhauled before hypertension control can have a meaningful effect. These include diagnosis, treatment, and monitoring, widely considered the 3 main components of management.

The diagnostic process for hypertension typically involves multiple measurements to account for subtle influences on blood pressure. The current American Heart Association (AHA) and American College of Cardiology (ACC) hypertension guidelines recommend that clinicians generate a measure of in-office blood pressure by taking an average of several individual measurements taken at different times.

In addition to its inconvenience for patients, this strategy overlooks such issues as “white-coat hypertension,” a situation in which patients will present with higher blood pressure in clinic due to stress related to the environment. To this end, experts have recommended having patients with suspected hypertension take multiple measurements outside of the clinic as well, reporting the values to their healthcare provider to bolster the potential diagnosis.

Treating hypertension typically involves a combination of medical therapy and lifestyle interventions. Treatment regimens generally include multiple medications taken at once, such as ACE, ARNIs, and beta-blockers. These drugs are far more effective at lowering blood pressure in tandem than individually, leading clinicians to prescribe patients multiple drugs at once. This significantly increases pill burden for patients and can negatively impact adherence.

Finally, the blood pressure monitoring process is significantly handicapped by patient adherence. Current guidelines recommend regular monitoring at home via similar cuffs to those used in the clinic. However, these devices are typically bulky and inefficient, requiring patients to refrain from talking, using their phones, or otherwise engaging in any activity that could offset the measurements taken.

Ultimately, Miedema acknowledges the shortcomings of modern hypertension treatment and monitoring, while encouraging further research into both the pharmacological and technological approaches to disease management.

“The current monitoring methods we have are not optimal. A 24-hour blood pressure monitor works well, and the data are very supportive, but they’re pretty annoying for patients,” Miedema said. “This is the one area where I think we have the most promise moving forward – the technology is getting better. I think we’ll have better methods to assess blood pressure in the near future.”

Editors’ Note: Miedema reports no relevant disclosures.

Hardy ST, Jaeger BC, Emanuel E, Muntner P. Blood Pressure Above Goal Among US Adults With Hypertension. JAMA. Published online February 02, 2026. 

Wadhera R, Dhruva S, Bikdeli B. et al. Cardiovascular Statistics in the United States, 2026: JACC Stats. 

https://doi.org/10.1016/j.jacc.2025.12.027

Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 2025;82(10). 

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Miedema highlights the shortcomings of current technology and medication for what is among the US’s fastest-growing and most devastating conditions.

Michael Miedema, MD

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