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Filling the Gaps: Educating Patients in Hypertension Risk, Detection, and Management
Patient education may be the missing piece needed to bridge the gap between hypertension treatments and improved outcomes.
Hypertension, defined as persistently elevated systolic blood pressure (BP) >140 mmHg and/or diastolic BP ≥90 mmHg, is among the leading risk factors for morbidity and mortality worldwide. Nearly half of the adult US population has hypertension – among these individuals, roughly 4 in 5 have blood pressure (BP) above the guideline-directed goal of <130/80 mm Hg. In 2023, hypertension was the primary or contributing cause for roughly 664,000 deaths in the US alone.1,2
Effective therapies for hypertension have been available for several years. Antihypertensive medications, such as ACE inhibitors and calcium channel blockers, enable BP control and can reduce mortality risk in patients with hypertension. However, recent research has shown that only 2 in 3 US adults with hypertension receive medical treatment – this percentage has not improved from 2009-2010 (66.6% [95% CI, 63.7 to 69.5%]) to 2021-2023 (65.1% [95% CI, 62.8 to 67.4%).2
Additionally, lifestyle interventions such as diet, exercise, and sleep have been shown to significantly impact BP. The International Society of Hypertension guides patients to prioritize healthy eating, increase aerobic exercise and muscle strengthening, and improve sleep quality and hygiene. Environmental factors, such as pollution and exposure to smoking, are also major contributors that can to some extent be modified.3
Despite this, treatment has stagnated over the past 15 years, with hypertension-related cardiovascular death rates almost doubling since 2000. Given the accessibility and proven efficacy of therapies, as well as the plethora of potential lifestyle interventions, experts have shifted their focus to encouraging further patient and clinician education in recent years, citing a communication breakdown as the driving force behind poor outcomes and insufficient treatment.
“We talk about blood pressure a lot, but I don’t know that we’ve made it clear to patients that one thing leads to another,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health, as well as editor-in-chief at the American College of Cardiology, told HCPLive in an exclusive interview. “We’re not translating appropriately what it means when blood pressure is elevated. And then, I think, people mistakenly think it’s static, that this one number is the only number that happens.”
Barriers in the Treatment Cascade
The actual treatment plan for hypertension often involves the implementation of multiple medications at once. Current guidelines recommend initiating therapy with a combination of an ACE inhibitor or ARB, a calcium channel blocker, and a diuretic. If these medications do not prove effective, clinicians are then advised to layer on additional treatments including alpha and beta blockers, central sympatholytic drugs, and direct vasodilators.4
“The reality is that most patients actually need multiple medicines,” Deepak Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital and Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, told HCPLive in an exclusive interview. “What many of us learned in medical school was to start a medicine, take it to the maximum dose, and if the blood pressure is not controlled, then start medicine number 2 and do the same thing. That is logical, but it is not what the data or the guidelines support.”
The rationale behind multiple medications being administered simultaneously is sound – 2 drugs targeting separate potential control pathways may have a more significant benefit than a single medication at a higher dose. However, the pill burden posed by these baseline treatment strategies are often considered daunting by both patients and clinicians alike, leading to what many believe is a driving force behind their underutilization.
“If patients are getting routine wellness checkups at the doctor’s office, hopefully blood pressure screening is occurring,” Bhatt said. “But even then, when patients do have high blood pressure, they don’t really want to go on medicines, and the doctor doesn’t really want to start them on medicine. Typically, what happens is that the doctor concludes, oh, well, you’re in the doctor’s office, it must be anxiety or white coat hypertension, so that blood pressure elevation isn’t real. Let’s check again in 6 months.”
This “white-coat hypertension” phenomenon is often cited as a major barrier to treatment – in essence, it describes an instance in which a patient presents with increased BP in clinic due to anxiety associated with the setting. Although demonstrably genuine, this effect is nonetheless a significant blockage in helping patients achieve BP control. To this end, at-home BP monitoring technologies have become a cornerstone of therapy in recent years, aiming to promote frequency and regularity of measurements.5,6
Home BP monitors, which have been endorsed by hypertension guidelines since 2017, allow patients to collect data on their condition independent from the potential anxiety of the clinic. Additionally, these measurements allow for more accurate medication titration, potentially addressing the treatment burden posed by the sheer volume of necessary drugs.5
However, despite the wide range of devices and the volume of recommendations, home BP monitors are underused among patients with hypertension. This reflects the broader need for further education directly from clinicians and providers, which has a proven history of improving patient awareness of and adherence to both monitoring and treatment of BP.
Practical Education
The actual mechanics behind patient education are multitudinous. Direct intervention from clinicians is, of course, the primary form – however, multiple clinical trials have examined the effectiveness of interventions such as text message reminders and electronically delivered educational content.
A 2018 study published in the American Journal of Hypertension enrolled patients via retail outlet health kiosks, which took patients’ email addresses in addition to measuring their BP. After randomly sampling a total of 2000 individuals, who were subsequently contacted and asked to participate in the study, the investigative team enrolled 140 to receive either standard care or standard care plus intervention.5
Intervention in this trial took the form of general educational information messages, addressing topics such as the importance of follow-up BP measurements, the potential health risks of elevated BP, the effectiveness and availability of BP medications, and the need to take these medications daily, among other factors. Interactive text messages were also sent according to the subject’s most recent kiosk BP level.6
At the trial’s combined 6- and 12-month endpoint, 23 or 61 patients in the intervention group had achieved BP control compared with 17 of 62 in the usual care arm (difference in proportions, 10.3%; 95% CI, -6.2% to 26.8%). Mean systolic BP was also 5.8 mmHg lower in the intervention group. Although the study was only a pilot trial, these data point to the overall effectiveness of educational material in aiding patients to achieve BP control. Furthermore, much of the difference between the groups was attributed to adherence to therapy, which was driven by the delivery of repeated and direct educational information.6
“If we pull back the root of adherence, often, when you ask a patient, they don’t understand what blood pressure is and what the complications that we’re trying to help reduce are, whether it’s kidney disease, whether it’s stroke, et cetera,” Le said. “We have to educate simply and say, ‘this is blood pressure, this is why we’re measuring it, this is why we want it this level, and these are the complications that occur.’”
Editors’ Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon. Bhatt reports disclosures with GSK, Merck, Cereno Scientific, Angiowave, Boehringer Ingelheim, Novo Nordisk, and others.
References
Hardy ST, Jaeger BC, Emanuel E, Muntner P. Blood Pressure Above Goal Among US Adults With Hypertension. JAMA. Published online February 02, 2026. doi:10.1001/jama.2025.25657
Wadhera R, Dhruva S, Bikdeli B. et al. Cardiovascular Statistics in the United States, 2026: JACC Stats. JACC. 2026 Mar, 87 (9) 1094–1134. https://doi.org/10.1016/j.jacc.2025.12.027
Charchar FJ, Prestes PR, Mills C, et al. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens. 2024 Jan 1;42(1):23-49. doi:10.1097/HJH.0000000000003563.
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). doi:10.1161/hyp.0000000000000249
Townsend RR, Cohen JB. White Coat Hypertension & Cardiovascular Outcomes. Curr Hypertens Rep. 2024;26(10):399-407. doi:10.1007/s11906-024-01309-0
Shea S, Thompson JLP, Schwartz JE, Chen Y, de Ferrante M, Vanderbeek AM, Buchsbaum R, Vargas C, Siddiqui KM, Moran AE, Stockwell M. The Retail Outlet Health Kiosk Hypertension Trial (ROKHYT): Pilot Results. Am J Hypertens. 2022 Jan 5;35(1):103-110. doi: 10.1093/ajh/hpab129.
