From Profusion to Confusion: The Saga of Managing Hypertension in Chronic Kidney Disease!

HYPERTENSION––AT A CRITICAL CROSSROADS? Hypertension (HTN), through its high incidence, prevalence, and dire consequences, remains a major contributor to the global burden of disease. The noncommunicable disease burden now exceeds that of infectious disease even in the developing world, with precious few resources anywhere to manage this burgeoning challenge. Nevertheless, HTN control rates remain unacceptably low. Currently, approximately 73 million Americans have HTN, and blood pressure (BP) is controlled in only around 50% of the cases. Between 1988–1994 and 2007–2010, the prevalence of uncontrolled high BP declined for all age groups. However, in 2007–2010, nearly one half of adults with HTN continued to have uncontrolled high BP. Good, clear guidance about how to screen for, detect, and treat HTN is needed for patients, health-care providers, insurance companies, public health bodies, agencies, and governments. The question we posed in 2014 was whether we have this guidance or whether the multiple overlapping and sometimes even contradictory statements recently issued do not in fact provide a perfect storm of confusion.