Dr. J. David Spence, FACP, FRCPC
Professor, Neurology and Clinical Pharmacology,
University of Western Ontario,
Director, Stroke Prevention and Atherosclerosis Research Centre,
Siebans-Drake/Robarts Research Institute,
London, ON.
Hypertension is such a common and important problem that Canadian physicians should be good at treating it. Unfortunately, our performance is pathetic: only 16% of Canadians have well-controlled blood pressure.1 This is a huge care gap, particularly for the elderly, since they have the most to gain. Perhaps the biggest missed opportunity in medicine today is the treatment of isolated systolic hypertension. I puzzle over why doctors do so badly at treating this condition, although I have my suspicions. I think one reason is that many doctors have several elderly patients in their practice with pseudohypertension;2 these patients feel unwell when their blood pressure is treated, and physicians may generalize from these unusual patients to elderly patients in general. Another reason may be that the elderly may be on many medications and there is (appropriately) reluctance to add more. The elderly may also be harder to treat because of missed secondary hypertension. Renovascular hypertension is much more common in the elderly, and adrenocortical hyperplasia also gets worse with age. The physiology and diagnosis of these problems are discussed below.
