Bridging the gap between hypertension guidelines and real-life practice: strategies and technological tools for improving long-term population blood pressure control

Hypertension is the leading cardiovascular risk factor. However, despite the availability of safe and effective antihypertensive drugs, blood pressure (BP) control rates remain low worldwide. In this context, the recent European hypertension guidelines present an additional challenge by lowering the BP threshold for initiating pharmacological treatment to below 140/90 mmHg for selected high-risk patients and recommending that BP values be lowered to below 130/80 mmHg for most hypertensive patients. In this narrative review, we discuss the barriers to the implementation of guideline-defined standards of care in high-, low-, and middle-income countries and consider some possible solutions to improve this situation. We discuss strategies for detecting hypertension and monitoring its control, including new technologies and settings for BP measurement. Key issues related to the treatment of hypertension at the population level are also addressed, including lifestyle interventions, improving adherence to treatment, and organizational solutions, particularly for long-term follow-up of hypertensive patients. Finally, we identify key areas for future research into the implementation of hypertension care standards and attempt to suggest possible strategies that may be particularly relevant in the future, with the aim of improving global hypertension control rates and reducing the burden of its complications.