Clinical Inertia and Poor Measurement Technique Undermine BP Control

Hypertension remains the most common modifiable cardiovascular risk factor in the United States, yet despite decades of effective therapy options, control rates have stagnated. This 8-part video series, “Updates in Hypertension Management: The Role of Early Combination Therapy,” features Pamela Kushner, MD, FAAFP, Clinical Professor of Family Medicine at the University of California, Irvine Medical Center and Medical Director of the Kushner Wellness Center in Los Angeles, California, who walks through why blood pressure control remains elusive in real-world primary care and how earlier combination therapy may change that trajectory.

The series opens by asking Kushner what she sees as the biggest contributor to poor blood pressure control today. She points first to clinical inertia, starting with the basics of measurement technique. Kushner notes that current standard of care calls for measuring blood pressure with the back supported and feet flat on the ground, after five minutes of rest, in both arms, with repeat measurement using an automated device, standards she says are frequently skipped in practice.

Kushner also flags a hesitancy among clinicians to intensify medication once it is started. She attributes this partly to time constraints, since explaining a new medication, addressing potential side effects, and building patient buy-in all require time that a busy primary care visit rarely affords. She adds that a lack of coordinated multi-specialty communication, where a cardiologist or endocrinologist may adjust a patient's regimen without the primary care clinician being aware, compounds the problem.

Health literacy is another recurring theme. Kushner describes patients who skip medication on days their blood pressure “feels okay,” a habit she says reflects a broader misunderstanding of hypertension as a 24-hour, every-day condition rather than an intermittent symptom to manage reactively. She cites the 2025 American College of Cardiology and American Heart Association guideline, which identifies hypertension as the most prevalent modifiable cardiovascular risk factor, and notes that nearly half of US adults have blood pressure readings meeting the threshold for hypertension. Only about 1 in 4 adults with high blood pressure achieves control, she says, and roughly half of those with uncontrolled hypertension, more than 37 million adults, have readings of 140/90 mm Hg or higher.

Kushner closes by underscoring the downstream cost argument: treating hypertension effectively is far less expensive than managing the cardiovascular and renal complications that follow years of uncontrolled disease.