Vnitr Lek 2026, 72(1):8-13 | DOI: 10.36290/vnl.2026.001
Most common mistakes in hypertension management
- II. interní klinika FN v Plzni a Lékařské fakulty v Plzni
Arterial hypertension is one of the most prevalent diseases in the Czech population, but unfortunately, its control does not reach satisfactory levels. It is therefore clear that there is still potential for improvement in its management. This article lists the most common problems, points out the possible consequences of these mistakes, and suggests the correct approach to solving them. In terms of diagnosis, we make errors not only in clinic blood pressure measurement but also in the use of out-of-office blood pressure measurement. Another shortcoming is the insufficient use of supplementary tests, which are mandatory for all hypertensive patients. In the context of hypertension treatment, this is primarily the failure to use fixed drug combinations at the initiation of treatment. Furthermore, there is medical inertia associated with insufficient treatment escalation and early treatment modification if the patient experiences adverse effects. In cases of severe hypertension, it is the failure to use mineralocorticoid receptor blockers as the fourth-line drug and the failure to use diuretics when the patient needs three or more antihypertensive drugs. Finally, there is insufficient monitoring of adherence to treatment.
Keywords: arterial hypertension, management errors in hypertension, diagnostic of hypertension, therapy of hypertension.
Accepted: February 3, 2026; Published: February 12, 2026 Show citation
References
- Cifkova R, et al. 30 year trends in major cardiovascular risk factors in the Czech population, Czech MONICA and Czech post MONICA, 1985 2016/17. PLoS One. 2020;15(5):e0232845.
Go to original source... - Holland M, Lewis P. An audit and suggested guidelines for in patient blood pressure measurement. J Hypertens. 2014;32:2166-2170.
Go to original source... - Mancia G, et al. 2023 ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023;41(12):1874-2071.
Go to original source... - Widimsky J, et al. Diagnostické a léčebné postupy u arteriální hypertenze - verze 2022. Hypertenze Kardiovaskulární Prevence. 2022;Supplementum:25.
- Ward AM, et al. Home measurement of blood pressure and cardiovascular disease: systematic review and meta analysis of prospective studies. J Hypertens. 2012;30(3):449-456.
Go to original source... - Clement DL, et al. Prognostic value of ambulatory blood pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348(24):2407-2415.
Go to original source... - Li Y, et al. Ambulatory hypertension subtypes and 24 hour systolic and diastolic blood pressure as distinct outcome predictors in 8341 untreated people recruited from 12 populations. Circulation. 2014;130(6):466-474.
Go to original source... - Roush GC, et al. Prognostic impact from clinic, daytime, and night time systolic blood pressure in nine cohorts of 13 844 patients with hypertension. J Hypertens. 2014;32(12):2332-2340.
Go to original source... - Stergiou GS, et al. 2021 European Society of Hypertension practice guidelines for office and out of office blood pressure measurement. J Hypertens. 2021;39(7):1293-1302.
Go to original source... - Stergiou GS, et al. Cuffless blood pressure measuring devices: review and statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens. 2022 Aug 1;40(8):1449-1460
Go to original source... - Afshin A, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13-27.
Go to original source... - Piché ME, Tchernof A, Després JP. Obesity Phenotypes, Diabetes, and Cardiovascular Diseases. Circ Res. 2020;126(11):1477-1500.
Go to original source... - Busetto L, et al. A new framework for the diagnosis, staging and management of obesity in adults. Nat Med. 2024;30(9):2395-2399.
Go to original source... - Vasan RS, et al. Hypertension Mediated Organ Damage: Prevalence, Correlates, and Prognosis in the Community. Hypertension. 2022;79(3):505-515.
Go to original source... - Adamczak M, Surma S, Więcek A. Hyponatremia in patients with arterial hypertension: pathophysiology and management. Arch Med Sci. 2023;19(6):1630-1645.
Go to original source... - Sourij C, et al. Prevalence of Undiagnosed Diabetes and Prediabetes according to Age and Obesity Status in Central Europe. Obes Facts. 2025;18(6):582-591.
Go to original source... - Visseren FLJ, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2021;42(34):3227-3337.
Go to original source... - Borghi C, et al. Adherence to Triple Single Pill Combination of Perindopril/Indapamide/Amlodipine: Findings from Real World Analysis in Italy. Adv Ther. 2023;40(4):1765-1772.
Go to original source... - Mancia G, et al. Two Drug Combinations as First Step Antihypertensive Treatment. Circ Res. 2019;124(7):1113-1123.
Go to original source... - Rea F, et al. Early cardiovascular protection by initial two drug fixed dose combination treatment vs. monotherapy in hypertension. Eur Heart J. 2018;39(40):3654-3661.
Go to original source... - Gupta P, et al. Risk Factors for Nonadherence to Antihypertensive Treatment. Hypertension. 2017;69(6):1113-1120.
Go to original source... - Krousel Wood M, et al. A hybrid 4 item Krousel Wood Medication Adherence Scale predicts cardiovascular events in older hypertensive adults. J Hypertens. 2019;37(4):851-859.
Go to original source... - Corrao G, et al. Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens. 2011;29(3):610-618.
Go to original source... - Burnier M, Egan BM. Adherence in Hypertension. Circ Res. 2019;124(7):1124-1140.
Go to original source... - Williams B, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug resistant hypertension (PATHWAY 2): a randomised, double blind, crossover trial. Lancet. 2015;386(10008):2059-2068.
Go to original source... - Ceral J, et al. Difficult to control arterial hypertension or uncooperative patients? The assessment of serum antihypertensive drug levels to differentiate non responsiveness from non adherence to recommended therapy. Hypertens Res. 2011;34(1):87-90.
Go to original source... - Murray CJL, et al. Global burden of 87 risk factors in 204 countries and territories, 1990 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-1249.
Go to original source...




