Top 50 most-cited articles on hypertension management in primary care: A bibliometric analysis
Rahaf Fayih Alotaibi, Norah G. A. Aldossari, Reema K. Alwahabi, Kadi N. ALjerah, Amal K. Alshammari, Orjowan F. Alshehri, Batool K. Bagais, Maryam J. Alhashim, Renad A. Alhawsah, Basmah O. Bamashmous
A
BSTRACT
Background:
Hypertension is a leading global risk factor for cardiovascular disease and premature death. In Canada, nearly one in four adults is affected, yet control rates are declining due to complex guidance and variable targets. The 2025 Canadian guidelines, aligned with the World Health Organization’s (WHO) HEARTS, define hypertension as ≥130/80 mm Hg, emphasizing practical primary care. This review evaluates adult management trends and identifies gaps affecting clinical outcomes.
Methods:
A systematic Web of Science search used “hypertension,” “high blood pressure,” or “elevated blood pressure” combined with “management” or “treatment.” Eligible studies were English, human-based, and had no year limits. Four reviewers independently extracted data on study design, demographics, management strategies, and outcomes. Descriptive statistics analyzed citation trends and emerging research areas.
Results:
The review included 50 highly cited studies (2002–2018), primarily from North America and Europe. Guidelines and consensus papers comprised 40% of the data. Pharmacologic therapy dominated—focusing on angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and diuretics—while lifestyle interventions appeared in only 16%. Citation counts ranged from 120 to over 6,000, with major guideline reports being the most referenced. Common adverse effects included peripheral edema and electrolyte imbalances. Notable gaps included limited geographic diversity, low female authorship, and a lack of research on non-pharmacologic care.
Conclusion:
Primary care relies heavily on medications, leaving lifestyle strategies underutilized despite proven efficacy. Citation impact reveals regional and institutional disparities in research output. Future efforts should prioritize region-specific studies, digital health tools, personalized treatments, and multidisciplinary care to improve long-term blood pressure control and global health equity.