Study reveals half of treated hypertension patients remain uncontrolled
A major international study of 340,000 patients found that blood pressure control remains inadequate for a substantial portion of people already taking multiple medications. The findings highlight a significant treatment gap that could drive demand for new drug therapies and reshape hypertension management strategies across major healthcare systems.
Originaltitel: Uncontrolled Hypertension Prevalence, Characteristic Profiles, and Risk of Cardiorenal and Metabolic Outcomes: Insights from the EnligHTN Study.
Majoriteten av hypertonibehandlade patienter uppnår inte målblodtryck trots multipel medicinering — en marknadsmöjlighet för nya antihypertensiva och behandlingsstöd. EnligHTN-studien analyserade cirka 340 000 patienter från USA, Storbritannien, Spanien, Tyskland och Israel mellan 2018 och 2023. Mellan 47–75 procent av patienter på minst två blodtryckssänkande läkemedel hade okontrollerad hypertoni, med stark variation mellan länder (Israel 33 %, USA 69 %). Okontrollerad hypertoni förknippas med signifikant högre förekomst av stroke, hjärtinfarkt, njursvikt och typ 2-diabetes jämfört med kontrollerad hypertoni. Dyslipidemi, diabetes och njursjukdom var vanliga samsjukligheter. Studien bekräftar ett betydande behandlingsgap inom flera väl utvecklade hälsovårdssystem och indikerar behov av bättre patientstratifiering, följsamhetsstöd eller nya terapeutiska ansatser för denna högriskgrupp.
INTRODUCTION: Blood pressure (BP) control often remains suboptimal despite patients receiving multiple antihypertensives. Recent clinical trials of novel antihypertensives have included patients with hypertension receiving ≥ 2 antihypertensives; however, evidence of hypertension prevalence, patient characteristics, and adverse outcomes risk in this population are limited. This study aimed to assess the prevalence of uncontrolled (uHTN) and controlled hypertension (cHTN) in patients receiving ≥ 2 antihypertensives and to describe patient characteristics and adverse outcomes risk. METHODS: EnligHTN is a multinational, observational, longitudinal, cohort study of adults with hypertension. Data from 2018 to 2023 were extracted from electronic medical records and claims data sources from the US, UK, Spain, Germany, and Israel. Adults with a hypertension diagnosis after 2018 and a BP measurement after receiving ≥ 2 antihypertensives for ≥ 30 days (index date) were included. uHTN was defined based on index BP according to national guidelines (US: ≥ 130/80 mmHg; other countries: ≥ 140/90 mmHg). Data were summarized by country. RESULTS: Overall, data from ~ 340,000 patients were included. Across countries, mean age of patients was 57‒70 years, 50-63% were male, and 37-50% were female. The proportion of patients with uHTN versus cHTN was: 69.4% versus 30.6% (US), 74.8% versus 25.2% (UK), 53.2% versus 46.8% (Germany), 47.3% versus 52.7% (Spain), and 32.5% versus 67.5% (Israel), respectively. Dyslipidemia, type 2 diabetes, and renal disease were common comorbidities across all countries. Prevalence of obesity ranged from 20-63% (uHTN) and 18-53% (cHTN). uHTN was associated with significantly higher rates of transient ischemic attacks, stroke, myocardial infarction, end-stage renal disease, and type 2 diabetes versus cHTN. CONCLUSIONS: Despite widespread availability of multiple antihypertensives, BP control remains suboptimal across diverse healthcare systems in multiple countries, with uHTN associated with increased risk of adverse cardiorenal and metabolic outcomes. Enhanced hypertension management strategies are urgently needed to reduce the burden of uHTN. Graphical abstract available for this article.