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transcript
Treatment-Resistant Hypertension:Magnitude of the Problem
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“Hypertension: uncontrolled and conquering the world”
Volume 370, Issue 9587, August 18, 2007, Page 539
0 200 400 600 800 1000120014001600
Number of People With Hypertension (millions)
2000
2025*
Ye
ar
972 million (26%)
1.56 billion (29%)
US
Canada
England
Germany
Greece
Spain
Japan
0 10 20 30 40 50 60 70 80 90
Lack of BP Control in Treated Hypertensive Patients† (%)
47%
59%
66%
71%
39%
50%
84%
*Projected. Most of the expected increase will be in economically developing regions.† Based on a literature search of the MEDLINE database of studies from January 1980 through July 2003.1. Kearney PM, et al. Lancet. 2005;365:217-223. 2. Kearney PM, et al. J Hypertens. 2004; 22:11-19.
Hypertension: a substantial and growing problem1 Lack of BP control is widespread, despite treatment2
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A particularly complex clinical challenge
• BP that remains above goal, in spite of…
*All medications should be titrated to the maximum in-label doses or until BP control is achieved, except in cases of intolerance, in which case treatments should be optimized to the maximum tolerated doses†Patients who require 4 antihypertensive agents to achieve BP control are also considered treatment resistant, according to some sources.1
1. Calhoun DA, et al. Circulation. 2008;117:e510-e526.2. Mancia G, et al. Eur Heart J. 2007;28:1462-1536.
Treatment-resistant hypertension is defined as:1,2
• compliance with maximum doses*… • of 3 antihypertensive medications†… • from different classes, ideally including a diuretic…BP Goal
• Reversible causes identified and addressed
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A common and increasing problem
1. Persell, S. Hypertension. 2011;57:1076-1080.2. Hypertension and cardiovascular disease. World Heart Federation. 2011.
http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/hypertension/. Accessed March 2, 2012.
3. Lloyd-Jones D, et al. Circulation. 2010;121:e46-e215.4. Calhoun DA, et al. Circulation. 2008;117:e510-e526.5. Egan BM, et al. Circulation. 2011;124:1046-1058.
• 100 million people worldwide (15% to 20% of uncontrolled hypertension) are estimated to have treatment-resistant hypertension1,2,3
• Despite focused efforts, the percentage of patients resistant to treatment has not fallen with newer medications and strategies; rather it has increased by 62% in the last 20 years*4,5
*In the time periods 1988-1994 vs 2005-2008, the proportion of treated uncontrolled hypertensive patients reportedly taking ≥3 BP medications increased from 16% to 28%.
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Treatment-resistant hypertension is associated with a substantially increased risk of CV events
CV=cardiovascular.Adapted from Pierdomenico SD, et al. Am J Hypertens. 2005;18:1422-1428.
Differences between groups were apparent from very early in the follow-up period, indicating the urgent need for BP control in patients with treatment-resistant hypertension.
CV Event Rate (5-year follow-up)
Controlled Hypertension 5%
Treatment Resistant 19%
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Note: Study did not include outcomes in untreated hypertensives or in patients with uncontrolled hypertension on 1-2 antihypertensive medications.
Summary: treatment-resistant hypertension
• Hypertension is– common and likely to increase– estimated to affect 1.56 billion people worldwide by 2025– elusive and difficult to control even in treated patients– a risk factor for CV disease when uncontrolled
• Treatment-resistant hypertension is defined as BP that remains above goal despite compliance with ≥3 antihypertensive medications
– 100 million people worldwide are estimated to have treatment-resistant hypertension– Prevalence will likely increase due to increasingly older age and more obese populations – Diabetes and chronic kidney disease (CKD) are risk factors
• Patients with treatment-resistant hypertension are at increased risk of CV events
– Based on a 5-year CV event follow-up, 19% of patients with treatment-resistant hypertension experienced an event compared with 5% of patients with controlled hypertension
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