treatment-resistant hypertension: magnitude of the problem

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Treatment-Resistant Hypertension: Magnitude of the Problem Power Over Pressure www.poweroverpressure. com

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Treatment-Resistant Hypertension: Magnitude of the Problem. Power Over Pressure www.poweroverpressure.com. “Hypertension: uncontrolled and conquering the world”. Volume 370, Issue 9587 ,  August 18, 2007 ,  Page 539. Hypertension: a substantial and growing problem 1. - PowerPoint PPT Presentation

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Page 1: Treatment-Resistant Hypertension: Magnitude of the Problem

Treatment-Resistant Hypertension:Magnitude of the Problem

Power Over Pressurewww.poweroverpressure.com

Page 2: Treatment-Resistant Hypertension: Magnitude of the Problem

“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*

Year

972 million (26%)

1.56 billion (29%)

US

Canada

England

Germany

Greece

Spain

Japan0 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

Power Over Pressurewww.poweroverpressure.com

Page 3: Treatment-Resistant Hypertension: Magnitude of the Problem

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

Power Over Pressurewww.poweroverpressure.com

Page 4: Treatment-Resistant Hypertension: Magnitude of the Problem

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%.

Power Over Pressurewww.poweroverpressure.com

Page 5: Treatment-Resistant Hypertension: Magnitude of the Problem

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%

Power Over Pressurewww.poweroverpressure.com

Note: Study did not include outcomes in untreated hypertensives or in patients with uncontrolled hypertension on 1-2 antihypertensive medications.

Page 6: Treatment-Resistant Hypertension: Magnitude of the Problem

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

Power Over Pressurewww.poweroverpressure.com