Adding an additional antihypertensive drug class to all treated but uncontrolled hypertensive patients in France would avoid 3.6% of cardiovascular and renal diseases annually.
Does adding an additional antihypertensive agent reduce cardiovascular morbidity and mortality in treated but uncontrolled hypertensive patients?
Overcoming therapeutic inertia by adding an additional antihypertensive agent in uncontrolled patients could substantially reduce cardiovascular and renal morbidity and mortality at a national level.
Objective: Hypertension causes over 55,000 deaths and 400,000 hospitalisations annually in France. Half of treated patients remain uncontrolled, with among them one-third still on monotherapy. Initiation with combination therapy and intensification of treatment among uncontrolled patients could reduce hypertension-related complications. The objective was to estimate the nationwide reduction in cardiovascular morbidity and mortality if all treated but uncontrolled hypertensive patients were to receive an additional antihypertensive agent.Design and method: The impact on the hypertension burden was estimated using a Comparative Risk Assessment modelling approach, computing the potential impact fraction of cases (PIF). Data sources included systolic blood pressure (BP) measurements from the ESTEBAN national health survey, cardiovascular and renal morbidity and mortality data from the French national database (SNDS). PIF were estimated for cardiovascular, cerebrovascular, and renal diseases in the 2021 French population. The expected BP effect of adding an antihypertensive agent was derived from the metaanalysis by Wang et al. (Lancet 2025) reporting a 6.2mmHg BP reduction when escalating from monotherapy to combination therapy, and 5.0mmHg for the addition of a further class beyond the combination therapy. Results: Adding an additional antihypertensive drug class to all treated but uncontrolled hypertensive patients would increase the hypertension control rate in France to 65%, thereby avoiding 3.6% of cardiovascular and renal diseases. The PIF are 4.8% for ischaemic heart disease, 4.6% for haemorrhagic stroke, and 1.3% for dementia. This would correspond annually to 5,411 deaths, 38,716 hospitalisations, and 633,477 hospital days avoided. The benefit would be greatest among men aged over 55 years. The effect limited to escalating all uncontrolled patients on monotherapy to dual therapy accounts for two thirds of the overall impact, as it would avoid 2.3% of cardiovascular, cerebrovascular and renal diseases, corresponding to 3,398 deaths and 25,049 hospitalisations per year. Conclusions: Initiating antihypertensive treatment with combination therapy and reducing therapeutic inertia could substantially decrease the burden of hypertension. This potential benefit must be balanced against the iatrogenic risks. These findings highlight the need for better alignment of clinical practice with existing guidelines and for strengthened efforts to address therapeutic inertia in hypertension care.
Olié et al. (Fri,) conducted a other in Uncontrolled hypertension. Adding an additional antihypertensive agent vs. Current treatment was evaluated on Cardiovascular and renal diseases avoided (potential impact fraction). Adding an additional antihypertensive drug class to all treated but uncontrolled hypertensive patients in France would avoid 3.6% of cardiovascular and renal diseases annually.
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