Inadequately controlled hypertension was associated with increased risks of MI (UK HR 1.16; 95% CI 1.01-1.34), stroke, ESKD, and type 2 diabetes compared to controlled hypertension.
Cohort (n=300,000)
Yes
Does inadequately controlled hypertension increase the risk of cardiorenal and metabolic outcomes compared to controlled hypertension in patients on ≥2 anti-HTN medications?
Inadequately controlled hypertension in patients on multiple medications is associated with a significantly higher risk of adverse cardiorenal and metabolic outcomes, including MI, stroke, ESKD, and T2D.
Hazard Ratio: 1.16 (95% CI 1.01–1.34)
Abstract Background Despite the availability of multiple antihypertensive medications, many patients with hypertension (HTN) remain uncontrolled. While clinical trials unequivocally show the benefits of lowering blood pressure (BP) on cardiorenal outcomes, understanding the prognosis of patients with uncontrolled HTN in real-world settings is vital for informing optimal management strategies. Purpose Compare the risk for cardiorenal and metabolic outcomes between inadequately controlled and controlled HTN patients. Methods Data from Telotròn (Spain (ESP)), IQVIA Ambulatory EMR linked with IQVIA PharMetrics® Plus claims (United States (US)), Clinical Practice Research Datalink (United Kingdom (UK)) and Meuhedet (Israel (ISR)) were included (additional data from other countries will be added). Patients with a HTN diagnosis whose first BP measurement while treated with ≥2 anti-HTN drugs for at least 30 days (index) was above BP target (US: ≥130/80 mmHg; UK, ESP, ISR: ≥140/90 mmHg) were considered inadequately controlled and those below were considered controlled. Incidence (per 100 person-years) of: heart failure (HF), stroke, myocardial infarction (MI), type 2 diabetes (T2D), end stage kidney disease (ESKD), all-cause mortality and major adverse cardiovascular events ((MACE); stroke+MI+all-cause mortality), during follow-up was calculated. Unadjusted and multivariable Cox proportional hazards models (adjusted for baseline patient characteristics) assessed differences in risk between the two groups. Results More than 300,000 patients with a diagnosis of HTN treated with ≥2 anti-HTN medications between 2018-2023 were included. Follow-up time ranged from 1-5 years. In UK and ISR, adjusted hazard ratios (HR) revealed an increased risk of MI (UK: HR: 1.16 (95% CI: 1.01,1.34); ISR: HR: 1.28 (95% CI: 1.18,1.39)), stroke (UK: HR: 1.52 (95% CI: 1.34,1.73); ISR: HR: 1.22 (95% CI: 1.13,1.31)) and ESKD (UK: HR: 3.04 (95% CI: 2.25,4.12); ISR: HR: 1.97 (1.65,2.35)) in inadequately controlled patients. In the US and ESP, which had shorter follow-up times, the incidence of cardiorenal outcomes did not significantly differ between inadequately controlled and controlled HTN groups. An elevated risk of T2D in patients with inadequately controlled HTN was observed across all countries (US: HR: 1.15 (95% CI: 1.04,1.28); ESP: HR: 1.40 (95% CI: 1.17,1.68); UK: HR: 1.23 (95% CI: 1.14,1.33); ISR: HR: 1.13 (95% CI: 1.07,1.19). Conclusion Patients with inadequately controlled HTN had a higher risk of developing adverse cardiorenal and metabolic outcomes, such as MI, stroke, ESKD and T2D, with a stronger increased risk observed with longer follow-up. Short follow-up durations may have underestimated the long-term risk of developing other cardiorenal outcomes in some countries. Early identification and implementation of effective management strategies for inadequately controlled HTN are crucial to improving long-term cardiorenal outcomes in these patients.
Cormack et al. (Sat,) conducted a cohort in Hypertension (n=300,000). Inadequately controlled hypertension vs. Controlled hypertension was evaluated on Incidence of heart failure, stroke, myocardial infarction, type 2 diabetes, end stage kidney disease, all-cause mortality and MACE (HR 1.16, 95% CI 1.01-1.34). Inadequately controlled hypertension was associated with increased risks of MI (UK HR 1.16; 95% CI 1.01-1.34), stroke, ESKD, and type 2 diabetes compared to controlled hypertension.