Uncontrolled Hypertension Prevalence, Characteristic Profiles, and Risk of Cardiorenal and Metabolic Outcomes: Insights from the EnligHTN Study

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. 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. 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. 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. Blood pressure can be harder to control in patients if their blood pressure remains above target despite treatment with two or more antihypertensive medications. This analysis of the EnligHTN study in patients with high blood pressure aimed to assess the characteristics of patients receiving two or more currently available antihypertensive medications, how common harder-to-control blood pressure is in these patients, and the likelihood for patients affected by it to develop serious medical conditions. Patients had harder-to-control blood pressure if their routine blood pressure measurement was above their country-specific target. Among ~ 340,000 patients across the United States, United Kingdom, Germany, Spain, and Israel, the average age of patients was between 57 and 70 years. Between 50% and 63% of patients were male, and between 37% and 50% were female. The percentage of patients with harder-to-control blood pressure across all five countries was between 32.5% and 74.8%. Common pre-existing medical conditions included high cholesterol, diabetes, and kidney disease. The proportion of patients with obesity ranged from 20% to 63% in patients with harder-to-control blood pressure and 18% to 53% in those with controlled blood pressure. Harder-to-control blood pressure was associated with a higher likelihood of developing a mini-stroke (known as a transient ischemic attack), stroke, heart attack, kidney failure, and diabetes versus controlled blood pressure. Overall, patients with harder-to-control blood pressure struggle to get their blood pressure under control despite two or more medications. This struggle to control blood pressure is associated with an increased chance of developing other serious medical conditions.