Real-world data regarding blood pressure control rates in hypertensive obese patients: a prospective, observational multicentric study performed in Romania

Abstract Background Achieving optimal blood pressure (BP) control is the most important aspect in the management of hypertension. There are complex mechanisms relating obesity to hypertension, fact that makes the hypertension treatment more challenging among those individuals, both for patients and physicians alike. Objective To assess the BP control rates in hypertensive obese patients treated with single pill combination (SPC) antihypertensive medications in real-world conditions. Design and method: Real-world, prospective, observational, multicenter study, performed in Romania (May-Aug 2023), collecting data from 192 sites (107 GPs and 85 Cardiology sites). The study included hypertensive obese patients, for which the investigator based on his/her best medical judgement and in line with the practice guidelines prescribed one SPC antihypertensive medication. The patient observational period was 12 weeks including 3 visits- V0 (baseline), V1 (4 weeks), V2 (12 weeks). Results 1299 hypertensive, obese patients (56.22±11years; 53.89% females), Body Mass Index (BMI) 34.35±4.21 kg/m2; within "very high" CV risk category (68.82%) (calculated as per SCORE2 and SCORE2-OP), CV family history (56.81%), comorbidities (52.12%). Among patients with comorbidities the most frequently identified were diabetes mellitus type 2 (37.37%), valvular heart disease (20.97%), angina (19.35%) and heart failure (16.24%). At 1-month visit, 723 patients (55.65%) failed to reach BP targeted values of ESC/ESH 2018 guidelines and 768 patients (59.12%) failed to reach BP targeted values of ESH 2023 guidelines. Interestingly, changes in SPC dose or prescription at 1-month visit were made only for patients considered in investigator’s opinion as "uncontrolled" - 292 patients (22.48%). The rest, 1007 patients (77.52%) were considered as "controlled" and no changes in the treatment were implemented. At the end of the observational period (3-month), the optimal BP control was reached in 36.33% patients (as per ESC/ESH 2018 guidelines), and in 33.03% patients (as per ESH 2023 guidelines), respectively. It is important to mention that at 3-month visit, the SBP values were for 86.29% of patients below 140 mmHg (regardless of age or associated comorbidities) (Fig.1). A small percentage of the "uncontrolled" patients at study end (7.5%) (ESC/ESH 2018), respectively (8.85%) (ESH 2023), were optimally controlled at V1 and no changes in the treatment were performed, nevertheless, the duration of optimal control was not maintained throughout the study. Conclusions This real-world evidence study identified an important therapeutic inertia of investigators regarding SPC therapy intensification by dose up-titration and showed that after a 3-month treatment period the optimal BP control was obtained on average in one out of three hypertensive obese patients.