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Treatment-Resistant Hypertension: Magnitude of the Problem

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.

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Treatment-Resistant Hypertension: Magnitude of the Problem

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

  2. “Hypertension: uncontrolled and conquering the world” Volume 370, Issue 9587, August 18, 2007, Page 539 Hypertension: a substantial and growing problem1 Lack of BP control is widespread, despite treatment2 47% 59% 2000 972 million (26%) 71% Year 66% 50% 1.56 billion (29%) 2025* 84% 39% Number of People With Hypertension (millions) Lack of BP Control in Treated Hypertensive Patients† (%) • *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. • Kearney PM, et al. Lancet. 2005;365:217-223. • Kearney PM, et al.J Hypertens. 2004; 22:11-19. Power Over Pressure www.poweroverpressure.com

  3. A particularly complex clinical challenge • BP that remains above goal, in spite of… 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 • *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 • Calhoun DA, et al. Circulation. 2008;117:e510-e526. • Mancia G, et al. Eur Heart J. 2007;28:1462-1536. Power Over Pressure www.poweroverpressure.com

  4. A common and increasing problem • 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%. Persell, S. Hypertension. 2011;57:1076-1080. 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. Lloyd-Jones D, et al. Circulation. 2010;121:e46-e215. Calhoun DA, et al. Circulation. 2008;117:e510-e526. Egan BM, et al. Circulation. 2011;124:1046-1058. Power Over Pressure www.poweroverpressure.com

  5. Treatment-resistant hypertension is associated with a substantially increased risk of CV events • 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. • Note: Study did not include outcomes in untreated hypertensivesor in patients with uncontrolled hypertension on 1-2 antihypertensive medications. CV=cardiovascular. Adapted from Pierdomenico SD, et al. Am J Hypertens. 2005;18:1422-1428. Power Over Pressure www.poweroverpressure.com

  6. 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 Pressure www.poweroverpressure.com

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