Abstract
IntroductionHypertension is a modifiable risk factor in patients at the highest risk for cardiovascular events. New invasive treatment options are becoming available that might be particularly appealing for high-risk patients. Therefore, the aim of this study was to determine the prevalence of high-risk patients on routine therapy that do not meet guideline recommended ambulatory blood pressure (ABP) targets. MethodsThis single-center, cross-sectional study was conducted at the Erasmus University Medical Center (Rotterdam, The Netherlands). Inclusion criteria were: (1) age 18–80 years, (2) drugs prescribed for hypertension or history of hypertension and (3) high cardiovascular risk as defined according to the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines. Patients underwent standardized office blood pressure (OBP) and same-day 24-h ABP measurements. Blood pressure (BP) control was defined according to the 2018 ESC/ESH and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. ResultsA total of 100 patients were enrolled (median age 71 years, 35% female). Mean OBP was 142.2/81.9 ± 18.6/12.6 mmHg and mean 24-h ABP was 126.1/70.1 ± 14.3/9.2 mmHg. Patients were on 2.0 [25th–75th percentile: 1.0–3.3] Defined Daily Doses of antihypertensive drugs. ESC/ESH guideline 24-h ABP and OBP targets were not met in 41.8% (95%CI: 31.5–52.6%) and 52.7% (95%CI: 42.0–63.3%), respectively. ACC/AHA guideline 24-h ABP and OBP targets were not met in 59.3% (95%CI: 48.5–69.5%) and 79.1% (95%CI: 69.3–86.9%), respectively. ConclusionsBP remains uncontrolled in 40–60% of high-risk hypertensive patients despite routine use of guideline-recommended therapy. Our findings support the search towards novel invasive BP lowering treatment options.
Highlights
Hypertension is a modifiable risk factor in patients at the highest risk for cardiovascular events
Inclusion criteria were (1) age 18–80 years, (2) use of anti hypertensive drugs prescribed for hypertension or a documented history of hypertension and (3) meeting one or more of the following 2018 European Society of Cardiology (ESC)/ European So ciety of Hypertension (ESH) guideline cardiovascular high or very-high risk criteria: diabetes mellitus, clinical cardiovascular disease, chronic kidney disease (CKD), left ventricular hypertrophy (LVH) or a calculated 10-year SCORE > 5% [16]
Systolic office blood pressure (OBP) was identified as the sole independent predictor of not meeting mean 24-hour ambulatory blood pressure (ABP) targets as defined according to either the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines or American College of Cardiology (ACC)/ American heart association (AHA) guidelines (Supplemental Tables 2 and 3)
Summary
Hypertension is a modifiable risk factor in patients at the highest risk for cardiovascular events. Blood pressure (BP) control was defined according to the 2018 ESC/ESH and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The 2017 American College of Cardiology (ACC) and American heart association (AHA) guidelines even set more stringent criteria for diagnosing hypertension with limits of ≥130/80 mmHg for OBP and ≥ 125/75 mmHg for mean 24-hour ABP [3]. Of note, both guidelines strongly encourage the use of ABP mea surements as ABP more closely relates to cardiovascular disease risk as compared to OBP [2–4]. No dedicated prospectively gathered data are available on the adequacy of BP control in a more heterogeneous, real-world cohort of high-risk patients as defined per- and treated according to contemporary guidelines [2,11]
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