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

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.