Practical solutions to the challenges of uncontrolled hypertension

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Practical solutions to the challenges of
uncontrolled hypertension

• A white paper
• Understanding the Challenging Patient

Redon, J. et al., J Hypertension 2008
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Background to the white paper

• This white paper is an urgent call to action from
  an international group of physicians
• Result of a working party meeting held in Munich
  on 11th July 2008 who came together to discuss
  the Challenges of getting to BP Goal
• Sponsored by Daiichi Sankyo Europe
• Published as a supplement in the Journal of
  Hypertension

Redon, J. et al., J Hypertension 2008
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The global burden of hypertension
7.6 million premature deaths worldwide
13.5 of global total deaths are attributedto
high blood pressure
92 million Disability-adjusted life years
(DALYs)associated with high blood pressure
Lawes et al. Lancet 200837115138
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The European hypertension critical situation35
of deaths attributable to hypertension
Deaths Attributed to Hypertension ()
NOTE High income country average was 17.6 Lawes
et al. Lancet 200837115138
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Cardiovascular diseaseEuropes No. 1 killer

• More than 4.3 million deaths/year
• 48 of all deaths
• Coronary heart disease most common cause of
  death inEurope 1.9 million deaths/year
• Stroke more than500,000 deaths/year
• Main cause of disease burden (23)
• Cost to EU estimatedat 192 billion per year

Allender et al. European Heart Network 2008
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The scale of the critical situation..

• Hypertension remains the leading cause of
  mortality and the third largest cause of
  disability worldwide
• In Europe the proportion of patients with
  acceptable blood pressure is in the region of
  30, even among those who are diagnosed and
  treated
• The majority of patients are not achieving
  acceptable blood pressure control
• these patients are Challenging Patients

acceptable blood pressure 140/90 mmHg
Mancia et al. J Hypertens 2007 WHO. The world
health report 2002 Chobanian et al. JAMA 2003.
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Getting to Goal Effective treatment reduces
morbidity and mortality
NOTE Reductions displayed are relative Neal et
al Lancet 20003561955-64
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A call to action

• This white paper
• Defines the scale of the current critical
  situation
• Examines the human impact created
  byuncontrolled hypertension
• Defines the challenges faced every day in the
  clinic
• Defines the Challenging Patient a challenging
  patient is in essence anyone with blood pressure
  of 140/90 mmHg or greater
• Suggests straightforward, practical steps that
  can save lives and prevent disability

Redon, J. et al., J Hypertension 2008
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InvestigatingThe Challenges
Redon, J. et al., J Hypertension 2008
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Challenge 1 Inadequate primary prevention
Inadequate primary prevention is a priority
challenge
Mendis, S., J Vasc Health Risk Manage 2005
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Challenge 2 Physicians faulty awareness of
risk

• Under-estimated degree of risk
• Over-estimated success of therapy

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Challenge 3 An urgent need for simplicity

• Dangerous gap between guidelines and clinical
  reality
• Physicians have comprehensive evidence-based
  guidelines but this can lead to overanalyses
• Can cause them to lose sight of the most
  important concept
• In the general population, blood pressure must be
  lowered to less than
• 140/90mmHg

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Challenges 4 5 The wider challenges

• Inadequate primary prevention
• Lifestyle / dietary risk factors
• Lack of patient empowerment and responsibility
• Over-simplistic belief that the drugs will cure
• Failure to recognise the benefits of therapy and
  corresponding non-compliance
• Unsupportive healthcare structures and policy
• Insufficient time, incentives or resources for
  physicians to control BP effectively

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Challenge 6 Therapeutic inertia
Therapeutic Inertia
Awareness
Compliance

• Physicians settle for getting patients close to
  BP goal

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White Paper Summary Multiple daily challenges
result in a cohort of Challenging Patients

• Challenging Patients are patients not achieving
  blood pressure lt140/90 mmHg
• Challenging Patients represent a significant
  burden on healthcare services across Europe
• Physicians are insufficiently aware of this
  problem and may not even recognise these
  Challenging Patients in clinical practice

Adapted from ESH Scientific Newsletter 20078No
3 http//www.eshonline.org/education/newsletter/20
07_03.pdf
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White Paper Recommendations

• Physicians should take a leadership role
• Drive awareness of the dangers of hypertension
• Acknowledge Challenging Patientsa Challenging
  Patient is in essence anyone with blood pressure
  of 140/90 mmHg or greater
• Utilise the multidisciplinary team
• Get serious about patient education
• Patient accountability for their cardiovascular
  health
• Simplify treatment
• Single Pill combination