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Practical solutions to the challenges of uncontrolled hypertension. A white paper Understanding t he Challenging Patient. Redon, J. et al., J Hypertension 2008. Background to the white paper. This white paper is an urgent call to action from an international group of physicians

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practical solutions to the challenges of uncontrolled hypertension

Practical solutions to the challenges of uncontrolled hypertension

A white paper

Understanding the Challenging Patient

Redon, J. et al., J Hypertension 2008

background to the white paper
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

the global burden of hypertension
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 (DALY’s)associated with high blood pressure

Lawes et al. Lancet 2008;371:1513–8

the european hypertension critical situation 35 of deaths attributable to hypertension
The European hypertension critical situation:35% of deaths attributable to hypertension

Deaths Attributed to Hypertension (%)

NOTE: High income country average was 17.6%

Lawes et al. Lancet 2008;371:1513–8

cardiovascular disease europe s no 1 killer
Cardiovascular diseaseEurope’s 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

the scale of the critical situation
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.

getting to goal effective treatment reduces morbidity and mortality
Getting to Goal: Effective treatment reduces morbidity and mortality

NOTE: Reductions displayed are relative

Neal et al Lancet 2000;356:1955-64

a call to action
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

investigating the challenges

InvestigatingThe Challenges

Redon, J. et al., J Hypertension 2008

challenge 1 inadequate primary prevention

Present distribution

Optimal distribution

Percent of population

High risk

0

5

10

15

20

25

30

35

40

10-year cardiovascular disease risk

Challenge 1: Inadequate primary prevention

Inadequate primary prevention is a priority challenge

Mendis, S., J Vasc Health Risk Manage 2005

challenge 2 physicians faulty awareness of risk
Challenge 2: Physicians’ faulty awareness of risk
  • Under-estimated degree of risk
  • Over-estimated success of therapy
challenge 3 an urgent need for simplicity
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

challenges 4 5 the wider challenges
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
white paper summary multiple daily challenges result in a cohort of challenging patients

Median

White Paper SummaryMultiple daily challenges result in a cohort of ‘Challenging Patients’
  • ‘Challenging Patients’ are patients not achieving blood pressure <140/90 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 2007;8:No 3

http://www.eshonline.org/education/newsletter/2007_03.pdf

white paper recommendations
White Paper Recommendations
  • Physicians should take a leadership role
  • Drive awareness of the dangers of hypertension
  • Acknowledge Challenging Patients:“a 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