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Practical solutions to the challenges of uncontrolled hypertension

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

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  1. Practical solutions to the challenges of uncontrolled hypertension A white paper Understanding the Challenging Patient Redon, J. et al., J Hypertension 2008

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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.

  7. Getting to Goal: Effective treatment reduces morbidity and mortality NOTE: Reductions displayed are relative Neal et al Lancet 2000;356:1955-64

  8. 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

  9. InvestigatingThe Challenges Redon, J. et al., J Hypertension 2008

  10. 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

  11. Challenge 2: Physicians’ faulty awareness of risk • Under-estimated degree of risk • Over-estimated success of therapy

  12. 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

  13. 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

  14. Physicians settle for getting patients close to BP goal Challenge 6: Therapeutic inertia Therapeutic Inertia Awareness Compliance

  15. 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

  16. 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

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