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Hypertension Treatment with Angiotensin Receptor Blockers and Other Antihypertensive Agents: A Real-World Registry
Giuliano Tocci1, Giulia Nardoianni2, Barbara Pala2,3
1Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy. giuliano.tocci@uniroma1.it.
Insights
Patients referred to a hypertension center often receive angiotensin receptor blockers (ARBs), particularly those with more cardiovascular risk factors and difficult-to-control hypertension. Treatment choices reflect patient complexity, with ARBs frequently used in combination therapies.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Research
Background:
- Specialized centers manage difficult-to-control hypertension (HTN), assessing cardiovascular (CV) risk and hypertension-mediated organ damage (HMOD).
- Referrals offer real-world data on high-CV risk HTN patients using standardized procedures.
Purpose of the Study:
- To analyze CV risk, blood pressure (BP) levels (office and out-of-office), and HMOD markers in referred adult patients.
- To evaluate the impact of clinical parameters on antihypertensive therapy choices.
Main Methods:
- Observational, cross-sectional study of 5,677 treated essential hypertension patients (≥18 years) at a European Hypertension Center.
- BP measured in-office and out-of-office; CV risk assessed using SCORE2.
- Patients stratified by antihypertensive therapy: angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, or other drugs.
Main Results:
- 52.9% of patients received ARBs, 30.2% ACE inhibitors, and 17.0% other drugs.
- ARB-treated patients were older, more frequently male, and had higher rates of obesity, dyslipidemia, diabetes, CV comorbidities, and resistant HTN.
- ARB users received more BP-lowering agents, often in complex triple or quadruple therapies, with comparable BP control to other groups.
Conclusions:
- Angiotensin receptor blockers (ARBs) are frequently used, often in combination, for referred adult hypertension patients.
- Patients on ARBs typically present with greater cardiovascular risk, comorbidities, and challenging-to-manage hypertension.
Introduction:
Patients with difficult to control hypertension (HTN) are often referred by general practitioners to specialized centers to estimate global cardiovascular (CV) risk profile, evaluate hypertension-mediated organ damage (HMOD), and optimize antihypertensive therapy. This referral provides a unique opportunity to analyse patients with high CV risk and HTN in a real-world setting, characterized by the rigorous adoption of uniform and state-of-the-art procedures by expert personnel.
Aim:
To examine (1) global CV risk profile, office and out-of-office blood pressure (BP) levels, and markers of HMOD in adult patients referred to a high-volume European Hypertension center; (2) to evaluate how these clinical parameters impact on the choice of different antihypertensive therapies.
Methods:
An observational, cross-sectional study was conducted in adult patients of both sexes, aged ≥ 18 years, with essential treated hypertension, who were consecutively evaluated at the Excellence Hypertension Center at Sant'Andrea Hospital in Rome, Italy. Office and out-of-office BP levels were measured, and different hypertension phenotypes were set according to European guidelines. CV risk profile was estimated according using SCORE2. Only patients with treated HTN were selected for the analysis and stratified according to antihypertensive therapies: (1) angiotensin receptor blockers (ARBs); (2) angiotensin converting enzyme (ACE) inhibitors; (3) other drugs (including diuretics, beta-blockers, calcium channel blockers, alpha-blockers, mineralocorticoid receptor antagonists).
Results:
From an overall database of 11,168 outpatients, a total of 5,677 patients with treated HTN were analysed (46.3% females, age 63.6 ± 13.1 years, BMI 27.4 ± 4.8 kg/m2, office BP 140.6 ± 17.5/85.5 ± 11.5 mmHg, 24-hour BP 128.7 ± 13.7/77.2 ± 9.7 mmHg, SCORE2 5.4 ± 4.3%). Among these, 52.9% were treated with ARBs, 30.2% with ACE inhibitors and 17.0% with other drugs. Patients treated with ARBs were more frequently males, and significantly older, had more frequently obesity (P < 0.001), dyslipidaemia (p < 0.001), and diabetes (p < 0.001) than those treated with other drug classes. They also had more frequently CV comorbidities (P < 0.001) and resistant HTN (P < 0.001). They received more BP lowering agents (P < 0.001), being more frequently treated with triple (P < 0.001), quadruple (P < 0.001), or more complex (P < 0.001) combination therapies. Comparable office and out-of-office BP control were recorded between patients treated with ARBs and those patients managed with either ACE inhibitors or other drugs.
Conclusions:
Among adult outpatients referred to an excellence hypertension center, the majority were treated with ARBs, alone or in combination therapies. ARB-treated patients presented more frequently CV risk factors, comorbidities, and difficult-to-treat HTN.
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