Uncontrolled Hypertension in Cardio-Renal-Metabolic Diseases: Real-World Insights on Patient Profiles and Management...

Hypertension (HTN) is a leading risk factor for cardiovascular (CV) and renal morbidity and mortality, yet blood pressure (BP) control remains suboptimal worldwide. Understanding management patterns, especially among patients with coexisting Type 2 diabetes mellitus (T2DM), chronic kidney diseases (CKDs), or heart failure (HF), and assessing uncontrolled HTN burden across diverse health systems are critical to inform guideline-concordant strategies to improve care.

Cross-sectional analysis includes participants with HTN, with or without comorbid T2DM, CKD, or HF enrolled in iCaReMe Global Registry across 29 countries. Demographic and clinical characteristics, antihypertensive treatment patterns, prevalence of uncontrolled HTN (defined as SBP ≥ 130 mmHg or DBP ≥ 80 mmHg), and its associated factors were assessed.

Among 23,063 participants, comorbidities included T2DM (71.4%), CKD (38.2%), and HF (14.6%). Key CV risk factors were family history of CV disease (34.3%), obesity (40.5%), and dyslipidemia (51.0%). Echocardiography (available in 28.6%) revealed left ventricular hypertrophy (LVH) in 30.6% and diastolic dysfunction in 42.4%. Overall, 88.7% were prescribed antihypertensive drugs: renin-angiotensin system (RAS) blockers (76.6%), calcium channel blockers (CCBs, 42.0%), beta-blockers (41.4%), diuretics (23.7%), with a majority (62.3%) on combination regimens. Uncontrolled HTN was prevalent in 75.4%, who were younger (59.8 vs 61.8 years) and exhibited higher burden of obesity (42.5% vs 34.6%), CKD (39.3% vs 33.1%), LVH (32.9% vs 24.8%), and treated less intensively with antihypertensives (60.2% vs 88.7%) and combinations (46.2% vs 61.8%) when compared to the controlled HTN group. Multivariate analysis confirmed independent association of non-use of RAS blockers/CCB/diuretics combinations (dual/triple therapy), obesity, and comorbid CKD, with uncontrolled HTN (OR [95% CI], 2.8 [2.44-3.18]/2.3 [1.66-3.16], 1.5 [1.38-1.65], and 1.4 [1.27-1.53], respectively, p < 0.0001).

This study uncovers alarming rates of uncontrolled HTN in real-world settings, exacerbated by comorbid T2DM/CKD/HF, underscoring the need to identify HTN management gaps and tailor innovative strategies to mitigate CV risk. Trial Registration: ClinicalTrials.gov identifier: NCT03549754.