EPIDEMIOLOGY AND CLINICAL BURDEN OF DISEASE AMONG UNCONTROLLED AND TREATMENT-RESISTANT HYPERTENSION PATIENTS: A SYSTEMATIC LITERATURE REVIEW

Objective: Despite the availability of antihypertensive treatments, it is estimated that only 20% of hypertensive patients have their blood pressure under control. This systematic literature review (SLR) identified evidence on the epidemiology and clinical burden of patients with uncontrolled hypertension (uHTN) and treatment-resistant hypertension (rHTN). Design and method: MEDLINE, Embase and Cochrane Database of Systematic Reviews were searched in March 2024, supplemented by grey literature searches. Eligible articles reported incidence/prevalence, treatment and comorbidity data among patients with uHTN (systolic blood pressure >=130 mmHg with >=2 prior antihypertensives) or rHTN (systolic blood pressure >=130 mmHg with >=3 prior antihypertensives/on-target blood pressure control with >=4 prior antihypertensives). The Methodological Standards for Epidemiological Research tool was used to assess the quality of included studies and results were qualitatively synthesised. Results: This SLR included 68 studies from 40 countries (including 25 studies from the United States) reporting epidemiology (n=58 studies), treatment outcomes (n=35) and comorbidity (n=42) data among over two million patients with uHTN or rHTN. Prevalence of uHTN ranged from 0.73–39.9% within diagnosed hypertension cohorts (n=15) and 12.3–54.6% within treated hypertension cohorts (n=4). Prevalence of rHTN ranged from 0.86–48.7% (diagnosed hypertension cohorts; n=38) and 0.5–55.6% (treated hypertension cohorts; n=12). The mean number of antihypertensives used ranged from 2.5–6.3, with medications such as calcium channel blockers (n=19; range: 19.8–98.4%), beta blockers (n=17; range: 17.1–96.9%) and diuretics (n=14; range: 15.3–100%) reported most frequently. Treatment adherence ranged from 33.8–91.5% (cohorts with rHTN). More than 25 comorbidities were reported, including diabetes (n=19; range: 0–67.4%), stroke (n=18; range: 0.007–40.8%), chronic kidney disease (n=15; range: 0–52%) and heart failure (n=13; range: 0.1–49.5%). Conclusions: This SLR suggested that uHTN and rHTN are prevalent, with these populations potentially experiencing a high burden of medications and comorbidities. There is an unmet need for medications that can reduce blood pressure in patients that have already received multiple lines of antihypertensive treatment and whose hypertension may be complicated by the presence of comorbidities.