Abstract 4365307: Burden of uncontrolled hypertension in real world practice: Insights from iCaReMe Global Registry

Background: Despite extensive evidence of strict blood pressure (BP) control benefits in preventing hypertension (HTN)-related morbidity and mortality, HTN control rates (defined as SBP < 130 mmHg and DBP < 80 mmHg), remain low. Thus, understanding the clinical burden of uncontrolled HTN is crucial. The iCaReMe Global Registry is an opportunity to gain contemporary insights into the socio-demographic, clinical characteristics, management patterns and determinants of uncontrolled HTN in routine care. Research Questions: To describe the real-world clinical burden of uncontrolled HTN and management patterns in patients with cardiovascular-renal-metabolic comorbidities. Methods: The iCaReMe Global Registry (NCT03549754) is a multinational, prospective, observational study assessing the management of HTN, T2DM, CKD, and/or HF. Baseline data of participants with HTN and office BP measures enrolled in 29 countries across six WHO regions between 2018 and 2024 were used for a cross-sectional descriptive analysis of demographic, clinical characteristics and medication. Data were grouped into: Controlled HTN (SBP and DBP<130/80mHg) and uncontrolled HTN (SBP or DBP≥130/80mmHg). Results: We examined 21,837 subjects with HTN and BP measures (mean age: 60.3 years, 52.0% female). Comorbidities included: T2DM in 71.3%, dyslipidemia in 51.3%, CKD in 37.8%, and HF in 15.0%. Overall, 24.6% of patients had SBP and DBP<130/80 mmHg (mean SBP/DBP: 114/67 mmHg), and 75.4% had SBP or DBP ≥130/80 mmHg (mean SBP/DBP: 141/84 mmHg) including 61% with SBP or DBP ≥140/90 mmHg. Patients with uncontrolled HTN, compared to controlled HTN group, were younger (59.8 vs 61.8 years), had higher obesity rates (42.5% vs 34.6%) and had more comorbid CKD (39.3% vs 33.1%). Among those with uncontrolled HTN, 60.2% were prescribed antihypertensive drugs including: 69.0% ACEi/ARB, 38.6% CCB, 17% diuretics, and only 46.2% received two or more antihypertensive drugs. Conclusion: Our findings reveal a significant burden of uncontrolled HTN, affecting 3 out of 4 of the study population, characterized by younger age, obesity, and higher comorbid CKD. Despite established guidelines and readily available medications, adherence to guideline directed medical therapy remains low in this high-risk HTN population. These data highlight the urgent need for improved treatment strategies to better control BP and prevent complications.