Antihypertensive Medication Patterns in Patients with Hypertension that is Harder to Control: Insights from the EnligHTN Study

INTRODUCTION: Many patients with hypertension have hypertension that is harder to control (defined as needing ≥ 2 antihypertensive medications) and fail to achieve adequate blood pressure (BP) control. We assessed treatment patterns and BP outcomes in a large, multinational cohort of patients initiating a third antihypertensive class whilst remaining on a stable regimen of two antihypertensives from different classes. METHODS: EnligHTN is an observational, longitudinal cohort study on hypertension management and outcomes. Data from the USA, UK, Germany, Spain, and Israel from 2018 to 2023, and Denmark from 2018 to 2024, were extracted from de-identified electronic medical records, claims data, and health registry sources. Adult patients with diagnosed hypertension were included if they initiated a third antihypertensive (index date) whilst remaining on a stable two-drug regimen. Baseline demographics and clinical characteristics, treatment patterns from index to 24 months, and BP control at 12 and 24 months from index were described. RESULTS: Data from 64,501 patients were included. Across countries and common third antihypertensive classes, the proportion of patients who discontinued their third medication after index ranged from 54% to 100% at 12 months and from 67% to 100% at 24 months. Among a subcohort of patients with BP measurements at 12 months from index, BP was below target in 23-89%. CONCLUSIONS: Many patients with harder-to-control hypertension discontinued their third class of antihypertensive within 1 year, and numerous did not achieve adequate BP control. These findings highlight a significant gap in current hypertension management and underscore the need for adherence-focused treatment strategies to improve treatment persistence and BP outcomes in these patients.