Less than a third of patients in Europe achieve acceptable
blood pressure control. The remaining two thirds are "challenging patients"
i.e. patients whose blood pressure physicians struggle to control. These are
the alarming findings of a White Paper published in the Journal of
Hypertension(1) by an international group of physicians calling for urgent
action. The group met to discuss the daily challenges European physicians
face in the current critical situation of hypertension control. The outcome
is a consensus that continued failure to control hypertension inflicts an
unacceptable yet avoidable toll on patients, families and society.
The group concluded: "a challenging patient is in essence
anyone with blood pressure of 140/90 mmHg or greater". Whilst the current
perception is "close to goal is acceptable", the reality is that the majority
of challenging patients die prematurely or live with avoidable disability(2).
Chairman, Professor Josef Redon, Hospital Clinico, University
of Valencia, Spain; commented on the meeting and subsequent White Paper: "As
a group we concluded that any patient with blood pressure of 140/90 mmHg or
greater is at significant risk of cardiovascular disease progression, death
and or disability. As it is a challenge to get these patients to goal BP
these 'challenging patients' require persistent optimization of therapy until
target blood pressure is achieved."
Inaction, or ineffective action, costs the EU community an
estimated EUR192b annually(3). Control rates are significantly higher in
other developed countries(4). To address the current critical situation key
challenges were identified and effective solutions postulated, with a simple
aim: to treat all challenging patients effectively to goal BP, preventing
disability, saving lives and helping to relieve the financial burden of
hypertension-driven cardiovascular disease.
The Challenges
Six key challenges in achieving goal BP were identified: (1)
inadequate primary prevention; (2) faulty awareness of risk; (3) lack of
simplicity of treatment; (4) therapeutic inertia; (5) insufficient patient
empowerment; and (6) unsupportive healthcare systems.
Recommendations
To address the challenges identified in the White Paper,
clinicians can take six effective actions to (i) identify and (ii) reduce the
number of challenging patients:
- Acknowledge their challenging patients & drive awareness of the dangers
of hypertension across all sectors of society: get patients to BP goal
quickly
- Invest in substantial patient education
- Make effective use of multidisciplinary team approaches
- Encourage patients to take responsibility for their own cardiovascular
health
- Simplify treatment regimens by using the most effective and convenient
option
- Clinicians should take a leadership role in their communities,
professions and society to effectively communicate the benefits of BP
control
Simple, effective treatment gets challenging patients to goal
This finding of the White Paper is supported by the results of
a randomised; double-blind multicentre study published in the latest issue of
Clinical Drug Investigation(5), which investigated simple, flexible treatment
regimens in a cohort of "challenging patients".
The objective of the study was to determine the efficacy and
safety of an olmesartan/amlodipine single daily pill (SEVIKAR(R)) combination
therapy in patients with moderate to severe hypertension who had failed to
respond to treatment with 8 weeks of amlodipine. At randomization almost 75%
of these patients were in essence "challenging patients", i.e. unable to
achieve goal BP on amlodipine monotherapy.
The key findings highlight that SEVIKAR(R) resulted in higher
BP reductions and rate of goal achievement than amlodipine 5 mg monotherapy
in as little as 8 weeks after treatment. Indeed more than 70% of challenging
patients on active combination therapy achieved their BP goal by week 24.
Results also demonstrated that appropriate uptitration of SEVIKAR(R) led to
further BP reductions and additional patients reaching BP goal, indicating
the importance of simple, effective treatment regimens to provide the
physician with flexibility to treat each individual patient's needs.
Importantly in an open-label period, the study demonstrated
how SEVIKAR(R) can achieve impressive BP reductions and goal rates in a
situation that is close to clinical practice, highlighting the importance of
persistent optimization of therapy until target BP is achieved.
This study is the latest in a line of large, randomised
clinical studies demonstrating the ability of SEVIKAR(R) to successfully
treat patients with uncontrolled hypertension(6) (challenging patients) to
the universally accepted BP goal of less than 140/90 mmHg - a threshold
considered significant in reducing cardiovascular risk. (7),(8),(9)
About DAIICHI SANKYO
DAIICHI SANKYO is a global pharmaceutical company that focuses
on researching and marketing innovative medications. The company was created
in 2005 through the merger of two traditional Japanese enterprises, Daiichi
and Sankyo. With net sales of more than 5.4 billion EUR in fiscal year 2007,
DAIICHI SANKYO is one of the world's 20 leading pharmaceutical companies. The
company's world headquarters is in Tokyo, and its European base is located in
Munich. DAIICHI SANKYO has affiliates in 12 European countries and has been
one of the strongest Japanese pharmaceutical companies located in Europe
since it set up European production facilities and marketing offices in 1990.
The company's research activities focus on the areas of: cardiovascular
diseases, hematology, diabetes, anti-infectives and cancer. Its aim is to
develop medications that are "best" in their class or to create new classes
of pharmaceutical drugs. For more information, please visit:
daiichi-sankyo.eu
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