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Hypertension: Charting A New Course to Address a Public Health Challenge
May 13, 2022
Ali Toumadj, PharmD
Sr. Medical Director, Early Programs, Alnylam Pharmaceuticals Inc
Hypertension (high blood pressure) has seen limited medical innovation in recent history and remains a serious public health issue. In fact, hypertension is the leading preventable risk factor for cardiovascular disease and premature death worldwide1 and impacts more than one billion people globally.2
May is National High Blood Pressure Education Month and World Hypertension Day (May 17), which provides an opportunity to reevaluate how we as healthcare professionals and other related stake-holders think about hypertension management, explore the underlying factors and importantly, recommit to advancing science and health equity to improve the lives of those affected.
When you look back at the past two decades, it’s incredible what science has accomplished. And yet, in hypertension — the leading cause of cardiovascular disease and premature death worldwide — we haven’t seen the same progress” - George Bakris, M.D., FAHA, FASN
Understanding Adherence Challenges
With hypertension, poor treatment adherence, including failure to take medication as prescribed or persist on therapy, is one of the leading causes of inadequate blood pressure control. Estimates suggest that between 50-80 percent of people with high blood pressure who have been prescribed anti-hypertensive medications are non-adherent or sub-optimally adherent to their treatment3, and approximately half of patients discontinue therapy within one year due to poor persistence.
Rather than placing blame on patients for not achieving blood pressure control, experts like George Bakris, M.D., endocrinologist and nephrologist at the University of Chicago Medicine, note that we must understand why this issue exists, stating, “To really get a handle on hypertension, we need to address the underlying factors that prevent people from achieving consistent blood pressure control. Suboptimal adherence, blood pressure variability, and access to care have all been foundational issues.”
Reasons a person may struggle to achieve consistent control of their blood pressure include:
- Access to care: Challenges in accessing care and treatment may be driven by many factors. Some patients live in “care deserts” — communities with few or no medical facilities, doctors or pharmacies — or have mobility issues that prevent them from traveling for care. They may also have financial challenges that make it difficult for them to afford care or treatments.
- Understanding or perception of risks: Those with hypertension may not know or fully appreciate the long-term consequences of poor blood pressure control, such as kidney disease, heart failure, heart attack, stroke, and other complications. Hypertension is largely symptomless, so if the risks seem distant and a person “feels fine,” they may believe there is no harm in skipping or stopping their medication.
- Treatment burden: Complex treatment regimens, including those that contain multiple medications and/or require frequent dosing, may cause patients to feel frustrated or unable to keep up with their treatments. Similarly, medications that are difficult to administer or require hospital visits to administer may create a significant burden that prevents people from continuing with treatment.
Significant racial disparities are also a factor in achieving adequate blood pressure control and contribute to hypertension-related morbidity and mortality. In the U.S., Black men and women face higher prevalence rates, as well as an earlier age of disease onset compared to their white counterparts. To address the challenges within these communities, culturally appropriate and multi-faceted educational resources are needed.
Addressing Hypertension Together Through Continual Innovation
Hypertension is an age-old nemesis and combatting hypertension requires new commitment from many different groups beyond those immediately impacted, including researchers, healthcare professionals, community/patient organizations, professional societies, policymakers, and the public at large.
No one group can solve this challenge alone, but as part of Alnylam’s commitment to helping address hypertension as a major public health issue, we are actively working to advance RNAi research in hypertension. We invite you to learn more about our programs in hypertension by visiting clinicaltrials.alnylam.com
