2) We are pleased to welcome a new & esteemed guest faculty member, Alta Schutte PhD @alta_schutte, Professor of Cardiovascular Medicine from @UNSWMedicine and @georgeinstitute & Past President @ISHBP pic.twitter.com/kjGVvQy9Cs
— cardio-met (@cardiomet_CE) March 26, 2025
4) Reminder: #Cardiovascular disease is the nr 1⃣ cause of death ☠️in the world, with raised #BP or #hypertension (#HTN) the leading contributing risk factor, accounting for 10.8 million deaths each year. See 🔓 https://t.co/pH4MtLqod4 pic.twitter.com/c3Nm8WcwVE
— cardio-met (@cardiomet_CE) March 26, 2025
5b) This is because most patients (~80%) require 2⃣ or more drugs to get their #BP controlled.
— cardio-met (@cardiomet_CE) March 26, 2025
6b) Generally, uncontrolled #HTN is defined as #SBP >=140 and/or DBP >=90 mmHg in patients taking #BP lowering treatment. (In the US, these thresholds would be 130/80.) And the proportion of uncontrolled HTN is substantial!
— cardio-met (@cardiomet_CE) March 26, 2025
7) This shows that we are doing a poor job in ensuring that pts with #hypertension are treated properly with existing low cost 💊. Treatment #inertia is a major driver. What do you think is the proportion of patients with uncontrolled #HTN not being uptitrated at a consult?
— cardio-met (@cardiomet_CE) March 26, 2025
9) However, often we actually do a good job with pharmacological mgmt prescribing multiple drugs, but the #BP remains high. This is called ‘drug-resistant #hypertension’ or ‘treatment-resistant hypertension’ or simply ‘#resistant HTN’. Which is TRUE? Resistant HTN occurs in
— cardio-met (@cardiomet_CE) March 26, 2025
11a) This is a very important patient group, since patients with resistant #HTN have a worse prognosis: risk of myocardial infarction #MI, #stroke, end-stage kidney disease #ESKD, and death 🪦 may be 2- to 6-fold higher. See 🔓 https://t.co/48yaGqfMEC.
— cardio-met (@cardiomet_CE) March 26, 2025
12) Approximately 10-20% of pts seem to have ‘apparent resistant #hypertension’, whereas only up to ~5% have true resistant hypertension. See this from @ESHypertension, @ISHBP, & @ERAKidney: 🔓https://t.co/1AtUY9sJTS pic.twitter.com/1dWP8eXEh6
— cardio-met (@cardiomet_CE) March 26, 2025
14a) Medication non-adherence is however the most common reason for apparent resistant #HTN! 30-50% of patients prescribed antihypertensive 💊are non-adherent. This often requires a careful discussion with a patient, as it is mostly hard to know whether a patient is adherent.
— cardio-met (@cardiomet_CE) March 26, 2025
14c) In some cases blood 🩸 or urine samples can be checked for medication adherence. See 🔓 https://t.co/Vv2LBxI3mM pic.twitter.com/C29tQwKQH5
— cardio-met (@cardiomet_CE) March 26, 2025
15b) Accurate #BP measurement in clinic is often a major problem – hence new 2023 Global Consensus Guidelines on how to do it appropriately: 🔓https://t.co/tjIew553ZX pic.twitter.com/bxrALMGrbZ
— cardio-met (@cardiomet_CE) March 26, 2025
16) It is preferable however to perform out-of-office #BP measurement through 24-hour ambulatory blood pressure monitoring #ABPM or home BP to confirm BP is elevated. See https://t.co/c8g4ETW6qk pic.twitter.com/c0jbPQschZ
— cardio-met (@cardiomet_CE) March 26, 2025
17b) This GP-based study found 1 in 7 patients to have primary #aldosteronism: 🔓 https://t.co/3iBSSJKshx
— cardio-met (@cardiomet_CE) March 26, 2025
18b) See Table 20 from 🔓https://t.co/1AtUY9sJTS pic.twitter.com/TJWAX3sUcj
— cardio-met (@cardiomet_CE) March 26, 2025
20a) As for treatment optimization, need to simplify the treatment regimen (dual or triple single-pill combination #SPCs preferred). The 4⃣ th & following lines of #antihypertensive drugs are mainly #spironolactone …
— cardio-met (@cardiomet_CE) March 26, 2025
20a) As for treatment optimization, need to simplify the treatment regimen (dual or triple single-pill combination #SPCs preferred). The 4⃣ th & following lines of #antihypertensive drugs are mainly #spironolactone …
— cardio-met (@cardiomet_CE) March 26, 2025
21a) More recently selective aldosterone synthase inhibitors #ASI such as #baxdrostat have also been effective in patients with #resistant #HTN in clinical trials. This may develop into an additional treatment in the future.
— cardio-met (@cardiomet_CE) March 26, 2025
22) Another new potential treatment option is the dual #endothelin antagonist, #aprocitentan. In a placebo-controlled trial, this drug had a sustained #BP lowering effect in people with resistant #HTN: https://t.co/ldk52Fac5j pic.twitter.com/07lvcsL6RQ
— cardio-met (@cardiomet_CE) March 26, 2025
24) For the first time in the 2023 @ESHypertension and 2024 @escardio #guidelines, renal #denervation is included as a treatment option for true #resistant #HTN.
— cardio-met (@cardiomet_CE) March 26, 2025
26) And you just earned 0.75 hr 🆓CE/#CME credit! Point your 🖱️ to https://t.co/swaTB3RWae to claim your certificate! Thanks to @alta_schutte for leading this program, and thank 🫵 for joining! Follow us here @cardiomet_ce for more expert-led CE, always available, always 🆓!
— cardio-met (@cardiomet_CE) March 26, 2025