Strategies for better BP treatment, control

Blood pressure (BP) management should be improved worldwide, including in Malaysia. Treatment inertia, lack of communication with patients, and guidelines unfocused on public health are key barriers to efficacious treatment and control of hypertension, said Professor Dr Bryan Williams, Chair of Medicine at University College London, and President of the International Society of Hypertension.

Williams called for improved communication with patients while empowering them with the information they require to challenge treatment inertia so that they obtain the best available treatment. “Patients need to understand why we want them to change their lifestyle ... we need to illustrate to patients more effectively what [lifestyle modifications and medication] will bring, in terms of their life expectancy and the quality of their life,” he said, at the recent 19th Annual Scientific Congress of the Malaysian Society of Hypertension in Kuala Lumpur.

The Global Burden of Disease 2024 data showed cardiovascular diseases were the main cause of death worldwide and in Malaysia. In Malaysia, hypertension was the number one risk factor for death in 2021, and death rates due to hypertension has remained high compared to global figures in 1990-2021. [https://ourworldindata.org] An analysis of the long-term trends of controlling, detecting, and treating BP in 12 high-income countries with developed healthcare systems revealed more than 60 percent of treated patients had a BP of above 140/90 mmHg on average due to treatment inertia; up to two-thirds of the patients were still on monotherapy after 3 years of treatment. [Lancet 2019;394(10199):639–651]

Treatment inertia is a challenge in hypertension because it involves treating an asymptomatic condition. Patients are less interested in taking medicines and tend to focus on the adverse effects of treatment since the potential benefits of treatment may not have been explained to them. Hence, there is a need to communicate the true benefits of preventive health. Treatment inertia has been ongoing despite the release of more than 50 national guidelines by many countries in the last 20 or 30 years. Hence, the 2018 guidelines introduced in Europe were the first to recommend combination therapy as initial therapy in an effort to overcome treatment inertia, he said.

Sharing the UK experience, Williams said they focused on improving the detection and treatment of hypertension over the last 20 or 30 years, resulting in a four-fold reduction of death rate. He advocated for healthcare systems to change and prioritize patients’ needs, while moving towards maintaining health and compressing age-related diseases so older persons remain productive and active for most of their life.

Reflecting on the global shortage of healthcare professionals, Williams said technology is needed to overcome the shortage. He noted the availability of various opportunities that allow for the focus on prevention including genomics, biomarkers and precision risk profiling, remote monitoring, diagnostics, and personalized approaches to treatment, all of which exhibits the power of AI to transform healthcare. He also highlighted the need for living guidelines that are continuously updated and evidence based, and the effective use of social media and digital technologies for health promotion.