I'm going to be our introductory talk tonight and really kind of paint the picture of much of the conversation that will follow. And we're going to just go through some kind of epidemiology and gaps in current hypertension care, and I'll try to keep myself on time. These are my disclosures. So, I think it's fair to call this a global hypertension crisis and crisis is an extreme word and obviously we're living through a pandemic. But I do note that everything about hypertension and the current 2021 era is going the wrong direction we have an incredibly high incidence of hypertension globally. I do note that our global pressure global blood pressure control rates are low, and unfortunately, our control is decreasing hypertension is well established to be the leading cause of end organ damage, as well as all cause and cardiovascular death. And we continue to struggle with medication adherence and I'm going to touch on each of these points individually throughout this next 10 minute talk. So let's start with hypertension on the United States, hypertension affects one into us adults you can't get a more simple figure than this. Look to your left look to your right, and one of those people if not both of hypertension hypertension as I've painted is already the leading preventable cause of cardiovascular morbidity including heart attack and stroke, and I'll show you some data related to hypertension. And unfortunately we have disparities in the management diagnosis treatment and care of patients who are suffering from hypertension is these disproportionately affect patients and communities of color and so we have no met unmet need in terms of targeting our therapeutic interventions and getting our patients adequately treated in particular to underserved communities and patient populations. Because it's just so dramatic. These are the global risk factors for all cause mortality. Across men and women, and you can see here on top that high systolic blood pressure hypertension is the single most or largest contributor to death out of any of our other known socio economic comorbidity and personal risk factors that Trump's tobacco and even high cholesterol. And if you look at the numbers, about 19.2% of all global deaths in 2019 were a consequence of high blood pressure hypertension. This figure probably resonates most of you probably seen this before because this is probably one of the most advertised figures in regards to the terrible job we're doing and blood pressure control. And you can see here this is a trend analysis of blood pressure control among patients with hypertension and he's population this is published in JAMA just last year. And you can see from 1990 to 2000, at the beginning of this figure out to 2009 2010 we were making strides towards improving our blood pressure management and control. And since 2013 that we've noted in remarkable in decline and this is not related to the change in blood pressure thresholds of systolic 130 this is related to us, suffering from an inadequate job of controlling the blood pressure of our patients 35% of us treated hypertensive patients treated remain uncontrolled and over 56% globally treated and untreated are not controlled. So I want I'm going to stay on this figure for one more second because I think this is really meaningful and again, is the reason why we are all here having this conversation tonight. So you can see two figures and I apologize but these are from recent publications from this year at the publication and Lancet from the blood pressure lowering lipid or treatment trial is collaboration I think they've put out three papers this year that are incredibly important and really resonate me with me especially when I'm counseling my patients on the left here is a meta regression of randomized trials looking at the management of high blood pressure hypertension. And what this red line represents is that for every millimeter every millimeter reduction in high blood pressure reduces your major cardiovascular event hazard ratio so on the y axis here is your hazard ratio. blood pressure from zero to 25, and you can see this gradient obviously, the more you get these blood pressure numbers down, the better, the larger the reduction there are in cardiovascular events, and really this analysis showed us that even a five millimeter reduction in blood pressure has a 10 to 11% relative risk reduction in cardiovascular events and we don't even need to make a substantial impact on blood pressure control to already have a benefit on cardiovascular outcomes. On the right here is a separate analysis that looked at different age strata. So in green here is people over the age of 85 blue is 75 to 85, 84 and you can see downward on younger age groups, and the difference between the two lines is five millimeters of mercury reduction and high blood pressure with an intervention. So just five millimeters of mercury reduction in blood pressure reduces major cardiovascular events across all age strata. As you can see here it's not just isolated among younger populations, but even older populations experience a benefit from blood pressure control. One thing that is really notable is that we are forecasting to see hypertension rates increase significantly over the near future. We saw that in 2016 adults with hypertension accounted for 41% of all us healthcare spending, and we're anticipating that treating hypertension is going to triple to $200 billion. By the time of 2030, and it's not just the cost to the healthcare system that's important. It's also the cost to the patient. Adults with high blood pressure spend more than three times the amount of medical care as those without hypertension and these have meaningful impacts across all age categories of life, as seen here on the right figure. Again, this is money coming out of our patient pockets that are trying to control an incredibly important risk factor that we are suffering to deliver on and I think that these these numbers are really resounding. The other issue we run into is adherence and we've spent a lot of time speaking about this before adherence, again remains probably one of the main addressable means of reducing or improving blood pressure control. In clinical trials and real world studies we know that between 30 to 50% of patients are non adherent to the clinical trial medications or medical practices in blue here is partial non adherence, and then the lighter shade of a teal here is And these are different studies throughout the last 10 years that really just demonstrate how big non adherence impacts the ability to measure therapies, understand the improvement in blood pressure changes cardiovascular events and overall overall represents what we struggle with in real world practice with our own patients. So in order to improve the hypertension pathway for all those people who are involved, we really need to diversify change and reorganize our ecosystem for hypertension management. There are many different ways to get to the end and we're going to be spending a lot of time on this webinar speaking about intervention list, and the role as we develop new technologies like we know that innovation, but this this pathway to the intervention requires patient either initiation or patient being seen by their provider, the provider knowing about what options are available, or will be available to treat high blood pressure. The referral from that general provider to specialists who many which are on this call, spend their careers really focusing on hypertension, as well as local experts who have really organized their efforts to provide resources to patients with uncontrolled hypertension, and then eventually when this is available on the market, there is the possibility of moving on towards the intervention list and bringing renal denervation and other invasive therapies for blood pressure to our patients. Next we're going to come after a discussion with the patient and the physician about their preferences on the patient side, we know that many patients are bothered by medication side effects. Many patients are learning and understanding with more public health announcement that the high blood pressure is a significant risk factor for their global health. Also, a lot of patients have experience that they have family members of parents, siblings who suffered from high blood pressure and understand that the morbidity that's related to this when it goes uncontrolled. On the physician side, I think anybody on this call who's manages patients, they've managed high blood pressure, we know how hard it is to add medications when we have very limited time with our patients in clinic. We know that the more medications that we add, the less likely we're going to get our patients to follow through with our, our, our preferred regimen for treatment. And we understand also that we need to start changing something, if we're going to make any gains in terms of how we control this very important comorbidity so so this this interaction between the patient and the physician is what's going to drive really the forward with incorporating renal denervation and finding patients who are really the right candidates for this novel therapy. I'm going to end on this slide and then with some concluding thoughts but really there's some overall themes that we have to consider as we move from a patient who gets diagnosed with uncontrolled blood pressure on to establishing and discussing anticipatory You know this starts with just recognizing and identifying patients with uncontrolled blood pressure risk stratifying them based on their comorbidities and global cardiovascular risk, confirming that no other secondary causes are addressable that can be driving their high blood pressure, and that both as medical conditions as well as us as clinicians, and the white coat hypertension, and then really understanding what the patient voices, what are their preferences, what are their goals and treatment, what are they concerned about and what are they willing to participate in to get better control over their hypertension management. So just to conclude I want to leave these kind of takeaways for people today to bring back with them to their clinic hypertension remains the leading global modifiable cause of cardiovascular events including heart attack and stroke, as well as that global control rates are at an all time low. Again, we know more than less than 2025% of treated hypertension patients have well controlled blood pressure and less than 40 to 50% of treated hypertension patients are well controlled. We noted in that really landmark figure from JAMA that US control rates have been decreasing, since 2013, and really moving the patient pathway ecosystem forward is going to involve an interaction between our specialists, our primary care providers, our interventionists, our hospital administrators, and most importantly our patients for identifying and understanding their preferences for how they want to manage their high blood pressure. Thank you very much for inviting me to speak today and I'm looking forward to our discussion later in this webinar.

global hypertension crisis

blood pressure control

end organ damage

cardiovascular death

disparities in hypertension management