Prevalenza e Controllo dell Ipertensione Arteriosa in Italia e nel Mondo
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1 Prevalenza e Controllo dell Ipertensione Arteriosa in Italia e nel Mondo Giuliano Tocci, MD, PhD, Centro per la Diagnosi e la Cura dell Ipertensione Arteriosa, Cattedra di Cardiologia, Dipartimento di Medicina Clinica e Molecolare, Facoltà di Medicina, Università di Roma Sapienza", Azienda Ospedaliera Sant Andrea, Roma, Italia. giuliano.tocci@uniroma1.it centro.ipertensione@ospedalesantandrea.it
2 Hypertension is the biggest single contributor to the global burden of disease and to global mortality Poulter N, et al. Lancet 2015;386:801-12
3 Seven Countries Study Hypertension Prevalence in Europe Wolf-Maier K, et al. JAMA 2003;289:
4 Frequency of hypertension in people aged 20 years and older by world region and sex in 2000 (upper) and 2025 (lower) Kearney P, et al. Lancet 2005;365:217-23
5 Progetto Cuore Istituto Superiore di Sanità (ISS): Epidemiologia e prevenzione delle malattie cerebro e cardiovascolari Questa indagine e stata realizzata nel (9.712 persone, anni) ed e stata ripetuta nel (9.107 persone, anni) su campioni rappresentativi di popolazione generale, inclusivi di tutte le regioni (un campione di 220 persone ogni 1,5 milioni di abitanti). Ultimo aggiornamento lunedì 27 luglio 2009
6 Italian GP Survey Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice N=615,373 Filippi A, et al. J Hum Hypertens 2009;23:
7 SILVIA Study Prevalence of Hypertension in adult outpatients under specialist care (hospital outpatient clinics) according to different macro-areas in Italy N=2,775 Mancia G, et al. J Hypertens 2004;22:
8 BP Stratification in Hypertensive Patients enrolled in Hypertension Surveys in Italy 71% N=52,715 22% n=1.831 n=3.739 n=3.374 n= n= n=2.081 Volpe M, Tocci G, et al. J Hypertens 2007 Jul;25(7):1491-8
9 Distribution of Patients in Hypertension Surveys performed in Italy between ,2 N=211, Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens 2015:1-6
10 Systolic BP levels in Patients included in Hypertension Surveys performed in Italy between ,2 First Assessment ( ) (n=52,715) 1 Second Assessment ( ) (n=158,876) 2 Systolic BP is more difficult to control than Diastolic BP!! 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens 2015:1-6
11 Hypertension Control in Europe Overall BP Control Rate: %
12 Potential Limitations of the Analysis on BP control rates in Hypertension Surveys performed in Italy between ,2 No access of individual data on BP levels and control. Limited data on hypertension management and control according to gender (female). Inclusion of different types of studies, populations, patients, regions and periods. Not comparable data over time. Tocci G, Volpe M, et al. J Hum Hypertens 2015:1-6
13 Systolic and Diastolic BP levels in Hypertension Surveys performed in Italy between ,2 (55% pts in Hypertension Clinics or Specialized Centres) (95% pts in General Medicine) 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens 2015:1-6
14 2013 ESH/ESC Hypertension Guidelines BP goals in hypertensive patients Recommendations Class Level A SBP goal <140 mmhg: a) is recommended in patients at low moderate CV risk; I B b) is recommended in patients with diabetes; I A c) should be considered in patients with previous stroke or TIA; IIa B d) should be considered in patients with CHD; IIa B e) should be considered in patients with diabetic or non-diabetic CKD. IIa B In elderly hypertensives less than 80 years old with SBP 160 mmhg there is solid evidence to recommend reducing SBP to between 150 and 140 mmhg. In fit elderly patients less than 80 years old SBP values <140 mmhg may be considered, whereas in the fragile elderly population SBP goals should be adapted to individual tolerability. In individuals older than 80 years and with initial SBP 160 mmhg, it is recommended to reduce SBP to between 150 and 140 mmhg provided they are in good physical and mental conditions. A DBP target of <90 mmhg is always recommended, except in patients with diabetes, in whom values <85 mmhg are recommended. It should nevertheless be considered that DBP values between 80 and 85 mmhg are safe and well tolerated. I IIb I I A C B A Mancia G, et al. Eur Heart J 2013 Jul;34(28):
15 2013 ESH/ESC Hypertension Guidelines Monotherapy vs. drug combination strategies to achieve target BP Mild BP elevation Low/Moderate CV risk Choose between Marked BP elevation High/Very High CV risk Single Agent Two Drug Combination Switch to different Agent Previous Agent at full dose Previous Combination at full dose Add a third Drug Full Dose Monotherapy Two Drug Combination at full dose Switch to different Two-Drug Combination Three Drug Combination at full dose Mancia G, et al. Eur Heart J 2013 Jul;34(28):
16 Antihypertensive strategies with ARB-based therapy combined with either HCTZ or CCB (or both) according to Individual Global CV Risk Stratification (1/2) High normal BP (SBP mmhg or DBP mmhg) Grade 1 HT (SBP mmhg or DBP mmhg) Grade 2 HT (SBP mmhg or DBP mmhg) Grade 3 HT (SBP 180 mmhg or DBP 110 mmhg) NO Risk Factors ARB (medium dose) If not at target, ARB (full dose) If not at target, * ARB/HCTZ * (full dose) Dyslipidemia, Hyperuricemia, Obesity ARB (low dose) If not at target, ARB (medium dose) If not at target, ARB/CCB (medium dose) If not at target, * ARB/CCB (full dose) * Metabolic Syndrome ARB (low dose) If not at target, ARB (medium dose) If not at target, ARB/CCB (medium dose) If not at target, * ARB/CCB (full dose) * Diabetes ARB (medium dose) If not at target, ARB (full dose) If not at target, ARB/CCB (medium dose) If not at target, * ARB/CCB (full dose) * MAU or Proteinuria ARB (medium dose) If not at target, ARB (full dose) If not at target, ARB/CCB (medium dose) If not at target, * ARB/CCB (full dose) * Elderly or Isolated Systolic Hypertension ARB (medium dose) If not at target, ARB (medium dose) If not at target, ARB/HCTZ (medium dose) If not at target, * ARB/HCTZ (full dose) * * Consider single-pill triple combination Tx, if BP not at target Volpe M, et al. High Blood Press Cardiovasc Prev 2014;21(2):
17 How to improve BP control in daily clinical practice of hypertension? Volpe M, et al. G Ital Cardiol (Rome) 2012 Dec;13(12): Volpe M, et al. Ipertensione Prev Cardiovasc 2012;19(4): Volpe M, et al. High Blood Press Cardiovasc Prev 2013 Mar;20(1):45-52
18 Key Points of the SIIA Strategy for improving BP control in Italy 1. Implementation of Home BP Measurements (partnership with patients) 2. Simplification of Therapy (single pill combination) 3. Network of Italian Hypertension Centers 4. Involvement of Healthcare Institutions 5. Larger use of new technologies, devices, smartphones and telemedicine for BP monitoring and control (SIIA App) 6. Analysis of New Large Databases ( street BP, GP database, European networks) Volpe M, et al. G Ital Cardiol (Rome) 2012 Dec;13(12): Ipertensione Prev Cardiovasc 2013; in press High Blood Press Cardiovasc Prev 2013 Mar 28. [Epub ahead of print]
19 World Hypertension Day in Italy: Distribution of the Population in 3 different time periods A real life example of population BP survey N=10,051 Tocci G, Borghi C, Parati G, Volpe M, et al. J Clin Hypertens 2015;Oct 13
20 World Hypertension Day in Italy: Distribution of Data Collecting Points in 3 different time periods (n=6,936; 69.0%) Tocci G, Borghi C, Parati G, Volpe M, et al. J Clin Hypertens 2015;Oct 13
21 World Hypertension Day in Italy: Distribution of Female Gender in 3 different time periods (n=6,936; 69.0%) Tocci G, Borghi C, Parati G, Volpe M, et al. J Clin Hypertens 2015;Oct 13
22 World Hypertension Day in Italy: HTN Prevalence and Awareness in 3 different time periods (n=6,936; 69.0%) Tocci G, Borghi C, Parati G, Volpe M, et al. J Clin Hypertens 2015;Oct 13
23 World Hypertension Day in Italy: HTN Treatment and Control in 3 different time periods (n=6,936; 69.0%) Tocci G, Borghi C, Parati G, Volpe M, et al. J Clin Hypertens 2015;Oct 13
24 Italian GP Survey Blood pressure control in patients with diagnosed hypertension: an updated survey in Italian general practice Survey N=615,373 N=941,754 25,1 74,9 Normotension Hypertension 1. Filippi A, et al. J Hum Hypertens 2009;23: Tocci G, Borghi C, Volpe M, et al. J Human Hypertension 2016; first revision
25 2015 Italian GP Survey Analysis from large database of GPs (year 2013): Gender Distribution N=893,879 Tocci G, Borghi C, Volpe M, et al. J Human Hypertension 2016; first revision
26 2015 Italian GP Survey Analysis from large database of GPs (year 2013): Prevalence of Hypertension according to Gender Groups N=893,879 HTN: n=236,455 (25.1%) pts Tocci G, Borghi C, Volpe M, et al. J Human Hypertension 2016; first revision
27 2015 Italian GP Survey Analysis from large database of GPs: Awareness* of Hypertension (year 2013) N=893,879 HTN: n=236,455 (25.1%) pts * Awareness was defined as BP measured by GPs Tocci G, Borghi C, Volpe M, et al. J Human Hypertension 2016; first revision
28 2015 Italian GP Survey Analysis from large database of GPs (year 2013): Control* of Hypertension according to Gender Groups N=893,879 HTN: n=236,455 (25.1%) pts * Control rate was calculated among those HT outpatients who have their BP measures Tocci G, Borghi C, Volpe M, et al. J Human Hypertension 2016; first revision
29 Prevalence of Hypertension in 2012 in adult outpatients followed in the general medicine according to different macro-areas in Italy n=363,324 (39.6%) n=276,643 (29.4%) n=300,839 (32.0%) Tocci G, Borghi C, Volpe M, et al. Manuscript in preparation, 2016
30 Prevalence of Hypertension in 2012 in adult outpatients followed in the general medicine according to gender and different regions in Southern Italy n=300,839 (32.0%) Tocci G, Borghi C, Volpe M, et al. Manuscript in preparation, 2016
31 Awareness of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to different macro-areas in Italy n=363,324 (39.6%) n=276,643 (29.4%) n=300,839 (32.0%) Tocci G, Borghi C, Volpe M, et al. Manuscript in preparation, 2016
32 Awareness of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to gender and different regions in Southern Italy n=300,839 (32.0%) Tocci G, Borghi C, Volpe M, et al. Manuscript in preparation, 2016
33 Control of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to different macro-areas in Italy n=363,324 (39.6%) n=276,643 (29.4%) n=300,839 (32.0%) Tocci G, Borghi C, Volpe M, et al. Manuscript in preparation, 2016
34 Control of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to gender and different regions in Southern Italy n=300,839 (32.0%) Tocci G, Borghi C, Volpe M, et al. Manuscript in preparation, 2016
35 Conclusive Remarks Hypertension still affects more than 25% of adult Italian individuals, with an approximately 60% rate of awareness among hypertensive patients. Two independent ad interim analyses, which covered a time period until , reported a marked improvement in average BP control rate, which raised from 30% to about 58%. Different factors, including combination therapies, patients education, physicians connections (network) and technologies, may be involved in this improved BP in Italy and in Europe. This improvement in overall BP control will lead to a reduced incidence of stroke, CHD, and CHF which is difficult to estimate at this time, but will certainly involved several thousand individuals. Tocci G, Borghi C, Volpe M, et al. J Human Hypertension 2016; first revision
36 Thank you for Your Attention! E:
37
38 Nuova Mission della Società Italiana dell Ipertensione Arteriosa (SIIA) Obiettivo SIIA 70% E n t ro il Volpe M. High Blood Press Cardiovasc Prev 2012;19(1):1-3
39 Diastolic BP levels in Patients included in Hypertension Surveys performed in Italy between ,2 First Assessment ( ) (n=52,715) 1 Second Assessment ( ) (n=158,876) 2 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens 2015:1-6
40 EFFECTUS Study Prevalence of major cardiovascular risk factors in adult outpatients under either general medicine or specialist care (hospital divisions of cardiology, diabetology, internal medicine) according to different macro-areas in Italy N=9.904 Tocci G, Volpe M, et al. Nutr Metab Cardiovasc Dis 2012 Aug;22(8):635-42
41 Prevalence of CV Risk Factors in Hypertensive Patients enrolled in Hypertension Surveys in Italy N=52,715 n= n= n= n=7.903 Volpe M, Tocci G, et al. J Hypertens 2007 Jul;25(7):1491-8
42 Distribution of Hypertensive Patients according to Global Cardiovascular Risk Stratification in Hypertension Surveys in Italy N=52,715 57% 43% Volpe M, Tocci G, et al. J Hypertens 2007 Jul;25(7):1491-8
43 What s next? Our generation of physicians has a concrete chance to control about 100% of hypertensive patients and to lead towards a major reduction in cardiovascular disease burden. International collaborations and networks, aiming at this goal also through a novel approach to practical recommendations, are required to achieve this ambitious healthcare target.
44 SIIA Objective 70% The Healthcare and Societal benefits of an improved control of hypertension in our Country, as outlined in the Objective of the Italian Society of Hypertension (SIIA), will represent a major progress in the control of the disease and will have significant implications for the Health and Economic burden of hypertension in Italy.
45 BP control rates in Patients included in Hypertension Surveys performed in Italy between ,2 towards 2015 SIIA Objective 70% 1st Assessment ( ) (n=52,715) 1 2nd Assessment (05-11) (n=158,876) 2 NEW 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens 2105;1-6 Tocci G, Borghi C, Volpe M,et al. Oral Presentation at SIIA national Congress. Bologna, September 24-26, 2015
46 BP control rates in Patients included in Hypertension Surveys performed in Italy between ,2 1st Assessment ( ) (n=52,715) 1 2nd Assessment (05-11) (n=158,876) 2 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens 2105;1-6
47 EFFECTUS Study Prevalence of major cardiovascular risk factors in overall the population and in patients stratified by clinical settings N=9.904 *p<0.001 vs GPs; #p<0.001 vs Cardiologists. Volpe M, et al. High Blood Press Cardiovasc Prev 2009;16(2):55-63
48 Systolic and Diastolic BP levels in Hypertension Surveys performed in Italy between ,2 (55% pts in Hypertension Clinics or Specialized Centres) (95% pts in General Medicine) 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens Nov;29(11):
49 Diastolic BP levels in Patients included in Hypertension Surveys performed in Italy between ,2 Surveys (n=150,806, 70.3%) Clinical Studies (n=60,785, 28.7%) 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens Nov;29(11):
50 Systolic BP levels in Patients included in Hypertension Surveys performed in Italy between Surveys (n=150,806, 70.3%) Clinical Studies (n=60,785, 28.7%) 1. Volpe M, Tocci G, et al. J Hypertens 2007;25(7): Tocci G, Volpe M, et al. J Hypertens 2012;30: Tocci G, Volpe M, et al. J Hum Hypertens Nov;29(11):
51 Systolic and Diastolic BP levels according to Referring Centers in Hypertension Surveys published between in Italy N= Tocci G, Volpe M. J Hypertens 2012 Jun;30(6):
52 Absolute numbers of adult outpatients included in the general medicine database in 2012 according to gender and different macro-areas in Italy N=940,806 (100,0%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
53 Proportions of adult outpatients included in the general medicine database in 2012 according to gender and different macro-areas in Italy N=940,806 (100,0%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
54 Absolute numbers of adult outpatients included in the general medicine database in 2012 according to gender and different regions in Northern Italy n=363,324 (39.6%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
55 Absolute numbers of adult outpatients included in the general medicine database in 2012 according to gender and different regions in Center Italy n=276,643 (29.4%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
56 Absolute numbers of adult outpatients included in the general medicine database in 2012 according to gender and different regions in Southern Italy n=300,839 (32.0%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
57 Prevalence of Hypertension in 2012 in adult outpatients followed in the general medicine according to gender and different regions in Northern Italy n=363,324 (39.6%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
58 Prevalence of Hypertension in 2012 in adult outpatients followed in the general medicine according to gender and different regions in Center Italy n=276,643 (29.4%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
59 Awareness of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to gender and different regions in Northern Italy n=363,324 (39.6%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
60 Awareness of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to gender and different regions in Center Italy n=276,643 (29.4%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
61 Control of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to gender and different regions in Northern Italy n=363,324 (39.6%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
62 Control of Hypertension among adult hypertensive outpatients followed in the general medicine in 2012 according to gender and different regions in Center Italy n=276,643 (29.4%) Tocci G, Volpe M, et al. Manuscript in preparation, 2016
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