Individualized blood pressure treatment: A multidisciplinary approach to uncontrolled hypertension in order to reduce morbidity and mortalit

Hypertension is assumed to affect approximately 40% of the adult population worldwide, making it the most important modifiable risk factor for morbidity and mortality. In addition to lifestyle changes, long-term use of antihypertensive medication is essential to prevent kidney disease, cerebrovascular- and cardiovascular disease. The European guidelines aim at maintaining the treated blood pressure <140/90 mmHg and <130/80 mmHg for most patients younger than 65 years old. Patients with a continuous, repeated office blood pressure >140 mmHg systolic or >90 mmHg diastolic, are defined as having uncontrolled hypertension. This group of patients is thought to make up as much as half of all hypertensive patients, and thus holds a great potential for treatment optimization. The IDA Study is initiated by researchers at the Section for Cardiovascular and Renal Research at Oslo University Hospital, Ullevål, and is a collaboration between leading hypertension researchers in Norway and also including general practitioners. The study has four participating sites; at the University Hospitals in Oslo, Bergen, Trondheim and Tromsø. Four PhD students, one at each hospital, are funded by the Norwegian Research Council. These PhD students/medical doctors have during the time period 2018-2022 recruited study participants with uncontrolled high blood pressure despite treatment with blood pressure-lowering drugs. Patients who fulfilled the inclusion criteria were randomized into two groups, which were given different follow-ups, aiming at detecting differences in blood pressure after 3- and 6 months. Patient inclusion was concluded Spring 2022. Results from the first 6 month follow-up have been analyzed, and several PhD students presented results from the IDA Study at the congress of European Society of Hypertension in Milan in 2023. Two of four PhD students have finished their theses. The long-term follow-up of the randomized study commenced in 2023 and is ongoing. Several scientific publications are in the pipeline. The aim of the IDA-study is to reduce worldwide morbidity and mortality through exploration of the mechanisms of therapy failure, as well as improving individual optimization of blood pressure treatment.

According to the World Health Organization, hypertension is the most important modifiable risk factor for global morbidity and mortality. The European guidelines aim at maintaining blood pressure <140/90 mmHg; however, a significant number of patients do not achieve this. The cause of this is thought to be multifactorial. With the IDA-study, we aim at exploring these factors to improve blood pressure control, and subsequently reducing morbidity and mortality through individualization of treatment modalities. Patients eligible for inclusion will be randomized into two groups, differing in the nature of the follow-up consultations. Differences in ambulatory blood pressure between the two groups will be registered after 3- and 6 months. The results may be of significant importance for patients with hypertension, possibly providing benefits such as reduced renal-, cardiovascular-, and cerebrovascular disease, as well as a reduction in side effects of medications, thereby improving the cost/benefit ratio of treatment. The IDA-study may be a step towards individualized treatment, increased patient involvement and shared decision-making in treating hypertension.