Uncontrolled hypertension: Cardiovascular risk, monitoring, and medication adherence

Abstract

Hypertension is a major risk factor for the development and progression of cardiovascular disease and the leading risk factor for all-cause mortality worldwide. Although awareness and control of hypertension have improved in the last decade, the proportion of patients meeting BP targets has stagnated, with about 50% of hypertensive patients still having uncontrolled hypertension. This thesis explored potential strategies in different aspects of hypertension management with the aim to further improve these control rates. First, we studied the cardiovascular risk associated with the presence of several genetic variants affecting blood pressure, salt intake and the presence of apparent treatment resistant hypertension (a blood pressure ≥140/90 mm Hg despite the use of ≥3 antihypertensive drugs, including a diuretic). Second, this thesis focuses on the monitoring of blood pressure and salt intake in patients with uncontrolled hypertension. We studied the role of smartphone application-assisted blood pressure measurements in the home setting in relation to more conventional methods of blood pressure measurement and evaluated different methods for self-monitoring of salt intake. Finally, this thesis focuses on identifying non-adherence to antihypertensive drugs, an important cause of uncontrolled blood pressure in patients with hypertension.