Now a Global Development Leader in Roche’s Cardiovascular Product Development, Shruti and her colleagues are working to help tackle this major health challenge. “Despite its significant impact on morbidity and mortality, the trajectory for hypertension in terms of patient care and patient outcomes has remained largely unchanged over the last 20 years," says Shruti. “To address this, Roche is rapidly expanding its footprint in this area with the hope of improving outcomes not just for hypertension, but also closely associated disorders from the cardiovascular, renal and metabolic (CVRM) spectrum.”
Despite readily available, user-friendly tools for the measurement of blood pressure, hypertension continues to go underdiagnosed and undertreated in many people. “Close to a third of all adults have hypertension, and a staggering amount, up to 80%, have blood pressure that remains uncontrolled despite the availability of several classes of therapy (such as ACE inhibitors, angiotensin receptor blockers, diuretics, beta and calcium channel blockers),” says Shruti. “If left untreated or poorly controlled, hypertension can lead to cardiovascular, cerebrovascular, and renal diseases such as stroke, coronary artery disease, heart failure, chronic kidney disease, dementia, and Alzheimer’s disease. In contrast, when hypertension is identified and blood pressure effectively controlled, many of these diseases can be prevented and, in some cases, even reversed.”
A comprehensive meta-analysis shows that a reduction in systolic blood pressure by as little as 5 mm Hg reduced the risk of major cardiovascular events by about 10%, irrespective of previous CVD diagnoses.5 Seemingly small improvements in blood pressure can have a significant clinical impact on future health outcomes. So why do so many people still have uncontrolled blood pressure?
Multiple factors play into this and while the rates of diagnosis are poor (approximately 46% of patients are unaware they have high blood pressure),6 arguably the biggest contributor is poor rates of adherence to standard of care medications.3 These require daily adherence yet the WHO estimates have shown that between 50% to 70% of patients adhere poorly to their prescribed treatment.7 This results in inconsistent blood pressure control, increasing the risk of CVD and other related diseases and premature death.3 Therefore, there is significant need for novel treatment approaches for hypertension to help reduce the associated burden and overcome the limitations of current therapies e.g. poor adherence and variable blood pressure control. Recent technological advances e.g. siRNAs in dyslipidemia which target previously unreachable mediators of hypertension, represent exciting new targets for novel medications.
“At Roche, we recognise that the complex interplay between CVRM diseases potentially offers the opportunity to manage these disorders using a far more holistic approach, rather than managing each disorder individually. We also have been the pioneer in cardiovascular disease biomarkers for more than a decade and continue bringing more innovative diagnostics solutions for people living with CVRM diseases,” says Shruti. “With this holistic approach, it may be possible to help treat hypertension as well as preventing adverse outcomes as we strive to provide transformative impact for patients around the world and change the trajectory of hypertension and CVRM diseases overall.”
References
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223-237.
World Heart Federation. Hypertension [Internet; cited February 2024]. Available from:
Burnier M, Egan BM. Adherence in Hypertension. Circ. Res. 2019;124:1124-1140.
Magnussen C, et al. Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality. N Engl J Med. 2023;5;389(14):1273-1285.
Blood Pressure Lowering Treatment Trialists' Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet. 2021 May 1;397(10285):1625-1636. doi: 10.1016/S0140-6736(21)00590-0. Erratum in: Lancet. 2021 May 22;397(10288):1884. doi: 10.1016/S0140-6736(21)01069-2.
World Health Organization. Hypertension [Internet; cited February 2024]. Available from:
Yousuf, F, et al. Medication Adherence in Patients With Uncontrolled Hypertension & Hypertensive Crisis Presenting to a Hospital Setting in Karachi, Pakistan. Cureus. 2023;15(1): e33995. doi: 10.7759/cureus.33995
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