Hypertension affects well over a billion people globally, putting them at risk of heart attacks, strokes and kidney failure.1 Rising prevalence of hypertension and associated cardiorenal conditions pose an escalating threat to patient health and health systems, demanding innovative approaches to properly address them.1
More than 1.4 billion people worldwide live with hypertension.1 In the United States, about one half of patients living with hypertension who are already taking multiple antihypertensive medications still struggle with persistently elevated blood pressure.2
Despite many classes of treatments available today,1,2 hypertension remains a highly prevalent,1 silent killer,1 and a leading risk factor for conditions such as stroke, heart attacks, kidney damage, dementia and premature death.3-5 This points to an important need for continued scientific progress and novel approaches to help patients meet blood pressure goals and reduce risk of cardiovascular disease and chronic kidney disease.4 As understanding of hypertension evolves, researchers are taking a closer look at the biological pathways that may help explain why blood pressure remains difficult to control for many people.
Why uncontrolled hypertension still matters
Hypertension is often described as a silent condition1 because it is predominantly an asymptomatic condition that is typically detected through systematic or opportunistic screening in a healthcare setting.6,7 Over time, persistently elevated blood pressure can place strain on the heart, blood vessels and kidneys,8-10 increasing the likelihood of serious events such as heart attack and stroke.3,4 Hypertension is the most prevalent and significant modifiable cardiovascular risk factor worldwide, accounting for more deaths and disability than any other modifiable risks.3,11,12
Compared with individuals without hypertension or whose hypertension is under control,3,4 treated but uncontrolled patients with hypertension face dramatically increased risks of all-cause mortality,3 mortality from cardiovascular disease,3 and even dementia.5 Even modest improvements in blood pressure control can make a meaningful difference.4 A systematic review and meta-analysis show that reducing systolic blood pressure by 10 mmHg can lower the risk of major cardiovascular events by around 20%, stroke by 27% and death from any cause by 13%.4
Treated but uncontrolled patients with hypertension are at a greater risk of:3,5
* based on US cohort study
† based on a retrospective analysis of 209 studies
Uncontrolled hypertension has become a constant part of my life, requiring continued care and monitoring. I am hopeful that ongoing research can improve understanding and management of hypertension, so people like me and my family can better manage our condition.
The link between aldosterone and the underlying biology of hypertension
Despite advances in blood pressure management over time, many patients remain uncontrolled despite the use of multiple therapies.6,7,13,14 Research suggests that an important role is played by elevated levels of aldosterone, a hormone produced by the adrenal glands that helps regulate blood pressure.15,16 When aldosterone is present in excess, it can result in increased blood pressure to unhealthy levels, placing added strain on the heart and kidneys.17,18 Exposure to increased levels of aldosterone has been correlated to inflammation, fibrosis, cardiac remodelling, albuminuria and renal disease progression.17-21
Elevated aldosterone levels have also been associated with a greater risk of cardiorenal complications, including stroke, atrial fibrillation, heart failure and organ damage.22,23 Existing blood pressure medicines have limitations in controlling aldosterone production at its source.24 Some act on targets earlier in the hormonal pathway, while others block aldosterone’s effects, rather than directly inhibiting aldosterone production at its source.24 In some patients, aldosterone can remain elevated — or rise again over time despite management — because the body can continue driving its production through other signals.24 Ongoing research is exploring a range of approaches to better understand and manage these underlying contributors. 25
Despite lifestyle changes and many classes of treatments available, millions of people globally still don’t have their blood pressure under control. Elevated levels of aldosterone is a key biological driver of uncontrolled hypertension and can contribute to progression of cardiovascular and kidney disease, underscoring an urgent need for research and innovation centred on targeting this hormone.
Connecting hypertension and CVRM diseases
Hypertension is part of a broader network of cardiovascular, renal and metabolic diseases that are deeply interconnected and often progressive.26 These conditions frequently coexist and can share underlying biological drivers.26
Hypertension remains one of the central public health challenges to both patients and care systems, contributing significantly to morbidity and mortality and over $80 billion in costs globally each year. At AstraZeneca, we are working to bring innovation forward spanning heart failure, chronic kidney disease and cardiometabolic disease, while deepening scientific understanding of risk factors and emerging pathways in uncontrolled hypertension and the broader interconnected CVRM landscape.
AstraZeneca's continued commitment to advancing CVRM science
At AstraZeneca, our ambition is to improve outcomes for the millions of people living with CVRM diseases by advancing earlier intervention, protecting vital organs and addressing underlying drivers of disease.
Through investment in scientific research, next-generation innovation and broader collaboration across the healthcare community, AstraZeneca is working to uncover meaningful solutions for CVRM disease and help drive the next wave of innovation for patients whose needs remain unmet.
