Unmet needs in blood pressure control in germany: real-world evidence on uncontrolled and resistant hypertension from a nationwide EMR analysis
J Weil, M Roos, E Ziegler, C Koehler, F MaderAbstract
Background
Hypertension (HTN) is a major driver of premature mortality and cardiovascular morbidity, including the development and progression of heart failure (HF). Despite the availability of effective pharmacological therapies, guideline-recommended blood pressure (BP) targets are frequently not achieved in routine clinical practice. Contemporary, large-scale real-world data characterising BP control and treatment intensity in Germany remain limited. The MapHTN project leverages nationwide electronic medical record (EMR) data to describe epidemiology, treatment patterns, and regional variation in controlled (cHTN), uncontrolled (uHTN), and resistant hypertension (rHTN). Patients with HF were analysed as a predefined subgroup to explore the interaction between BP control, treatment burden, and comorbidity.
Methods
We performed a retrospective secondary analysis of EMR data from general practitioners, cardiologists, and internists across Germany, covering the year 2024. Adults (≥18 years) with a documented diagnosis of HTN were included. Patients were classified as cHTN or uHTN based on mean recorded BP values (target ≤140/90 mmHg). Among uHTN patients, rHTN was defined as treatment with ≥3 antihypertensive drug classes, each prescribed at least twice. BP measurements, antihypertensive treatment patterns, and comorbidities—including HF—were assessed . Diagnoses and medications were identified using ICD-10-GM and ATC codes, respectively.
Results
In 2024, 663,650 patients with diagnosed HTN were identified. Of these, 28.2% (n = 186,991) had evaluable BP data and were classified as cHTN (45.2%) or uHTN (54.8%). According to European Society of Hypertension categories, cHTN comprised optimal/normal BP (52.2%) and high-normal BP (47.8%), whereas uHTN consisted of grade 1 (64.6%), grade 2 (25.9%), and grade 3 HTN (9.6%). Antihypertensive prescribing patterns were largely similar between cHTN and uHTN groups, with a substantial proportion of patients remaining uncontrolled despite treatment with ≥2 drug classes. Notably, 54.9% of uHTN patients received only 0 or 1 antihypertensive class, indicating marked undertreatment. The median number of BP measurements was 2 per patient per year.
Conclusion
MapHTN reveals substantial and persistent gaps in BP control in routine clinical care in Germany,. These findings underscore the need for stricter guideline-directed therapy, improved longitudinal BP assessment, and optimised care coordination. Targeted interventions—such as structured hypertension management programmes, individualised treatment escalation, and region-specific implementation strategies—may be required to improve outcomes. The predefined HF subgroup analysis provides clinically relevant insights into the interface between HTN management and HF, highlighting opportunities to address care gaps in this high-risk population.