Clinical Scorecard: Exploring the Link Between Fibrotic Conditions and Resistant Hypertension in England
At a Glance
Category
Detail
Condition
Treatment-resistant hypertension and fibrotic conditions
Key Mechanisms
Fibrosis involves excessive extracellular matrix deposition causing organ scarring; treatment-resistant hypertension may share fibrotic pathways
Target Population
Adults with hypertension in England, particularly those with treatment-resistant hypertension
Care Setting
Primary care and secondary care settings within the NHS in England
Key Highlights
Among 1,340,495 people with hypertension in 2015, 16.5% had treatment-resistant hypertension.
Fibrotic conditions were more prevalent in treatment-resistant hypertension (75.4%) versus managed hypertension (68.9%).
Treatment-resistant hypertension was significantly associated with cardiomyopathy, diabetes types 1 and 2, liver fibrosis, valve fibrosis, and urinary fibrosis.
Guideline-Based Recommendations
Diagnosis
Define hypertension control status using NICE guidelines based on prescribed medications.
Identify treatment-resistant hypertension as Stage 4 hypertension, hospitalization due to hypertension, or cardiac fibrosis.
Management
Manage hypertension with lifestyle changes and medications per NICE recommendations.
Recognize treatment-resistant hypertension as requiring further evaluation for associated fibrotic conditions.
Monitoring & Follow-up
Monitor patients with treatment-resistant hypertension for development or presence of fibrotic conditions.
Use routinely collected electronic healthcare records to track hypertension control and comorbidities.
Risks
Treatment-resistant hypertension is associated with increased risk of multiple fibrotic conditions.
Fibrotic multimorbidity may contribute to decreased quality of life and increased mortality.
Patient & Prescribing Data
People with hypertension registered in primary care in England during 2015
83.5% had managed hypertension via lifestyle or medication; 16.5% had treatment-resistant hypertension despite multiple therapies
Clinical Best Practices
Apply NICE guidelines to classify hypertension control status accurately.
Screen for fibrotic conditions in patients with treatment-resistant hypertension to identify common disease pathways.
Use linked primary and secondary care electronic health records for comprehensive patient assessment.
Recognize the need for further research to understand shared mechanisms between fibrosis and resistant hypertension.
by Georgie M Massen, Philip W Stone, R Gisli Jenkins, Richard J Allen, Louise V Wain, Iain Stewart, Upasana Tayal, Jennifer K Quint, on behalf of the DEMISTIFI consortium
