Background: Hypertension (HTN) is a leading cause of premature death and a major driver of cardiovascular and renal disease. Despite proven therapies, blood pressure control in routine care remains alarmingly inadequate. Understanding real-world treatment patterns and care gaps is critical to reducing preventable morbidity and mortality. The MapHTN study leverages nationwide electronic health records to quantify blood pressure control, therapy intensity, and comorbidity burden among adults with HTN in Germany.
Methods: Adults (≥18 years) with documented HTN between January 2022 and December 2024 in primary care, cardiology, and internal medicine practices were analyzed. Blood pressure control was defined as mean BP ≤140/90 mmHg according to current guidelines [1]. Annual blood pressure readings, medication regimens, and comorbidities were extracted via ATC and ICD 10 GM codes.
Results: In 2024, 663,650 patients had ≥1 HTN diagnosis; only 28% (n=186,991) had ≥1 documented blood pressure measurement (median 2/year), leaving 72% without any measurement. Among measured patients, 55% were uncontrolled. Guideline-recommended intensive therapy was rare: triple therapy (ACE inhibitor/ARB + CCB + diuretic) in 8%, quadruple therapy with BB in 4%, quadruple therapy including MRA in 1%. Even under therapy, a substantial proportion remained uncontrolled. Comorbidities were widespread: dyslipidemia 41%, type 2 diabetes 29%, atherosclerosis 27%, coronary artery disease 21%, chronic kidney disease 12%, heart failure 11%. These data highlight systemic under-treatment of high-risk patients.
Conclusion: MapHTN reveals a critical, persistent care gap in hypertension management in Germany. Infrequent blood pressure monitoring, low use of guideline-recommended therapies, high rates of uncontrolled HTN, and pronounced multimorbidity underscore an urgent need for structured management programs, improved intersectoral coordination, optimized combination therapies, and innovative care pathways. Targeted interventions are essential to achieve reliable blood pressure control and reduce the escalating burden of cardiovascular disease in routine practice.
1. Williams B, et al. 2023 ESC/ESH Guidelines for arterial hypertension.EurHeart J. 2023;44(42):3727–3878.
