Differences in patient and physician perspectives on pharmaceutical therapy and renal denervation for the management of hypertension

Abstract

Objective: To study patient and physician attitudes to pharmaceutical therapy and renal denervation for the management of hypertension. Methods: Data were analyzed from 19 market research studies in Western Europe and the United States conducted between 2010 and 2019 to obtain quantitative and qualitative perspectives. The analysis incorporated insights from 2768 patients and the experiences of 1902 physicians either actively performing or interested to perform device procedures, or hypertension specialists who would refer patients for a device-based intervention. Results: Referring cardiologists and proceduralists were more likely to recommend the renal denervation procedure to patients with higher BP levels and a greater number of antihypertensive medications. Physicians perceived patient reluctance towards a procedure as an important obstacle to recommending renal denervation as a treatment option for uncontrolled hypertension. Patient interest in the renal denervation procedure did not correlate with BP severity ( P = NS), and the highest preference for the procedure was in patients diagnosed with hypertension but not receiving treatment ( P < 0.001). Patients who perceived high BP as a major problem ( P = 0.029) and those who experienced side effects attributed to their BP medications ( P = 0.006) had a higher preference for renal denervation. Conclusion: Patients with hypertension often regard the choice of renal denervation to lower BP differently from physicians. A considerable proportion of hypertensive patients, especially those not taking medications, may prefer a device-based approach to reduce their BP.

Differences between expert reported and patient reported burden of disease rankings

“…In this study, patient reported burden of disease rankings are developed and compared with the usual expert reported burden of disease rankings. Prior research shows that patient reported and expert reported burden of disease could differ as patients tend to focus on subjective health experiences (quality of life) and experts tend to focus on mortality and disability (quantity of life) 8 – 10 . In accordance, this study shows that these differences are also reflected in the often used burden of disease rankings.…”

“…Although these rankings provide valuable insight in the biomedical burden of different diseases, they do not yet provide insight in the psychological burden of different diseases experienced and reported by patients on a daily basis. Since patient reported burden of disease often differs from expert reported burden of disease, deviations between patient reported and expert reported burden of disease rankings are likely to occur 8 – 10 . In order to understand how these rankings differ, it is important to develop patient reported burden of disease rankings and discuss how these compare with the usual expert reported burden of disease rankings.…”

Clinical Trial Design Principles and Outcomes Definitions for Device-Based Therapies for Hypertension: A Consensus Document From the Hypertension Academic Research Consortium

“…72 In a recent survey, patient and physician attitudes toward pharmaceutical therapies and RDN for hypertension may be differ relative to severity of hypertension and medication burden. 73 Specifically, preference for device-based therapy among patients may be highest among those not taking medications and may be independent of BP severity. HARC encourages incorporating such assessments in device-based hypertension trials and developing health status models specific to this area of study.…”

2022 Malaysian Working Group Consensus Statement on Renal Denervation for management of arterial hypertension

“…Patients’ regard for RDN often differs from their physicians’ perspective. This preference for RDN need not necessarily happen only for those with high pill burden or very severe hypertension [ 21 – 23 ].…”