To determine the adequacy of hypertension treatment in patients with multiple sclerosis (MS).

The impact of comorbidities on MS disease course has been a recent focus of research. Hypertension, in particular, has been associated with worsened clinical outcomes and low quality of life in patients with MS. Thus, the adequate control of blood pressure is an important aspect of the overall care provided to MS patients. We investigated whether MS patients who have evidence of hypertension are being appropriately treated with anti-hypertensive medications.

We used the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS, funded by Biogen) international database and identified MS patients with in-office evidence of hypertension (American Heart Association 2017 Guidelines definition: systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥80 mm Hg). We assessed whether these patients were receiving anti-hypertensive medications.

A total of 10,635 patients were identified with mean age 48.2 years (SD=12.6) and mean disease duration 12 years (SD=9.6). The mean number of blood pressure (BP) measurements per patient was 2.4 (SD=1.9). There were 9,760 (91.8%) patients with BP measurements. Of those, 2,718 (27.9%) had at least two BP measurements with systolic BP (SBP) ≥130 mm Hg and/or diastolic BP (DBP) ≥80 mm Hg. In patients with two elevated BP readings, 997 (36.7%) were receiving treatment with anti-hypertensive medication. Of all patients with BP measurements, 1,019 (10.4%) had at least two BP measurements with SBP ≥140 mm Hg and/or DPB ≥90 mm Hg. Of these, 474 (46.2%) were receiving anti-hypertensive medications. Angiotensin converting enzyme inhibitors, beta-blockers and diuretics were the most commonly used anti-hypertensive medications. 

Hypertension appears undertreated in MS patients and its management deserves attention from MS specialists.