Hypertension (HTN) is a leading cause of cardiovascular disease (CVD), affecting >80 million EU citizens and >50% of people aged >65 years, resulting in 1 million deaths per year, predominantly from CVD and chronic kidney disease (CKD). The damage done by CVD costs almost €300 billion annually in the EU alone. Despite existing therapies, patients with HTN still face substantial risks, due to pre-existing and ongoing end-organ damage due, in part, to inadequate blood pressure (BP) control. SGLT2 inhibitors (SGLT2i) are recommended for both type-2 diabetes and heart failure to reduce morbidity and mortality. SGLT2i reduce BP and might also improve outcomes for HTN by reducing end-organ damage through diverse other actions. However, confirmation that SGLT2i are clinically useful for the management of HTN is required to change guidelines and clinical practice. Therefore, we designed a multicentre, double-blind, randomised, placebo-controlled trial (SGLT2-HYPE), comparing the effects of dapagliflozin to placebo in people with inadequately controlled HTN, aged ≥65 years and with at least one other CVD or risk factor. The primary endpoint is a composite of CVD and CKD morbidity and mortality; a key secondary endpoint assesses quality of life. With 5,792 participants, assuming an annual placebo event rate of 2.5% compared to 2% with SGLT2i, a 3-year recruitment period and a minimum follow-up period of 4 years (7 years in total), the trial has 80% power for p250,000 deaths globally each year.

Optimization of atrial fibrillation (AF) disease management is highly needed. The AF prevalence is 7.8% above the age of 65 years and it will further increase as the population ages and predisposing factors become more prevalent. Multimorbidity (93.5%) and polypharmacy (76.5%) are very common in these patients. The mean number of comorbidities is 5.0 in those ≥65 years old. There is a great need to optimize the management of AF patients - and not only the arrhythmia - to reduce the burden on patients, society, healthcare system and the economy. The aim of the EHRA-PATHS project is to create well founded, innovative systematic care pathways to tackle multimorbidity in elderly AF patients. We hypothesize that such a well-structured, interdisciplinary, and patient-tailored care program is feasible throughout all healthcare systems in Europe, and effective to optimize outcomes. There are 5 objectives: 1. Further characterize multimorbidity, polypharmacy and sex differences in AF patients by means of clinical data registries. 2. Perform a European needs assessment study to map current clinical practice and identify unmet needs concerning multimorbid AF patient management. 3. Devise and implement new software-supported interdisciplinary, patient-centred care pathways to detect, manage, and follow-up on multimorbidity and polypharmacy in elderly AF patients with a focus on each patient’s unique profile. 4. A two-part evaluation with an initial base mapping followed by a European cluster randomised controlled trial to evaluate the newly developed holistic care paths with predefined key performance indicators. A cost-utility analysis will be included. 5. Disseminate the insights, care pathways and implementation strategy from this project to patients, physicians, hospitals, other healthcare providers and regulatory authorities. The consortium combines extensive expertise from multiple specialties with the support of ESC and EHRA to impact outcomes of multimorbid AF patients.