Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients

Abstract

This study shows a high prevalence of true-resistant hypertension. This prevalence is lower than that of apparent treatment-resistant hypertension, demonstrating the importance to exclude causes of pseudo-resistant hypertension including white-coat hypertension with the use of ambulatory BP measurement. The burden of resistant hypertension is highest in patients with chronic kidney disease. New treatments for resistant hypertension are highly needed, considering the disastrous complications of the disease.

Resistant hypertension in times of changing definitions and treatment recommendations

“…In conclusion, Noubiap et al 5 remind us that resistant hypertension affects a sizeable proportion of patients with treated hypertension, and about half of them have true resistant hypertension that requires more aggressive BP management to avoid the deleterious consequences of persistently elevated BP. The study also reveals that the concept of resistant hypertension, particularly ‘controlled’ resistant hypertension and the number of drugs used, may deserve to be revised in keeping with the recent decrease in diagnostic thresholds and multidrug low-dose treatment recommendations for hypertension.…”

“…In their  Heart manuscript, Noubiap et al 5 report the findings of a meta-analysis that estimates the prevalence of apparent resistant, true resistant and pseudo-resistant hypertension among patients with treated hypertension. By including 91 cohort or cross-sectional studies with over 3.2 million patients with hypertension in total (most of them from high-income countries), they estimated the prevalence of resistant hypertension across different geographical regions.…”

“…As the systematic review by Noubiap et al 5 reveals, the definitions used to classify patients with apparent resistant hypertension varied substantially between studies, with some adopting the AHA and others the ESC definition. Some of the studies were based on selected patient populations and might not have been representative of the treated or total hypertensive population.…”

“…As Noubiap et al 5 point out, it is more important to know the true prevalence of resistant hypertension after pseudo-resistance has been excluded than to have an overall estimate of apparent resistant hypertension. However, only 12 studies involving about 75 000 individuals were identified that had reported the prevalences of true resistant and pseudo-resistant hypertension, and these were mainly hospital-based and relied on office-based BP measurements.…”

Heartbeat: Time to switch from aortic valve area to aortic valve index?

“…In a meta-analysis of published data including over 3.2 million patients about 10% of patients had pseudo-resistant, so called ‘white coat’ hypertension, with normal blood pressure (BP) documented on home or ambulatory BP measurements. (figure 2)4 An additional 15% of patients were classified as apparent-treatment-resistant, who had not been fully evaluated for pseudo-resistant hypertension or medical non-compliance. However, there still was a 10% overall prevalence of true-resistant hypertension with an even higher prevalence in those with chronic kidney disease (23%), renal transplantation (56%) and the elderly (12%).…”