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Contemporary Prevalence and Treatment Patterns Among US Adults With Apparent Treatment-Resistant Hypertension
William B Earle1,2, Nathan W Watson2,3, Stephen P Juraschek4
1Knight Cardiovascular Institute, Division of Cardiology, Department of Medicine, Oregon Health and Science University, Portland, OR. (W.B.E.).
Hypertension (Dallas, Tex. : 1979)
|March 4, 2026
Summary
Resistant hypertension remains stable despite rising hypertension rates. While multidrug treatments increased, many patients still have uncontrolled blood pressure, highlighting a persistent challenge in cardiovascular health management.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Resistant hypertension is linked to poor cardiovascular outcomes and mortality.
- Recent guidelines advocate for lower blood pressure targets.
- Prevalence and prescribing patterns for resistant hypertension require current characterization.
Purpose of the Study:
- To determine the current prevalence of apparent treatment-resistant hypertension (aTRH) in US adults.
- To analyze trends in aTRH prevalence and treatment over time.
- To identify demographic and clinical factors associated with aTRH.
Main Methods:
- Utilized data from the National Health and Nutrition Examination Survey (2003-2020).
- Defined aTRH based on diuretic use and blood pressure thresholds or number of antihypertensive medications.
- Identified medications through pill bottle review.
Main Results:
- The prevalence of aTRH was 6.41% among hypertensive adults and remained stable over time.
- aTRH prevalence among treated adults decreased from 17.7% to 12.6%.
- Older age, Black race, higher BMI, and cardiovascular comorbidities were associated with aTRH.
Conclusions:
- Apparent treatment-resistant hypertension prevalence has been stable despite increasing hypertension rates.
- Increased use of multidrug regimens aligns with guidelines, yet uncontrolled hypertension persists.
- Further strategies are needed to manage resistant hypertension effectively.
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