Patient Characteristics and Clinical Outcomes in a Specialist Hypertension Clinic: A Pragmatic Real-World...

Patients referred to specialist hypertension clinics often have complex disease characterized by secondary causes, treatment resistance and coexisting kidney disease. Real-world outcome data in this setting remain limited. We conducted a retrospective cohort study of 199 patients attending a tertiary hypertension clinic between January 2017 and December 2023. Baseline demographics, comorbidities, antihypertensive therapy, and blood pressure (BP) were recorded. BP changes were assessed annually for up to 3 years. Subgroup analyses examined outcomes by age, sex, diabetes, chronic kidney disease, obesity, resistant hypertension, secondary hypertension, and baseline systolic BP. Cardiovascular events were identified from clinical records. Mean age of patients was 44.1 ± 14.0 years and 61.3% were male. Secondary hypertension was present in 32.7% and resistant hypertension in 17.2%. Median follow-up was 13.8 months (IQR 4.7-30.1), with follow-up BP available for 146 patients. Mean baseline BP was 156/97 mmHg. At final follow-up, significant reductions were observed, with mean systolic and diastolic BP decreases of -13.6 and -8.8 mmHg, respectively (both p < 0.001). BP improvements were consistent across clinical subgroups. Qualitative urine antihypertensive drug screening identified medication non-adherence in a subset of patients, with targeted interventions associated with subsequent BP improvement. Cardiovascular events were infrequent (6.5%). This study shows that specialist hypertension care achieves substantial BP reductions in complex real-world patients. Objective assessment of medication adherence appears clinically valuable, although BP control remains challenging and residual cardiovascular risk persists. Larger multicenter studies with longer follow-up are needed to define predictors of cardiovascular outcomes and optimize care pathways.