Prevalence of Resistant Hypertension Among Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis

Resistant Hypertension (RHTN) is defined as blood pressure remaining above target levels despite adherence to three or more antihypertensive agents of different classes, including a diuretic. RHTN was found to be a significant prognostic factor for cardiovascular and renal complications among individuals with Type 2 Diabetes Mellitus (T2DM). This systematic review and meta-analysis aimed to estimate the global prevalence of RHTN among patients with T2DM and to explore key demographic and clinical correlates.

A systematic literature search was conducted across multiple electronic databases, including PubMed, Scopus, Web of Science, Embase, and the Cochrane Library, to identify studies examining the prevalence of resistant hypertension among patients diagnosed with T2DM. Data synthesis was accomplished using a random-effects model. Between-study heterogeneity was assessed utilising the I² statistic. Assessment of potential publication bias was performed through the Doi plot analysis and the Luis Furuya-Kanamori index (LFK index) methodology. Statistical significance was established at p < 0.05. The study was prospectively registered in PROSPERO (CRD42024549125).

Nine studies encompassing 159,082 participants from various regions worldwide were incorporated. The synthesis of data revealed a pooled prevalence rate of RHTN in individuals with T2DM of 14% (95% CI, 11-17%), accompanied by a substantial degree of heterogeneity (I2=98%). Meta-regression revealed that resistant hypertension among diabetic cases increased with increasing mean age [Beta = 0.02]. The Doi plot asymmetry and LFK index [-2.93] revealed publication bias.

This review highlighted the significant prevalence of RHTN among the T2DM population. However, given the high heterogeneity, publication bias, and limited geographical representation, these findings should be interpreted with caution. Subgroup analysis also revealed no significant reduction in heterogeneity, underscoring the need for further qualitative studies to assess contextual factors.

Meta-analysis revealed 14% of individuals with T2DM have RHTN, highlighting the need for routine screening along with personalised blood pressure management in this population. To strengthen clinical practice and improve comparability, future research should prioritise robust study designs and standardised diagnostic criteria.