Prevalence of Resistant Hypertension in the United States, 2003–2008
Abstract
The prevalence of resistant hypertension is unknown. Much previous knowledge comes from referral populations or clinical trial participants. Using data from the National Health and Nutrition Examination Survey from 2003 through 2008, nonpregnant adults with hypertension were classified as resistant if their blood pressure was ≥140/90 mm Hg and they reported using antihypertensive medications from 3 different drug classes or drugs from ≥4 antihypertensive drug classes regardless of blood pressure. Among US adults with hypertension, 8.9% (SE: 0.6%) met criteria for resistant hypertension. This represented 12.8% (SE: 0.9%) of the antihypertensive drug–treated population. Of all drug-treated adults whose hypertension was uncontrolled, 72.4% (SE: 1.6%) were taking drugs from <3 classes. Compared with those with controlled hypertension using 1 to 3 medication classes, adults with resistant hypertension were more likely to be older, to be non-Hispanic black, and to have higher body mass index (all P <0.001). They were more likely to have albuminuria, reduced renal function, and self-reported medical histories of coronary heart disease, heart failure, stroke, and diabetes mellitus ( P <0.001). Most (85.6% [SE: 2.4%]) individuals with resistant hypertension used a diuretic. Of this group, 64.4% (SE: 3.2%) used the relatively weak thiazide diuretic hydrochlorothiazide. Although not rare, resistant hypertension is currently found in only a modest proportion of the hypertensive population. Among those classified here as resistant, inadequate diuretic therapy may be a modifiable therapeutic target. Cardiovascular diseases, diabetes mellitus, obesity, and renal dysfunction were all common in this population.
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Among treated adults with hypertension, prevalent apparent treatment-resistant hypertension occurs in approximately 12% to 15% of population-based samples.
“Among treated adults with hypertension, prevalent aTRH occurs in ≈12% to 15% of population-based13–16 and 15% to 18% of clinic-based reports.17–20”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [14]
Obesity is a major risk factor for resistant hypertension, i.e. uncontrolled blood pressure despite being on three or more antihypertensive medications.
“Moreover, obesity is a major risk factor for resistant hypertension, i.e. patients who have uncontrolled blood pressure despite being on three or more antihypertensive medications (7;8).”
From Obesity-Associated Hypertension: Recent Progress in Deciphering the Pathogenesis (2014) · cites this paper as [8]
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- Authors
- Persell, S. D.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Persell, Stephen D.
- ORCID
- Persell, Stephen D.
- Venue
- Hypertension
- Published
- 2011-06
- Volume
- 57
- Issue
- 6
- Pages
- 1076-1080
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2160704477
- Cited by
- 761
- References
- 23
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 25 · 2023: 30 · 2022: 19 · 2021: 18 · 2020: 32 · 2019: 35 · 2018: 48 · 2017: 52 · 2016: 64 · 2015: 93 · 2014: 118 · 2013: 119 · 2012: 68
- FWCI
- 70.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (1k08hs015647-01)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- resistant hypertension, prevalence, antihypertensive drug classes, uncontrolled hypertension, diuretic therapy, hydrochlorothiazide, albuminuria, renal dysfunction, cardiovascular comorbidity, diabetes mellitus, obesity, racial disparities, NHANES
- MeSH terms
- Adult, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Drug Resistance, Drug Therapy, Humans, Hypertension, Nutrition Surveys, Risk Factors, United States, Prevalence, Risk Assessment
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