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How common is true resistant hypertension?

Journal of Human Hypertension volume 25, pages 137–140 (2011)Cite this article

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Resistant hypertension, defined as failure to achieve goal blood pressures in patients taking optimal or maximum tolerated doses of three or more antihypertensive drugs, is estimated to occur in about 25% of hypertensive patients on treatment. Poor adherence with treatment is considered to have an important role leading to apparent drug resistant hypertension. We have demonstrated that observed drug taking (‘tablet feed’), followed by close monitoring of blood pressure in a clinic environment, together with ambulatory blood pressure monitoring, identifies a high proportion of patients (about two-thirds) of those presenting with resistant hypertension, whose persistently elevated blood pressure levels are due to poor adherence with drug treatment.

High blood pressure remains the major risk factor contributing to the global burden of disease.1 Population surveys consistently report that those receiving antihypertensive treatment are, in general, poorly controlled.2 In the United Kingdom, for example, only about one-half of hypertensive patients on treatment achieve target blood pressures (<140/90).3 ‘Resistant hypertension’ has been a loosely worded term to categorize hypertensive patients whose blood pressure has failed to reach target levels despite antihypertensive drug use, and is a major cause of referral to specialist centres. Resistant hypertension represents a heterogeneous group of patients, which includes: patients on inadequate doses and/or insufficient number of drugs, poor patient adherence with treatment (also known as pseudo-resistant hypertension), white coat hypertension, undiagnosed secondary hypertension and true resistant hypertension. The prevalence of true resistant hypertension, currently defined as failure to achieve target blood pressures despite the use of three or more medications at optimal or maximum tolerated doses, is not known, but estimated to occur in about 25% of hypertensive patients receiving treatment.4 However, the proportion of these ‘true’ resistant hypertensive patients is likely to include an unknown number of patients with pseudo-resistant hypertension. In either case, such patients are at high residual cardiovascular risk because of poor blood pressure control.

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Authors and Affiliations

  1. Imperial College Healthcare NHS Trust, London, UK

    J Bunker & W Callister

  2. Imperial College London, London, UK

    C-L Chang & P S Sever

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  1. J Bunker
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  2. W Callister
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  3. C-L Chang
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  4. P S Sever
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Correspondence to P S Sever.

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Bunker, J., Callister, W., Chang, CL. et al. How common is true resistant hypertension?. J Hum Hypertens 25, 137–140 (2011). https://doi.org/10.1038/jhh.2010.108

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