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Resistant hypertension—its identification and epidemiology

Nature Reviews Nephrology volume 9, pages 51–58 (2013)Cite this article

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A Correction to this article was published on 09 July 2013

This article has been updated

Abstract

Resistant hypertension is currently defined as the failure to achieve a goal blood pressure <140/90 mmHg in patients who are compliant with maximal tolerated doses of a minimum of three antihypertensive drugs, one of which must be a diuretic. The increasing prevalence of obesity and hypertension in the general population mean that this disorder has gained attention in the past decade. In the past 2 years, large-scale population-based studies such as the US National Health and Nutrition Examination Survey (NHANES) have specifically examined the prevalence and incidence of resistant hypertension, and associated risk factors. The findings suggest the prevalence of resistant hypertension is 8–12% of adult patients with hypertension (6–9 million people). The increasing prevalence of resistant hypertension contrasts with the improvement in blood pressure control rates during the same period. Studies also show that patients with resistant hypertension aged >55 years, of black ethnicity, with high BMI, diabetes or chronic kidney disease have an increased risk of cardiovascular events compared to nonresistant hypertensive patients. Analyses that exclude the effects of white-coat hypertension and pseudoresistant hypertension are also needed to clarify the epidemiology of true resistant hypertension.

Key Points

  • Best estimates of the prevalence of resistant hypertension suggest it affects 9–12% of the 72 million people with hypertension in the US

  • Resistant hypertension occurs predominantly in men, those aged >55 years, and in individuals who are black, have diabetes mellitus, are obese or have stage 3 or higher chronic kidney disease

  • Ambulatory blood pressure monitoring and assessment of adherence to medication is essential to eliminate pseudoresistant hypertension as a diagnosis

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Change history

  • 09 July 2013

    In the print and online pdf versions of this article, the doi was incorrectly given as “10.1038/nrgastro.2012.260” instead of “10.1038/nrneph.2012.260”. The error has been corrected online.

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Author information

Authors and Affiliations

  1. 1st Department of Medicine, Section of Nephrology and Hypertension, American Hellenic Educational Progressive Association (AHEPA), University General Hospital, Aristotle University of Thessaloniki, St Kiriakidis 1, Thessaloniki, PO 54636, Greece

    Pantelis A. Sarafidis & Panagiotis Georgianos

  2. Department of Medicine, Department of Medicine, American Society of Hypertension Comprehensive Hypertension Center, The University of Chicago, 5841 South Maryland Avenue, MC 1027, Chicago, 60637, IL, USA

    George L. Bakris

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  1. Pantelis A. Sarafidis
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  3. George L. Bakris
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Contributions

P. A. Sarafidis and G. L. Bakris contributed equally to discussion of content for the article, researching data to include in the manuscript, writing, reviewing and editing of the manuscript before submission.

Corresponding author

Correspondence to George L. Bakris.

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Competing interests

G. L. Bakris has acted as a consultant for Abbott, CVRx, Daichi–Sankyo, Medtronic, Novartis, Relypsa and Takeda, and that he has received grants from Forest Laboratories and Takeda. In addition, G. L. Bakris is joint principal investigator of the Symplicity HTN 3 clinical trial and the principal investigator of AMETHYST-DN clinical trial. P. A. Sarafidis and P. Georgianos declare no competing interests.

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Sarafidis, P., Georgianos, P. & Bakris, G. Resistant hypertension—its identification and epidemiology. Nat Rev Nephrol 9, 51–58 (2013). https://doi.org/10.1038/nrneph.2012.260

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