Abstract
Resistant hypertension is a well-recognised clinical challenge. However, the definition and epidemiology of true resistant hypertension (RH) are less understood, especially in Asia. This cross-sectional study examined the prevalence of RH referred from primary care clinics based on various guidelines. RH was defined as blood pressure (BP) being above the threshold using ambulatory blood pressure monitoring despite adequate lifestyle measures and optimal treatment with ≥3 medications at maximally tolerated doses. Between one in four (n = 94, 24.0% using Malaysian guidelines) and up to two-thirds (n = 249, 63.7% using 2018 American guidelines) of adults referred for uncontrolled hypertension met the criteria of true RH. Of those with RH, a further one-quarter (n = 26, 26.6%) were deemed to have refractory hypertension (elevated BP despite treatment with at least 5 antihypertensive medications). Adults with RH were generally younger, more likely to be male, had a higher BMI and were more likely to have gout, CKD, and angina compared to those with controlled hypertension. The prevalence of RH amongst Asian adults with poor hypertension control is high. A concerted effort is needed to reduce the high burden of RH, especially among this population.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
de Jager RL, van Maarseveen EM, Bots ML, Blankestijn PJ, investigators S. Medication adherence in patients with apparent resistant hypertension: findings from the SYMPATHY trial. Br J Clin Pharmacol. 2018;84:18–24.
Chia YC, Ching SM. Prevalence and predictors of resistant hypertension in a primary care setting: a cross-sectional study. BMC Fam Pr. 2014;15:131.
Kario K, Tomitani N, Buranakitjaroen P, Chia YC, Park S, Chen CH, et al. Home blood pressure control status in 2017‐2018 for hypertension specialist centers in Asia: results of the Asia BP@ Home study. The. J Clin Hypertens. 2018;20:1686–95.
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. International society of hypertension global hypertension practice guidelines. Hypertension. 2020;75:1334–57.
Noubiap JJ, Nansseu JR, Nyaga UF, Sime PS, Francis I, Bigna JJ. Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart 2019;105:98.
Clinical Practice Guidelines: Management of Hypertension. In. Vol 5th edition. Ministry of Health Malaysia: Putrajaya, 2018.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC/ESH Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39:3021–104.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension .2018;71:1269–324.
Vaduganathan M, Mensah George A, Turco Justine V, Fuster V, Roth, Gregory A. The global burden of cardiovascular diseases and risk. J Am Coll Cardiol. 2022;80:2361–71.
Huang H-C, Cheng H-M, Chia Y-C, Li Y, Van Minh H, Siddique S, et al. The role of renal nerve stimulation in percutaneous renal denervation for hypertension: a mini-review. J Clin Hypertens. 2022;24:1187–93.
Kario K, Chia YC, Wang JG. The HOPE Asia Network activity 2022: towards better hypertension management in Asia. J Clin Hypertens (Greenwich). 2022;24:1109–11.
Acknowledgements
The authors wish to thank Ang KL, Lim SR, Lee V, Lai YLC, Chieng MCH, Lim SH, Yunos NE, Parveen R and staff from Clinical Research Center, Sarawak General Hospital and all primary care facilities who were involved in the study. The authors would like to thank the Director General of Health Malaysia for permission to publish this manuscript.
Funding
The study was funded by a grant from the National Institutes of Health, Ministry of Health, Malaysia.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Rights and permissions
About this article
Cite this article
Yeo, J.J.P., Yeo, L.S., Tan, S.S.N. et al. Prevalence of true resistant hypertension in those referred for uncontrolled hypertension in Malaysia: A comparison using different definitions. Hypertens Res 47, 352–357 (2024). https://doi.org/10.1038/s41440-023-01418-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41440-023-01418-4
Keywords
This article is cited by
-
Intriguing review and topics in this month of Hypertension Research
Hypertension Research (2024)