The global prevalence and potential determinants of resistant hypertension Α meta-analysis

OBJECTIVE To determine the global prevalence and potential contributing factors of resistant hypertension. METHOD The study employed a meta-analysis design to consolidate existing research on resistant hypertension. Scopus, Embase, and PubMed were the selected databases for the search strategy, covering the period from January 5th to February 20th, 2025. Data collection encompassed author information, study designs, sample sizes, locations, endpoints, prevalence rates of resistant hypertension, and associated factors. Statistical analysis involved a single-arm meta-analysis to establish the frequency of resistant hypertension across studies. Furthermore, the MantelHaenszel test or inverse variance method was utilized to determine potential contributing factors associated with resistant hypertension. RESULTS In our study, a total of 42 articles were included, comprising data from 1,641,846 patients. Our investigation unveiled that the prevalence of resistant hypertension among hypertensive patients was 28.0%. Additionally, we identified several factors associated with an increased risk of resistant hypertension, including age, duration of hypertension, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, diabetes mellitus (DM), dyslipidemia, coronary heart disease (CHD), chronic kidney disease (CKD), microalbuminuria, left ventricular hypertrophy (LVH), and estimated glomerular filtration rate (eGFR). However, we did not find any association between male gender, smoking, and the risk of resistant hypertension. CONCLUSIONS Our study has identified the global prevalence of resistant hypertension and potential associated factors. These findings can serve as a reference for developing strategies to manage resistant hypertension.