Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients.
Noubiap JJ, Nansseu JR, Nyaga UF, et al.Heart. 2018; 105(2):98-105.
Aims
To estimate the prevalence of apparent treatment-resistant, pseudo-resistant and true-resistant hypertension in the general treated hypertensive population and in patients with other cardiovascular comorbidities.
Interventions
PubMed/MEDLINE, Excerpta Medica Database, Web of Science and Global Index Medicus databases were searched from inception to 30 September 2017 to identify cross-sectional and cohort studies reporting data on the prevalence of resistant hypertension (RH) in treated adults (>18 years) with hypertension. Two reviewers independantly screened the titles, abstract and full text of eligible articles and assessed study methodological quality, with disagreements resolved by consensus. A random-effects model was used to estimate the prevalence of resistant hypertension across studies and heterogeneity was assessed via the χ² test on Cochran’s Q statistic.
Participants
91 studies published between 1991 and 2017 were included in the metaanalysis reporting data from 3,207,911 patients with hypertension on antihypertensive drugs globally (Populations: general, 65 studies; elderly, 5 studies; chronic kidney disease, 4 studies; renal transplants, 4 studies; obesity, 2 studies).
Outcomes
The prevalence of true-resistant, apparent treatment-resistant and pseudo-resistant hypertension in the general population treated for hypertension and other specific populations treated for hypertension (obese, elderly, chronic kidney disease, kidney transplant recipients).
Follow-up
Not available
CET Conclusions
This is a well conducted systematic review that includes data from a vast number of patients (3.2 million) from 91 studies. A good number of databases were searched and data extraction was done in duplicate with clearly defined outcomes. Included studies were assessed for risk of bias and less than 5% were deemed to be high risk. Heterogeneity was explored using subgroup analysis and meta-regression because the apparent degree of heterogeneity was very high (97%), which indicates significant differences between the included studies. The main reason for this was found to be the method used to measure blood pressure. The overall prevalence of true resistant hypertension was 10.3% (6-15.5%, 95% CI). The highest prevalence was found in the Western Pacific (19.2%). Interestingly a similarly high prevalence was found for resistant pseudo-hypertension, or white-coat hypertension, compared to true resistant hypertension. The authors recommend the use of ambulatory blood pressure monitoring over office measurement as a key conclusion.
Trial registration
None