A cross-sectional evaluation of racial and ethnic differences in apparent treatment resistant hypertension among US adults.

BACKGROUND: Treatment resistant hypertension (TRH) represents a major public health challenge in the United States, substantially increasing risks of major cardiovascular events. The racial and ethnic differences in prescribing patterns and outcomes of treatment resistant hypertension are not well characterized. OBJECTIVES: This study exams racial differences in TRH epidemiology, treatment and outcomes in a national sample of hypertensive adults. METHODS: We analyzed US adults (≥18 years) with hypertension from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 (N=4,174). Apparent treatment resistant hypertension (aTRH) was defined as uncontrolled blood pressure (systolic blood pressure, SBP≥130 mmHg or diastolic blood pressure, DBP≥80 mmHg) despite concurrent use of ≥3 antihypertensive classes including a diuretic or use of ≥4 medications regardless of blood pressure. Estimates were weighted to represent the US population. RESULTS: Among adults with hypertension, the overall prevalence of aTRH was 6.61 [CI: 5.58, 7.65]. Prevalence was the highest among non-Hispanic Blacks (9.57%), followed by non- Hispanic Whites (6.81%) and Hispanics (3.49%). Despite more antihypertensive medications (average number of antihypertensive medications: 3.87, 3.66 and 3.58 among Black, Whites and Hispanic participants, respectively; p <0.001), blood pressure levels were the highest among Black participants. Black participants had the lowest rate of BP control (10.5%) compared to Whites (23.8%) and Hispanics (14.4%) (Pdiff<0.01). CONCLUSIONS: Non-Hispanic Blacks bear disproportionate burden in aTRH while Hispanics are likely undertreated, although small sample size in the former group limits conclusive findings. Further research is needed to disentangle the interrelationship between TRH, race and ethnicity and mediating factors.