Key result
Higher BMI links to ~11% greater odds of true resistant hypertension alongside elevated ambulatory BP.
Why the study?
Resistant hypertension is associated with increased cardiovascular risk and ambulatory blood pressure monitoring is crucial for its management, but ambulatory blood pressure characteristics of these patients remain unclear.
Cohort (n=770)
Yes
Odds Ratio: 1.06 (95% CI 1.032–1.089)
p-value: p=<0.001
High BMI and elevated 24-hour systolic blood pressure are significant risk factors for true resistant hypertension, which is also characterized by a relatively poor response to diuretics.
Supports risk stratification by BMI and ambulatory BP; leaves open optimal management of true resistant hypertension.
Background Resistant hypertension (RH) is a condition associated with increased cardiovascular risks. Ambulatory blood pressure monitoring (ABPM) plays a crucial role in the diagnosis and management of RH. However, owing to the lack of a uniform definition and the diagnostic challenges of RH, the ABPM characteristics of RH patients remain unclear. Purpose This study aims to investigate the ABPM characteristics of true RH (tRH) patients before and during titration of a standard antihypertensive regimen. Methods This prospective, multicenter study included untreated patients with primary hypertension, and excluded those with potential pseudo-RH. Antihypertensive medications were titrated strictly according to guideline recommendations. ABPM profiles were recorded at baseline and during follow-up. Results A total of 770 participants were enrolled in the study, with 640 completing the follow-up procedures. Thirty-six tRH patients were identified, accounting for 5.63% of the total cohort. Compared with non-RH patients, tRH patients had a greater BMI (27.50±4.07 vs. 25.76±3.28, P=0.002) and higher office and ambulatory blood pressure (BP) levels prior to treatment. During the medication titration process, tRH patients only presented significantly higher ambulatory BP levels after the addition of diuretics compared to those in whom BP could be controlled with adequate diuretic use. Multivariate stepwise logistic regression analysis revealed that BMI (OR=1.106, 95% CI: 1.010 to 1.212, P=0.030) and 24 systolic BP (OR=1.060, 95% CI: 1.032 to 1.089, P < 0.001) were significantly associated with the final diagnosis of tRH. Conclusions True RH patients presented significantly higher ambulatory BP levels before treatment compared to non-RH patients. High BMI and 24h systolic BP are risk factors for tRH in untreated hypertensive patients. The relatively poor response to diuretics in tRH patients may be a key factor contributing to their poor BP control.Flowchart Ambulatory blood pressure profiles
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Yang et al. (2025) conducted a cohort in Primary hypertension (n=770). 24h systolic blood pressure was evaluated on Final diagnosis of true resistant hypertension (OR 1.060, 95% CI 1.032-1.089, p=<0.001). Higher 24h systolic blood pressure (OR 1.060; 95% CI 1.032-1.089) and BMI (OR 1.106; 95% CI 1.010-1.212) were significantly associated with the final diagnosis of true resistant hypertension.
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