Trends in the prevalence of apparent treatment-resistant hypertension among U.S. adults, 1999–2018

Aim: This study aimed to investigate the changing trends in the prevalence of apparent treatment-resistant hypertension (aTRH) in American adults between 1999 and 2018. Methods: We analyzed data from 50,906 non-pregnant individuals aged ≥20 years who participated in the National Health and Nutrition Examination Survey. Prevalence estimates were standardized by age and sex based on 2010 U.S. Census data. Results: Overall, the prevalence of aTRH remained relatively stable during the study period, ranging from 1.27 % to 1.33 %. However, significant differences existed between different sociodemographic subgroups. Higher prevalence was observed in older adults (≥65 years), women, non-Hispanic Black individuals, and those with lower levels of education level or family income. These differences may reflect age-related physiological changes, individual differences in drug response, genetic susceptibility, and the influence of structural social factors affecting health. Subgroup analysis showed that obesity, type 2 diabetes mellitus, cardiovascular diseases, and chronic kidney disease were all associated with a higher prevalence of aTRH. Conclusion: Our findings highlight the persistent burden of aTRH in specific high-risk populations and underscore the need for targeted, equity-oriented interventions to improve blood pressure control and reduce health disparities.