Key result
Black adults with apparent resistant hypertension show ~13-point lower blood pressure control rates than White adults.
Why the study?
Racial and ethnic differences in prescribing patterns and outcomes of treatment resistant hypertension are not well characterized in the US population.
Cross-Sectional (n=4,174)
Yes
Absolute Event Rate: 10.5% vs 23.8%
p-value: p=<0.01
Non-Hispanic Black adults face a disproportionately higher burden of apparent treatment-resistant hypertension and lower rates of blood pressure control despite being prescribed more antihypertensive medications.
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.
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Gu et al. (2026) conducted a cross-sectional in Hypertension (n=4,174). Non-Hispanic Black race vs. Non-Hispanic White and Hispanic race/ethnicity was evaluated on Rate of blood pressure control (p=<0.01). Non-Hispanic Black adults had the highest prevalence of apparent treatment resistant hypertension (9.57%) and lowest rate of blood pressure control (10.5%) compared to Whites (23.8%; Pdiff<0.01).
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