True resistant hypertension was confirmed in 21.9% of patients with apparent resistance, while 75% had pseudo-resistance mainly due to suboptimal dosing and underuse of triple combination therapy.
Most cases of apparent treatment-resistant hypertension are actually pseudo-resistant, primarily driven by the underuse of guideline-recommended triple combination therapy and suboptimal dosing.
ABSTRACT The goal of the TREAT study is to estimate the prevalence of true resistant hypertension in a Belgian setting of patients with apparent treatment resistant hypertension (aTRH) and to evaluate which determining factor of pseudo‐resistant hypertension contributes the most to this prevalence. TREAT is a single‐visit, multicentric, non‐interventional, cross‐sectional survey. Inclusion criteria included: patients over 18 years receiving 3 or more antihypertensive molecules and referred to specialized hospital centers for aTRH. A total of 201 eligible patients were included. Only 56.7% of the patients were treated with the guideline recommended triple combination therapy (i.e. renin–angiotensin–aldosterone system inhibitor, calcium channel blocker and thiazide (‐like) diuretic), and only 23.4% were treated with the maximal recommended dose. WCH was present in 8.7% of the 115 patients with available ambulatory blood pressure recordings. Therapeutic adherence was self‐reported as good by 80% of patients, while 20% reported poor or moderate adherence. In this cohort, the prevalence (95% CI) of true resistant hypertension was estimated at 21.9% (14.7%–30.6%). Among patients referred to specialized centers for aTRH, about 3 out of 4 presented with pseudo‐resistant hypertension. The occurrence of WCH and poor adherence appeared rather limited in our study, but half of the participants were polymedicated with non‐recommended combinations of antihypertensive molecules. Inadequate dosing was observed in the majority of patients and a third was not using a single pill combination. Hence, pseudo‐resistant hypertension seems to be mainly associated with the underuse of triple combination therapy and, most likely, with suboptimal dosing.
Sofie et al. (2026) studied this question. True resistant hypertension was confirmed in 21.9% of patients with apparent resistance, while 75% had pseudo-resistance mainly due to suboptimal dosing and underuse of triple combination therapy.