Prognosis of apparent treatment-resistant hypertension and poor adherence: a nationwide cohort study.

Large-scale studies of the prognosis of resistant hypertension in Asian populations are limited, and the impact of poor adherence on clinical prognosis in patients with apparent treatment-resistant hypertension has not been studied.

A nationwide cohort analysis was done utilizing the National Health Insurance Service database in Korea, covering patients who participated in health examinations from 2013 to 2018.

A total of 935,002 patients were classified into apparent treatment-resistant (N = 69,372) or nonresistant (N = 865,630) hypertension based on blood pressure control and antihypertensive medication use. Medication adherence was assessed using the proportion of days covered.

The primary composite outcome included all-cause mortality, myocardial infarction, stroke, and heart failure. Other outcomes were the development of atrial fibrillation and progression to end-stage renal disease (ESRD). The median follow-up duration was 6. 0 (interquartile range [IQR], 4. 1-7.

0) years. Patients with apparent treatment-resistant hypertension were at a higher risk for the primary composite outcome than those with nonresistant hypertension (hazard ratio [HR], 1. 32; 95% confidence interval [CI], 1. 29-1. 35).

The incidence rates of ESRD were notably higher in the resistant hypertension group (HR, 3. 02; 95% CI, 2. 85-3. 20). Among participants with resistant hypertension, 3852 (5. 7%), 11,667 (17. 3%), and 51,879 (77%) had poor, suboptimal, and optimal adherence, respectively.

Poor medication adherence in apparent treatment-resistant hypertension was associated with a higher risk of the primary composite outcome compared to optimal adherence (HR, 1. 49; 95% CI, 1. 36-1. 63).

Apparent treatment-resistant hypertension is associated with significant cardiovascular risks in the Korean population.

Poor adherence to antihypertensive medication significantly elevates the risk of adverse clinical outcomes in patients with apparent treatment-resistant hypertension, underscoring the need for stringent management of these patients.