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. 2025 Jan;48(1):49-59.
doi: 10.1038/s41440-024-01988-x. Epub 2024 Nov 14.

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

Chan Joo Lee #  1   2 , Hokyou Lee #  2   3 , Jiwon Seo  4 , Jinseub Hwang  5 , Dayoung Kang  5 , Soo-Hyun Park  6 , Jin-Taek Hwang  6   7 , Jae Ho Park  6 , Sungha Park  8   9
Affiliations

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

Chan Joo Lee et al. Hypertens Res. 2025 Jan.

Abstract

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.

Keywords: Medication adherence; Prognosis; Resistant hypertension.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: CJL has received honoraria from Novartis, Organon, Viatris, Boryung, Daiichi Sankyo, Chong Kun Dang, Daewoong, and JW Pharmaceutical. CJL has received stock option from Mediwhale. SP received honoraria from Viatris, Organon, Boryoung, Hanmi, Daewoong, Donga, Celltrion, Servier, Daiichi Sankyo, Chong Kun Dang, and Daewon, and a research grant from Daiichi Sankyo. SP has received consultation fees from Skylab. In addition, SP received stock options from Mediwhale. The other authors have no conflicts of interest to declare. Ethics: This study complied with the Declaration of Helsinki, and its design was approved by Yonsei University Health System’s Institutional Review Board (institutional review board number: 4-2022-0325). The requirement for informed consent was waived because the data were deidentified and anonymized. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for cohort studies.

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