Epidemiology of Uncontrolled and Treatment‑Resistant Hypertension: A Registry‑Based Observational Study

Background This study aimed to describe blood pressure control rates and prevalence of treatment resistant hypertension among diagnosed individuals.Methods Randomly selected adults who had at least one primary or secondary healthcare visit and who were registered residents of Stockholm County, Sweden, on December 31st, 2019, were included. Blood pressure control in diagnosed individuals was assessed using two targets: <140/90 mmHg and <130/80 mmHg. The prevalence of treatment-resistant hypertension defined by three commonly used criteria was calculated and its association with clinical characteristics, drug treatment patterns, and comorbidities were assessed.Results By the end of 2019, among those with a hypertension diagnosis, 57% (<140/90 mmHg) or 19% (<130/80 mmHg) had controlled blood pressure depending on the threshold used. The point prevalence of treatment-resistant hypertension ranged from <1% to 17% depending on definition and was associated with older age, higher body mass index, and multiple comorbidities including type 2 diabetes, cardiovascular disease, heart failure, and chronic kidney disease.Conclusion Blood pressure control remains a major clinical challenge, with fewer than one in five patients with a hypertension diagnosis achieving <130/80 mmHg. The prevalence of treatment-resistant hypertension varied widely depending on the definition used and was closely associated with a greater burden of comorbidities, indicating an unmet need for improved strategies for this clinically challenging subgroup.