Factors associated with uncontrolled hypertension in treated hypertensive patients: lifestyle, clinical factors, and inflammatory parameters

Uncontrolled hypertension remains common despite antihypertensive treatment, and both clinical context and systemic inflammation may contribute to poor blood pressure control. This study aimed to identify lifestyle, clinical, and inflammatory factors associated with uncontrolled hypertension in treated hypertensive adults, with particular emphasis on the inflammatory prognostic index (IPI). This cross-sectional study with prospective data collection included 219 treated hypertensive adults at a university hospital in Turkey between November 2025 and April 2026. Participants underwent 7-day home blood pressure monitoring and were classified as having controlled ( n = 100) or uncontrolled hypertension ( n = 119), defined as a mean home blood pressure of ≥ 135/85 mmHg despite treatment. Clinical, lifestyle, treatment-related, laboratory, and inflammatory variables were assessed. Multivariable logistic regression and receiver operating characteristic analyses were used to identify factors independently associated with uncontrolled hypertension and evaluate discriminatory performance. Compared with the controlled hypertension group, patients with uncontrolled hypertension showed a distinct clinical and inflammatory profile. Urban residence was more common in the uncontrolled hypertension group (60.5% vs. 38.0%, p < 0.001), whereas sufficient physical activity did not differ significantly between the groups. Electrocardiographic left ventricular hypertrophy was also more frequent in patients with uncontrolled hypertension (79.8% vs. 36.0%, p < 0.001). CRP and all evaluated inflammatory indices were significantly higher in the uncontrolled hypertension group, including IPI (2.45 [1.25–4.81] vs. 1.72 [1.14–2.60], p < 0.001). In multivariable analysis, urban residence (OR 2.55, 95% CI 1.40–4.67; p = 0.002) and IPI (OR 1.54 per 1-unit increase, 95% CI 1.24–1.91; p < 0.001) were independently associated with uncontrolled hypertension. IPI alone showed modest discriminatory ability (AUC 0.644), whereas the full multivariable model yielded an AUC of 0.741. In treated hypertensive adults, urban residence and higher IPI were independently associated with uncontrolled hypertension. IPI alone had limited discriminatory ability, supporting its potential role as an exploratory adjunct to broader clinical assessment rather than as a standalone marker.