Apparent treatment-resistant hypertension in ambulatory hypertensive patients in Northeast Ethiopia: prevalence, treatment patterns, and predictors

Abstract

Apparent treatment-resistant hypertension (aTRH) significantly contributes to the rising prevalence of uncontrolled hypertension in Africa, leading to serious cardiovascular and cerebrovascular risks. Despite its critical importance, comprehensive, evidence-based data on aTRH in sub-Saharan Africa, including Ethiopia, remains scarce. The Northeast Amhara region has been particularly underexplored in this regard. This study aimed to assess the prevalence, treatment pattern, and predictors of aTRH among ambulatory adult hypertensive patients attending hypertension clinics in Dessie Comprehensive Specialized Hospital (DCSH) and Boru Meda General Hospital (BMH) in Northeast Ethiopia. A multi-center cross-sectional study was conducted from February 1 to July 30, 2024, involving 240 hypertensive patients (192 from DCSH and 48 from BMH) who were on at least one antihypertensive medication. Patients were selected using a multistage sampling (stratified proportional, followed by simple random sampling) method. Data was collected through rigorous medical record reviews, and descriptive statistics were used for data summarization. The study followed the latest (2018) AHA guideline definition to affirm aTRH, targeting goal blood pressure (BP) of < 130/80 mmHg. Logistic regression analysis identified factors associated with aTRH, with statistical significance set at p < 0.05. aTRH was observed in 9.2% of patients. About 48.3% were on dual antihypertensive therapy, with calcium channel blockers (65.4%), diuretics (60.4%), and angiotensin-converting enzyme inhibitors (60.0%) being the most common medications. Individual medications most frequently prescribed included amlodipine (62.9%), enalapril (60.0%), and hydrochlorothiazide (44.6%). Over half of the patients (56.2%) had poorly controlled BP at the last follow-up. At least one-time change in antihypertensive regimens was the sole predictor of aTRH (Adjusted Odds Ratio [AOR]: 2.85, 95% CI: 1.14–7.10, p = 0.025). aTRH is notably prevalent in the region, significantly exacerbating the overall burden of uncontrolled hypertension in Ethiopia. Encountering at least one-time antihypertensive regimen change is positively associated with aTRH. To mitigate the dire impact of aTRH, it is crucial to implement targeted interventions, including optimizing treatment strategies, improving adherence, and addressing factors contributing to resistance.