Prevalence and Factors Associated with Apparent Treatment-Resistant Hypertension Among Adults with Hypertension Attending the Medical Outpatient Clinic at Mbarara Regional Referral Hospital: A Cross-sectional Study

Background : Apparent treatment-resistant hypertension (aTRH) poses a clinical challenge and is associated with poor cardiorenal outcomes. Despite the growing burden of hypertension in sub-Saharan Africa, data on aTRH remain scarce, particularly in Uganda. We sought to determine the prevalence and factors associated with aTRH among adults with hypertension. Methods : A cross-sectional study was conducted at MRRH, including patients with treated hypertension for ≥ 6 months, who had taken antihypertensives in the past 2 weeks. Apparent TRH was defined as office systolic blood pressure ≥140mmHg or diastolic blood pressure ≥ 90mmHg in a patient on ≥3 antihypertensive agents (including a diuretic) or ≥4 antihypertensive agents irrespective of blood pressure level. Simple proportions were used for the prevalence of aTRH, while modified Poisson regression with robust variance was used for associated factors, reporting adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). Results : A total of 250 participants were enrolled. The mean age was 58 (±13) years, and 200 (80%) were female. The prevalence of aTRH was 30.8% (95% CI: 25.4–36.8). Male aPR 1.90 (95% CI: 1.23–2.94; p= 0.004), eGFR <60 mL/min/1.73m² aPR 1.81 (95% CI: 1.23–2.64; p=0.002), and increasing age aPR 0.98 (95% CI: 0.96-0.99; p= 0.003) were significantly associated with aTRH. Conclusion : Apparent TRH is highly prevalent, nearly one-third of treated patients, and is independently associated with male sex, impaired kidney function, and younger age. We recommend that targeted efforts focus on younger individuals, males, and those with impaired kidney function to improve blood pressure control and reduce associated risks.