Prevalence of Refractory and Resistant Hypertension
A Systematic Review of the Literature Protocol
DOI:
https://doi.org/10.48492/servir0212.40032Keywords:
Hypertension, Resistant Hypertension, Refractory Hypertension, PrevalenceAbstract
Introduction: Hypertension (HTN) is a global health condition that causes approximately 10.8
million deaths annually, and is one of the main risk factors for cardiovascular disease and
stroke. HTN is characterized by a constant rise in blood pressure, defined by systolic pressure
(SBP) and diastolic pressure (DBP). Refractory arterial hypertension (RAH) is a severe form of
HTN, where blood pressure remains uncontrolled despite the use of five or more
antihypertensive drugs from different classes. Resistant HTN (RAHb), on the other hand,
refers to uncontrolled blood pressure even with the administration of three or more drugs. A
significant proportion of cases considered resistant are actually pseudo-resistant, resulting
from inadequate blood pressure measurements or problems with adherence to treatment.
Objective/s: The aim of this systematic review is to assess the prevalence of the different
types of hypertension.
3 de 11
Methods: A systematic review of the literature will be carried out according to the JBI
methodology for systematic reviews of prevalence and incidence. The review will consider
studies that include adult individuals diagnosed with resistant or refractory HTN. Studies in
English, Spanish and Portuguese will be included. There will be no time restrictions on the
date of publication. The selection of studies will be carried out by two independent reviewers,
using a third reviewer in case of disagreement. The results of the search, study selection and
inclusion process will be presented in a PRISMA flowchart. Prevalence data will be assessed
using the JBI SUMARI critical appraisal tool for prevalence studies. Data extraction, evidence
analysis and results on the extent and type of evidence will be presented in a table.
Downloads
References
Armario, P., Calhoun, D. A., Oliveras, A., Blanch, P., Vinyoles, E., Banegas, J. R., Gorostidi, M.,
Segura, J., Ruilope, L. M., Dudenbostel, T., & de la Sierra, A. (2017). Prevalence and clinical
characteristics of refractory hypertension. Journal of the American Heart Association, 6(12).
https://doi.org/10.1161/JAHA.117.007365
Aromataris, Edoardo., & Munn, Zachary. (2020). JBI manual for evidence synthesis edited by E.
Aromataris, Z. Munn. Joanna Briggs Institute.
Calhoun, D. A., Booth, J. N., Oparil, S., Irvin, M. R., Shimbo, D., Lackland, D. T., Howard, G., Safford,
M. M., & Muntner, P. (2014). Determination of prevalence, risk factors, and comorbidities in
10 de 11
a large, population-based cohort. Hypertension, 63(3), 451–458.
https://doi.org/10.1161/HYPERTENSIONAHA.113.02026
Carey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C.
R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., Lackland, D. T., Laffer, C. L., NewtonCheh, C., Smith, S. M., Taler, S. J., Textor, S. C., Turan, T. N., & White, W. B. (2018a). Resistant
hypertension: Detection, evaluation, and management a scientific statement from the
American Heart Association. Hypertension, 72(5), E53–E90.
https://doi.org/10.1161/HYP.0000000000000084
Carey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C.
R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., Lackland, D. T., Laffer, C. L., NewtonCheh, C., Smith, S. M., Taler, S. J., Textor, S. C., Turan, T. N., & White, W. B. (2018b). Resistant
hypertension: Detection, evaluation, and management a scientific statement from the
American Heart Association. Hypertension, 72(5), E53–E90.
https://doi.org/10.1161/HYP.0000000000000084
Filippone, E. J., Naccarelli, G. V., & Foy, A. J. (2024). Controversies in Hypertension V: Resistant
and Refractory Hypertension. In American Journal of Medicine (Vol. 137, Issue 1, pp. 12–
22). Elsevier Inc. https://doi.org/10.1016/j.amjmed.2023.09.015
Forouzanfar, M. H., Liu, P., Roth, G. A., Ng, M., Biryukov, S., Marczak, L., Alexander, L., Estep, K.,
Abate, K. H., Akinyemiju, T. F., Ali, R., Alvis-Guzman, N., Azzopardi, P., Banerjee, A.,
Bärnighausen, T., Basu, A., Bekele, T., Bennett, D. A., Biadgilign, S., … Murray, C. J. L. (2017).
Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg,
1990-2015. JAMA - Journal of the American Medical Association, 317(2), 165–182.
https://doi.org/10.1001/jama.2016.19043
McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C.,
Christodorescu, R. M., Daskalopoulou, S. S., Ferro, C. J., Gerdts, E., Hanssen, H., Harris, J.,
Lauder, L., McManus, R. J., Molloy, G. J., Rahimi, K., Regitz-Zagrosek, V., Rossi, G. P., Sandset,
E. C., … Khamidullaeva, G. A. (2024). 2024 ESC Guidelines for the management of elevated
blood pressure and hypertension. European Heart Journal, 45(38), 3912–4018.
https://doi.org/10.1093/eurheartj/ehae178
Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J.
(2016). Global disparities of hypertension prevalence and control. Circulation, 134(6), 441–
450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912
Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G.,
Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension. In Nature
Reviews Disease Primers (Vol. 4). Nature Publishing Group.
https://doi.org/10.1038/nrdp.2018.14
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer,
L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M.,
Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D.
11 de 11
(2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.
In The BMJ (Vol. 372). BMJ Publishing Group. https://doi.org/10.1136/bmj.n71
Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo,
N. C., Beaton, A., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill,
T. J., Carapetis, J. R., Catapano, A. L., Chugh, S., Cooper, L. T., Coresh, J., … Fuster, V. (2020).
Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the
GBD 2019 Study. In Journal of the American College of Cardiology (Vol. 76, Issue 25, pp.
2982–3021). Elsevier Inc. https://doi.org/10.1016/j.jacc.2020.11.010
Siddiqui, M., Dudenbostel, T., & Calhoun, D. A. (2016). Resistant and Refractory Hypertension:
Antihypertensive Treatment Resistance vs Treatment Failure. Canadian Journal of
Cardiology, 32(5), 603–606. https://doi.org/10.1016/j.cjca.2015.06.033
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Jéssica Amaral, Lara Saraiva, Beatriz Cabral, Marta Almeida, Mauro Mota
This work is licensed under a Creative Commons Attribution 4.0 International License.
In order to promote the free circulation of knowledge, Servir is open access journal. All its content is available and protected under the Creative Commons license (CC BY 4.0).
The journal allows self-archiving in institutional repositories of all versions, which may become immediately available
