WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Amer Ahmed Abdullah Al-Qaftan, Duraid Khalil Ibrahim, Abdulhadi Mohammed Tarkh

ABSTRACT

Background: Resistant hypertension (RH) is a subtype of hypertension that makes it difficult to achieve blood pressure targets below 140/90 mmHg even using three anti-hypertensive drugs, including diuretics, or four anti-hypertensive medications. Although the exact cause is unknown, several factors contribute to the development of resistant hypertension. Objectives: To show the factors which predict resistant hypertension among adult patients within a sample of Iraqi patients. Methods: This is a cross-sectional study. Included adult patients aged more than 18 years old who had hypertension based on a history of prior diagnosis and therapy, blood pressure ≥ 140/90 mmHg on two to three office visits two weeks apart, home blood pressure readings >130/80 mmHg, or a single blood pressure reading of ≥180/110 mmHg. The study patients were assessed at the medical consultation clinic of Azadi Teaching Hospital from May 2024 to September 2025. Patients were divided into two groups based on blood pressure control: group I (controlled hypertension) included 200 patients who achieved blood pressure measurements < 140/90 on two visits, and group II (resistant hypertension) included 100 patients whose blood pressure measurement was ≥140/90 mmHg despite adhering to medications and taking three antihypertensive drugs on the optimal dose, including the diuretic. All patients who participated in the trial provided informed consent. Results: The mean age ± standard deviation of the study participants was 61.64 ± 9.12 years. Male gender represents 59.66 % of the study patients. Statistically significant different was found regarding excess salt intake (P value <0.001) and BMI (P value <0.001). Moreover, statistically significant difference was found with regard to presence of chronic kidney disease (P value <0.001) and obstructive sleep apnea (P value = 0.016). Furthermore, statistically significant difference found concerning drug intake of non-steroidal anti-inflammatory drugs intake (P value <0.001), diuretics (P value <0.001), angiotensin converting enzyme inhibitors (P value <0.001), calcium channel blockers (P value <0.001), and drug compliance history (P value <0.001). Additionally, statistically significant difference found concerning systolic blood pressure (P value <0.001), diastolic blood pressure (P value <0.001), serum creatinine (P value <0.001), and estimated-GFR (P value 0.033). Lastly, patients with resistant hypertension had statistically significant cardiac structural remodeling and functional abnormalities as shown by Echocardiography. Conclusion: Certain factors significantly associated with resistant hypertension. These factors are excess salt intake, obesity, chronic kidney disease, obstructive sleep apnea and cardiac structural remodeling and functional abnormalities. Clinician should keep in mind these factors when treating resistant hypertensive patients.