Abstract Body: Objective:
We enrolled patients with essential hypertension at 15 medical centers and design a prospective clinical study to investigate the prevalence and clinical characteristics of apparent and true resistant hypertension(ATRH). In addition, we explored the effect of duration of diuretic use on blood pressure(BP) control in ATRH patients. This study aims to provide evidence for further exploring the diagnosis and treatment of ATRH.

Methods: At the beginning, the patient who met the inclusion criteria were included in the study and took one tablet of O/A (20/5mg) every day. Thereafter, ambulatory blood pressure monitoring(ABPM) were completed every four weeks. During the follow-up, the drug dose of patients with controlled BP remained unchanged. Patients with uncontrolled BP were given additional drugs, and so on, until the BP controlled. The longest follow-up period was 24 weeks. Statistical analysis was performed using SPSS26. Depending on the data distribution, baseline data were evaluated using Student's t test, Mann-Whitney U test, or χ2 test. Binary logistic regression was used to further analyze the independent risk factors of ATRH.

Results: A total of 772 patients were screened in this study, and finally, 545 patients' completed follow-up datas were obtained. We conluded that the incidence of ATRH was 5.13%, and only 3.18% of the patients failed to control BP after further extension of diuretic use to 3 months. A baseline comparison showed that the proportion of males, overweight (25.68±3.22 kg/m2 vs 28.85±3.32 kg/m2, P < 0.001) and eGFR < 60% were higher in the ATRH group; the patients in the ATRH group had a higher BMI, RBC count, CREA, UR concentrations and a lower HDL-C concentrations; ATRH patients exhibited higher ABPM, SBP load and nighttime DBP load than the non-ATRH group; the non-ATRH group had a more obvious BP dipping at night, and the BP rhythm was more regular. Further binary logistic regression analysis found that BMI (OR 1.25, 95% CI 1.10-1.42) and a < 10% decrease in nocturnal DBP (OR 3.24, 95% CI 1.19-8.79) were independent risk factors for ATRH.

Conclusion: Under the stepwise titration of the standard treatment regimen, the prevalence of ATRH in the our study was 5.13%, and prolongs the duration of diuretic use can further promote the BP control of patients. ATRH is more common in male patients with obesity and kidney failure. Patients with a higher ABPM, BMI and a < 10% decrease in nocturnal DBP were more likely to develop ATRH.