Prevalence of Coronary Artery Disease Across Arterial Hypertension Phenotypes: Uncontrolled, Resistant, and Refractory Hypertension

Objective: To assess the age-stratified prevalence of coronary artery disease (CAD) across uncontrolled, resistant, and refractory hypertension. Design and method: An analysis was conducted using data from a registry of patients with arterial hypertension (AH) (n = 57,396). Three groups were formed based on blood pressure (BP) control and the number of prescribed antihypertensive drugs (AHDs): uncontrolled AH as BP >= 140/90 mm Hg while taking 1–2 AHDs; resistant AH as BP >= 140/90 mm Hg while taking at least three AHDs, including a diuretic; and refractory AH as BP >= 140/90 mm Hg while taking five or more AHDs of different classes including a thiazide-like diuretic and a mineralocorticoid receptor antagonist. The prevalence of CAD was assessed within each hypertension phenotype and age. Data analysis was performed using statistical software R. Results: Analysis demonstrated a statistically significant association (p < 0.001) between hypertension phenotypes and the prevalence of CAD. Increasing age was independently associated with higher odds of CAD. Patients with refractory hypertension exhibited the highest prevalence of CAD across all age groups with rates increasing from approximately 60% at age 45 to over 90% in older age groups. The resistant hypertension was also associated with a markedly higher prevalence of CAD rising from approximately 40% to 75% between the ages of 25 and 60, and reaching 80–90%. Each one-year increment in age was significantly (p<0.001) associated with increased odds of CAD with an odds ratio of 1.052 95% CI: 1.049; 1.054 in patients with uncontrolled hypertension, 1.039 95% CI: 1.033; 1.045 in patients with resistant hypertension, 1.056 95 CI: 1.028; 1.086 in patients with refractory hypertension (p<0.001).Conclusions: Arterial hypertension phenotype is a critical, age-independent factor associated with an increased prevalence of coronary artery disease. Patients with resistant and, in particular, refractory hypertension represent the most vulnerable subgroup, demonstrating an exceptionally high burden of CAD already in middle age. These findings highlight the need for earlier identification and more intensive management strategies in these high-risk populations.