AFRICA Cardiovascular Journal of Africa • SAHS Biennial Congress 2024 16 Submission ID: 1636 Introduction The surge of cardiovascular disease across Sub-Saharan Africa is driven largely by hypertension and other cardiometabolic risk factors. South Africa, like other low-middle-income countries, faces a disproportionate burden due to the increasing prevalence of hypertension, exacerbated by low awareness, treatment, and control rates. The emergence of treatment-resistant hypertension (TRH) characterised by blood pressure above target levels despite use of three or more antihypertensive medications at maximally tolerated doses, or on four or more agents regardless of blood pressure control status -presents significant challenges to this goal. An increased risk of major adverse cardiovascular events, hypertensive-mediated organ damage, and increased healthcare costs are associated with this hypertension phenotype. Despite these serious implications, the impact of TRH in the South African context remains underexplored. Methods An observational analytical study was conducted at the chronic outpatient clinic at Wentworth Hospital, a district hospital in KwaZuluNatal, South Africa, between March and April 2024. Our objective was to determine the prevalence, predictors, and profiles of TRH in a primary care setting among people living with hypertension (PLWH). We analysed demographic, clinical, and biochemical parameters of 400 systematically randomised essential hypertensive patients aged over 30. Participants underwent office blood pressure (BP) monitoring and completed an interviewer-administered questionnaire that assessed medication adherence, and risk score assessments. A chart review was conducted to assess clinical parameters and the antihypertensive drug profile. Determinants of apparent TRH were identified using a multivariate logistic regression model. Results The mean age of the sample was 64.42 years (SD = 10.75), with a female preponderance of 65% (n = 260), and two-thirds comprised of Black Africans (35.3%) and Indians (30.5%). Most of the PLWH were obese, with a median body mass index of 30.24 kg/m² (IQR = 8.2). The prevalence of apparent TRH was 18.8% (n = 75) among treated hypertensives, with uncontrolled TRH accounting for 11% (n = 44) and controlled TRH for 7.8% (n = 31). Compared with their non-resistant counterparts, multivariable analysis revealed that waist circumference (odds ratio [OR] = 1.04, p = <0.001), electrocardiographic left ventricular hypertrophy (OR = 5.06, p = 0.005), chronic kidney disease (OR = 2.70, p = 0.002), dyslipidaemia (OR = 2.51, p = 0.035), and a high obstructive sleep apnoea (OSA) risk score (OR = 2.16, p = 0.004) were predictive of apparent TRH. Mineralocorticoid receptor antagonists were an underused antihypertensive drug class overall, accounting for 10.8% (n = 43). Conclusion Hypertension control in Africa remains a critical priority, particularly in a healthcare setting burdened with multiple challenges. Notably, this study is the first to describe the prevalence of apparent TRH in a general hypertensive population in primary care in South Africa. These insights are particularly valuable for enhancing hypertensive management and updating guidelines locally, especially regarding the utility of cost-effective anthropometric and OSA screening measures to identify at-risk patients for further care escalation. Our findings reveal a complex interplay between cardiometabolic conditions and TRH, underscoring the need for multifaceted interventions to prevent cardiovascular events in this high-risk subgroup of PLWH. Name: Presenting Author Information Article Category Abstract Title University of Kwa-Zulu Natal, College of Health sciences kellygov2@gmail.com English Abstract Researchers/Clinicians - Early, mid & senior career Prevalence and predictors of apparent treatment-resistant hypertension among patients in primary care in South Africa: a single-centre observational study Author Affiliation: Email: Kellicia Courtney Govender Science Theme Clinical Authors Name & Surname Title Expertise Affiliation Email Country Kellicia C. Govender Dr General medicine University of Kwa-Zulu Natal, College of Health sciences kellygov2@gmail.com South Africa Mergan Naidoo Prof Family medicine University of Kwa-Zulu Natal, College of Health sciences South Africa ORAL PRESENTATION
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