Prevalence of and associated factors for resistant hypertension in primary care settings: a systematic review and meta-analysis

Resistant hypertension (RHT) constitutes a significant global public health challenge, though its prevalence within primary care is not well characterized. This study therefore aimed to estimate the prevalence of RHT and identify associated factors in primary care settings. We systematically searched PubMed and Embase for studies reporting RHT prevalence in primary care, published through October 2025. Two reviewers independently extracted data and study demographics. Pooled prevalence estimates were calculated using a random-effects meta-analysis and compared across settings, measurement methods, and regions; associated factors were explored via meta-regression. Fifteen observational studies, encompassing 1,993,839 individuals, were included. Based on guideline consensus definitions, the pooled prevalence of RHT was 13% (95% CI, 10–17%; I² = 99.9%). Stratified by setting, the pooled prevalence was 13% (95% CI, 9–18%; I2 = 99.9%) in 11 primary care cohorts, 14% (95% CI, 4–37%; I2 = 99.5%) in 3 community health cohorts, and 15% in 1 institutional care cohort. Meta-regression identified male sex as a potential factor associated with RHT in primary care. Furthermore, the observed heterogeneity in this study likely stems from expected variations in environment, design, and other factors across the included studies. The prevalence of RHT is high in primary care populations. However, substantial heterogeneity, a limited number of studies, and methodological variations necessitate cautious interpretation and more rigorous research to inform public health interventions.