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Recent meta-analysis indicate that the pooled prevalence of resistant hypertension (RHT) barely differed between sex. However differences between RHT women and men in patients characteristics, associated factors and hypertension management are not well-described.

Design and method:

In the cross-sectional questionnaire-based observational study we included 7306 hypertensive females and 5069 hypertensive males,  > 18 years old and treated for at least 12 months with antihypertensive drugs. We defined hypertension control as blood (BP) levels both <140 mmHg/<90 mmHg. Patients were divided into 3 groups: controlled hypertension, uncontrolled hypertension (not fulfilling the criteria of RHT) and RHT (uncontrolled hypertension despite using 3 antihypertensive drugs including diuretic). Cardiovascular (CV) risk was evaluated according to 2013 ESH/ESC guidelines.


There were no differences in the rates of controlled hypertension (47.6 vs 47.0%), uncontrolled hypertension (27.3 vs 28.8%) and RHT (25.1 vs 24.2%) between women and men respectively (p = 0.17). Among patients with RHT, women as compared with men were older and had lower diastolic BP and eGFR as well as higher pulse pressure (PP). CV disease (16.9 vs 14.3%; p = 0.034), abdominal obesity and metabolic syndrome (MS, 70.5 vs 60.1%; p < 0.001) were more frequent among women than men with RHT. In RHT patients low (1.0 vs 0%) and high (25.3 vs 20.8%) added risk categories were more frequent and moderate (13.6 vs 18.0%) and very high (60.1 vs 61.2%) added risk categories less frequent in women the men (p < 0.001). Men with RHT were treated more frequently with aldosterone antagonists (16.1 vs 13.8%; p = 0.048) and alfa-blockers (8.9 vs 2.1%; p < 0.001) and less frequently with thiazide diuretics (78.5 vs 81.3%; p = 0.032). In a multivariate models higher PP, presence of MS, CAD and eGFR < 60 ml/min/1.73 m2 were related to the presence of RHT both in males and females. In women RHT was also related to the abdominal obesity, CVD and diseases causing disability. In men, RHT was additionally related to the diseases requiring treatment with non-steroidal anti-inflammatory drugs.


Although there were no differences in the rate of RHT between women and men, we identified gender related differences in CV profiles in RHT patients and in factors related with the presence of RHT.

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