Treatment Resistant Hypertension Market Set to Transform at a CAGR of 5% with Increasing Diagnosis and Treatment of Resistant Patients along with Approval and Development of Newer Therapies During the Study Period (2020-2034) | DelveInsight

The treatment-resistant hypertension (TRH) market is expected to grow in the coming years due to the rising prevalence of uncontrolled hypertension and associated cardiovascular risks. Increasing awareness, improved diagnostic practices, and innovations in combination therapies, as well as device-based interventions, are driving market expansion.

LAS VEGAS, July 31, 2025 /PRNewswire/ -- DelveInsight's Treatment Resistant Hypertension Market Insights report includes a comprehensive understanding of current treatment practices, treatment resistant hypertension emerging drugs, market share of individual therapies, and current and forecasted market size from 2020 to 2034, segmented into 7MM [the United States, the EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan].

Key Takeaways from the Treatment Resistant Hypertension Market Report

• Resistant hypertension is managed through a combination of nonpharmacological and pharmacological approaches. Resistant hypertension is initially managed with an ACEi or ARB, a CCB, and a long-acting thiazide diuretic; if uncontrolled, spironolactone is recommended as a fourth-line agent, with β-blockers or α-blockers added if further escalation is needed.
• The diagnosed prevalence of TRH ranges from 10–14% across the 7MM, suggesting a consistent yet notable burden of the condition.
• In 2024, there were nearly 13 million diagnosed prevalent cases of TRH across the 7MM, with the United States accounting for the highest number, driven by a major contribution by aging population(40+ age group majorly), heightened awareness of hypertension management as leading pharma companies are focusing on treating resistant patients now, along with ian ncrease diagnosis.
• In the US in 2024, the highest diagnosed prevalence of treatment-resistant hypertension was observed in adults aged 60 and above, while the lowest was seen in the 18–39 age group, reflecting a clear positive correlation between age and hypertension prevalence. According to DelveInsight's analysis, the market size for treatment resistant hypertension was found to be USD 6.8 billion in the 7MM in 2024, and is projected to grow significantly, driven by the anticipated launch of novel therapies and increased adoption of advanced device-based treatments expected to reshape the treatment landscape.
• TRYVIO, developed by Idorsia Pharmaceuticals, is the first new class of antihypertensive in nearly 40 years, targeting the endothelin pathway by inhibiting ET-1. Approved by the FDA and EMA in 2024 and by the UK's MHRA in January 2025 for use with other drugs in adults with TRH, it was commercially launched in the US in October 2024. With approval still pending in Japan, the market there remains a significant untapped opportunity for future growth.
• Followed by TRYVIO's launch in 2024, AstraZeneca's Baxdrostat and Mineralys Therapeutics' Lorundrostat are anticipated to enter the US market by 2026. Out of both the therapies, Lorundrostat's pivotal trial interim data is available; however, Baxdrostat's Phase III data is still awaited.
• Leading treatment resistant hypertension companies developing emerging therapies, such as AstraZeneca, Mineralys Therapeutics, E-Star BioTech, Ionis Pharmaceuticals, Kardigan, Regeneron Pharmaceuticals, Alnylam Pharmaceuticals, Roche, and others, are developing novel treatment resistant hypertension drugs that can be available in the treatment resistant hypertension market in the coming years.
• The promising treatment resistant hypertension therapies in the pipeline include Baxdrostat (CIN-107), Lorundrostat (MLS-101), MANP, Tonlamarsen (ION904), REGN5381, Zilebesiran (ALN-AGT01), and others.

Discover more about the treatment resistant hypertension treatment market @ Treatment Resistant Hypertension Medication

Treatment-Resistant Hypertension Market Dynamics

The treatment resistant hypertension market dynamics are expected to change in the coming years. Advances in pharmaceuticals and procedures, along with innovations in pharmacogenomics, precision medicine, and digital health platforms, are expanding the landscape of treatment options for TRH by enabling personalized care, enhancing patient engagement and remote management, and necessitating multidisciplinary collaboration among cardiologists, nephrologists, endocrinologists, and other specialists for comprehensive care.

Furthermore, potential therapies are being investigated for treatment resistant hypertension, and it is safe to predict that the treatment space will significantly impact the treatment resistant hypertension market during the forecast period. Moreover, the anticipated introduction of emerging therapies with improved efficacy and a further improvement in the diagnosis rate are expected to drive the growth of the treatment resistant hypertension market in the 7MM.

However, several factors may impede the growth of the treatment resistant hypertension market. Managing TRH often necessitates complex medication regimens and lifestyle modifications, leading to challenges in patient adherence and treatment optimization; however, despite therapeutic advancements, a subset of patients remains resistant to current options, underscoring the need for alternative strategies, even as stringent regulatory and reimbursement hurdles delay new therapy development and adoption, further compounded by the significant economic burden TRH places on healthcare systems, highlighting the urgent need for cost-effective solutions.

Furthermore, the treatment resistant hypertension market growth may be offset by failures and discontinuation of emerging therapies, unaffordable pricing, market access and reimbursement issues, and a shortage of healthcare specialists. In addition, the undiagnosed, unreported cases and the unawareness about the disease may also impact the treatment resistant hypertension market growth.

Treatment Resistant Hypertension Treatment Market

Resistant hypertension is managed through a combination of lifestyle modifications, pharmacological therapy, and, when necessary, interventional procedures. Key lifestyle changes include maintaining a healthy weight through regular exercise and a balanced diet, reducing salt intake, limiting alcohol consumption, and quitting smoking. Pharmacological treatment typically involves a combination of a renin–angiotensin system inhibitor, a long-acting calcium channel blocker, and a diuretic at the highest tolerable doses, preferably as a single-pill formulation. Spironolactone is currently the preferred fourth-line agent, while alternatives include alpha-blockers, beta-blockers, centrally acting sympatholytics, and vasodilators. For patients whose blood pressure remains uncontrolled despite these strategies, options such as renal denervation and emerging drug therapies should be considered.

Lifestyle interventions are particularly important, with a recent meta-analysis identifying them as the most effective non-pharmacologic approach, achieving a reduction in office systolic blood pressure by approximately 7.26 mmHg. Dietary patterns such as the DASH and Mediterranean diets, characterized by high intake of fruits, vegetables, whole grains, and low-fat dairy, and low levels of saturated fats and sugars, have shown proven benefit. Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, offers a promising alternative by blocking aldosterone activity even in its absence. While spironolactone remains the standard add-on therapy, its anti-androgenic effects may limit its use, especially in men or those with hyperkalemia.

TRYVIO (aprocitentan) marks a significant advancement as the first antihypertensive from a new drug class in over three decades, targeting the endothelin pathway. Approved by the FDA in early 2024, TRYVIO is a convenient once-daily oral therapy that simplifies prescribing and adherence. The removal of the REMS requirement by the FDA signals increased confidence in its safety. Though it's now available for patients at high cardiovascular risk, fluid retention, reported in 18% of patients at higher doses, which may affect its adoption compared to existing options. While Idorsia has not yet revealed a global commercialization partner, the positive Phase III outcomes indicate strong market potential for TRYVIO.

To know more about FDA-approved drugs for treatment resistant hypertension, visit @ Treatment Resistant Hypertension Treatment

Treatment Resistant Hypertension Pipeline Therapies and Key Companies

Several TRH drugs with different mechanisms of action that are in development are aldosterone synthase inhibitors (baxdrostat, lorundrostat), Guanylyl Cyclase A (GC-A) receptor activators (MANP), Natriuretic Peptide Receptor 1 (NPR1) agonists (REGN5381), angiotensinogen expression inhibitors (zilebesiran), and targeting angiotensinogen (tonlamarsen). The success of these candidates could diversify the treatment landscape and intensify competition.

Baxdrostat is an oral, small-molecule drug that selectively inhibits aldosterone synthase, the enzyme responsible for producing aldosterone in the adrenal glands. Baxdrostat emerges as a strong contender in the resistant hypertension pipeline, with AstraZeneca positioning it as a potential multi-blockbuster asset. As an oral aldosterone synthase inhibitor, it targets patients with uncontrolled or resistant hypertension. The Phase II results have shown significant reductions in SBP, outperforming TRYVIO, with a favorable safety profile. First, mention the drug's current phase. The Phase III results, expected in the second half of 2025, will be key in validating its commercial and clinical potential.

Lorundrostat, another Phase III investigational oral therapy. It is gaining attention as a high-potential entrant in the antihypertensive market. Developed by Mineralys Therapeutics, the drug is a highly selective oral aldosterone synthase inhibitor, and early data positions it as a potential best-in-class option for patients with resistant or uncontrolled hypertension. Positive outcomes from both the Phase II Advance-HTN and Phase III Launch-HTN trials validate its clinical promise, with efficacy surpassing that of TRYVIO in terms of blood pressure reduction. What further strengthens Lorundrostat's profile is its superior selectivity and greater reduction in plasma aldosterone concentration compared to baxdrostat. With approximately four times higher selectivity, the drug may offer a more targeted approach to managing cardiorenal metabolic conditions, a segment with significant unmet clinical needs.

The anticipated launch of these emerging therapies are poised to transform the treatment resistant hypertension market landscape in the coming years. As these cutting-edge therapies continue to mature and gain regulatory approval, they are expected to reshape the treatment resistant hypertension market landscape, offering new standards of care and unlocking opportunities for medical innovation and economic growth.

Discover more about treatment resistant hypertension drugs in development @ Treatment Resistant Hypertension Clinical Trials

Recent Developments in the Treatment Resistant Hypertension Market

• In May 2025, Q1 presentation, Alnylam Pharmaceuticals and Roche announced plans to release the topline results from the KARDIA-3 study and to initiate a Phase III cardiovascular outcomes trial of zilebesiran in the second half of 2025.
• In the Q1 2025 presentation, Regeneron Pharmaceuticals announced the initiation of a Phase II clinical trial evaluating REGN5381 for the treatment of uncontrolled hypertension.
• In March 2025, Idorsia Pharmaceuticals announced that the US FDA had fully released TRYVIO from its REMS requirement. Idorsia has also released from the PMR to conduct a worldwide descriptive study that collects prospective and retrospective data in women exposed to TRYVIO during pregnancy and/or lactation, as these data are no longer needed.
• In February 2025, Idorsia Pharmaceuticals announced that the exclusivity agreement signed in November 2024 with an undisclosed party for the global rights to aprocitentan had concluded without the party signing the deal as foreseen in the nonbinding term sheet.

Treatment Resistant Hypertension Overview

Resistant hypertension is characterized by blood pressure that remains elevated at or above 130 mmHg systolic and 80 mmHg diastolic, despite the use of three or four different classes of antihypertensive medications, including a thiazide diuretic, all at their highest tolerated doses. It can also refer to cases where blood pressure is controlled, but only with the use of four or more antihypertensive agents. This definition encompasses both resistant and refractory hypertension in patients whose blood pressure remains uncontrolled despite being on an adequate regimen that includes a diuretic. Individuals who require more than three medications to control their blood pressure may also benefit from referral to a hypertension specialist.

The assessment of resistant hypertension begins with confirming the accuracy of blood pressure readings, as mistakes such as using an improperly sized cuff or incorrect arm positioning can lead to misleadingly high values. It is also important to rule out the white coat effect by using validated out-of-office monitoring methods, such as ambulatory or home blood pressure monitoring under clinical guidelines. Automated office blood pressure (AOBP) measurement, which involves repeated readings taken every 1–2 minutes with the patient alone in a quiet room using a specialized oscillometric device, is a useful technique to reduce this effect.

Treatment Resistant Hypertension Epidemiology Segmentation

The treatment resistant hypertension epidemiology section provides insights into the historical and current treatment resistant hypertension patient pool and forecasted trends for the 7MM. It helps recognize the causes of current and forecasted patient trends by exploring numerous studies and views of key opinion leaders.

The treatment resistant hypertension market report offers epidemiological analysis for the study period 2020–2034 in the 7MM, segmented into:

• Total Diagnosed Prevalent Cases of Treatment Resistant Hypertension
• Gender-Specific Diagnosed Prevalent Cases of Treatment Resistant Hypertension
• Age-Specific Diagnosed Prevalent Cases of Treatment Resistant Hypertension

Scope of the Treatment Resistant Hypertension Market Report

• Therapeutic Assessment: Treatment Resistant Hypertension current marketed and emerging therapies
• Treatment Resistant Hypertension Market Dynamics: Key Market Forecast Assumptions of Emerging Treatment Resistant Hypertension Drugs and Market Outlook
• Competitive Intelligence Analysis: SWOT analysis and Market entry strategies
• Unmet Needs, KOL's views, Analyst's views, Treatment Resistant Hypertension Market Access and Reimbursement

Download the report to understand the treatment resistant hypertension market trends @ Treatment Resistant Hypertension Market Report

Table of Contents

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