Background: Despite significant progress in the pharmacological management of hypertension, uncontrolled arterial hypertension (UAH) remains a critical global health problem. The persistence of elevated blood pressure (BP) despite treatment is associated with increased cardiovascular morbidity, metabolic abnormalities, and irreversible damage to target organs.

Objective: To investigate the clinical and metabolic profile, modifiable risk factors, and structural organ damage among patients with uncontrolled arterial hypertension in Uzbekistan.

Methods: A prospective observational study was conducted among 362 patients aged 35–75 years with stage II–III hypertension who failed to achieve target BP (<140/90 mmHg) despite ongoing therapy. Clinical parameters (BMI, HR, BP), biochemical markers (glucose, lipids, uric acid, creatinine), and instrumental data (echocardiography, funduscopy) were analyzed. GFR was calculated using the CKD-EPI equation. Statistical processing was performed with SPSS v26 using t-test, χ² test, and logistic regression.

Results: Men comprised 57.3% of the sample (mean age 58.2 ± 9.1 years). The main metabolic disorders were obesity (64%), dyslipidemia (48%), hyperuricemia (41%), and hyperglycemia (35%). Frequent BP surges (>1/week) occurred in 38% of patients and were associated with significantly higher left ventricular mass index (129 ± 15 vs. 112 ± 12 g/m²; p < 0.01), microalbuminuria (46%), and reduced GFR < 60 mL/min/1.73 m² (27%). Independent predictors of uncontrolled BP included obesity (OR = 2.1; 95% CI 1.2–3.8), hyperuricemia (OR = 1.9; 95% CI 1.1–3.2), and HR > 80 bpm (OR = 1.6; 95% CI 1.03–2.5).

Conclusion: UAH represents a multifactorial condition where metabolic imbalance and organ involvement interact to sustain poor BP control. Addressing obesity, hyperuricemia, and lifestyle determinants should be prioritized to improve BP regulation and reduce cardiovascular risk.

Uncontrolled hypertension, risk factors, hyperuricemia, obesity

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