耐药性高血压:疾病负担与新兴治疗方案。

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Current Hypertension Reports Pub Date : 2024-05-01 Epub Date: 2024-02-16 DOI:10.1007/s11906-023-01282-0
John M Flack, Michael G Buhnerkempe, Kenneth Todd Moore
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引用次数: 0

摘要

综述的目的:定义抵抗性高血压(RHT),回顾其病理生理学和疾病负担,确定有效管理高血压的障碍,并强调新出现的治疗方案:抵抗性高血压的定义是:同时处方≥3 种或≥4 种不同类别的降压药物,但血压(BP)≥130/80 毫米汞柱,或同时处方≥至 4 种药物(最大耐受剂量),包括一种利尿剂,但血压(BP)仍未得到控制。血压是由肾素-血管紧张素-醛固酮系统、交感神经系统、内皮素系统、钠尿肽、动脉血管和免疫系统之间复杂的相互作用调节的;其中任何一个系统受到破坏都会导致血压升高。非裔美国人、老年患者以及糖尿病和/或慢性肾脏病(CKD)患者的 RHT 表现尤为突出。在接受过药物治疗的高血压患者中,只有四分之一的人接受过足够强化的治疗(处方药>2 种),因此可考虑诊断为高血压。针对新治疗靶点的新治疗策略包括抑制钠-葡萄糖共转运体 2、氨肽酶 A、醛固酮合成、磷酸二酯酶 5、黄嘌呤氧化酶和多巴胺 beta-羟化酶,以及刺激可溶性鸟苷酸环化酶、非类固醇类矿物皮质激素受体拮抗剂和双重内皮素受体拮抗剂。RHT 的负担仍然很重。更好地利用目前已获批准的疗法并整合新兴疗法是解决高危 aTRH 患者需求的治疗手段中值得欢迎的补充。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Resistant Hypertension: Disease Burden and Emerging Treatment Options.

Purpose of review: To define resistant hypertension (RHT), review its pathophysiology and disease burden, identify barriers to effective hypertension management, and to highlight emerging treatment options.

Recent findings: RHT is defined as uncontrolled blood pressure (BP) ≥ 130/80 mm Hg despite concurrent prescription of ≥ 3 or ≥ 4 antihypertensive drugs in different classes or controlled BP despite prescription of  ≥ to 4 drugs, at maximally tolerated doses, including a diuretic. BP is regulated by a complex interplay between the renin-angiotensin-aldosterone system, the sympathetic nervous system, the endothelin system, natriuretic peptides, the arterial vasculature, and the immune system; disruption of any of these can increase BP. RHT is disproportionately manifest in African Americans, older patients, and those with diabetes and/or chronic kidney disease (CKD). Amongst drug-treated hypertensives, only one-quarter have been treated intensively enough (prescribed > 2 drugs) to be considered for this diagnosis. New treatment strategies aimed at novel therapeutic targets include inhibition of sodium-glucose cotransporter 2, aminopeptidase A, aldosterone synthesis, phosphodiesterase 5, xanthine oxidase, and dopamine beta-hydroxylase, as well as soluble guanylate cyclase stimulation, nonsteroidal mineralocorticoid receptor antagonism, and dual endothelin receptor antagonism. The burden of RHT remains high. Better use of currently approved therapies and integrating emerging therapies are welcome additions to the therapeutic armamentarium for addressing needs in high-risk aTRH patients.

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来源期刊
Current Hypertension Reports
Current Hypertension Reports 医学-外周血管病
CiteScore
10.50
自引率
0.00%
发文量
65
审稿时长
6-12 weeks
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of hypertension. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antihypertensive therapies, associated metabolic disorders, and therapeutic trials. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
期刊最新文献
Is There a Role for SGLT2 Inhibitors in Patients with End-Stage Kidney Disease? Advances on the Experimental Research in Resistant Hypertension. Importance of the (Pro)renin Receptor in Activating the Renin-Angiotensin System During Normotensive and Preeclamptic Pregnancies. Hypertension and Cardiovascular Outcomes in Inflammatory and Autoimmune Diseases: A Systematic Review and Meta-analysis. Pediatric Blood Pressure and Cardiovascular Health in Adulthood.
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