抵抗性高血压:我们的现状与未来?

IF 1.5 Q3 PERIPHERAL VASCULAR DISEASE Integrated Blood Pressure Control Pub Date : 2020-08-05 eCollection Date: 2020-01-01 DOI:10.2147/IBPC.S223334
Mansur K Pathan, Debbie L Cohen
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引用次数: 0

摘要

抵抗性高血压是高血压的一个重要亚型,会导致脑血管、心血管和肾脏疾病的风险增加。美国心脏病学会和美国心脏协会修订后的指南现在将耐药性高血压定义为,尽管使用了包括利尿剂在内的三种最大剂量的抗高血压药物,血压仍高于目标值,或者高血压患者需要使用四种或更多药物才能充分控制血压。这些药物通常包括最大剂量或最大耐受剂量的钙通道阻滞剂、肾素-血管紧张素系统抑制剂和利尿剂。随着对抵抗性高血压认识的提高,必须将假性抵抗性高血压或表观高血压与真正的抵抗性高血压区分开来。表观抵抗性高血压的病因包括测量误差和不遵医嘱用药。如果将表面抵抗性高血压患者计算在内,真正抵抗性高血压的患病率可能比文献报道的要低得多。对真正的抵抗性高血压患者的评估包括筛查继发性高血压的病因和干扰药物。成功治疗抵抗性高血压的方法包括改变生活方式和优化药物治疗,通常包括使用矿物质皮质激素受体拮抗剂。展望高血压治疗的未来发展,一系列基于设备的新疗法正在积极开发中。其中,肾脏神经支配是最接近常规临床应用的疗法。在推荐将这些设备用于抵抗性高血压的常规治疗之前,还需要进一步的研究。
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Resistant Hypertension: Where are We Now and Where Do We Go from Here?

Resistant hypertension is an important subtype of hypertension that leads to an increased risk of cerebrovascular, cardiovascular, and kidney disease. The revised guidelines from the American College of Cardiology and American Heart Association now define resistant hypertension as blood pressure that remains above goal despite use of three maximally titrated anti-hypertensive medications including a diuretic or as a hypertensive patient who requires 4 or more agents for adequate BP control. These agents typically include a calcium-channel blocker, a renin-angiotensin system inhibitor, and a diuretic at maximal or maximally tolerated doses. As recognition of resistant hypertension increases, it is important to distinguish pseudo-resistant or apparent hypertension from true resistant hypertension. Etiologies of apparent resistant hypertension include measurement error and medication non-adherence. The prevalence of true resistant hypertension is likely much lower than reported in the literature when accounting for patients with apparent resistant hypertension. Evaluation of patients with true resistant hypertension includes screening for causes of secondary hypertension and interfering medications. Successful management of resistant hypertension includes lifestyle modification and optimization of medical therapy, often including the use of mineralocorticoid receptor antagonists. Looking ahead at developments in hypertension management, a slew of new device-based therapies are under active development. Of these, renal denervation is the closest to routine clinical application. Further study is needed before these devices can be recommended in the routine treatment of resistant hypertension.

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来源期刊
Integrated Blood Pressure Control
Integrated Blood Pressure Control PERIPHERAL VASCULAR DISEASE-
CiteScore
4.60
自引率
0.00%
发文量
13
审稿时长
16 weeks
期刊最新文献
Prevalence and Predictors of Depression Symptoms Among Afghan Hypertensive Patients: Secondary Analysis of a Multi-Center Cross-Sectional Study. Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda [Response to Letter]. Resistance Training in Cardiovascular Diseases: A Review on Its Effectiveness in Controlling Risk Factors. Thoughts on "Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda" [Letter]. Adherence to Lifestyle Modification Practices and Its Associated Factors Among Hypertensive Patients in Bahir Dar City Hospitals, North West Ethiopia [Letter].
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