Pimenta Eduardo, Calhoun David A
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 933 19th Street South, Room 115, Birmingham, AL 35294, USA.
Curr Hypertens Rep. 2007 Nov;9(5):353-9. doi: 10.1007/s11906-007-0066-7.
Resistant hypertension is defined as blood pressure that remains uncontrolled despite using at least three antihypertensive medications in effective doses, ideally including a diuretic. Stricter blood pressure goals, higher obesity rates, older age, and increased use of certain exogenous substances are related to an increasing prevalence of resistant hypertension. The evaluation of patients with resistant hypertension focuses on identifying contributing factors and secondary causes of hypertension including hyperaldosteronism, obstructive sleep apnea, renal artery stenosis, and pheochromocytoma. Hyperaldosteronism is now recognized as the most common secondary cause and all patients with resistant hypertension should be screened with a plasma aldosterone-renin ratio even if the serum potassium level is normal. Treatment includes reversal of contributing factors, appropriate treatment of secondary causes, and use of effective multidrug regimens. Recent studies indicate that the addition of spironolactone to standard treatment regimens induces significant blood pressure reduction in patients with resistant hypertension.
尽管使用了至少三种有效剂量的抗高血压药物（理想情况下包括利尿剂），血压仍未得到控制。更严格的血压目标、更高的肥胖率、老龄化以及某些外源性物质使用的增加与顽固性高血压患病率的上升有关。对顽固性高血压患者的评估重点在于识别导致高血压的因素和继发性病因，包括原发性醛固酮增多症、阻塞性睡眠呼吸暂停、肾动脉狭窄和嗜铬细胞瘤。原发性醛固酮增多症现已被认为是最常见的继发性病因，所有顽固性高血压患者即使血清钾水平正常，也应进行血浆醛固酮 - 肾素比值筛查。治疗包括逆转相关因素、对继发性病因进行适当治疗以及使用有效的联合药物治疗方案。最近的研究表明，在标准治疗方案中添加螺内酯可使顽固性高血压患者的血压显著降低。
