Sarafidis Pantelis A, Bakris George L
Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Am Coll Cardiol. 2008 Nov 25;52(22):1749-57. doi: 10.1016/j.jacc.2008.08.036.
Resistant hypertension is defined as failure to achieve goal blood pressure (BP) when a patient adheres to the maximum tolerated doses of 3 antihypertensive drugs including a diuretic. Although the exact prevalence of resistant hypertension is currently unknown, indirect evidence from population studies and clinical trials suggests that it is a relatively common clinical problem. The prevalence of resistant hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. Management of resistant hypertension must begin with a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with "pseudo-resistance," such as improper BP measurement technique, the white-coat effect, and poor patient adherence to life-style and/or antihypertensive medications. Education and reinforcement of life-style issues that affect BP, such as sodium restriction, reduction of alcohol intake, and weight loss if obese, are critical in treating resistant hypertension. Exclusion of preparations that contribute to true BP treatment resistance, such as nonsteroidal anti-inflammatory agents, cold preparations, and certain herbs, is also important. Lastly, BP control can only be achieved if an antihypertensive treatment regimen is used that focuses on the genesis of the hypertension. An example is volume overload, a common but unappreciated cause of treatment resistance. Use of the appropriate dose and type of diuretic provides a solution to overcome treatment resistance in this instance.
顽固性高血压的定义为，患者坚持服用包括利尿剂在内的3种最大耐受剂量的抗高血压药物时，血压仍未达到目标值。虽然目前尚不清楚顽固性高血压的确切患病率，但来自人群研究和临床试验的间接证据表明，这是一个相对常见的临床问题。由于人口老龄化以及肥胖、睡眠呼吸暂停和慢性肾病的增加趋势，顽固性高血压的患病率预计将会上升。顽固性高血压的管理必须从对患者进行仔细评估开始，以确认诊断并排除与“假性耐药”相关的因素，如不当的血压测量技术、白大衣效应以及患者对生活方式和/或抗高血压药物的依从性差等。对影响血压的生活方式问题进行教育和强化，如限制钠摄入、减少酒精摄入以及肥胖者减轻体重等，对于治疗顽固性高血压至关重要。排除导致真正血压治疗抵抗的制剂，如非甾体抗炎药、感冒药和某些草药，也很重要。最后，只有采用针对高血压病因的抗高血压治疗方案才能实现血压控制。例如容量超负荷，这是导致治疗抵抗的一个常见但未被充分认识的原因。在这种情况下，使用适当剂量和类型的利尿剂可提供克服治疗抵抗的解决方案。
