Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 115 Community Health Services Building, 933 19th Street South, Birmingham, AL 35294, USA.
Curr Cardiol Rep. 2009 Nov;11(6):407-13. doi: 10.1007/s11886-009-0059-z.
Resistant hypertension is a common medical problem. It carries a significantly increased risk of end-organ damage and cardiovascular events compared with more easily controlled hypertension. Resistant hypertension is most often related to isolated systolic hypertension and is characterized by aldosterone excess and increased intravascular volume. Its diagnosis requires the exclusion of pseudoresistance. The etiology of resistant hypertension is almost always multifactorial. Common reversible contributing factors need to be identified and addressed. Secondary causes of hypertension, such as primary aldosteronism, parenchymal and vascular kidney disease, and obstructive sleep apnea, require investigation and effective treatment if present. Therapy for resistant hypertension should be based on use of rational drug class combinations at optimal doses, with particular attention to adequate diuretic use. The addition of an aldosterone antagonist may further improve blood pressure control.
耐药性高血压是一种常见的医学问题。与更容易控制的高血压相比，它会显著增加靶器官损害和心血管事件的风险。耐药性高血压最常与单纯性收缩期高血压有关，其特征是醛固酮过多和血管内容量增加。其诊断需要排除假性耐药。耐药性高血压的病因几乎总是多因素的。需要确定和解决常见的可逆性促成因素。如果存在，需要对高血压的继发性病因（如原发性醛固酮增多症、实质和血管性肾病以及阻塞性睡眠呼吸暂停）进行调查和有效治疗。耐药性高血压的治疗应基于合理的药物类别组合在最佳剂量下使用，特别注意充分使用利尿剂。添加醛固酮拮抗剂可能进一步改善血压控制。
