Volpe Massimo, Tocci Giuliano
Division of Cardiology, II Faculty of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Via di Grottarossa, 1035-9, 00189 Rome, Italy.
Expert Rev Cardiovasc Ther. 2010 Jun;8(6):811-20. doi: 10.1586/erc.10.47.
Arterial hypertension is a very complex disease characterized by a sustained rise in systolic and/or diastolic blood pressure (BP) levels and a significantly increased risk of developing major adverse cardiovascular and renal outcomes. Although BP-lowering treatment reduces the hypertension-related burden of disease, BP control continues to be poorly achieved worldwide. A major factor contributing to this therapeutic failure is represented by resistant (or refractory) hypertension. The diagnosis of 'resistant hypertension' is very common in clinical practice, yet it is often used to improperly define patients with difficult or challenging forms of hypertension. An incorrect use of this definition by physicians may lead to clinical behaviors that do not help to improve BP control; on the other hand, correct diagnosis of resistant hypertension may facilitate the successful treatment of hypertension. In this article, we will review and discuss the definition, pathophysiological mechanisms, diagnostic algorithms and potential new therapeutic options for treating resistant hypertension.
动脉高血压是一种非常复杂的疾病，其特征是收缩压和/或舒张压水平持续升高，以及发生主要不良心血管和肾脏结局的风险显著增加。尽管降压治疗可减轻与高血压相关的疾病负担，但全球范围内血压控制仍不理想。导致这种治疗失败的一个主要因素是顽固性（或难治性）高血压。“顽固性高血压”的诊断在临床实践中非常常见，但它常被用于不恰当地定义患有困难或具有挑战性高血压形式的患者。医生对这一定义的错误使用可能导致无助于改善血压控制的临床行为；另一方面，正确诊断顽固性高血压可能有助于高血压的成功治疗。在本文中，我们将回顾和讨论顽固性高血压的定义、病理生理机制、诊断算法以及潜在的新治疗选择。
