Siyam Fadi, Brietzke Stephen A, Sowers James R
Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA.
Hosp Pract (1995). 2010 Nov;38(4):90-7. doi: 10.3810/hp.2010.11.345.
Resistant hypertension is defined as blood pressure uncontrolled to guideline levels despite the use of ≥3 antihypertensive medications. When evaluating patients with resistant hypertension, it is important to consider issues such as blood pressure measurement technique, lifestyle, other comorbid conditions and medications, and the white coat effect. To this point, potential contributing factors include obstructive sleep apnea, excess alcohol intake, and use of blood pressure-elevating medications, such as nonsteroidal anti-inflammatory drugs, sympathomimetics, certain anorexic agents, and oral contraceptives. Secondary causes of hypertension are common in patients with resistant hypertension and appropriate screening tests should be performed as suggested by signs, symptoms, and laboratory abnormalities. In this regard, there is increasing evidence that hyperaldosteronism is common in the resistant hypertensive patient group. Pharmacologic therapy in patients with resistant hypertension is centered on drug combinations that have different mechanisms of action, including diuretics, which are essential in maximizing antihypertensive effects. The role of mineralocorticoid receptor antagonists is expanding, especially in patients with the metabolic syndrome, where aldosterone excess is increasingly recognized as an etiology of resistant hypertension. Finally, when appropriate, specialist referral may be necessary to appropriately assess and treat these patients.
顽固性高血压的定义为尽管使用了≥3种抗高血压药物，但血压仍未控制在指南规定的水平。在评估顽固性高血压患者时，重要的是要考虑诸如血压测量技术、生活方式、其他合并症和药物以及白大衣效应等问题。就此而言，潜在的促成因素包括阻塞性睡眠呼吸暂停、过量饮酒以及使用升高血压的药物，如非甾体抗炎药、拟交感神经药、某些食欲抑制剂和口服避孕药。高血压的继发性病因在顽固性高血压患者中很常见，应根据体征、症状和实验室异常情况进行适当的筛查测试。在这方面，越来越多的证据表明，醛固酮增多症在顽固性高血压患者群体中很常见。顽固性高血压患者的药物治疗以具有不同作用机制的药物联合为主，包括利尿剂，利尿剂对于最大化降压效果至关重要。盐皮质激素受体拮抗剂的作用正在扩大，尤其是在代谢综合征患者中，醛固酮过多越来越被认为是顽固性高血压的一个病因。最后，在适当的时候，可能需要转诊至专科医生处，以便对这些患者进行适当的评估和治疗。
