de Souza Fabio, Muxfeldt Elizabeth Silaid, Salles Gil Fernando
Internal Medicine Department, University Hospital Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Expert Rev Cardiovasc Ther. 2012 Jun;10(6):735-45. doi: 10.1586/erc.12.58.
Resistant hypertension (RH) is defined as uncontrolled office blood pressure (BP) in spite of the use of at least three antihypertensive medications. Although its condition has a high prevalence, it is still understudied, and its prognosis is not well established. Some prospective studies evaluated the prognostic value of ambulatory BP monitoring, ECG and renal parameters. They pointed out that ambulatory BPs are important predictors of cardiovascular morbidity and mortality, whereas office BP has no prognostic value. The diagnosis of true RH and the nondipping pattern are also valuable predictors of cardiovascular outcomes. Moreover, several ECG (prolonged ventricular repolarization, serial changes in the strain pattern and left ventricular hypertrophy) and renal parameters (albuminuria and reduced glomerular filtration rate) are also powerful cardiovascular risk markers in RH. These markers and others yet unexplored, such as arterial stiffness and serum biomarkers, may improve cardiovascular risk stratification in these very high-risk patients.
顽固性高血压（RH）的定义为尽管使用了至少三种抗高血压药物，但诊室血压（BP）仍未得到控制。尽管其发病率很高，但仍研究不足，其预后也尚未明确确立。一些前瞻性研究评估了动态血压监测、心电图和肾脏参数的预后价值。他们指出，动态血压是心血管发病和死亡的重要预测指标，而诊室血压则没有预后价值。真性RH的诊断和非勺型模式也是心血管结局的有价值预测指标。此外，一些心电图指标（心室复极延长、应变模式的系列变化和左心室肥厚）和肾脏参数（蛋白尿和肾小球滤过率降低）也是RH中强大的心血管风险标志物。这些标志物以及其他尚未探索的指标，如动脉僵硬度和血清生物标志物，可能会改善这些高危患者的心血管风险分层。
