Limonta Livia Beatriz Santos, Valandro Letícia Dos Santos, Shiraishi Flávio Gobis, Barretti Pasqual, Franco Roberto Jorge da Silva, Martin Luis Cuadrado
Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP, Botucatu, SP, Brazil.
Int J Hypertens. 2012;2012:392657. doi: 10.1155/2012/392657. Epub 2012 Dec 24.
Resistant hypertension (RH) is characterized by blood pressure above 140 × 90 mm Hg, despite the use, in appropriate doses, of three antihypertensive drug classes, including a diuretic, or the need of four classes to control blood pressure. Resistant hypertension patients are under a greater risk of presenting secondary causes of hypertension and may be benefited by therapeutical approach for this diagnosis. However, the RH is currently little studied, and more knowledge of this clinical condition is necessary. In addition, few studies had evaluated this issue in emergent countries. Therefore, we proposed the analysis of specific causes of RH by using a standardized protocol in Brazilian patients diagnosed in a center for the evaluation and treatment of hypertension. The management of these patients was conducted with the application of a preformulated protocol which aimed at the identification of the causes of resistant hypertension in each patient through management standardization. The data obtained suggest that among patients with resistant hypertension there is a higher prevalence of secondary hypertension, than that observed in general hypertensive ones and a higher prevalence of sleep apnea as well. But there are a predominance of obesity, noncompliance with diet, and frequent use of hypertensive drugs. These latter factors are likely approachable at primary level health care, since that detailed anamneses directed to the causes of resistant hypertension are applied.
顽固性高血压（RH）的特征是尽管使用了包括利尿剂在内的三种适当剂量的抗高血压药物类别，血压仍高于140×90 mmHg，或者需要四类药物来控制血压。顽固性高血压患者出现高血压继发原因的风险更大，针对这种诊断的治疗方法可能会使他们受益。然而，目前对顽固性高血压的研究很少，有必要对这种临床情况有更多的了解。此外、很少有研究在新兴国家评估这个问题。因此，我们建议通过使用标准化方案，对在高血压评估和治疗中心诊断出的巴西患者的顽固性高血压的具体原因进行分析。这些患者的管理采用了预先制定的方案，该方案旨在通过管理标准化确定每位患者顽固性高血压的原因。获得的数据表明，在顽固性高血压患者中，继发性高血压的患病率高于一般高血压患者，睡眠呼吸暂停的患病率也更高。但存在肥胖、饮食不依从和频繁使用抗高血压药物的情况。由于针对顽固性高血压原因进行了详细的问诊，后几种因素在初级卫生保健层面可能是可以解决的。
