Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 430 BMR3, 1530 3rd Ave South, Birmingham, AL 35242.
Hypertension. 2014 Mar;63(3):451-8. doi: 10.1161/HYPERTENSIONAHA.113.02026. Epub 2013 Dec 9.
Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30 239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic, ≥140/90 mm Hg) on ≥5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic, ≥140/90 mm Hg on ≥3 or <140/90 mm Hg on ≥4 antihypertensive classes) and all participants treated for hypertension served as comparator groups. Of 14 809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension (n=2144) and 41.7% among participants on ≥5 antihypertensive drug classes. Among all participants with hypertension, black race, male sex, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes mellitus, and history of stroke and coronary heart disease were associated with refractory hypertension. Compared with resistant hypertension, prevalence ratios for refractory hypertension were increased for blacks (3.00; 95% confidence interval, 1.68-5.37) and those with albuminuria (2.22; 95% confidence interval, 1.40-3.52) and diabetes mellitus (2.09; 95% confidence interval, 1.32-3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension when compared with those with either comparator group. These data indicate that although resistant hypertension is relatively common among treated patients with hypertension, true antihypertensive treatment failure is rare.
难治性高血压是降压治疗失败的一种极端表型。评估参与 Reasons for Geographic And Racial Differences in Stroke (REGARDS) 研究的参与者，该研究是一项大型（n=30239）基于人群的队列研究，以确定难治性高血压的患病率以及相关的心血管危险因素和合并症。难治性高血压定义为在≥5 种降压药物类别中血压控制不佳（收缩压/舒张压，≥140/90mmHg）。将存在耐药性高血压（收缩压/舒张压，≥140/90mmHg 时使用≥3 种或<140/90mmHg 时使用≥4 种降压药物类别）的患者和所有接受高血压治疗的患者作为对照组。在接受降压治疗的 14809 名 REGARDS 参与者中，有 78 人（0.5%）患有难治性高血压。在耐药性高血压患者（n=2144）中，难治性高血压的患病率为 3.6%，在使用≥5 种降压药物类别的患者中为 41.7%。在所有患有高血压的参与者中，黑种人、男性、生活在中风带或扣带、较高的体重指数、较低的心率、降低的估计肾小球滤过率、白蛋白尿、糖尿病和中风和冠心病病史与难治性高血压有关。与耐药性高血压相比，黑人（3.00；95%置信区间，1.68-5.37）和白蛋白尿（2.22；95%置信区间，1.40-3.52）以及糖尿病（2.09；95%置信区间，1.32-3.31）患者的难治性高血压患病率比值增加。与对照组相比，难治性高血压患者的Framingham 冠心病和中风 10 年风险中位数更高。这些数据表明，尽管在接受治疗的高血压患者中，耐药性高血压相对常见，但真正的降压治疗失败却很少见。
