Department of Nephrology and Hypertension, University Hospital Erlangen, Germany.
Cardiology Unit, Clinical and Molecular Medicine Department Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
Int J Cardiol. 2014 Mar 1;172(1):17-22. doi: 10.1016/j.ijcard.2013.12.125. Epub 2014 Jan 4.
Although the blood pressure (BP) of many patients can be controlled using standard combinations, treatment of hypertension frequently represents a clinical challenge to the primary care physician. This article will review best practices for managing patients with easy- and difficult-to-treat hypertension, including preferred antihypertensive combinations, optimizing adherence and persistence, recognizing white-coat hypertension, and intensifying therapy for treatment-resistant patients. Each physician must decide based on his or her own level of experience at what point a patient becomes too challenging and would benefit from referral to a hypertension specialist for more intensive management and to complete the exclusion of secondary forms of arterial hypertension. With intensive pharmacotherapy, many patients with difficult-to-treat hypertension can achieve BP control. If it fails, interventional strategies (e.g., renal denervation) are a valid option to get BP controlled.
尽管许多患者的血压（BP）可以通过标准组合来控制，但高血压的治疗常常对初级保健医生构成临床挑战。本文将回顾管理易治性和难治性高血压患者的最佳实践，包括首选的降压联合治疗、优化依从性和持久性、识别白大衣高血压以及对治疗抵抗的患者强化治疗。每位医生都必须根据自己的经验水平来决定，在什么情况下患者变得过于棘手，需要转介给高血压专家进行更强化的管理，并彻底排除继发性高血压。通过强化药物治疗，许多难治性高血压患者可以实现血压控制。如果治疗失败，介入策略（如肾去神经术）是控制血压的有效选择。
