St Walburga Hospital, Meschede, Private Practice at the Medical Care Center, Dialysis Center, Cuxhaven.
Dtsch Arztebl Int. 2014 Jun 20;111(25):425-31. doi: 10.3238/arztebl.2014.0425.
The introduction of invasive treatments, some of which are irreversible, for the entity called treatment-resistant hypertension (TRH) creates the need for a comprehensive discussion of the diagnostic evaluation that TRH requires and the available options for its conservative treatment.
The pertinent literature is selectively reviewed in the light of the authors' longstanding clinical experience.
Our review of the literature suggests that the high prevalence of TRH in Germany (ca. 20%) can be nearly halved with the aid of more thorough diagnostic evaluation. Such an evaluation should include a review of the patient's antihypertensive drugs (adherence, daily dosing, concomitant medication), investigation for other vascular changes that might affect blood pressure measurement, and exclusion of white-coat hypertension, sleep apnea syndrome, and secondary rather than essential hypertension. As there have been no randomized trials of treatment for TRH, the physician confronted with such cases must devise treatments on the basis of observational data and pathophysiological reasoning (volume status considering renin levels, sympathetic blockade, vasodilatation). Such measures can presumably lower the number of truly treatment-resistant cases still further.
To save patients from preventable harm, patients should undergo a thorough diagnostic evaluation and-under close monitoring for side effects-conservative pharmacological and nonpharmacological treatments should be deployed before any invasive treatment is performed.
针对所谓的治疗抵抗性高血压（TRH），引入了一些具有侵袭性且不可逆转的治疗方法，这就需要对 TRH 所需的全面诊断评估以及其保守治疗的可用选择方案进行讨论。
根据作者长期的临床经验，有针对性地对相关文献进行了选择性回顾。
我们对文献的回顾表明，借助更彻底的诊断评估，德国 TRH 的高患病率（约 20%）可降低近一半。此类评估应包括对患者的降压药物（遵医嘱情况、每日剂量、伴随用药）进行审查，以调查可能影响血压测量的其他血管变化，并排除白大衣高血压、睡眠呼吸暂停综合征以及继发性而非原发性高血压。由于针对 TRH 尚未进行过随机治疗试验，因此面对此类病例的医生必须根据观察数据和病理生理学推理（考虑肾素水平的容量状态、交感神经阻滞、血管舒张）来制定治疗方案。这些措施可能会进一步降低真正的治疗抵抗病例数量。
为了避免可预防的伤害，应在进行任何侵袭性治疗之前，对患者进行彻底的诊断评估，并在密切监测副作用的情况下，采用保守的药物和非药物治疗。
