Luft F C
Experimental and Clinical Research Center, Kooperation zwischen dem Max-Delbrück-Centrum für Molekulare Medizin und der Medizinischen Fakultät der Charité, Lindenbergerweg 80, 13125, Berlin, Deutschland,
Internist (Berl). 2015 Mar;56(3):224-9. doi: 10.1007/s00108-014-3568-9.
When blood pressure is poorly controlled despite treatment with a diuretic and two antihypertensive drugs at adequate doses, the hypertension is termed resistant. The prevalence of resistant hypertension is increasing. Once pseudo-resistance due to poor compliance, secondary forms of hypertension, and massive salt consumption have been excluded, some authorities maintain that blood pressure can be invariably lowered using minoxidil or mineralocorticoid receptor blockade. I also adhered to this belief until we encountered a patient who despite treatment with seven antihypertensive agents, electrical carotid sinus stimulation, and catheter-based renal denervation continued to exhibit extraordinarily high blood pressure values. I am now convinced that resistant hypertension does indeed exist. The prevalence of such patients can be substantially reduced by means of a thorough history and physical examination, determining drug serum concentrations, and excluding secondary causes.
尽管使用利尿剂和两种足量的抗高血压药物进行治疗，但血压仍控制不佳时，这种高血压被称为顽固性高血压。顽固性高血压的患病率正在上升。一旦排除了因依从性差、继发性高血压形式和大量盐摄入导致的假性耐药性，一些权威人士认为，使用米诺地尔或盐皮质激素受体阻滞剂总能降低血压。在遇到一位患者之前，我也一直秉持这种观点，该患者尽管接受了七种抗高血压药物治疗、颈动脉窦电刺激以及基于导管的肾去神经支配治疗，但血压仍持续异常高。我现在确信顽固性高血压确实存在。通过全面的病史和体格检查、测定药物血清浓度以及排除继发性病因，这类患者的患病率可以大幅降低。
