Siddiqui Mohammed, Calhoun David A
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Curr Opin Nephrol Hypertens. 2017 Jan;26(1):14-19. doi: 10.1097/MNH.0000000000000286.
Refractory hypertension is a recently proposed phenotype of antihypertensive treatment failure. As such it represents an extreme subtype of resistant or difficult-to-treat hypertension. Resistant hypertension is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is typically defined as having an uncontrolled blood pressure on three or more antihypertensive medications, including a diuretic. Refractory hypertension is rare with a prevalence of approximately 5% of patients with uncontrolled resistant hypertension. It is defined as an uncontrolled blood pressure with the use of five or more antihypertensive medications, including a long-acting thiazide diuretic, such as chlorthalidone, and a mineralocorticoid receptor antagonist such as spironolactone.
Persistent excess fluid retention is thought to commonly underlie development of resistant hypertension, recent studies suggest that refractory may be more likely attributable to heightened sympathetic output as opposed to inappropriate fluid retention.
Treatment recommendations for resistant hypertension are generally based on intensification of diuretic therapy, especially with combined use of chlorthalidone and spironolactone. Although fuller elucidation is needed, such an approach may not be appropriate for refractory hypertension, which instead, may require effective sympathetic inhibition, either with medications or device-based approaches.
难治性高血压是最近提出的一种抗高血压治疗失败的表型。因此，它代表了难治性或难以治疗的高血压的一种极端亚型。难治性高血压相对常见，估计在接受治疗的高血压患者中患病率为10%-20%。它通常被定义为在使用三种或更多种抗高血压药物（包括利尿剂）的情况下血压仍未得到控制。难治性高血压较为罕见，在血压未得到控制的难治性高血压患者中患病率约为5%。它被定义为在使用五种或更多种抗高血压药物（包括长效噻嗪类利尿剂如氯噻酮和盐皮质激素受体拮抗剂如螺内酯）的情况下血压仍未得到控制。
持续性液体潴留过多被认为是难治性高血压发生的常见原因，最近的研究表明，难治性高血压更可能归因于交感神经输出增加，而非不适当的液体潴留。
难治性高血压的治疗建议通常基于强化利尿治疗，尤其是联合使用氯噻酮和螺内酯。尽管需要更全面的阐释，但这种方法可能不适用于难治性高血压，难治性高血压可能需要通过药物或基于器械的方法进行有效的交感神经抑制。
