Departments of Emergency Medicine and Internal Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX, 77030, USA.
Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX, 77030, USA.
Curr Hypertens Rep. 2018 Mar 19;20(3):21. doi: 10.1007/s11906-018-0818-6.
Early lowering of blood pressure is advised for patients with severe hypertension associated with signs of impending or progressive organ damage, whereas aggressive treatment is not recommended in patients with asymptomatic severe hypertension. As treatment goals for asymptomatic hypertension and true hypertensive emergency drastically differ, it is essential to identify patients with evidence of impending or progressive organ damage. Biomarkers may assist providers in identifying high-risk patients who would benefit from early blood pressure reduction.
In this review, we discuss both currently available and investigational biomarkers that may help identify patients who might benefit from more aggressive therapy. We focus on serum and urinary biomarkers associated with acute cardiovascular, renal, and cerebrovascular damage. There is a dearth of literature regarding the use of biomarkers to assess acute hypertension-related target organ damage. We are primarily forced to draw conclusions on the use of biomarkers from studies of related conditions such as acute heart failure. Further research is needed on the clinical significance of abnormal levels of novel biomarkers of renal, cardiac, and cerebral dysfunction in the setting of severe hypertension, particularly in those patients without overt clinical signs of organ failure.
伴有即将发生或进展性器官损伤迹象的严重高血压患者建议早期降压，而无症状严重高血压患者不建议积极治疗。由于无症状高血压和真正的高血压急症的治疗目标有很大差异，因此确定有即将发生或进展性器官损伤证据的患者至关重要。生物标志物可以帮助医生识别出有获益于早期降压的高危患者。
在这篇综述中，我们讨论了目前可用和正在研究的生物标志物，这些标志物可能有助于识别可能从更积极治疗中获益的患者。我们重点关注与急性心血管、肾脏和脑血管损伤相关的血清和尿液生物标志物。关于使用生物标志物评估急性高血压相关靶器官损伤的文献很少。我们主要只能从急性心力衰竭等相关疾病的研究中得出关于生物标志物使用的结论。需要进一步研究严重高血压中新型肾功能、心脏功能和脑功能障碍生物标志物异常水平的临床意义，特别是在那些没有明显器官衰竭临床迹象的患者中。
