Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
Institut universitaire de médicine sociale et préventive, University of Lausanne, Lausanne, Switzerland.
Nat Rev Nephrol. 2018 Jul;14(7):428-441. doi: 10.1038/s41581-018-0006-6.
Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to antihypertensive therapy. Patients with resistant hypertension are at high risk of complications, particularly cardiovascular events, and optimization of medical treatment remains the cornerstone of their management. Such optimization should be based on simple algorithms and include the use of aldosterone antagonists. The available data from clinical trials do not support the use of device-based approaches such as renal denervation, baroreflex activation therapy or arteriovenous anastomosis for the treatment of resistant hypertension in the majority of patients. Therefore, device treatment remains a last-resort for patients with truly resistant hypertension in the context of clinical research in highly skilled tertiary referral centres. Future research should focus on improving understanding of the intrinsic (physiological and psychological factors) and extrinsic (environmental stressors) mechanisms that contribute to a lack of response to blood-pressure-lowering drugs in adherent patients. The use of biomarkers to identify patients with early target organ damage and new technologies, such as renal nerve stimulation, to predict blood pressure responses to renal denervation could aid the selection of patients who might benefit from device therapies.
抗药性高血压定义为排除继发性高血压后，完全遵医嘱接受降压治疗的患者，其动态血压对优化的药物治疗无反应。抗药性高血压患者并发症风险较高，尤其是心血管事件，优化药物治疗仍然是其管理的基石。这种优化应基于简单的算法，包括使用醛固酮拮抗剂。临床试验的现有数据不支持在大多数患者中使用基于设备的方法，如肾去神经术、压力感受器激活治疗或动静脉吻合术来治疗抗药性高血压。因此，在高度熟练的三级转诊中心的临床研究背景下，设备治疗仍然是真正抗药性高血压患者的最后手段。未来的研究应侧重于提高对导致降压药物治疗无反应的内在（生理和心理因素）和外在（环境压力源）机制的理解。使用生物标志物来识别早期靶器官损伤的患者和新技术，如肾神经刺激，来预测肾去神经术对血压的反应，可以帮助选择可能从设备治疗中获益的患者。
