Romano Simone, Idolazzi Chiara, Fava Cristiano, Fondrieschi Luigi, Celebrano Mario, Delva Pietro, Branz Lorella, Donato Angela, Dalbeni Andrea, Minuz Pietro
Section of General Medicine and Hypertension, Department of Medicine, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy.
SIMG, Italian Society of Primary Care Physicians, Florence, Italy.
High Blood Press Cardiovasc Prev. 2018 Sep;25(3):295-301. doi: 10.1007/s40292-018-0268-x. Epub 2018 Jun 29.
Resistant hypertension, is a clinical condition that may confer high cardiovascular risk. Aim of the observational study was to evaluate the prevalence of resistant hypertension, and the association with cardiovascular risk factors or diseases in the Verona urban area.
Eleven family doctors retrieved anonymised data concerning blood pressure, diagnosis of hypertension and treatments from a population of 17,502 adult subjects. The prevalence of resistant hypertension was estimated considering patients who had been consecutively treated with at least four antihypertensive medications, regardless of blood pressure values. Further search concerning the clinical characteristics associated with resistant hypertension was performed in a random subsample of 55 patients.
The prevalence of hypertension was 21.9%, that of resistant hypertension was 2.1%, approximately 10% of the whole hypertensive population. High prevalence of diabetes mellitus (53%) and hyperlipidemia (83%) was found in association with resistant hypertension. As for end organ damage, high prevalence of carotid artery stenosis (45%), ischemic heart disease (43%) and left ventricular hypertrophy (40%) was observed in patients with resistant hypertension. Blood pressure was higher than 140/90 mmHg in 58% of patients in spite of treatment with four or more different antihypertensive drugs. The average age, systolic and pulse pressure were significantly higher in the subgroup of patients with resistant hypertension.
Patients with resistant hypertension are characterised by a higher systolic and pulse pressure and a very high attributable cardiovascular risk, due to high prevalence of cardiovascular risk factors and overt organ damage and cardiovascular disease.
难治性高血压是一种可能带来高心血管风险的临床病症。这项观察性研究的目的是评估维罗纳市区难治性高血压的患病率，以及与心血管危险因素或疾病的关联。
11名家庭医生从17502名成年受试者群体中检索了有关血压、高血压诊断和治疗的匿名数据。难治性高血压的患病率是根据连续接受至少四种抗高血压药物治疗的患者来估算的，无论其血压值如何。在55名患者的随机子样本中进一步搜索了与难治性高血压相关的临床特征。
高血压患病率为21.9%，难治性高血压患病率为2.1%，约占整个高血压人群的10%。发现难治性高血压患者中糖尿病（53%）和高脂血症（83%）的患病率较高。至于靶器官损害，难治性高血压患者中颈动脉狭窄（45%）、缺血性心脏病（43%）和左心室肥厚（40%）的患病率较高。尽管使用了四种或更多不同的抗高血压药物治疗，但仍有58%的患者血压高于140/90 mmHg。难治性高血压患者亚组的平均年龄、收缩压和脉压显著更高。
难治性高血压患者的特征是收缩压和脉压较高，且由于心血管危险因素的高患病率、明显的器官损害和心血管疾病，其心血管风险归因度非常高。
