Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan.
Hypertens Res. 2020 Aug;43(8):744-753. doi: 10.1038/s41440-020-0468-3. Epub 2020 May 18.
Resistant hypertension is associated with a poor prognosis due to organ damage caused by prolonged suboptimal blood pressure control. The concomitant use of mineralocorticoid receptor (MR) antagonists with other antihypertensives has been shown to improve blood pressure control in some patients with resistant hypertension, and such patients are considered to have MR-associated hypertension. MR-associated hypertension is classified into two subtypes: one with a high plasma aldosterone level, which includes primary aldosteronism (PA), and the other with a normal aldosterone level. In patients with unilateral PA, adrenalectomy may be the first-choice procedure, while in patients with bilateral PA, MR antagonists are selected. In addition, in patients with other types of MR-associated hypertension with high aldosterone levels, MR antagonists may be selected as a first-line therapy. In patients with normal aldosterone levels, ARBs or ACE inhibitors are used as a first-line therapy, and MR antagonists may be used as an add-on agent. Since MR antagonist therapy may have efficacy as a first-line or add-on agent in these patients, it is important to recognize this type of hypertension. Further studies are needed to elucidate the pathogenesis and management of MR-associated hypertension in more detail to improve the clinical outcomes of patients with MR-associated hypertension.
由于长期血压控制不理想导致的器官损伤，耐药性高血压预后不良。在一些耐药性高血压患者中，联合使用盐皮质激素受体（MR）拮抗剂和其他降压药已被证明可改善血压控制，这些患者被认为患有 MR 相关性高血压。MR 相关性高血压分为两种亚型：一种是血浆醛固酮水平升高，包括原发性醛固酮增多症（PA），另一种是醛固酮水平正常。在单侧 PA 患者中，肾上腺切除术可能是首选治疗方法，而在双侧 PA 患者中，则选择 MR 拮抗剂。此外，在其他类型的高醛固酮水平的 MR 相关性高血压患者中，MR 拮抗剂可能作为一线治疗药物。在醛固酮水平正常的患者中，ARB 或 ACEI 作为一线治疗药物，MR 拮抗剂可作为附加药物。由于 MR 拮抗剂治疗可能对这些患者作为一线或附加药物有效，因此识别这种类型的高血压很重要。需要进一步研究以更详细地阐明 MR 相关性高血压的发病机制和管理，以改善 MR 相关性高血压患者的临床结局。
