Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, IL 60637, USA.
Am J Hypertens. 2023 Feb 13;36(2):73-81. doi: 10.1093/ajh/hpac111.
The rates of uncontrolled hypertension, along with downstream cardiovascular outcomes, has been worsening in this country. Despite the plethora of antihypertensive medications on the market, the prevalence of resistant hypertension (RH) is estimated to be 13.7%. Therefore in addition to increased clinical education and focus on lifestyle management of hypertension and medication compliance, new therapies are needed to address this rise in hypertension.
A systematic review of the available medical literature was performed to identify emerging treatment options for RH.
Six different pharmacologic classes and 2 procedural interventions were identified as being appropriate for review in this paper. The pharmacologic classes to be explored are non-steroidal mineralocorticoid receptor antagonists, aminopeptidase A inhibitors, dual endothelin antagonists, aldosterone synthetase inhibitors, atrial natriuretic peptide inhibitors, and attenuators of hepatic angiotensinogen. Discussion of procedural interventions to lower blood pressure will focus on renal denervation and devices that increase carotid baroreceptor activity.
Promising medication and procedural interventions are being developed and studied to expand our treatment arsenal for patients with uncontrolled essential hypertension and RH.
该国未控制的高血压率以及下游心血管结局一直在恶化。尽管市场上有大量的抗高血压药物，但估计难治性高血压 (RH) 的患病率为 13.7%。因此，除了加强高血压的临床教育和关注生活方式管理以及药物依从性外，还需要新的疗法来应对高血压的上升。
对现有医学文献进行了系统回顾，以确定 RH 的新治疗选择。
确定了六种不同的药理类和两种程序干预措施，作为本文的审查对象。将要探讨的药理类包括非甾体类盐皮质激素受体拮抗剂、氨基肽酶 A 抑制剂、双重内皮素拮抗剂、醛固酮合酶抑制剂、心钠肽抑制剂和肝血管紧张素原的抑制剂。降低血压的程序干预讨论将集中在肾去神经和增加颈动脉压力感受器活性的设备上。
正在开发和研究有前途的药物和程序干预措施，以扩大我们对未控制的原发性高血压和 RH 患者的治疗方案。
