Division of Public Health Science, Westminster International University in Tashkent, Tashkent, Uzbekistan.
Tashkent Medical Academy, Tashkent, Uzbekistan.
Blood Press. 2023 Dec;32(1):2185457. doi: 10.1080/08037051.2023.2185457.
The current review is to describe the definition and prevalence of resistant arterial hypertension (RAH), the difference between refractory hypertension, patient characteristics and major risk factors for RAH, how RAH is diagnosed, prognosis and outcomes for patients.
According to the WHO, approximately 1.28 billion adults aged 30-79 worldwide have arterial hypertension, and over 80% of them do not have blood pressure (BP) under control. RAH is defined as above-goal elevated BP despite the concurrent use of 3 or more classes of antihypertensive drugs, commonly including a long-acting calcium channel blocker, an inhibitor of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a thiazide diuretic administered at maximum or maximally tolerated doses and at appropriate dosing frequency. RAH occurs in nearly 1 of 6 hypertensive patients. It often remains unrecognised mainly because patients are not prescribed ≥3 drugs at maximal doses despite uncontrolled BP.
RAH distinctly increases the risk of developing coronary artery disease, heart failure, stroke and chronic kidney disease and confers higher rates of major adverse cardiovascular events as well as increased all-cause mortality. Timely diagnosis and treatment of RAH may mitigate the associated risks and improve short and long-term prognosis.
本综述旨在描述耐药性动脉高血压（RAH）的定义和流行情况，难治性高血压的区别，RAH 患者的特征和主要危险因素，RAH 的诊断方法，以及患者的预后和结局。
根据世界卫生组织的数据，全球约有 12.8 亿 30-79 岁的成年人患有动脉高血压，其中超过 80%的人血压未得到控制。RAH 被定义为尽管同时使用 3 种或更多类别的降压药物（通常包括长效钙通道阻滞剂、肾素-血管紧张素系统抑制剂[血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂]和噻嗪类利尿剂），但血压仍高于目标值。RAH 发生在近 1/6 的高血压患者中。它通常未被识别，主要是因为尽管血压未得到控制，但患者未被开具最大剂量的≥3 种药物。
RAH 明显增加了罹患冠状动脉疾病、心力衰竭、中风和慢性肾病的风险，并导致更高的主要不良心血管事件发生率以及全因死亡率的增加。及时诊断和治疗 RAH 可能减轻相关风险并改善短期和长期预后。
