Department for Cardiovascular Diseases, Clinical Center Nis, 18000 Nis, Serbia.
Faculty of Medicine, University of Nis, 18000 Nis, Serbia.
Medicina (Kaunas). 2023 Apr 20;59(4):803. doi: 10.3390/medicina59040803.
With the medical and social importance of resistant arterial hypertension (HTN) in mind, we had three goals in this paper: to study the definitions of resistant HTN in the guidelines on the topic, to analyze them, and to suggest some improvements. We found (at least) eleven insufficiencies in the definition of resistant HTN: (1) different blood pressure (BP) values are used for diagnoses; (2) the number of BP measurements is not specified; (3) the is not obtained; (4) it fails to provide or or BP values; (5) secondary HTN is not currently defined as true resistant HTN, but as apparently treatment-resistant HTN; (6) the definition usually directly incorporates BP cut-offs for systolic BP (sBP) and diastolic BP (dBP) making the diagnosis temporary; (7) in the exclusion strategy for resistant HTN; (8) there is potentially a need to introduce a category of resistant HTN; (9) to what to consider it as sufficient to change the diagnosis from "apparent treatment-resistant HTN" to the "resistant HTN"; (10) sBP values for 61 and 81 year old patients in some guidelines fulfill the criterion for resistant HTN; (11) it probably ought to read "In the absence of contraindications and compelling indications…" in the others. We believe that it is better to use the phrase "above the target BP" for the definition of (treatment) resistant HTN, because the whole story of resistant HTN is related to non-responders to antihypertensive treatment. Therefore, as we and not to normal values, it is appropriate to define resistant HTN as an insufficiency to reach the target BP values. Moreover, the definition of (treatment) resistant HTN should not be universal for every patient with HTN, but it should be age-related: (treatment) resistant HTN is elevated BP the target/normal BP values. Using this modification, there will be no need to automatically change the definition of resistant HTN when we change the BP targets in the future.
考虑到耐药性动脉高血压（HTN）在医学和社会上的重要性，我们在本文中有三个目标：研究主题指南中耐药性 HTN 的定义，对其进行分析，并提出一些改进建议。我们发现（至少）在耐药性 HTN 的定义中有十一个不足之处：（1）用于诊断的血压（BP）值不同；（2）未指定 BP 测量次数；（3） 未获得；（4）未能提供 或 或 BP 值；（5）目前并未将继发性 HTN 定义为真正的耐药性 HTN，而是定义为明显的治疗抵抗性 HTN；（6）该定义通常直接纳入收缩压（sBP）和舒张压（dBP）的 BP 截止值，使诊断具有临时性；（7） 在耐药性 HTN 的排除策略中；（8）可能需要引入一类 耐药性 HTN；（9）考虑到什么 将“明显的治疗抵抗性 HTN”的诊断更改为“耐药性 HTN”；（10）在一些指南中，61 岁和 81 岁患者的 sBP 值满足耐药性 HTN 的标准；（11）在其他指南中，可能应该将“在无禁忌症和强制性指征的情况下……”改为“在无禁忌症和强制性指征的情况下……”。我们认为，使用“高于目标 BP”来定义（治疗）耐药性 HTN 更好，因为耐药性 HTN 的整个故事都与抗高血压治疗的无反应者有关。因此，由于我们 而不是正常值，将无法达到目标 BP 值定义为耐药性 HTN 是恰当的。此外，（治疗）耐药性 HTN 的定义不应适用于每个 HTN 患者，而应与年龄相关：（治疗）耐药性 HTN 是高于目标/正常 BP 值的 BP。使用这种修改，当我们在未来改变 BP 目标时，将无需自动更改耐药性 HTN 的定义。
