Park Sungha, Shin Jinho, Ihm Sang Hyun, Kim Kwang-Il, Kim Hack-Lyoung, Kim Hyeon Chang, Lee Eun Mi, Lee Jang Hoon, Ahn Shin Young, Cho Eun Joo, Kim Ju Han, Kang Hee-Taik, Lee Hae-Young, Lee Sunki, Kim Woohyeun, Park Jong-Moo
Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea.
Clin Hypertens. 2023 Nov 1;29(1):30. doi: 10.1186/s40885-023-00255-4.
Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients.
尽管报告存在差异，但据报道，真性难治性高血压和貌似难治性高血压（aTRH）的患病率分别为10.3%和14.7%。由于与难治性高血压相关的肥胖、慢性肾脏病和糖尿病的患病率迅速上升，难治性高血压的患病率预计也会上升。通常，aTRH患者存在假性难治性高血压[由于白大衣未控制高血压（WUCH）、药物剂量不足、依从性差和诊室血压（BP）测量不准确导致的aTRH]。由于WUCH在aTRH患者中患病率较高，因此采用诊室外血压测量，即动态血压监测（ABPM）和家庭血压监测（HBPM），对于排除WUCH至关重要。依从性差尤其成问题，评估依从性的方法仍然有限且往往在临床上不可行。因此，应强调使用HBPM并提高单片固定剂量联合治疗的使用率，以提高药物依从性。此外，原发性醛固酮增多症和症状性阻塞性睡眠呼吸暂停在高血压患者中相当常见，在难治性高血压患者中更为常见。筛查这些疾病至关重要，因为治疗这些继发性病因可能有助于控制其他方面难以治疗的患者的血压。最后，适当的药物治疗方案结合生活方式改变对于控制这些患者的血压至关重要。
