Buso Giacomo, Agabiti-Rosei Claudia, Lemoli Matteo, Corvini Federica, Muiesan Maria Lorenza
Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia Brescia, Italy.
Lausanne University Hospital, University of Lausanne Lausanne, Switzerland.
Eur Cardiol. 2024 Jun 19;19:e07. doi: 10.15420/ecr.2023.51. eCollection 2024.
Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains .140 mmHg or .90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.
顽固性高血压（RH）的定义为，尽管采取了适当的生活方式并使用了包括利尿剂在内的三种药物的最佳或最大耐受剂量组合，但收缩压（SBP）或舒张压（DBP）仍分别保持在140 mmHg以上或90 mmHg以上。该定义涵盖了控制性RH类别，即由四种或更多种抗高血压药物有效控制血压（BP）的情况，以及难治性高血压，即尽管使用了包括利尿剂在内的五种或更多种不同类别的药物，但血压仍未得到控制。为了确认是否存在RH，必须排除假性顽固性高血压的各种原因（如不正确的血压测量技术和药物依从性差）以及继发性高血压。应通过诊室外血压测量来确认血压控制不充分。RH影响约5%的高血压人群，并与心血管发病率和死亡率增加相关。一旦确认存在RH，患者评估包括识别生活方式问题或干扰药物/物质等促成因素，以及评估高血压介导的器官损害。RH的管理包括生活方式干预和优化当前药物治疗。如果血压仍未得到控制，应依次引入其他药物，并且可以考虑肾去神经支配作为一种额外的治疗选择。然而，在这种情况下实现最佳血压控制仍然具有挑战性。本综述旨在概述RH，包括其流行病学、病理生理学、诊断检查以及最新的治疗进展。
