Kaplan N M
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Geriatrics. 1995 May;50(5):24-5, 29-30; 33 passim.
Hypertension is considered to be "resistant" if a patient's diastolic blood pressure remains above 90 mm Hg despite the use of full doses of three antihypertensive medications. The most likely causes of ineffective blood pressure control include inadequate drug regimens and patient factors such as noncompliance, obesity, cigarette smoking, alcoholism, and "office hypertension." The two most common physiologic causes of resistance are volume overload and secondary hypertension, particularly renovascular disease. When suspicion of renovascular hypertension is high, immediate renal arteriography is indicated. In most patients, however, the less invasive captopril challenge is an adequate screening test. Most hypertensive patients with true resistance can be treated by altering their medication regimen.
如果患者尽管使用了三种抗高血压药物的全剂量，但舒张压仍保持在90毫米汞柱以上，则高血压被认为是“顽固性的”。血压控制无效的最可能原因包括药物治疗方案不足以及患者因素，如不依从、肥胖、吸烟、酗酒和“诊室高血压”。抵抗的两个最常见生理原因是容量超负荷和继发性高血压，尤其是肾血管疾病。当对肾血管性高血压的怀疑很高时，应立即进行肾动脉造影。然而，在大多数患者中，侵入性较小的卡托普利激发试验是一种充分的筛查试验。大多数真正有抵抗性的高血压患者可以通过改变药物治疗方案来治疗。
