PDF(Pubmed)
Abstract：
Treatment-resistant hypertension (TRH) is defined as blood pressure levels that remain above the therapeutic goal despite concurrent use of three or more antihypertensive medications taken at maximally tolerated doses, one of which should be a diuretic. Additionally, individuals on four or more antihypertensive agents regardless of blood pressure are also considered to have TRH. Amongst people diagnosed with TRH, African American adults face a huge management gap, resulting in increased cardiovascular disease risk. The primary objective of this review was to identify the commonly encountered etiologies and extensively discuss the current management strategies of TRH with a particular focus on African Americans. Relevant studies were identified by analyzing scientific databases and journals such as PubMed, Cochrane, MEDLINE, Cureus, and American Heart Association (AHA). The studies identified and examined common causes of TRH, describing their pathophysiology and highlighting different treatment options for the respective etiologies. The most prevalent etiologies of TRH amongst African Americans were chronic kidney disease (CKD), renal artery stenosis (RAS), fibromuscular dysplasia, obstructive sleep apnea (OSA), endocrine causes (Conn syndrome, Cushing syndrome, etc.), sympathetic nervous system overactivity, lifestyle factors, inaccurate blood pressure measurement, and inappropriate treatment. Of the etiologies reviewed, OSA, lifestyle factors, and CKD exhibited a striking prevalence among the subpopulation studied. Unfortunately, there was a paucity of articles addressing this topic amongst African Americans, and therefore there was not a substantial appreciation of the prevalence of some of the identified etiologies in the population of interest. Thorough diagnostic testing for associated or underlying conditions provides a basis for successful management. This review brought to the fore the need for doctors and patients to collaborate in order to improve TRH management and help patients lead healthier lives.
摘要：
治疗抗性高血压（TRH）定义为尽管同时使用三种或更多种以最大耐受剂量服用的抗高血压药物，但血压水平仍高于治疗目标。其中一个应该是利尿剂。此外,无论血压如何,服用四种或更多种抗高血压药的个体也被认为患有TRH.在被诊断为TRH的人群中，非裔美国成年人面临巨大的管理差距，导致心血管疾病风险增加。这篇综述的主要目的是确定常见的病因，并广泛讨论TRH的当前管理策略，特别关注非裔美国人。通过分析科学数据库和期刊，如PubMed，科克伦,MEDLINE,Cureus,美国心脏协会（AHA）研究确定并检查了TRH的常见原因，描述他们的病理生理学，并强调各自病因的不同治疗方案。在非裔美国人中，最普遍的TRH病因是慢性肾病（CKD），肾动脉狭窄（RAS），纤维肌性发育不良,阻塞性睡眠呼吸暂停(OSA)内分泌原因(康恩综合征，库欣综合征,等。),交感神经系统过度活跃，生活方式因素，血压测量不准确,和不适当的治疗。在审查的病因中，OSA,生活方式因素，CKD在研究的亚群中表现出惊人的患病率。不幸的是,在非裔美国人中，很少有涉及这个话题的文章，因此，对感兴趣人群中某些已确定病因的患病率没有实质性的了解。对相关或潜在疾病的彻底诊断测试为成功管理提供了基础。这篇评论使医生和患者需要合作，以改善TRH管理并帮助患者过上更健康的生活。
