PDF(Pubmed)
Abstract：
Resistant hypertension (RH) includes hypertensive patients with uncontrolled blood pressure (BP) while receiving ≥3 BP-lowering medications or with controlled BP while receiving ≥4 BP-lowering medications. The exact prevalence of RH is challenging to quantify. However, a reasonable estimate of true RH is around 5% of the hypertensive population. Patients with RH have higher cardiovascular risk as compared with hypertensive patients in general. Standardized office BP measurement, confirmation of medical adherence, search for drug- or substance-induced BP elevation, and ambulatory or home BP monitoring are mandatory to exclude pseudoresistance. Appropriate further investigations, guided by clinical data, should be pursued to exclude possible secondary causes of hypertension. The management of RH includes the intensification of lifestyle interventions and the modification of antihypertensive drug regimens. The essential aspects of lifestyle modification include sodium restriction, body weight control, regular exercise, and healthy sleep. Step-by-step adjustment of the BP-lowering drugs based on the available evidence is proposed. The suitable choice of diuretics according to patients\' renal function is presented. Sacubitril/valsartan can be carefully substituted for the prior renin-angiotensin system blockers, especially in those with heart failure with preserved ejection fraction. If BP remains uncontrolled, device therapy such as renal nerve denervation should be considered. Since device-based treatment is an invasive and costly procedure, it should be used only after careful and appropriate case selection. In real-world practice, the management of RH should be individualized depending on each patient\'s characteristics.
摘要：
顽固性高血压（RH）包括血压不受控制（BP）的高血压患者，同时接受≥3种降低BP的药物或接受≥4种降低BP的药物的血压控制。RH的确切患病率难以量化。然而,对真实RH的合理估计约为高血压人群的5%.一般情况下，与高血压患者相比，RH患者的心血管风险更高。标准化办公室BP测量，医疗依从性的确认，寻找药物或物质引起的血压升高，并且必须进行动态或家庭BP监测以排除假性抵抗。适当的进一步调查，以临床数据为指导，应努力排除高血压的可能次要原因。RH的管理包括加强生活方式干预和修改抗高血压药物方案。改变生活方式的基本方面包括限制钠，体重控制,定期锻炼,和健康的睡眠。建议根据现有证据逐步调整降血压药物。根据患者的肾功能，提出了利尿剂的合适选择。sacubitril/valsartan可以小心地代替先前的肾素-血管紧张素系统阻滞剂，尤其是那些射血分数保留的心力衰竭患者。如果BP仍然不受控制，器械治疗如肾神经去神经治疗应考虑。由于基于设备的治疗是一种侵入性和昂贵的程序，只有在仔细和适当的案例选择后，才能使用它。在现实世界的实践中，RH的管理应根据每个患者的特点进行个体化.
