引用本文:李师承,刘 伶,严晓伟.难治性高血压的诊疗进展[J].中国临床新医学,2019,12(5):488-493.
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难治性高血压的诊疗进展
李师承,刘 伶,严晓伟
530021 南宁,广西壮族自治区人民医院心血管内科(李师承,刘 伶);100730 北京,中国医学科学院北京协和医院心血管内科(严晓伟)
摘要:
[摘要] 难治性高血压是一种特殊类型的高血压,危害较大。合理的诊断和治疗对有效控制患者血压、预防心脑血管事件发生有重要的意义。正确的诊断需要明确或排除包括依从性差、继发性高血压等多种影响血压控制的因素。有效的降压治疗一方面需要强调生活方式的改善,另一方面要在肾素-血管紧张素系统抑制剂(RASI)、钙离子通道阻滞剂(CCB)和利尿剂治疗的基础上,根据血浆肾素水平调整药物剂量,并加用醛固酮拮抗剂等其他降压药物。
关键词:  难治性高血压  诊断  治疗  靶器官损伤
DOI:10.3969/j.issn.1674-3806.2019.05.05
分类号:R 544.1
基金项目:
Resistant hypertension: progress in diagnosis and treatment
LI Shi-cheng, LIU Ling, YAN Xiao-wei
Department of Cardiology, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract:
[Abstract] Resistant hypertension(RH) is a special type of hypertension, which is underscored by the associated risk of adverse outcomes compared with non-RH. Accurate diagnosis and treatment play an important role in control of blood pressure(BP) and prevention of cardiovascular events. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics and calcium channel blocker(CCB), addition of the renin-angiotensin system inhibitor(RASI) and a mineralocorticoid receptor antagonist according to the plasma renin level, and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action is used to lower BP.
Key words:  Resistant hypertension(RH)  Diagnosis  Treatment  Target organ damage