药源性高血压的发病机制、致病药物及其防治

Drug-induced hypertension: mechanism,causative durgs,prevention,and management

药源性高血压为常见药物不良反应之一,其发病机制包括交感神经活动亢进,肾性水钠潴留,肾素-血管紧张素-醛固酮系统激活,以及动脉弹性功能和结构改变。临床表现为血压升高、反跳现象,甚至出现高血压危象。高危因素包括高龄、性别、遗传原因、既往高血压病史、超重、钠敏感、基础疾病。高危人群应避免使用可致血压升高的药物;必须使用时,应从最小剂量开始并应监测血压水平。一旦出现高血压应立即停药或减少剂量,并予对症治疗。

Drug-induced hypertension is one of the common1 adverse drug reactions. The mechanism of drug-induced hypertension may involve stimulation of sympathetic nervous system activity, sodium and water retention, renin-angiotensin-aldosterone system activation, and changes in function and structure of arterial elasticity. Clinical presentations are increased blood pressure, rebound phenomenon, and even hypertensive crisis. The risk factors for drug-induced hypertension are advanced age, sex, genetic causes, previous history of hypertension, overweight, susceptibity to sodium, and underlying diseases. The drugs known to cause hypertension should be avoided in high-risk patients; if drug treatment is necessary, the treatment should start with a minimum dosage and blood pressure should be monitored during treatment. Once drug-induced hypertension occurs, the drug should he discontinued immediately or the dosage should be reduced, and symptomatic treatment should be given.