尿毒症难治性高血压的原因及治疗策略

The pathogenesis and treatment strategy of refractory hypertension in uremic patients

难治性高血压在尿毒症患者中非常常见,严重威胁患者的预后和生活质量。大量研究表明水钠潴留、肾素-血管紧张素系统持续激活、交感神经过度兴奋和多种升压因素是尿毒症难治性高血压的主要发生机制。在临床上应严格控制水钠摄入,充分发挥透析降压的潜力,综合应用降压和其它辅助药物,对合并局限性肾动脉狭窄或内科治疗很不满意者,可考虑介入性降压治疗。

Refractory hypertension （RFH） is a common manifestation, which is a serious threat to the prognosis and quality of life in uremic patients. Many studies have revealed that water/sodium retention, acti- vation of renin-angiotensin system, excessive excitement of sympathetic nerve, and other participating factors are the main factors for uremic RFH. Strict control of water and sodium intake, judiciously using hemodialy- sis for antihypertension, and comprehensive application of antihypertensives and other auxiliary drugs are the measures to treat RFH. Percutaneous transluminal renal artery stenting for patients with local renal artery ste- nosis, and renal denervation for those refractory to drug treatment may be required.