顽固性高血压的研究进展

Advances in studies on refractory hypertension

高血压是心血管疾病的主要危险因素,而顽固性高血压患者发生心血管并发症的风险特别高。真正的顽固性高血压的诊断是排除了所有其他可能导致血压失控的原因(包括继发继发高血压、对降压治疗依从性差、白大衣效应的假性抵抗)后的原发性高血压。优化治疗是高血压管理的基石。治疗方案包括生活方式干预,强化药物治疗,肾脏去神经术,颈动脉窦刺激和动静脉吻合术。在本综述中,讨论了顽固性高血压的流行病学、相关风险和诊断治疗,强调了基于器械治疗的临床试验的局限性。

Hypertension is the predominant driver of cardiovascular disease,and patients with resistant hypertension are at particularly high risk of cardiovascular complications.True resistant hypertension refers to a diagnosis of essential hypertension with exclusion of all other potential causes of uncontrolled blood pressure,(including secondary hypertension,pseudo-resistance due to poor adherence to antihypertensive therapy or the white-coat effect).Optimization of medical treatment remains the cornerstone of their management.Treatment options include lifestyle interventions,intensive pharmacological therapy,renal denervation,stimulation of the carotid sinus and arteriovenous anastomosis.In this Review,we discuss the epidemiology,associated risks,diagnosis and management of resistant hypertension.We highlight the limitations of clinical trials of device.