顽固性高血压的健康管理

Health Management of Resistant Hypertension

高血压是心血管疾病的重要危险因素之一。尽管目前有很多治疗高血压的药物,但对血压的控制仍不够充分,部分未控制的高血压称为顽固性高血压。顽固性高血压的管理需要筛查出继发性高血压和识别出肥胖、过量饮酒、食盐过量摄入等生活方式所引起的高血压。优化药物治疗仍然是顽固性高血压管理的基石。对于大多数病人,现有的临床试验不支持在常规的临床实践中,通过例如肾脏去神经化,压力反馈激活疗法或动静脉吻合术等治疗顽固性高血压。未来的研究应侧重于提高对内在因素(生理和心理因素)和外在因素(环境压力因素)的理解。

High blood pressure is one of the leading factors influencing the cardiovascular risk.Despite the numerous antihypertensive drugs available,hypertension remains insufficiently controlled and part of these“uncontrolled”patients meet the definition of resistant hypertension.The management of resistant hypertension includes the screening of secondary forms of hypertension and the identification of life style factors such as obesity,excessive alcohol and dietary sodium intake.Optimization of medical treatment remains the cornerstone of their management.The available data from clinical trials do not support the use of device-based approaches such as renal denervation,baroreflex activation therapy or arteriovenous anastomosis for the treatment of resistant hypertension in the majority of patients.Future research should focus on improving understanding of the intrinsic(physiological and psychological factors)and extrinsic(environmental stressors)mechanisms that contribute to a lack of response to blood-pressure-lowering drugs in adherent patients.