维持性血液透析合并难治性高血压的治疗进展

Progress in Treatment of Maintenance Hemodialysis Patients Complicated with Resistant Hypertension

在维持性血液透析患者中,难治性高血压发病率较高,发病机制复杂。目前主要的治疗方式有调整透析方案、加用降压药物以及手术介入治疗等。透析方案的调整包括在常规的血液透析基础上联合血液灌流、血液透析滤过、低钠透析等,第4种降压药物的选择包括地尔硫艹卓、螺内酯、特拉唑嗪等,手术介入治疗有肾去神经术、肾动脉栓塞术、压力感受器激活疗法等。但由于试验研究人群的个体差异以及目前试验研究数量有限,各种治疗方法的适应证尚未形成统一认识,药物选择尚未完全,手术治疗的安全性和有效性也需进一步临床试验进行验证。

In maintenance hemodialysis patients,the incidence of resistant hypertension is high,and the pathogenesis is complicated.At present,the main treatment methods include adjusting the dialysis plan,adding antihypertensive drugs,and surgical intervention,etc.The adjustment of the dialysis plan includes the combination of hemoperfusion,hemodiafiltration,low-sodium dialysis on the basis of conventional hemodialysis and so on.The fourth choice of antihypertensive drugs includes diltiazem,spironolactone,terazosin,etc.The surgical interventional methods include renal denervation,renal artery embolization,baroreflex activation therapy,etc.However,due to the individual differences in the test research population and the limited number of test studies at present,the indications of each treatment method have not formed a unified understanding,the choice of drugs is not yet complete,and the safety and effectiveness of surgical treatment need further clinical trials to verify.