高血压V中的争议:耐药和耐火性高血压
Edward J Filippone1, Gerald V Naccarelli2, Andrew J Foy2
1Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa.
The American journal of medicine
|October 13, 2023
概括
耐性高血压,即尽管服用药物,但血压无法控制,影响到15%的患者. 治疗包括优化药物,评估守,并准潜在的原因,如阿尔多激素过量或同情的基调.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
背景情况:
- 显而易见的抗性高血压 (尽管服用≥3种药物,但不控制血压) 影响高血压患者的≤15%.
- 明显耐药性高血压 (尽管服用≥5种药物但血压不受控制) 影响≤10%的耐药病例.
- 这两种情况都会增加并发症和心血管风险.
研究的目的:
- 概述明显耐药和耐火性高血压的诊断和管理策略.
- 为了区分真正的抗性/耐药高血压与伪抗性.
- 讨论最佳的药理和干预方法.
主要方法:
- 基于指南的血压测量方法.
- 优化抗高血压治疗方案.
- 对白衣效应和药物坚持的评估.
- 药物管理针对体积过载,阿尔多激素过量和同情的音调.
主要成果:
- 真正的耐药高血压通常涉及体积过载和阿尔多激素过量.
- 真正耐火性高血压与增强的同情性音调有关.
- 螺旋诺拉克是耐药高血压的首选药物; 费内伦适用于白尿.
- 交感抑制是耐性高血压的一个潜在策略.
结论:
- 准确的诊断和坚持评估对于管理耐性高血压至关重要.
- 针对性疗法,如螺旋乳,结合剂,或finerenone改善结果.
- 需要进一步的研究来确定耐火性高血压的最佳治疗方法.
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