抗性高血压:来自韩国高血压学会的共识文件
Sungha Park1, Jinho Shin2, Sang Hyun Ihm3,4
1Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
Clinical hypertension
|November 1, 2023
概括
抗性高血压影响超过10%的患者. 明显耐治疗高血压 (aTRH) 往往是由于白衣高血压或不良坚持,需要在办公室外监测血压.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 内分泌学 在内分泌学.
背景情况:
- 耐药性高血压 (RH) 和明显耐治疗性高血压 (aTRH) 影响了大量患者群体.
- 肥胖,糖尿病和慢性病的患病率越来越高,预计将导致RH的增加.
- 伪抗性,包括白外套失控高血压 (WUCH),在aTRH中很常见.
研究的目的:
- 突出明显耐治疗高血压 (aTRH) 的患病率和原因.
- 强调在诊断aTRH时,室外血压测量的重要性.
- 讨论改善坚持和识别抗性高血压的次要原因的策略.
主要方法:
- 关于抗性高血压和aTRH流行情况的当前文献的综述.
- 讨论诊断方法,包括门诊血压监测 (ABPM) 和家庭血压监测 (HBPM).
- 探索导致的因素,如不坚持,白袍失控高血压 (WUCH),原发性阿尔多斯特隆症和阻塞性睡眠呼吸暂停.
主要成果:
- 据报道,明显耐治疗高血压 (aTRH) 的患病率为14.7%.
- 白外套失控高血压 (WUCH) 是aTRH中伪抗性的常见原因.
- 违法行为是一个重大挑战,可行的评估方法有限.
- 主要的阿尔多斯特主义和阻塞性睡眠呼吸暂停是RH患者常见的次要原因.
结论:
- 室外血压测量 (ABPM,HBPM) 对于排除aTRH中的WUCH至关重要.
- 建议通过HBPM和固定剂量组合改善药物坚持性.
- 查二次原因,如原发性阿尔多斯特隆症和睡眠呼吸暂停,对于在耐性高血压中有效的血压管理至关重要.
- 综合治疗包括药物治疗和生活方式改变是控制耐药高血压的关键.
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