抗性高血压:诊断,评估和治疗的实际方法
Roberto Parodi1, Laura Brandani2, César Romero3
1Rosario National University, Hospital Provincial del Centenario, Rosario, Argentina.
European journal of internal medicine
|January 16, 2024
概括
抗性高血压 (RH) 影响5%的高血压患者,其特点是尽管得到最佳治疗,但血压不受控制. 管理需要改变生活方式,坚持,以及先进的疗法来降低心血管风险.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 耐性高血压 (RH) 被定义为不受控制的血压 (BP),尽管服用了三种或更多抗高血压药物的最佳剂量.
- 真正的RH需要通过家庭或门诊监测,坚持和排除次要原因来确认不充分的血压控制.
- 肺炎患者面临心血管事件,死亡率和末端器官损伤的风险增加.
研究的目的:
- 定义抗性高血压 (RH) 和其诊断标准.
- 概述患病率,血液动力学模式和与RH相关的风险.
- 讨论当前和未来的治疗策略来管理RH.
主要方法:
- 根据治疗坚持,药物类别 (利尿剂,RAS抑制剂,CCB) 和血压值 (<140/90 mmHg) 来定义RH.
- 使用家庭血压监测 (HBPM) 或24小时门诊监测进行确认.
- 除了高血压和伪抗性的二次原因.
主要成果:
- 根据严格的标准,真正的高血压患病率估计为高血压人口的5%.
- 血液动力学概况通常涉及系统血管阻力和血体积增加,心脏输出正常/低.
- 红血与更高的心血管事件,死亡和器官损伤率有关.
结论:
- 准确诊断RH至关重要,需要排除伪抗性.
- 管理涉及生活方式的修改,确保坚持,优化药物治疗 (长效利尿剂,MRAs),并解决惯性.
- 需要进一步的随机对照试验 (RCT) 来确定RH的最佳药物治疗,新药可能会改善未来的治疗.
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