对抗性高血压的诊断和管理
Ernesto L Schiffrin1, Naomi D L Fisher2
1Lady Davis Institute for Medical Research and Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, QC, Canada ernesto.schiffrin@mcgill.ca.
BMJ (Clinical research ed.)
|June 19, 2024
概括
耐性高血压,尽管服用多种药物,但血压不受控制,造成了显著的心血管风险. 新的药物和脏剥皮为这种具有挑战性的疾病提供了有前途的治疗方法.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 抗性高血压被定义为血压仍然不受控制,尽管最佳治疗至少有三种抗高血压药物,包括利尿剂.
- 它与心力衰竭,缺血性心脏病,中风和功能衰竭的风险增加有关.
- 排除明显的耐治疗高血压,通常是由于不坚持,对于诊断至关重要.
研究的目的:
- 审查目前对抗性高血压的指导方针和治疗策略.
- 突出新兴的药物和基于设备的治疗方法来治疗耐药高血压.
- 讨论在特定患者群体中管理耐药高血压的新药和方法.
主要方法:
- 审查当前的专业组织指导方针对抗性高血压管理.
- 分析支持已知和新型抗高血压药物的证据.
- 基于设备的干预措施的评估,包括脏皮化.
主要成果:
- 标准治疗包括改变生活方式和ACE抑制剂/ARBs,通道阻断剂和 thiazide 利尿剂的组合.
- 建议使用矿物甲类皮质体受体抗剂作为第四线药物.
- 新型药物,如阿尔多氨酸合成酶抑制剂,双内啡素受体对抗剂和非类固醇MRA正在开发中.
- 脏缩是对抗性高血压最受支持的基于设备的治疗方法.
结论:
- 抗性高血压需要一个多方面的治疗方法,结合生活方式的改变,药物治疗和潜在的基于设备的干预措施.
- 新兴疗法为难以控制血压的患者提供了新的希望.
- 个性化治疗策略对于管理耐性高血压至关重要,特别是在特殊人群中,如CKD患者.
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