难治性高血压ppt课件

Stimulants (methylphenidate, dexmethylphenidate, dextroamphetamine, amphetamine, methamphetamine, modafinil)
Alcohol Oral contraceptives Cyclosporine EPO Natural licorice Herbal compounds (ephedra or ma huang)
12
Pheochromocytoma
Obstructive Sleep Apnea
Renal parenchymal disease
Secondary Causes
Primary aldosteronism
the first year of treatment4
9
White-Coat Effect
Studies indicate that a significant whitecoat effect (when clinic blood pressures are persistently elevated while out-of-office values are normal or significantly lower) is as common in patients with resistant hypertension as in the more general hypertensive population, with a prevalence in the range of 20% to 30%.5
11
Drug-Related Causes
Non-narcotic analgesics Non-steroidal anti-inflammatory agents, including aspirin, selective COX-2 inhibitors
Sympathomimetic agents (decongestants, diet pills, cocaine)
2
Contents
1
Diagnosis
2
Evaluation
3
Treatment
3
Definition
three antihypertensive agents of different classes
one of the 3 agents should be a diuretic
all agents should be prescribed at optimal dose amounts.
Resistant Hypertension: Diagnosis, Evaluation, and
Treatment
(A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood
6
Pseudoresistance
Poor Adherence
Poor Blood Pressure Technique
White-Coat Effect
Secondary Causes
Lifestyle Factors
7
Poor Blood Pressure Technique
measuring the blood pressure before letting the patient sit quietly
use of too small a cuff
8
Poor Adherence
a major cause of lack of blood pressure control
5 to 10 years less than 40% of follow-up3
of patients
40% of patients
10
Lifestyle Factors
Obesity is a common feature of patients with resistant hypertension.
Excessive dietary sodium intake
Heavy alcohol intake is associated with both an increased risk of hypertension, as well as treatmentresistant hypertension.
Resistant hypertension
blood pressure remains above goal
4
Prevalence1
Framingham Heart Study
48%
NHANES 53%
ALLHAT2 50%
5
Patient Characteristics
Patient Characteristics Associated With Resistant Hypertension Older age High baseline blood pressure Obesity Excessive dietary salt ingestion Chronic kidney disease Diabetes Left ventricular hypertrophy Black race Female sex Residence in southeastern United States
Pressure Research)anding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the longterm clinical management of this disorder.