难治性高血压.

Resistant hypertension
blood pressure remains above goal
Prevalence1
Framingham Heart Study
48%
NHANES 53%
ALLHAT2 50%
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)
JENNY
Objective
Expanding 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.
Pseudoresistance
Poor Adherence
Poor Blood Pressure Technique
White-Coat Effect
Secondary Causes
Lifestyle Factors
Poor Blood Pressure Technique
measurinБайду номын сангаас the blood pressure before letting the patient sit quietly
Contents
1
Diagnosis
2
Evaluation
3
Treatment
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.
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: Diagnosis, Evaluation, and
Treatment
(A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood
Drug-Related Causes
Non-narcotic analgesics Non-steroidal anti-inflammatory agents, including aspirin, selective COX-2 inhibitors
Sympathomimetic agents (decongestants, diet pills, cocaine)
the first year of treatment4
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
use of too small a cuff
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
Pheochromocytoma
Obstructive Sleep Apnea
Renal parenchymal disease
Secondary Causes
Primary aldosteronism
Renal artery stenosis
Stimulants (methylphenidate, dexmethylphenidate, dextroamphetamine, amphetamine, methamphetamine, modafinil)
Alcohol Oral contraceptives Cyclosporine EPO Natural licorice Herbal compounds (ephedra or ma huang)