难治性高血压

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
use of too small a cuff
Fra Baidu bibliotek
Poor Adherence
a major cause of lack of blood pressure control
5 to 10 years of less than 40% follow-up3
of patients
40% of patients
Stimulants (methylphenidate, dexmethylphenidate, dextroamphetamine, amphetamine, methamphetamine, modafinil)
Alcohol Oral contraceptives Cyclosporine EPO Natural licorice Herbal compounds (ephedra or ma huang)
Resistant Hypertension: Diagnosis, Evaluation, and
Treatment
(A Scientific Statement From the American Heart Association Professional Education Committee of the
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
Council for High Blood 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 long-term clinical management of this disorder.
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 treatment-resistant hypertension.
Pheochromocytoma
Obstructive Sleep Apnea
Renal parenchymal disease
Secondary Causes
Primary aldosteronism
Renal artery stenosis
Pseudoresistance
Poor Adherence
Poor Blood Pressure Technique
White-Coat Effect
Secondary Causes
Lifestyle Factors
Poor Blood Pressure Technique
measuring the blood pressure before letting the patient sit quietly
the first year of treatment4
White-Coat Effect
Studies indicate that a significant white-coat effect (when clinic blood pressures are persistently elevated while out-ofoffice 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
Drug-Related Causes
Non-narcotic analgesics Non-steroidal anti-inflammatory agents, including aspirin, selective COX-2 inhibitors
Sympathomimetic agents (decongestants, diet pills, cocaine)