难治性高血压
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Stimulants (methylphenidate, dexmethylphenidate, dextroamphetamine, amphetamine, methamphetamine, modafinil)
Alcohol Oral contraceptives Cyclosporine EPO Natural licorice Herbal compounds (ephedra or ma huang)
Leabharlann Baidu Evaluation
Ambulatory Blood Pressure Monitoring
A mean ambulatory daytime blood pressure of <135/85 mm Hg is considered elevated.
Biochemical Evaluation
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.
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
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
Resistant Hypertension: Diagnosis, Evaluation, and
Treatment
(A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood
CYT006-AngQb
a Vaccine Against Hypertension Targeting Angiotensin II, Reduces Early-Morning and Day-Time Blood Pressure
a virus-like-particle based conjugate vaccine targeting (Ang II) 72 mild-to-moderate hypertensive patients.
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
A routine metabolic profile
Urinalysis
A paired, morning plasma aldosterone
Plasma renin activity
Noninvasive Imaging
Treatment
1. Maximize Adherence
the use of a long-acting combination of products
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.
Aliskiren
There is no doubt that aliskiren is an effective antihypertensive agent and that at effective doses it is well tolerated. It appears to be safe, but this statement is made with the obvious qualification for any novel drug or class that rare or long-term adverse events may take time to become apparent.7
Drug-Related Causes
Non-narcotic analgesics Non-steroidal anti-inflammatory agents, including aspirin, selective COX-2 inhibitors
Sympathomimetic agents (decongestants, diet pills, cocaine)
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
2. Non pharmacological Recommendations
Weight Loss Dietary Salt Restriction Moderation of Alcohol Intake Increased Physical Activity Ingestion of a High-Fiber, Low-Fat Diet
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.
Blood Pressure Measurement
sit quietly correct cuff size; support the arm at heart level the average of 2 readings supine and upright blood pressures
Physical Examination
DOSE: 75mg-300mg qd p.o
Darusentan
Darusentan provides additional reduction in blood pressure in patients who have not attained their treatment goals with three or more antihypertensive drugs. As with other vasodilator drugs, fluid management with effective diuretic therapy might be needed .
injections of either 100 or 300 µg
the vaccine with an optimized dose regimen
CYT006-AngQb
CYT006-AngQb reduced blood pressure in situations where the renin-angiotensin-aldosterone system is stimulated, and was particularly effective in the morning hours when most cardiovascular events occur.
Pheochromocytoma
Obstructive Sleep Apnea
Renal parenchymal disease
Secondary Causes
Primary aldosteronism
Renal artery stenosis
Cushing’s disease Hyperparathyroidism
Aortic coarctation
Evaluation
Medical History: duration,
severity, progression of the hypertension; treatment adherence; response to prior medications
Assessment of Adherence
3.Treatment of Secondary Causes of Hypertension
4. Pharmacological Treatment
Aliskiren
Effects of aliskiren and valsartan on plasma ANG I and II levels. Aliskiren alone or in combination with valsartan was tested in 120 mildly sodium depleted, Nor-motensive adults (age, 18 to 35 years) in a double-dummy, double blind, randomized, placebocontrolled, 4-period crossover study. Subjects received single doses of aliskiren 300 mg alone, aliskiren 150 mg in combination with valsartan 80 mg, valsartan 160 mg alone, and placebo separated by 2-week washout periods
Alcohol Oral contraceptives Cyclosporine EPO Natural licorice Herbal compounds (ephedra or ma huang)
Leabharlann Baidu Evaluation
Ambulatory Blood Pressure Monitoring
A mean ambulatory daytime blood pressure of <135/85 mm Hg is considered elevated.
Biochemical Evaluation
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.
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
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
Resistant Hypertension: Diagnosis, Evaluation, and
Treatment
(A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood
CYT006-AngQb
a Vaccine Against Hypertension Targeting Angiotensin II, Reduces Early-Morning and Day-Time Blood Pressure
a virus-like-particle based conjugate vaccine targeting (Ang II) 72 mild-to-moderate hypertensive patients.
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
A routine metabolic profile
Urinalysis
A paired, morning plasma aldosterone
Plasma renin activity
Noninvasive Imaging
Treatment
1. Maximize Adherence
the use of a long-acting combination of products
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.
Aliskiren
There is no doubt that aliskiren is an effective antihypertensive agent and that at effective doses it is well tolerated. It appears to be safe, but this statement is made with the obvious qualification for any novel drug or class that rare or long-term adverse events may take time to become apparent.7
Drug-Related Causes
Non-narcotic analgesics Non-steroidal anti-inflammatory agents, including aspirin, selective COX-2 inhibitors
Sympathomimetic agents (decongestants, diet pills, cocaine)
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
2. Non pharmacological Recommendations
Weight Loss Dietary Salt Restriction Moderation of Alcohol Intake Increased Physical Activity Ingestion of a High-Fiber, Low-Fat Diet
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.
Blood Pressure Measurement
sit quietly correct cuff size; support the arm at heart level the average of 2 readings supine and upright blood pressures
Physical Examination
DOSE: 75mg-300mg qd p.o
Darusentan
Darusentan provides additional reduction in blood pressure in patients who have not attained their treatment goals with three or more antihypertensive drugs. As with other vasodilator drugs, fluid management with effective diuretic therapy might be needed .
injections of either 100 or 300 µg
the vaccine with an optimized dose regimen
CYT006-AngQb
CYT006-AngQb reduced blood pressure in situations where the renin-angiotensin-aldosterone system is stimulated, and was particularly effective in the morning hours when most cardiovascular events occur.
Pheochromocytoma
Obstructive Sleep Apnea
Renal parenchymal disease
Secondary Causes
Primary aldosteronism
Renal artery stenosis
Cushing’s disease Hyperparathyroidism
Aortic coarctation
Evaluation
Medical History: duration,
severity, progression of the hypertension; treatment adherence; response to prior medications
Assessment of Adherence
3.Treatment of Secondary Causes of Hypertension
4. Pharmacological Treatment
Aliskiren
Effects of aliskiren and valsartan on plasma ANG I and II levels. Aliskiren alone or in combination with valsartan was tested in 120 mildly sodium depleted, Nor-motensive adults (age, 18 to 35 years) in a double-dummy, double blind, randomized, placebocontrolled, 4-period crossover study. Subjects received single doses of aliskiren 300 mg alone, aliskiren 150 mg in combination with valsartan 80 mg, valsartan 160 mg alone, and placebo separated by 2-week washout periods