顽固性高血压的生活管理方式

Lifestyle Management of Refractory Hypertension

摘要: 目的：本综述旨在描述顽固性动脉高血压(RAH)的定义和患病率、与难治性高血压之间的区别、患者特征和RAH的主要危险因素、如何诊断RAH、患者的预后和结果。材料和方法：根据世界卫生组织的数据，全世界约有12.8亿30~79岁的成年人患有动脉高血压，其中超过80%的人血压(BP)未得到控制。RAH被定义为尽管同时使用3种或更多类抗高血压药物，但血压仍高于目标值，通常包括长效钙通道阻滞剂、肾素–血管紧张素系统抑制剂(血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂)和噻嗪类利尿剂以最大或最大耐受剂量和适当的给药频率给药。RAH发生在6名高血压患者中的近1名。它常常未被识别，主要是因为尽管血压未得到控制，但患者并未开出≥3种最大剂量的药物。结论：RAH明显增加患冠状动脉疾病、心力衰竭、中风和慢性肾病的风险，并导致更高的主要心血管不良事件发生率以及全因死亡率增加。及时诊断和治疗RAH可以减轻相关风险并改善短期和长期预后。

Abstract: Purpose: The current review is to describe the definition and prevalence of resistant arterial hy-pertension (RAH), the difference between RAH and refractory hypertension, patient characteristics and major risk factors for RAH, how RAH is diagnosed, prognosis and outcomes for patients. Materi-als and Methods: According to the WHO, approximately 1.28 billion adults aged 30~79 worldwide have arterial hypertension, and over 80% of them do not have blood pressure (BP) under control. RAH is defined as above-goal elevated BP despite the concurrent use of 3 or more classes of antihy-pertensive drugs, commonly including a long-acting calcium channel blocker, an inhibitor of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor block-er), and a thiazide diuretic administered at maximum or maximally tolerated doses and at appro-priate dosing frequency. RAH occurs in nearly 1 of 6 hypertensive patients. It often remains unrec-ognised mainly because patients are not prescribed ≥3 drugs at maximal doses despite uncon-trolled BP. Conclusion: RAH distinctly increases the risk of developing coronary artery disease, heart failure, stroke and chronic kidney disease and confers higher rates of major adverse cardio-vascular events as well as increased all-cause mortality. Timely diagnosis and treatment of RAH may mitigate the associated risks and improve short and long-term prognosis.