Resistant Hypertension An Overview of Evaluation and Treatment

被引:271
作者
Sarafidis, Pantelis A. [2 ]
Bakris, George L. [1 ]
机构
[1] Univ Chicago, Pritzker Sch Med, Hypertens Dis Unit, Sect Endocrinol Diabet & Metab,Dept Med, Chicago, IL 60637 USA
[2] Aristotle Univ Thessaloniki, AHEPA Hosp, Dept Med 1, Sect Nephrol & Hypertens, GR-54006 Thessaloniki, Greece
关键词
resistant hypertension; management; evaluation; treatment;
D O I
10.1016/j.jacc.2008.08.036
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Resistant hypertension is defined as failure to achieve goal blood pressure (BP) when a patient adheres to the maximum tolerated doses of 3 antihypertensive drugs including a diuretic. Although the exact prevalence of resistant hypertension is currently unknown, indirect evidence from population studies and clinical trials suggests that it is a relatively common clinical problem. The prevalence of resistant hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. Management of resistant hypertension must begin with a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with "pseudo-resistance," such as improper BP measurement technique, the white-coat effect, and poor patient adherence to life-style and/or antihypertensive medications. Education and reinforcement of life-style issues that affect BP, such as sodium restriction, reduction of alcohol intake, and weight loss if obese, are critical in treating resistant hypertension. Exclusion of preparations that contribute to true BP treatment resistance, such as nonsteroidal anti-inflammatory agents, cold preparations, and certain herbs, is also important. Lastly, BP control can only be achieved if an antihypertensive treatment regimen is used that focuses on the genesis of the hypertension. An example is volume overload, a common but unappreciated cause of treatment resistance. Use of the appropriate dose and type of diuretic provides a solution to overcome treatment resistance in this instance. (J Am Coll Cardiol 2008; 52: 1749- 57) (c) 2008 by the American College of Cardiology Foundation
引用
收藏
页码:1749 / 1757
页数:9
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