Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome?
Apparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome?
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DOI：
10.1053/j.ackd.2014.08.006
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发表时间：
2014-11
影响因子：
2.9
通讯作者：
S. Vemulapalli;Crystal C Tyson;L. Svetkey
中科院分区：
文献类型：
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作者：
S. Vemulapalli;Crystal C Tyson;L. Svetkey
为了确定心血管(CV)结局风险增加的患者，表观治疗抵抗高血压(ATRH)被定义为尽管在最大耐受剂量下使用了3种或3种以上不同类别的降压药物，理想情况下包括利尿剂，但血压仍高于目标水平。最近在选定人群中的流行病学研究估计，aTRH在高血压患者中的患病率为10%至15%，aTRH与心血管疾病和肾脏结局的风险增加有关。此外，aTRH和CKD是相关的。虽然aTRH的发病机制是多因素的，但肾脏被认为起着重要作用。容量扩张、醛固酮浓度、盐皮质激素受体活性、动脉僵硬和交感神经系统活性的增加是aTRH发病机制的核心，也是治疗的靶点。尽管利尿剂是aTRH治疗的基础，但病理生理学和临床数据表明，醛固酮拮抗剂在其中起着重要作用。介入技术，如肾去神经和颈动脉压力感受器激活，调节交感神经系统，目前正处于治疗aTRH的第三阶段试验。到目前为止，这些技术还没有得到证实，也没有被研究过与心血管预后或CKD患者的关系。
To identify patients at increased risk of cardiovascular (CV) outcomes, apparent treatment-resistant hypertension (aTRH) is defined as having a blood pressure above goal despite the use of 3 or more antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. Recent epidemiologic studies in selected populations estimated the prevalence of aTRH as 10% to 15% among patients with hypertension and that aTRH is associated with elevated risk of CV and renal outcomes. Additionally, aTRH and CKD are associated. Although the pathogenesis of aTRH is multifactorial, the kidney is believed to play a significant role. Increased volume expansion, aldosterone concentration, mineralocorticoid receptor activity, arterial stiffness, and sympathetic nervous system activity are central to the pathogenesis of aTRH and are targets of therapies. Although diuretics form the basis of therapy in aTRH, pathophysiologic and clinical data suggest an important role for aldosterone antagonism. Interventional techniques, such as renal denervation and carotid baroreceptor activation, modulate the sympathetic nervous system and are currently in phase III trials for the treatment of aTRH. These technologies are as yet unproven and have not been investigated in relationship to CV outcomes or in patients with CKD.