Management of resistant hypertension. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology
Management of resistant hypertension. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology
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DOI：
10.1016/j.lpm.2014.07.016
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发表时间：
2014-12-01
期刊：
影响因子：
2.7
通讯作者：
Halimi, Jean-Michel
中科院分区：
文献类型：
--
作者：
Denolle, Thierry;Chamontin, Bernard;Halimi, Jean-Michel
为了改善顽固性高血压的管理，法国心脏病学会的附属机构法国高血压学会发表了一组11项建议。其主要目的是提供最新的信息，基于最强有力的科学依据，并易于适用于在法国卫生系统内工作的卫生专业人员的日常临床实践。顽固性高血压定义为尽管采取了包括适当的生活方式和饮食措施在内的治疗策略，并同时使用三种降压药物（包括噻嗪类利尿剂、肾素-血管紧张素系统阻滞剂），但诊室测量和门诊测量均未控制的血压（BP）（ARB或ACEI）和钙通道阻滞剂，至少四周，在最佳剂量。治疗依从性必须密切监测，因为大多数可能影响治疗抗性的因素（过量的饮食盐摄入、酒精、抑郁症和药物相互作用、或血管加压药）。如果顽固性高血压的诊断得到证实，病人应转介往高血压专科医生诊治，以检查是否有潜在的靶器官损害及继发性高血压的成因。建议的治疗方案是一个包括四个治疗类别的综合疗法，包括螺内酯（每日12.5至25毫克）。如果出现禁忌症或对螺内酯无反应，或发生不良反应，应开具β受体阻滞剂、α受体阻滞剂或中枢作用降压药。由于肾去神经术治疗高血压仍在评估中，因此该技术只能由高血压专科诊所开具。
To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information, based on the strongest scientific rationale and which is easily applicable to daily clinical practice for health professionals working within the French health system. Resistant hypertension is defined as uncontrolled blood pressure (BP) both on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least four weeks, at optimal doses.Treatment compliance must be closely monitored, as most factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression and drug interactions, or vasopressors).If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension.The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5 to 25 mg/day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a beta-blocker, an a-blocker, or a centrally acting antihypertensive drug should be prescribed.Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.