Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association.
Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association.
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DOI：
10.1161/hyp.0000000000000084
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发表时间：
2018-11
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通讯作者：
American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council
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作者：
Carey RM;Calhoun DA;Bakris GL;Brook RD;Daugherty SL;Dennison-Himmelfarb CR;Egan BM;Flack JM;Gidding SS;Judd E;Lackland DT;Laffer CL;Newton-Cheh C;Smith SM;Taler SJ;Textor SC;Turan TN;White WB;American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council
难治性高血压（RH）定义为尽管同时使用3种降压药物（通常包括长效钙通道阻滞剂、肾素-血管紧张素系统阻滞剂（血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂）和利尿剂），但患者血压（BP）仍高于目标值。抗高血压药物应以最大或最大耐受日剂量给药。RH还包括使用≥4种降压药物后血压达到目标值的患者。RH的诊断需要保证抗高血压药物的依从性并排除“白大衣效应”（办公室血压高于目标，但办公室外血压达到或低于目标）。与非RH相比，RH的不良结局相关风险强调了其重要性。这篇文章是美国心脏协会关于RH检测、评估和管理的最新科学声明。一旦确认了抗高血压药物的依从性，并且门诊BP记录排除了白大衣效应，则评估包括识别促成的生活方式问题，检测干扰抗高血压药物有效性的药物，筛查继发性高血压，以及评估靶器官损伤。RH的管理包括最大化生活方式干预，使用长效噻嗪类利尿剂（氯噻酮或吲达帕胺），添加盐皮质激素受体拮抗剂（螺内酯或依普利酮），如果血压仍然升高，则逐步添加具有补充作用机制的降压药物以降低血压。如果血压仍然不受控制，建议转诊至高血压专科医生。
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.