Diagnosis and management of resistant hypertension.

IF 5.1 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Heart Pub Date : 2024-10-28 DOI:10.1136/heartjnl-2022-321730
Miguel Camafort, Reinhold Kreutz, Myeong-Chan Cho
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Abstract

Resistant hypertension is a condition where blood pressure levels remain elevated above target despite changes in lifestyle and concurrent use of at least three antihypertensive agents, including a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (ACE inhibitor or angiotensin receptor blocker) and a diuretic. To be diagnosed as resistant hypertension, maintaining adherence to therapy is required along with confirmation of blood pressure levels above target by out-of-office blood pressure measurements and exclusion of secondary causes of hypertension. The key management points of this condition include lifestyle changes such as reduced sodium and alcohol intake, regular physical activity, weight loss and discontinuation of substances that can interfere with blood pressure control. It is also recommended that current treatment be rationalised, including single pill combination treatment where antihypertensive drugs should be provided at the maximum tolerated dose. It is further recommended that current drugs be replaced with a more appropriate and less difficult treatment regimen based on the patient's age, ethnicity, comorbidities and risk of drug-drug interactions. The fourth line of treatment for patients with resistant hypertension should include mineralocorticoid receptor antagonists such as spironolactone, as demonstrated in the PATHWAY-2 trial and meta-analyses. Alternatives to spironolactone include amiloride, doxazosin, eplerenone, clonidine and beta-blockers, as well as any other antihypertensive drugs not already in use. New approaches under research are selective non-steroidal mineralocorticoid receptor antagonists such as finerenone, esaxerenone and ocedurenone, selective aldosterone synthase inhibitors such as baxdrostat, and dual endothelin antagonist aprocitentan.

耐药性高血压的诊断和管理。
抵抗性高血压是指在改变生活方式和同时使用至少三种降压药(包括长效钙通道阻滞剂(CCB)、肾素-血管紧张素系统阻滞剂(ACE 抑制剂或血管紧张素受体阻滞剂)和利尿剂)的情况下,血压仍高于目标值。要确诊为抵抗性高血压,必须坚持治疗,同时通过诊室外血压测量确认血压水平高于目标值,并排除继发性高血压的病因。该病症的治疗要点包括改变生活方式,如减少钠和酒精的摄入、定期进行体育锻炼、减轻体重以及停用会干扰血压控制的药物。此外,还建议对目前的治疗方法进行合理化调整,包括单药联合治疗,应按最大耐受剂量提供降压药物。此外,还建议根据患者的年龄、种族、合并症和药物间相互作用的风险,以更合适、难度更低的治疗方案取代现有药物。PATHWAY-2 试验和荟萃分析表明,抵抗性高血压患者的第四线治疗方案应包括矿物皮质激素受体拮抗剂,如螺内酯。螺内酯的替代药物包括阿米洛利、多沙唑嗪、依普利酮、氯尼丁和β-受体阻滞剂,以及其他尚未使用的降压药物。正在研究的新方法包括选择性非甾体类矿物质皮质激素受体拮抗剂,如非格列酮、埃克塞酮和奥昔列酮;选择性醛固酮合成酶抑制剂,如巴曲司他,以及双重内皮素拮抗剂阿普西坦。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Heart
Heart 医学-心血管系统
CiteScore
10.30
自引率
5.30%
发文量
320
审稿时长
3-6 weeks
期刊介绍: Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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