Options for patients with out-of-control blood pressure: after all avenues have been exhausted.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Weiwei Zeng, Brian Tomlinson
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引用次数: 0

Abstract

Introduction: Uncontrolled hypertension is the leading risk factor for global mortality. Most hypertensive patients can be controlled with standard medication combinations, but some may not respond adequately to ≥3 or even to ≥5 antihypertensive agents.

Areas covered: In this review, we summarize the recent literature on difficult-to-treat hypertension identified by a Medline search, and we discuss the options for fourth line and subsequent therapy.

Expert opinion: It is essential to confirm resistant hypertension with out-of-office blood pressure measurements and to consider lifestyle factors, adherence to medication and secondary causes of hypertension. When true resistant hypertension is confirmed and blood pressure is not controlled with an optimal triple combination, preferably as a fixed dose combination tablet, spironolactone is usually recommended as the fourth medication. Comorbid conditions should be treated as appropriate with sodium-glucose-cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, sacubitril-valsartan or finerenone. Renal denervation appears to be a useful addition to overcome some of the problems of medication adherence. The endothelin antagonist aprocitentan may be a final option in some countries. Of the drugs in development, the RNA based therapeutics that inhibit angiotensinogen synthesis appear to be some of the most promising.

血压失控患者的选择:在用尽所有方法之后。
简介无法控制的高血压是导致全球死亡的首要风险因素。大多数高血压患者可以通过标准药物组合得到控制,但有些患者可能对≥3 种甚至≥5 种降压药反应不佳:在这篇综述中,我们总结了通过Medline检索发现的有关难治性高血压的最新文献,并讨论了四线治疗和后续治疗的选择:专家观点:通过诊室外血压测量确认耐药高血压,并考虑生活方式因素、药物治疗依从性和继发性高血压病因至关重要。如果确诊为真正的耐药性高血压,且使用最佳的三联药物(最好是固定剂量的复方片剂)仍无法控制血压,通常建议将螺内酯作为第四种药物。合并症应酌情使用钠-葡萄糖共转运体 2 抑制剂、胰高血糖素样肽-1 受体激动剂、沙库比特利-缬沙坦或非利奈酮治疗。肾脏去神经化似乎是一种有效的辅助治疗手段,可以克服一些服药依从性方面的问题。在一些国家,内皮素拮抗剂阿普西坦可能是最后的选择。在开发中的药物中,基于 RNA 的抑制血管紧张素原合成的疗法似乎最有前景。
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
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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