Are Diuretics a Clandestine Risk Factor for Patients With Treatment-Resistant Hypertension?

IF 6.9 1区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Bertram Pitt, Christopher S Wilcox
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引用次数: 0

Abstract

The control of blood pressure in patients with treatment-resistant hypertension is paramount and requires the use of thiazide or loop diuretics to enhance renal salt excretion and reduce expanded body fluid volumes. However, the use of diuretics in patients with treatment-resistant hypertension without suppressing the production of aldosterone and MR (mineralocorticosteroid receptor) activation and signaling may not be sufficient to prevent the development of heart failure and excessive cardiovascular mortality and the progression of chronic kidney disease. This review examines the evidence that diuretic therapy for treatment-resistant hypertension may constitute a risk factor for preventable cardiovascular and renal disease progression that is concealed by the strong offsetting effects of a fall in blood pressure. To gain the full benefits of diuretic therapy in treatment-resistant hypertension may require the earlier prescription of MR antagonists coincident with diuretics rather than delaying their use to fourth-line agents in those who remain uncontrolled. This will require testing in appropriate clinical trials.

利尿剂是难治性高血压患者的潜在危险因素吗?
难治性高血压患者的血压控制是至关重要的,需要使用噻嗪类药物或利尿剂来促进肾盐排泄和减少扩大的体液量。然而,在治疗难治性高血压患者中使用利尿剂而不抑制醛固酮的产生和MR(矿皮质类固醇受体)的激活和信号传导可能不足以预防心力衰竭的发展和心血管死亡率过高以及慢性肾脏疾病的进展。这篇综述研究了利尿剂治疗难治性高血压可能构成可预防的心血管和肾脏疾病进展的危险因素的证据,这种危险因素被血压下降的强大抵消作用所掩盖。为了在难治性高血压患者中获得利尿剂治疗的全部益处,可能需要更早地在使用利尿剂的同时使用MR拮抗剂,而不是将其延迟到仍未控制的患者中使用第四线药物。这需要在适当的临床试验中进行测试。
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
Hypertension
Hypertension 医学-外周血管病
CiteScore
15.90
自引率
4.80%
发文量
1006
审稿时长
1 months
期刊介绍: Hypertension presents top-tier articles on high blood pressure in each monthly release. These articles delve into basic science, clinical treatment, and prevention of hypertension and associated cardiovascular, metabolic, and renal conditions. Renowned for their lasting significance, these papers contribute to advancing our understanding and management of hypertension-related issues.
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