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首页> 外文期刊>Cardiology clinics >Resistant hypertension, secondary hypertension, and hypertensive crises: diagnostic evaluation and treatment.
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Resistant hypertension, secondary hypertension, and hypertensive crises: diagnostic evaluation and treatment.

机译：抵抗性高血压，继发性高血压和高血压危机：诊断评估和治疗。

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摘要

Hypertension is a very common modifiable risk factor for cardiovascular morbidity and mortality. Patients with hypertension represent a diverse group. In addition to those with primary hypertension, there are patients whose hypertension is attributable to secondary causes, those with resistant hypertension, and patients who present with a hypertensive crisis. Secondary causes of hypertension account for less than 10% of cases of elevated blood pressure (BP), and screening for these causes is warranted if clinically indicated. Patients with resistant hypertension, whose BP remains uncontrolled in spite of use of 3 or more antihypertensive agents, are at increased cardiovascular risk compared with the general hypertensive population. After potentially correctible causes of uncontrolled BP (pseudoresistance, secondary causes, and intake of interfering substances) are eliminated, patients with true resistant hypertension are managed by encouraging therapeutic lifestyle changes and optimizing the antihypertensive regimen, whereby the clinician ensures that the medications are prescribed at optimal doses using drugs with complementary mechanisms of action, while adding an appropriate diuretic if there are no contraindications. Mineralocorticoid receptor antagonists are formidable add-on agents to the antihypertensive regimen, usually as a fourth drug, and are effective in reducing BP even in patients without biochemical evidence of aldosterone excess. In the setting of a hypertensive crisis, the BP has to be reduced within hours in the case of a hypertensive emergency (elevated BP with evidence of target organ damage) using parenteral agents, and within a few days if there is hypertensive urgency, using oral antihypertensive agents.
机译：高血压是心血管疾病发病率和死亡率的非常常见的可改变危险因素。高血压患者代表不同的人群。除患有原发性高血压的患者外，还有高血压归因于继发性原因的患者，患有抵抗性高血压的患者以及出现高血压危象的患者。高血压的继发原因占不到高血压（BP）病例的10％，如果临床上有必要，则有必要筛查这些原因。与普通高血压人群相比，尽管使用了3种或更多种降压药但其BP仍不受控制的抵抗性高血压患者的心血管风险增加。在消除了潜在的可纠正的不受控制的BP病因（假性耐药，继发性病因和摄入干扰物质）后，可通过鼓励治疗性生活方式的改变和优化降压方案来治疗真正耐药性高血压的患者，从而临床医生确保按以下方法开药：最佳剂量使用具有互补作用机制的药物，如果没有禁忌症，则添加​​适当的利尿剂。盐皮质激素受体拮抗剂是抗高血压方案的强大附加剂，通常作为第四种药物，即使在没有生化证据表明醛固酮过量的患者中也能有效降低血压。在发生高血压危机的情况下，如果使用肠胃外药物，在高血压紧急情况下（血压升高，表明目标器官受损的证据）必须在数小时内降低血压;如果存在高血压紧急情况，则必须在几天内降低口服血压降压药。

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