Current Hypertension Reports ( IF 3.9 ) Pub Date : 2024-02-16 , DOI: 10.1007/s11906-023-01282-0 John M Flack 1 , Michael G Buhnerkempe 2 , Kenneth Todd Moore 3
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Purpose of Review
To define resistant hypertension (RHT), review its pathophysiology and disease burden, identify barriers to effective hypertension management, and to highlight emerging treatment options.
Recent Findings
RHT is defined as uncontrolled blood pressure (BP) ≥ 130/80 mm Hg despite concurrent prescription of ≥ 3 or ≥ 4 antihypertensive drugs in different classes or controlled BP despite prescription of ≥ to 4 drugs, at maximally tolerated doses, including a diuretic. BP is regulated by a complex interplay between the renin–angiotensin–aldosterone system, the sympathetic nervous system, the endothelin system, natriuretic peptides, the arterial vasculature, and the immune system; disruption of any of these can increase BP. RHT is disproportionately manifest in African Americans, older patients, and those with diabetes and/or chronic kidney disease (CKD). Amongst drug-treated hypertensives, only one-quarter have been treated intensively enough (prescribed > 2 drugs) to be considered for this diagnosis. New treatment strategies aimed at novel therapeutic targets include inhibition of sodium-glucose cotransporter 2, aminopeptidase A, aldosterone synthesis, phosphodiesterase 5, xanthine oxidase, and dopamine beta-hydroxylase, as well as soluble guanylate cyclase stimulation, nonsteroidal mineralocorticoid receptor antagonism, and dual endothelin receptor antagonism.
Summary
The burden of RHT remains high. Better use of currently approved therapies and integrating emerging therapies are welcome additions to the therapeutic armamentarium for addressing needs in high-risk aTRH patients.
中文翻译：
顽固性高血压：疾病负担和新兴的治疗选择
审查目的
为了定义顽固性高血压 （RHT），回顾其病理生理学和疾病负担，确定有效高血压管理的障碍，并强调新兴的治疗选择。
最新发现
RHT 定义为尽管同时开具 3 ≥≥ 4 种不同类别的抗高血压药物，但仍未控制的血压 （BP） ≥ 130/80 毫米汞柱，或者尽管开具了 ≥ 至 4 种药物，但仍控制了血压，以最大耐受剂量，包括利尿剂。血压受肾素-血管紧张素-醛固酮系统、交感神经系统、内皮素系统、利钠肽、动脉脉管系统和免疫系统之间复杂相互作用的调节;其中任何一项的破坏都会增加血压。RHT 在非裔美国人、老年患者以及糖尿病和/或慢性肾病 （CKD） 患者中尤为明显。在药物治疗的高血压患者中，只有四分之一的患者接受了足够密集的治疗（开具了 > 2 药物）以考虑进行此诊断。针对新治疗靶点的新治疗策略包括抑制钠-葡萄糖协同转运蛋白 2、氨肽酶 A、醛固酮合成、磷酸二酯酶 5、黄嘌呤氧化酶和多巴胺 β-羟化酶，以及可溶性鸟苷酸环化酶刺激、非甾体盐皮质激素受体拮抗作用和双重内皮素受体拮抗作用。
总结
RHT 的负担仍然很高。更好地使用目前批准的疗法和整合新兴疗法是治疗武器库中受欢迎的补充，以满足高危 aTRH 患者的需求。
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