Resistant hypertension is defined as blood pressure above goal despite confirmed adherence to 3 first-line antihypertensive agents or when blood pressure is controlled with 4 or more medications at maximal or maximally tolerated doses. In addition to meeting these criteria, identifying patients with true resistant hypertension requires both accurate in-office blood pressure measurement as well as excluding white coat effects through out-of-office blood pressure measurements. Patients with resistant hypertension are at higher risk for adverse cardiovascular events and are more likely to have a potentially treatable secondary cause contributing to their hypertension. Effective treatment of resistant hypertension includes ongoing lifestyle modifications and collaboration with patients to detect and address barriers to optimal medication adherence. Pharmacologic treatment should prioritize optimizing first-line, once daily, longer acting medications followed by the stepwise addition of second-, third-, and fourth-line agents as tolerated. Physicians should systematically evaluate for and address any underlying secondary causes. A coordinated, multidisciplinary team approach including clinicians with experience in treating resistant hypertension is essential. New treatment options, including both pharmacologic and device-based therapies, have recently been approved, and more are in the pipeline; their optimal role in the management of resistant hypertension is an area of ongoing research.

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顽固性高血压的评估和管理：核心课程 2024


顽固性高血压被定义为尽管已确认坚持使用 3 种一线抗高血压药物，或者使用 4 种或更多药物以最大或最大耐受剂量控制血压，但血压仍高于目标。除了满足这些标准之外，识别真正的难治性高血压患者还需要准确的诊室血压测量以及通过诊室外血压测量排除白大衣效应。难治性高血压患者发生不良心血管事件的风险较高，并且更有可能存在导致高血压的潜在可治疗的继发原因。难治性高血压的有效治疗包括持续改变生活方式以及与患者合作，以发现和解决最佳药物依从性的障碍。药物治疗应优先优化一线、每日一次、长效药物，然后根据耐受情况逐步添加二线、三线和四线药物。医生应系统评估并解决任何潜在的次要原因。包括具有治疗顽固性高血压经验的临床医生在内的协调一致的多学科团队方法至关重要。新的治疗方案，包括药物和基于设备的疗法，最近已获得批准，并且更多方案正在酝酿中；它们在顽固性高血压治疗中的最佳作用是一个正在进行的研究领域。