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难治性高血压的定义、危险因素和评估

Authors
Norman M Kaplan, MD
David A Calhoun, MD
Section Editor
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc
Translators
李卫虹, 主任医师

引言

使用多种药物治疗后仍持续存在高血压的患者具有较高的不良心血管事件风险，而且比高血压得到控制的患者更可能存在继发性(即，可明确的)病因，通常该病因至少在部分程度上是可逆的。

难治性高血压的定义、患病率、危险因素和评估将总结在此。继发性高血压的特定原因将简要提及。难治性高血压的治疗和预后，转诊至高血压专科医生的指征，以及如何识别需要进行继发性高血压筛查的患者，将在别处讨论。 (参见“难治性高血压的治疗”和“哪些患者应评估肾血管性或其他原因的继发性高血压？”)

定义

难治性高血压 — 在2008年美国心脏协会的科学声明和2013年欧洲高血压和心脏病学会(European Societies of Hypertension and Cardiology, ESH/ESC)的指南中，难治性高血压定义为：尽管同时使用3种不同种类的抗高血压药物，但血压仍高于目标值[1,2]。因此，使用4种或更多药物控制血压的患者应该被认为有难治性高血压。

如果能耐受，3种药物中的一种应该是利尿剂，所有药物应以最佳剂量开具处方(即，最大推荐降压剂量的50%或以上)[1]。处于平均风险的高血压患者的目标血压值为小于140/90mmHg。有证据支持在动脉粥样硬化性心血管疾病、糖尿病或慢性肾脏病的患者中目标血压应更低。支持性数据参见其他专题。 (参见“高血压治疗中目标血压应该是多少”和“心血管疾病患者或心血管疾病高风险患者的目标血压”，关于‘目标血压值’一节和“糖尿病患者的高血压治疗”，关于‘目标血压’一节和“成人非糖尿病慢性肾脏病的进展与抗高血压治疗”，关于‘血压目标值’一节)

虽然难治性高血压患者的收缩压和舒张压可能均升高，但单纯收缩期高血压更常见。ALLHAT试验纳入超过33,000例使用不同抗高血压药物治疗的高血压患者，发现只有67%的受试者达到了收缩压低于140mmHg，而92%的患者达到了舒张压低于90mmHg[3]。

                        

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-20.
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