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哪些患者应评估肾血管性或其他原因的继发性高血压？

Author
Stephen Textor, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc
Translators
张丽, 主任医师

引言

对一名高血压患者的评估既要考虑到其可能的病因，也要取决于实现可接受的血压控制的难度，因为许多类型的继发性高血压可导致“难治性”高血压[1]。对于可能存在原发性(或特发性)高血压的患者，评估方法相对有限，因为全面的实验室检测通常价值很低。(参见“成人高血压的初始评估”)

相比之下，具有提示可能存在继发性高血压的临床特征的患者应进行更全面的评估。如果存在继发性高血压，最有效的治疗策略通常是针对高血压具体机制的措施。此外，有些疾病是可以治愈的，从而可使血压部分或完全恢复正常。

因为对每名高血压患者都进行继发性高血压的全面评估不符合成本效果，所以了解提示继发性高血压的临床特征非常重要。本文将总结应该进行继发性高血压评估的患者的识别方法。肾血管性高血压的检测方法以及单侧和双侧肾动脉粥样硬化性狭窄的治疗将单独讨论。(参见“诊断肾血管性高血压”和“单侧动脉粥样硬化性肾动脉狭窄的治疗”和“动脉粥样硬化性双侧肾动脉狭窄或孤立有功能肾肾动脉狭窄的治疗”)

一般临床特征

有许多一般临床线索可提示继发性高血压(表 1)：

●重度或难治性高血压。难治性高血压的定义是，尽管同时使用恰当剂量的3种不同类型的降压药(包括一种利尿剂)，但高血压仍持续存在。(参见“难治性高血压的定义、危险因素和评估”，关于‘定义’一节)

             

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Literature review current through: 2017-06 . | This topic last updated: 2015-07-28.
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