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难治性高血压的治疗

Authors
David A Calhoun, MD
Raymond R Townsend, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc
Translators
童传凤, 主任医师

引言

难治性高血压定义：尽管同时应用3种不同种类的降压药(其中一种为利尿剂)，血压仍高于目标值[1]。对于需4种或以上药物才能控制血压的患者，认为是难治性高血压。

难治性高血压患者出现不良心血管事件的风险较高，且其存在继发性病因(通常至少部分性可逆)的可能性高于高血压得以控制的患者。

本文将总结非继发因素引起的难治性高血压的治疗及预后。难治性高血压的定义、患病率、危险因素和评估，以及高血压继发性病因(如肾血管性疾病和原发性醛固酮增多症)将在别处讨论。 (参见“难治性高血压的定义、危险因素和评估”和“哪些患者应评估肾血管性或其他原因的继发性高血压？”)

定义和血压目标

难治性高血压定义：尽管同时应用3种不同种类的降压药[其中一种为利尿剂(根据肾功能选择)]，血压仍高于目标值[1]。对于需4种或以上药物才能控制血压的患者，认为是难治性高血压。

平均风险的高血压患者的目标血压低于140/90mmHg。有证据支持对于动脉粥样硬化性心血管疾病患者和蛋白尿性慢性肾脏病患者的目标血压应更低(即，<130/80mmHg)。支持性数据见其他专题。 (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“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)

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-11.
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