|
|
顽固性高血压的生活管理方式
|
Abstract:
目的：本综述旨在描述顽固性动脉高血压(RAH)的定义和患病率、与难治性高血压之间的区别、患者特征和RAH的主要危险因素、如何诊断RAH、患者的预后和结果。材料和方法：根据世界卫生组织的数据，全世界约有12.8亿30~79岁的成年人患有动脉高血压，其中超过80%的人血压(BP)未得到控制。RAH被定义为尽管同时使用3种或更多类抗高血压药物，但血压仍高于目标值，通常包括长效钙通道阻滞剂、肾素–血管紧张素系统抑制剂(血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂)和噻嗪类利尿剂以最大或最大耐受剂量和适当的给药频率给药。RAH发生在6名高血压患者中的近1名。它常常未被识别，主要是因为尽管血压未得到控制，但患者并未开出≥3种最大剂量的药物。结论：RAH明显增加患冠状动脉疾病、心力衰竭、中风和慢性肾病的风险，并导致更高的主要心血管不良事件发生率以及全因死亡率增加。及时诊断和治疗RAH可以减轻相关风险并改善短期和长期预后。
Purpose: The current review is to describe the definition and prevalence of resistant arterial hy-pertension (RAH), the difference between RAH and refractory hypertension, patient characteristics and major risk factors for RAH, how RAH is diagnosed, prognosis and outcomes for patients. Materi-als and Methods: According to the WHO, approximately 1.28 billion adults aged 30~79 worldwide have arterial hypertension, and over 80% of them do not have blood pressure (BP) under control. RAH is defined as above-goal elevated BP despite the concurrent use of 3 or more classes of antihy-pertensive drugs, commonly including a long-acting calcium channel blocker, an inhibitor of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor block-er), and a thiazide diuretic administered at maximum or maximally tolerated doses and at appro-priate dosing frequency. RAH occurs in nearly 1 of 6 hypertensive patients. It often remains unrec-ognised mainly because patients are not prescribed ≥3 drugs at maximal doses despite uncon-trolled BP. Conclusion: RAH distinctly increases the risk of developing coronary artery disease, heart failure, stroke and chronic kidney disease and confers higher rates of major adverse cardio-vascular events as well as increased all-cause mortality. Timely diagnosis and treatment of RAH may mitigate the associated risks and improve short and long-term prognosis.
| [1] | Acelajado, M.C., Hughes, Z.H., Oparil, S. and Calhoun, D.A. (2019) Treatment of Resistant and Refractory Hyperten-sion. Circulation Research, 124, 1061-1070. https://doi.org/10.1161/CIRCRESAHA.118.312156 |
| [2] | Whelton, P.K., Carey, R.M., Aronow, W.S., et al. (2017) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/-ASPC/ NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clini-cal Practice Guidelines. Hypertension, 71, 1269-1324. https://doi.org/10.1161/HYP.0000000000000066 |
| [3] | Carey, R.M., Calhoun, D.A., Bakris, G.L., et al. (2018) Re-sistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement from the American Heart Associa-tion. Hypertension, 72, E53-E90. |
| [4] | Pickering, T.G., Hall, J.E., Appel, L.J., et al. (2005) Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals from the Subcommittee of Professional and Public Education of the American Heart Associa-tion Council on High Blood Pressure Research. Circulation, 111, 697-716. https://doi.org/10.1161/01.CIR.0000154900.76284.F6 |
| [5] | Calhoun, D.A., Jones, D., Textor, S., et al. (2008) Re-sistant Hypertension: Diagnosis, Evaluation, and Treatment. A Scientific Statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension, 51, 1403-1419. https://doi.org/10.1161/HYPERTENSIONAHA.108.189141 |
| [6] | Parati, G., Stergiou, G.S., Asmar, R., et al. (2010) European Society of Hypertension Practice Guidelines for Home Blood Pressure Monitoring. Journal of Human Hypertension, 24, 779-785. https://doi.org/10.1038/jhh.2010.54 |
| [7] | Bhatt, H., Siddiqui, M., Judd, E., Oparil, S. and Calhoun, D. (2016) Prevalence of Pseudoresistant Hypertension due to Inaccurate Blood Pressure Measurement. Journal of the American Society of Hypertension, 10, 493-499.
https://doi.org/10.1016/j.jash.2016.03.186 |
| [8] | Messerli, F.H., Ventura, H.O. and Amodeo, C. (1985) Osler’s Maneuver and Pseudohypertension. The New England Journal of Medicine, 312, 1548-1551. https://doi.org/10.1056/NEJM198506133122405 |
| [9] | Whelton, P.K., Carey, R.M., Aronow, W.S., et al. (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ -ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiolo-gy/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiol-ogy, 71, e127-e248. https://doi.org/10.1016/j.jacc.2017.11.006 |
| [10] | Mancia, G., Facchetti, R., Vanoli, J., et al. (2022) White-Coat Hypertension without Organ Damage: Impact on Long- Term Mortality, New Hypertension, and New Organ Damage. Hypertension, 79, 1057-1066.
https://doi.org/10.1161/HYPERTENSIONAHA.121.18792 |
| [11] | Grassi, G., Turri, C., Vailati, S., Dell’Oro, R. and Mancia, G. (1999) Muscle and Skin Sympathetic Nerve Traffic during the ‘White-Coat’ Effect. Circulation, 100, 222-225. https://doi.org/10.1161/01.CIR.100.3.222 |
| [12] | Salles, G.F., Cardoso, C.R.L. and Muxfeldt, E.S. (2008) Prognostic Influence of Office and Ambulatory Blood Pressures in Resistant Hypertension. Archives of Internal Medi-cine, 168, 2340-2346.
https://doi.org/10.1001/archinte.168.21.2340 |
| [13] | de la Sierra, A., Segura, J., Banegas, J.R., et al. (2011) Clinical Features of 8295 Patients with Resistant Hypertension Classified on the Basis of Ambulatory Blood Pressure Monitoring. Hypertension, 57, 898-902.
https://doi.org/10.1161/HYPERTENSIONAHA.110.168948 |
| [14] | Hameed, M.A., Tebbit, L., Jacques, N., Thomas, M. and Dasgupta, I. (2016) Non-Adherence to Antihypertensive Medication Is Very Common among Resistant Hyper-tensives: Results of a Directly Observed Therapy Clinic. Journal of Human Hypertension, 30, 83-89. https://doi.org/10.1038/jhh.2015.38 |
| [15] | Schulz, M., Krueger, K., Schuessel, K., et al. (2016) Medication Adher-ence and Persistence according to Different Antihypertensive Drug Classes: A Retrospective Cohort Study of 255,500 Patients. International Journal of Cardiology, 220, 668-676. https://doi.org/10.1016/j.ijcard.2016.06.263 |
| [16] | Elliott, W.J. (2008) What Factors Contribute to the Inadequate Control of Elevated Blood Pressure? The Journal of Clinical Hypertension, 10, 20-26. https://doi.org/10.1111/j.1524-6175.2007.08028.x |
| [17] | Abegaz, T.M., Shehab, A., Gebreyohannes, E.A., et al. (2017) Nonadherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis. Medicine, 96, e5641. https://doi.org/10.1097/MD.0000000000005641 |
| [18] | Nieuwlaat, R., Wilczynski, N., Navarro, T., et al. (2014) In-terventions for Enhancing Medication Adherence. Cochrane Database of Systematic Reviews, 2014, CD000011. https://doi.org/10.1002/14651858.CD000011.pub4 |
| [19] | Hyman, D.J. and Pavlik, V. (2015) Medication Adherence and Resistant Hypertension. Journal of Human Hypertension, 29, 213-218. https://doi.org/10.1038/jhh.2014.73 |
| [20] | Bangalore, S., Kamalakkannan, G., Parkar, S. and Messerli, F.H. (2007) Fixed-Dose Combinations Improve Medication Compliance: A Meta-Analysis. The American Journal of Medicine, 120, 713-719.
https://doi.org/10.1016/j.amjmed.2006.08.033 |
| [21] | Kassavou, A., Wang, M., Mirzaei, V., et al. (2022) The Asso-ciation between Smartphone App-Based Self-Monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth, 10, e34767. https://doi.org/10.2196/34767 |
| [22] | Borghi, C., Tubach, F., De Backer, G., et al. (2016) Lack of Control of Hyper-tension in Primary Cardiovascular Disease Prevention in Europe: Results from the EURIKA Study. The American Jour-nal of Medicine, 218, 83-88.
https://doi.org/10.1016/j.ijcard.2016.05.044 |
| [23] | de la Sierra, A., Segura, J., Banegas, J.R., et al. (2022) Clinical Features of 8295 Patients with Reviewer Disclosures Reviewer Employment Research Grant Other Research Support Speakers’ Bureau/Honoraria Exp.
https://pubmed.ncbi.nlm.nih.gov/?term=longqueryec1bd4807d9e18d38fb3 |
| [24] | Thomas, G., Xie, D., Chen, H.Y., CRIC Study Investigators, et al. (2016) Prevalence and Prognostic Significance of Apparent Treatment Resistant Hyper-tension in Chronic Kidney Disease: Report from the Chronic Renal Insufficiency Cohort Study. Hypertension, 67, 387-396. https://doi.org/10.1161/HYPERTENSIONAHA.115.06487 |
| [25] | Shalaeva, E., Bano, A., Kasimov, U., et al. (2022) Coronary Artery Calcium Score and Coronary Computed Tomography Angiography Predict One-Year Mor-tality in Patients with Type 2 Diabetes and Peripheral Artery Disease Undergoing Partial Foot Amputation. Diabetes & Vascular Disease Research, 19, No. 5.
https://doi.org/10.1177/14791641221125190 |
| [26] | Egan, B.M., Zhao, Y., Li, J., et al. (2013) Prevalence of Optimal Treatment Regimens in Patients with Apparent Treatment-Resistant Hypertension Based on Office Blood Pressure in a Community-Based Practice Network. Hypertension, 62, 691-697. https://doi.org/10.1161/HYPERTENSIONAHA.113.01448 |
| [27] | Tanner, R.M., Calhoun, D.A., Bell, E.K., et al. (2013) Prevalence of Apparent Treatment-Resistant Hypertension among Individuals with CKD. Clinical Journal of the American Society of Nephrology, 8, 1583-1590.
https://doi.org/10.2215/CJN.00550113 |
| [28] | Smith, S.M., Huo, T., Delia Johnson, B., et al. (2014) Cardiovascular and Mortality Risk of Apparent Resistant Hypertension in Women with Suspected Myocar-Dial Ischemia: A Report from the NHLBI-Sponsored WISE Study. Journal of the American Heart Association, 3, e000660. https://doi.org/10.1161/JAHA.113.000660 |
| [29] | Sim, J.J., Bhandari, S.K., Shi, J., et al. (2013) Characteristics of Resistant Hypertension in a Large, Ethnically Diverse Hypertension Population of an Integrated Health System. Mayo Clinic Proceedings, 88, 1099-1107.
https://doi.org/10.1016/j.mayocp.2013.06.017 |
| [30] | Osborn, J.W. and Banek, C.T. (2018) Catheter-Based Renal Nerve Ablation as a Novel Hypertension Therapy: Lost, and Then Found, in Translation. Hypertension, 71, 383-388.
https://doi.org/10.1161/HYPERTENSIONAHA.117.08928 |
| [31] | Appel, L.J., American Society of Hypertension Writing Group, Giles, T.D., et al. (2009) ASH Position Paper: Dietary Approaches to Lower Blood Pressure. The Jour-nal of Clinical Hypertension, 11, 358-368.
https://doi.org/10.1111/j.1751-7176.2009.00136.x |
| [32] | Saneei, P., Salehi-Abargouei, A., Esmaillzadeh, A. and Azadbakht, L. (2014) Influence of Dietary Approaches to Stop Hypertension (DASH) Diet on Blood Pressure: A Sys-tematic Review and Meta-Analysis on Randomized Controlled Trials. Nutrition, Metabolism and Cardiovascular Dis-eases, 24, 1253-1261.
https://doi.org/10.1016/j.numecd.2014.06.008 |
