《难治性高血压》.pptVIP

难治性高血压 Objective Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder. 1 Contents 2 3 Diagnosis Evaluation Treatment Definition blood pressure remains above goal three anti-hypertensive agents of different classes one of the 3 agents should be a diuretic all agents should be prescribed at optimal dose amounts. Resistant hypertension Prevalence1 NHANES 53% Framingham Heart Study 48% ALLHAT2 50% Patient Characteristics Patient Characteristics Associated With Resistant Hypertension Older age High baseline blood pressure Obesity Excessive dietary salt ingestion Chronic kidney disease Diabetes Left ventricular hypertrophy Black race Female sex Residence in southeastern United States Pseudoresistance Poor Blood Pressure Technique Poor Adherence Lifestyle Factors White-Coat Effect Secondary Causes measuring the blood pressure before letting the patient sit quietly use of too small a cuff Poor Blood Pressure Technique a major cause of lack of blood pressure control Poor Adherence less than 40% of patients 40% of patients the first year of treatment4 5 to 10 years of follow-up3 White-Coat Effect Studies indicate that a significant white-coat effect (when clinic blood pressures are persistently elevated while out-of-office values are normal or significantly lower) is as common in patients with resistant hypertension as in the more general hypertensive population, with a prevalence in the range of 20% to 30%.5 Lifestyle Factors Obesity is a common feature of patients with resistant hypertension. Excessive dietary sodium intake Heavy alcohol intake is associated with both an increased risk of hypertension, as well as treatment-resistant hypertension. Non-narcotic analgesics Non-steroidal anti-inflammatory agents, including aspirin, selective COX-2 inhibitors Sympat