Diagnosis and management of resistant hypertension

医学 螺内酯 依普利酮 盐皮质激素受体 血压 多沙唑嗪 醛固酮 阿替洛尔 内科学 利尿剂 药理学 血管紧张素受体 缬沙坦 血管紧张素转换酶抑制剂 内分泌学 血管紧张素转换酶 血管紧张素II
作者
Miguel Camafort,Reinhold Kreutz,Myeong‐Chan Cho
出处
期刊:Heart [BMJ]
卷期号:110 (22): 1336-1342 被引量:1
标识
DOI:10.1136/heartjnl-2022-321730
摘要

Resistant hypertension is a condition where blood pressure levels remain elevated above target despite changes in lifestyle and concurrent use of at least three antihypertensive agents, including a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (ACE inhibitor or angiotensin receptor blocker) and a diuretic. To be diagnosed as resistant hypertension, maintaining adherence to therapy is required along with confirmation of blood pressure levels above target by out-of-office blood pressure measurements and exclusion of secondary causes of hypertension. The key management points of this condition include lifestyle changes such as reduced sodium and alcohol intake, regular physical activity, weight loss and discontinuation of substances that can interfere with blood pressure control. It is also recommended that current treatment be rationalised, including single pill combination treatment where antihypertensive drugs should be provided at the maximum tolerated dose. It is further recommended that current drugs be replaced with a more appropriate and less difficult treatment regimen based on the patient’s age, ethnicity, comorbidities and risk of drug–drug interactions. The fourth line of treatment for patients with resistant hypertension should include mineralocorticoid receptor antagonists such as spironolactone, as demonstrated in the PATHWAY-2 trial and meta-analyses. Alternatives to spironolactone include amiloride, doxazosin, eplerenone, clonidine and beta-blockers, as well as any other antihypertensive drugs not already in use. New approaches under research are selective non-steroidal mineralocorticoid receptor antagonists such as finerenone, esaxerenone and ocedurenone, selective aldosterone synthase inhibitors such as baxdrostat, and dual endothelin antagonist aprocitentan.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
1秒前
2秒前
苏乂发布了新的文献求助10
4秒前
5秒前
bitahu发布了新的文献求助10
9秒前
想把太阳揣兜里应助洪亮采纳,获得10
11秒前
11秒前
12秒前
天天快乐应助宋凤娇采纳,获得10
12秒前
CC关闭了CC文献求助
13秒前
苏乂完成签到,获得积分10
14秒前
Aran_Zhang完成签到 ,获得积分0
15秒前
苗条凡发布了新的文献求助10
16秒前
20秒前
Dr_Chu完成签到 ,获得积分10
23秒前
24秒前
扶苏完成签到,获得积分10
24秒前
25秒前
宇智波张三完成签到,获得积分10
26秒前
linliqing完成签到,获得积分10
27秒前
27秒前
扶苏发布了新的文献求助10
28秒前
冷傲新柔发布了新的文献求助10
29秒前
李媛关注了科研通微信公众号
29秒前
30秒前
体贴寒烟完成签到 ,获得积分10
30秒前
奇怪的茶叶菌应助狗东西采纳,获得20
31秒前
牛牛牛发布了新的文献求助10
32秒前
33秒前
Tao发布了新的文献求助30
34秒前
冷傲新柔完成签到,获得积分10
34秒前
北过居庸完成签到,获得积分10
34秒前
宗师算个瓢啊完成签到 ,获得积分10
36秒前
916应助迷你的梦蕊采纳,获得20
37秒前
礼礼驳回了Ava应助
38秒前
Juyi发布了新的文献求助10
38秒前
药宫完成签到,获得积分10
41秒前
42秒前
bkagyin应助科研通管家采纳,获得10
43秒前
在水一方应助科研通管家采纳,获得30
43秒前
高分求助中
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 2500
Future Approaches to Electrochemical Sensing of Neurotransmitters 1000
生物降解型栓塞微球市场(按产品类型、应用和最终用户)- 2030 年全球预测 1000
壮语核心名词的语言地图及解释 900
Canon of Insolation and the Ice-age Problem 380
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 360
Quantum Sensors Market 2025-2045: Technology, Trends, Players, Forecasts 300
热门求助领域 (近24小时)
化学 医学 材料科学 生物 工程类 有机化学 生物化学 物理 内科学 计算机科学 纳米技术 复合材料 化学工程 遗传学 基因 物理化学 催化作用 光电子学 量子力学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3915771
求助须知:如何正确求助?哪些是违规求助? 3461325
关于积分的说明 10916228
捐赠科研通 3188215
什么是DOI,文献DOI怎么找? 1762491
邀请新用户注册赠送积分活动 852881
科研通“疑难数据库(出版商)”最低求助积分说明 793603