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盘点:关于难治性高血压,不得不知的那些研究

2016-10-25 MedSci MedSci原创

难治性高血压是指在尽管服用3种或3种以上的降压药后血压仍然偏高的一种危险疾病。随着老龄化的来临和肥胖的持续流行,估计难治性高血压的患病仍将增加。本文中,梅斯医学小编列了有关难治性高血压的近期研究,供大学学习参考。【1】Hypertension:慢性肾病患者难治性高血压的发生率较高,预后不好慢性肾脏病患者中难治性高血压(ATRH)和临床结果的关系尚未研究清楚。研究者分析慢性肾功能不全队列研究(C

难治性高血压是指在尽管服用3种或3种以上的降压药后血压仍然偏高的一种危险疾病。随着老龄化的来临和肥胖的持续流行,估计难治性高血压的患病仍将增加。

本文中,梅斯医学小编列了有关难治性高血压的近期研究,供大学学习参考。

【1】Hypertension:慢性肾病患者难治性高血压的发生率较高,预后不好

慢性肾脏病患者中难治性高血压(ATRH)和临床结果的关系尚未研究清楚。研究者分析慢性肾功能不全队列研究(CRIC)中3367名高血压患者的数据,确定非透析慢性肾病患者ATRH的发生率、相关性及临床预后。

ATRH的定义为应用三种及三种以上的抗高血压药,且血压≥140/90mmHg,或者基线时,应用四种及四种以上的抗高血压药,才能维持血压在目标值。ATRH的发生率为40.4%。高龄、男性、黑人、糖尿病、BMI较高与ATRH发生较高相关。ATRH受试者比非ATRH患者的临床事件发生率较高,比如心肌梗死卒中、外周动脉疾病、充血性心力衰竭(CHF)以及各种原因的死亡的复合预后(HR(95%CI))(1.38 [ 1.22-1.56 ]),肾脏事件(1.28 [ 1.11-1.46 ]);心力衰竭(1.66 [ 1.38-2.00 ]);与全因死亡率(1.24 [ 1.06-1.45 ])。各种类型的ATRH及应用4种抗血压药物维持血压在目标值的受试者,心急梗死,卒中,外周动脉疾病,CHF及全因死亡率等复合预后的发生率增加(HR(95%CI))(1.30 [ 1.12-1.51 ]),和CHF(1.59 [ 1.28-1.99 ])发生高于非ATRH患者。在那些肾小球滤过率≥30mL/min/1.73m2的受试者,ATRH与CHF和肾脏事件的发生相关。

研究结果表明慢性肾脏病患者中难治性高血压是常见的,并与慢性肾脏病患者不良预后的高风险相关。这表明需要早期识别和管理慢性肾脏疾病发生ATRH患者。(文章详见--Hypertension:慢性肾病患者难治性高血压的发生率较高,预后不好

【2】ESC 2015:螺内酯——难治性高血压中老树新花(PATHWAY-2研究)

ESC 2015年会的高血压Hotline专场,研究者Bryan William教授发布了PATHWAY-2研究的结果。

Bryan William教授总结道,本研究第一次证实了螺内酯(25~50mg/d)在治疗难治性高血压方面相对于其他药物绝对优势。对于难治性高血压的控制率几乎达到60%,显著高于其他几组。且其耐受性良好,并未增加不良事件的发生。研究者评价道,该研究结果提示,螺内酯是难治性高血压最有效的药物,是当之无愧的赢家。这一结果这可能会影响指南的推荐,而且今后难治性高血压的定义可能需要修改为,即使应用了螺内酯,血压仍不能被有效控制的高血压。

该研究分析314例难治性高血压(非糖尿病患者收缩压>140mmHg,糖尿病患者收缩压>135mmHg)患者,在基础降压治疗基础上,顺序接受螺内酯(25~50mg)、比索洛尔(5~10mg)、多沙唑嗪(4~8mg)或安慰剂治疗。结果显示,与安慰剂组相比,螺内酯组患者家庭自测收缩压进一步降低8.70mmHg(P<0.001);与比索洛尔/多沙唑嗪相比,进一步使家庭自测收缩压降低4.26mmHg(P<0.001)。

研究表明,螺内酯作为一种老药,但在难治性高血压中显示出较大的优势,而且非常安全,堪称老树新花。(文章详见--ESC 2015:螺内酯——难治性高血压中老树新花(PATHWAY-2研究)

【3】Hypertension:锻炼和戒烟,有助于难治性高血压的治疗

研究者指出,“在难治性高血压患者当中,我们发展了各种各样侵入性的、不可逆的治疗方法,比如说去肾交感神经术,但关于生活方式影响的研究则很少。”该团队强调:“判断微创方法的疗效十分重要,这不仅能减少患者的不便,还能避免这些操作和手术可能带来的并发症。”

这些数据来源于对REGARDS(the population-based Reasons for Geographic and Racial Differences in Stroke)研究的2043名参与者的一项分析。虽然这些患者都至少联用3种甚至4种抗高血压药来控制血压,但是他们的血压仍然在140/90mmHg及以上。

平均随访4.5年,随访期间共发生360例次心血管事件。在把年龄、种族、血脂情况、肾脏疾病和糖尿病等混杂因素考虑进去的情况下,6种健康的生活方式中只有2项,即体育锻炼和戒烟,是心血管预后的独立影响因素。特别需要说明的是,戒烟能使心血管风险降低46%,而每周4次以上体育锻炼的人和完全不运动的人相比,其心血管风险降低了33%。

研究人员认为,该结果提示对难治性高血压患者来说,增加健康生活方式的数量能获得增疗效益。考虑到该研究只报道了13.7%的参与者至少保持了4种健康的生活方式,改善患者心血管风险的潜力巨大。(文章详见--Hypertension:锻炼和戒烟,有助于难治性高血压的治疗

【4】Hypertension:体重指数可预测顽固性高血压患者24小时尿醛固酮水平

来自伯明翰阿拉巴马大学医学部Dudenbostel教授在黑人和白人患者中进行了一项临床研究以探究体重指数与血浆醛固酮浓度、血浆肾素活性、醛固酮:肾素比值和24小时尿醛固酮是否存在正相关关系。Dudenbostel等人对2170例顽固性高血压患者进行了横断面研究。在整个队列中对所有研究对象测量了血浆醛固酮浓度、血浆肾素活性、醛固酮:肾素比值、24小时尿醛固酮和体重指数,以及性别和种族(65.3%白人,40.3%男性)。

研究结果发现体重指数在前75%以内的患者血浆醛固酮浓度、醛固酮-肾素比值与体重指数显著相关(P <0.0001),而在体重指数在后25%的患者血浆醛固酮浓度、醛固酮-肾素比值与体重指数不存在相关。另外,血浆肾素活性与体重指数无相关性。24小时尿醛固酮水平与体重指数呈正相关(P <0.0001)。无论在黑人和白人患者中,醛固酮水平与增加的体重指数呈正相关,在黑人和白人的男性中这种相关性更为明显。 

这些研究结果表明:肥胖,特别是男性的腹部肥胖,促进了顽固性性高血压患者的高醛固酮水平。(文章详见-- Hypertension:体重指数可预测顽固性高血压患者24小时尿醛固酮水平

【5】Endocr Pract:顽固性高血压患者应筛查原发性醛固酮增多症

最近的研究数据表明,有高血压的人与非高血压人群相比,可能不会增加原发性醛固酮增多症风险;不过,顽固性高血压患者应筛查原发性醛固酮增多症。

来自纽约西奈山医学院糖尿病和骨疾病的Khadeen Christi Cheesman博士和同事对296名成年高血压患者的数据进行了评估。

根据血浆醛固酮浓度和醛固酮肾素比,选出了14名可能患有原发性醛固酮增多症的患者,初始测试率为4.7%。这些患者中的6名进行了口服盐负荷验证性试验,证实2名患者有原发性醛固酮增多症,患病率为0.7%。

研究人员写道:“虽然有高血压的人与非高血压人群相比,可能不会增加原发性醛固酮增多症风险;但是对于顽固性高血压患者,应筛查原发性醛固酮增多症。”(文章详见--Endocr Pract:顽固性高血压患者应筛查原发性醛固酮增多症

【6】EHJ:顽固性高血压诊治十项要点须知

《欧洲心脏杂志》(Eur Heart J)近期发表了一篇有关顽固性高血压(treatment-resistant hypertension)治疗的综述,旨在指导心脏病学专业医生更好的进行诊疗活动,以下为文章的十个要点。

1.欧洲高血压学会/欧洲心脏病学会指南对于顽固性高血压的定义是:在适当生活方式干预及抗高血压治疗后,患者收缩压>140mmHg和/或舒张压>90mmHg,其中抗高血压治疗包括一种利尿剂(全剂量)及两种不同种类剂量适度的降血压药物。根据血压测量方式(诊所血压、24小时动态血压等)的不同,各地报道的顽固性高血压发病率在3%至30%不等。

2.对于疑似顽固性高血压的患者,应强制进行24小时动态血压监测(ABPM),以辅助确诊、风险分层及病情检查,而且ABPM可减少白大衣高血压,从而将顽固性高血压控制在10%以下。由ABPM检查确诊的顽固性高血压标准是:血压>130/80 mm Hg,脉压>63mmHg,或缺乏血压夜间下降现象(幅度为白天血压的10%),或存在夜间血压升高现象(即逆向夜间血压勺形曲线)。这些指标均与继发性高血压相关。当患者血压<130/80 mm Hg时,诊断宜为白大衣高血压或血压检测误差。(文章详见--EHJ:顽固性高血压诊治十项要点须知

【7】Lancet:肾动脉交感神经消融术加标准化阶梯治疗能有效缓解顽固性高血压(DENERHTN研究)

经导管去肾神经术可以有效缓解顽固性高血压。研究人员在一项多中心随机对照试验中,比较了肾神经射频消融术加之标准化高血压阶梯治疗(SSAHT)与单纯SSAHT对顽固性高血压的疗效。

自2012年5月22日至2013年10月14日,供收集1416名病例,经筛查,106名顽固性高血压患者参与试验(每组53名),101例参与数据分析,手术组为48例,对照组为53例。6个月随访结果显示,日间动态收缩压较基线平均变化在手术组为-15.8 mmHg (95% CI:-19.7~-11.9),在对照组为-9.9 mmHg (-13.6~-6.2);校正基线血压后两组差异为-5.9 mmHg [-11.3~-0.5, (P=0.0329)]。在6个月随访期间,两组服用的抗高血压药物数量及药物依从性无明显差异。共发生3例去肾神经术治疗相关轻微不良事件,2例腰痛,1例轻微腹股沟血肿。两组患者随访期间均出现相似的轻微估计肾小球滤过率下降。

研究结论:去肾神经术加之SSAHT治疗与单纯SSAHT治疗相比,更有效地降低顽固性高血压患者的血压,这有利于降低心血管不良事件的发生率。(文章详见--Lancet:肾动脉交感神经消融术加标准化阶梯治疗能有效缓解顽固性高血压(DENERHTN研究)

【8】Hypertension:顽固性高血压增心血管病和终末期肾病风险

美国一项研究表明,显著顽固性高血压(aTRH)可升高心血管疾病和终末期肾病风险。论文8月4日在线发表于《高血压》(Hypertension)。

此项研究从14684例接受降压治疗的受试者中确定了1870例aTRH患者,并评估了aTRH与冠心病、卒中、全因死亡、心衰、外周动脉疾病和终末期肾病的相关性。应用利尿剂并非aTRH所必需。

结果显示,与无aTRH的受试者相比,aTRH患者的冠心病、卒中、全因死亡、心衰、外周动脉疾病和终末期肾病的多变量校正危险比(HR)分别为1.44、1.57、1.30、1.88、1.23和1.95。aTRH与冠心病和心血管疾病综合转归(HR 1.47和1.46)亦有相关性。(文章详见--Hypertension:顽固性高血压增心血管病和终末期肾病风险


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likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 06:58:39 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151238, encodeId=79d415123899, content=学习新知识谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 26 06:40:32 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151222, encodeId=a47b151222cc, content=确实很好的研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-11-20 往日如昨

    很实用,值得学习

    0

  2. 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objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-29 李东泽

    很好,不错,以后会多学习

    0

  3. 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objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-28 李东泽

    很好,不错,以后会多学习

    0

  4. 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objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-28 cqykthl

    难治性高血压,

    0

  5. 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GetPortalCommentsPageByObjectIdResponse(id=151638, encodeId=b31215163859, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Fri Oct 28 07:09:39 CST 2016, time=2016-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151636, encodeId=18301516369c, content=难治性高血压,, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Fri Oct 28 07:02:48 CST 2016, time=2016-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528330, encodeId=ef9d152833096, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Thu Oct 27 09:24:00 CST 2016, time=2016-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151370, encodeId=c5b81513e014, content=好东西,分享了, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCcmyvDOwDu2ZpuYyovmsD12IBHmUCwr5bZqNic2p50ogCxUAIj4YqJ3PsGwoXOhJPQAvicmu6RqOww/0, createdBy=a0bf1958339, createdName=七九九八, createdTime=Wed Oct 26 17:28:24 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151253, encodeId=23ec151253b1, content=三高问题需要认真对待!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 07:01:12 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151252, encodeId=977115125246, content=难治性高血压是指在尽管服用3种或3种以上的降压药后血压仍然偏高的一种危险疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 06:58:39 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151238, encodeId=79d415123899, content=学习新知识谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 26 06:40:32 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151222, encodeId=a47b151222cc, content=确实很好的研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-27 freve
  6. 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createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCcmyvDOwDu2ZpuYyovmsD12IBHmUCwr5bZqNic2p50ogCxUAIj4YqJ3PsGwoXOhJPQAvicmu6RqOww/0, createdBy=a0bf1958339, createdName=七九九八, createdTime=Wed Oct 26 17:28:24 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151253, encodeId=23ec151253b1, content=三高问题需要认真对待!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 07:01:12 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151252, encodeId=977115125246, content=难治性高血压是指在尽管服用3种或3种以上的降压药后血压仍然偏高的一种危险疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 06:58:39 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151238, encodeId=79d415123899, content=学习新知识谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 26 06:40:32 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151222, encodeId=a47b151222cc, content=确实很好的研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-26 七九九八

    好东西,分享了

    0

  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCcmyvDOwDu2ZpuYyovmsD12IBHmUCwr5bZqNic2p50ogCxUAIj4YqJ3PsGwoXOhJPQAvicmu6RqOww/0, createdBy=a0bf1958339, createdName=七九九八, createdTime=Wed Oct 26 17:28:24 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151253, encodeId=23ec151253b1, content=三高问题需要认真对待!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 07:01:12 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151252, encodeId=977115125246, content=难治性高血压是指在尽管服用3种或3种以上的降压药后血压仍然偏高的一种危险疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 06:58:39 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151238, encodeId=79d415123899, content=学习新知识谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 26 06:40:32 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151222, encodeId=a47b151222cc, content=确实很好的研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-26 榄枷檬

    三高问题需要认真对待!

    0

  8. 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likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Wed Oct 26 06:58:39 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151238, encodeId=79d415123899, content=学习新知识谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Oct 26 06:40:32 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=151222, encodeId=a47b151222cc, content=确实很好的研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-26 榄枷檬

    难治性高血压是指在尽管服用3种或3种以上的降压药后血压仍然偏高的一种危险疾病。

    0

  9. 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objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-26 刘煜

    学习新知识谢谢。

    0

  10. 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objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160923/IMG57E54D670B3C08868.jpg, createdBy=e90b1956497, createdName=Carlos007, createdTime=Wed Oct 26 00:56:20 CST 2016, time=2016-10-26, status=1, ipAttribution=)]
    2016-10-26 Carlos007

    确实很好的研究

    0

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