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Hypertension:顽固性高血压患者强化降压治疗疗效分析

2018-12-24 xing.T MedSci原创

由此可见,强化降压治疗与顽固性高血压患者主要不良心血管事件风险降低显著相关。

关于顽固性高血压患者的目标血压(BP)的证据有限。近日,血管权威杂志Hypertension上发表了一篇研究文章,该研究旨在评估强化降压治疗(收缩压<120mmHg)与标准治疗(收缩压<140mmHg)对顽固性高血压患者的疗效。

该研究使用了来自SPRINT(收缩压血压干预试验)的数据进行二次分析。该研究包括了1397例顽固性高血压患者和7698例无顽固性高血压患者。研究人员使用Cox比例风险模型比较了强化降压和标准治疗组之间首次发生的主要不良血管事件(心血管死亡、心肌梗死卒中)的时间。

平均随访时间为3.1年; 381例患者确诊为主要不良心血管事件。强化治疗组的主要不良心血管事件风险显著低于标准治疗组(风险比为0.62; 95%CI为0.40-0.96; P=0.03)。强化治疗组患者的全因和心血管死亡风险也显著低于标准治疗组(全因死亡风险比为0.60; 95%CI为0.38-0.97; P=0.03;心血管死亡风险比为0.34; 95%CI为0.15-0.81; P=0.01)。在各个亚组中观察到类似的关联。

由此可见,强化降压治疗与顽固性高血压患者主要不良心血管事件风险降低显著相关。

原始出处:

Tetsuro Tsujimoto,et al. Intensive Blood Pressure Treatment for Resistant Hypertension Secondary Analysis of a Randomized Controlled Trial.Hypertension.2018.https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.118.12156

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    2019-06-24 feather89
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    2018-12-25 龙胆草

    学习谢谢分享

    0

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西班牙动态血压注册研究在近8万的高血压患者中发现,总体上有1.4%的高血压患者属于真性顽固性高血压(服用≥5种降压药时诊室血压仍≥140/90 mmHg)。

Heart:顽固性高血压的全球患病率

由此可见,该研究显示真顽固性高血压的患病率很高。这种患病率低于明显治疗顽固性高血压,表明使用动态血压测量排除包括白大衣高血压在内的假顽固性高血压的重要性。慢性肾病患者的顽固性高血压负担最高。考虑到疾病的灾难性并发症,急需新的治疗顽固性高血压的方法。

Lancet:颈动脉支架治疗顽固性高血压

在经过治疗的高血压患者汇总,大约10%为顽固性高血压,定义为尽管经过三种或更多种药物治疗(包括利尿剂)患者的血压仍然未被控制。继续增加药物是有效的,但是并不是所有患者都能够长期耐受这些药物。

Hypertension:肾脏去神经支配治疗顽固性高血压和阻塞性睡眠呼吸暂停!

由此可见,在这项随机对照试验中,RDN降低了顽固性高血压和OSA患者的诊室和动态血压,伴随改善OSA临床严重程度。

JAHA:细胞外液体积是慢性肾脏疾病患者发生不受控制和顽固性高血压的独立决定因素

在这个大型CKD患者人群中,较低的肾小球滤过率、较高的体重指数、糖尿病和非洲裔均与高血压严重程度相关,但与血压控制无关。较多的细胞外水含量、较大的年龄和较多的白蛋白尿是CKD患者发生顽固性和不受控制性高血压的独立决定因素。该研究结果主张在这类人群中大量使用利尿剂。

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