Resistant arterial hypertension: modern view of the problem
- 作者: Kuchmin A.1, Diskalenko O.1, Izotova A.1, Morozov S.1, Ekimov V.1
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隶属关系:
- Kirov Military Medical Academy
- 期: 卷 25, 编号 4 (2023)
- 页面: 653-664
- 栏目: Review
- URL: https://journals.rcsi.science/1682-7392/article/view/253758
- DOI: https://doi.org/10.17816/brmma465745
- ID: 253758
如何引用文章
详细
In clinical practice, uncontrolled arterial hypertension remains a difficult but solvable task, given the available arsenal of antihypertensive drugs. However, resistant arterial hypertension is diagnosed in 10%–15% of these cases. A significantly higher risk of cardiovascular complications indicates the extreme importance of the successful treatment of this pathology. Resistant hypertension is defined as above-goal high blood pressure in a patient despite concurrent use of three antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a renin–angiotensin blocker (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. All antihypertensive drugs should be administered at maximum or maximally tolerated doses. Resistant hypertension also includes cases in which blood pressure targets are achieved with ≥4 antihypertensive medications. The diagnosis of resistant hypertension requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office blood pressure above goal but out-of-office blood pressure at or below the target). Once antihypertensive medication adherence is confirmed and out-of-office blood pressure recordings exclude a white-coat effect, the evaluation includes the identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. The management of resistant hypertension includes the maximization of lifestyle interventions, correction of sleep disorders, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower blood pressure if blood pressure remains high.
作者简介
Alexey Kuchmin
Kirov Military Medical Academy
Email: kuchmin.63@mail.ru
ORCID iD: 0000-0003-2888-9625
SPIN 代码: 7787-1364
MD, Dr. Sci. (Med.), Professor
俄罗斯联邦, Saint PetersburgOlga Diskalenko
Kirov Military Medical Academy
编辑信件的主要联系方式.
Email: olgadiska1705@gmail.com
ORCID iD: 0000-0001-9927-7779
SPIN 代码: 8139-5706
MD, Cand. Sci. (Med.)
俄罗斯联邦, Saint PetersburgAnna Izotova
Kirov Military Medical Academy
Email: suave77@mail.ru
ORCID iD: 0000-0001-8356-1863
SPIN 代码: 8985-7950
MD, Cand. Sci. (Med.)
俄罗斯联邦, Saint PetersburgSergey Morozov
Kirov Military Medical Academy
Email: morozovserg102@gmail.com
ORCID iD: 0009-0004-9992-1017
SPIN 代码: 5138-3820
MD, Cand. Sci. (Med.)
俄罗斯联邦, Saint PetersburgVitaly Ekimov
Kirov Military Medical Academy
Email: v.ekimov2012@mail.ru
ORCID iD: 0000-0003-3750-4301
SPIN 代码: 2901-9561
Senior lecturer
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