顽固高血压教材课件.pptxVIP

顽固性高血压;顽固性高血压还是叫难治性高血压;类治疗顽固的高血压-apparent treatment resistant hypertension?(aTRH) has been used in the literature to encompass patients with BP ≥140/90 mm Hg who take ≥3 antihypertensive medications, 包括白大衣高血压，以及降压药依从性不太好的高血压患者?12?and?13? Lastly, the term?refractory hypertension?may refer to patients whose BP remains uncontrolled after ≥3 visits to a hypertension clinic over 6 months.?14 ;;the term?refractory hypertension?may refer to patients whose BP remains uncontrolled after ≥3 visits to a hypertension clinic over 6 months.?14 Proceedings from Duke Resistant Hypertension Think Tank Sreekanth Vemulapalli,?MDa,?Jamy Ard,?MDb,?George L. Bakris,?MDc,?Deepak L. Bhatt,?MD, MPHd,?Alan S. Brown,?MDe,?William C. Cushman,?MDf,?Keith C. Ferdinand,?MDg,?John M. Flack,?MD, MPHh,?Jerome L. Fleg,?MDi,?Barry T. Katzen,?MDj,?John B. Kostis,?MDk,?Suzanne Oparil,?MDl,?Chet B. Patel,?MDa,?m,Carl J. Pepine,?MDn,?Ileana L. Pi?a,?MD, MPHo,?Krishna J.Rocha-Singh,?MDp,?Raymond R. Townsend,MDq,?Eric D. Peterson,?MD, MPHa,?m,?Robert M. Califf,?MDa,?m,?Manesh R. Patel,?MDa,?m,? /science/journaleart Journal Volume 167, Issue 6, June 2014, Pages 775–788.;诊断：排除诊断法Treatment-resistant hypertension diagnosis;测量准确;排除生活习惯的干扰;排除继发性高血压;并非所有血压没控制的高血压都是“治疗顽固的高血压”;患病率;实际患病率比以前报告的低得多;顽固性高血压-高CVD风险;风险高;家测血压，12小时动态血压监测;顽固性高血压-最常用的4类降压药;顽固性高血压降压药选择;利尿剂剂量;利尿剂最佳使用方式;利尿剂;袢利尿剂“抗利钠利尿反跳效应”rebound antinatriuretic effect (braking phenomenon);噻嗪类 螺内酯， 速尿 ， 阿米洛利;3年随访, 利尿剂与beta1 阻滞剂没有显著升高血糖;3年随访, 利尿剂与beta1 阻滞剂没有显著增加糖尿病发生率;;加醛固酮受体拮抗剂是aTRH血压进一步下降;噻嗪利尿剂（抑制肾脏远曲小管Na-Cl共转运体），能够逆转这些病征。 提示KLHL3 与CUL3 在此肾远端单位部位表达, KLHL3 与CUL3突变与本病之间存在一种机制上的联系, 增加 Na-Cl重吸收, 导致高血压、高血钾、代谢性酸中毒。 ;患者60岁男，血清肌酐高，没有用醛固酮受体拮抗剂;Region;疗效;排除继发性高血压：顽固性高血压病例;改新的6个药的治疗方案：缬沙坦, 160 mg qd; eplerenone, 50 mg bid; carvedilol, 25 mg bid ; hydralazine, 100 mg tid ; clonidine, 0.1 mg bid; bumetanide, 1 mg qd, 家测血压（135/85,夜间110/70）仍然大于 180/90 mm Hg. ;Effect of Common Medications on the Aldosterone-Renin Ratio (ARR)a 升高ARRb的药：β-阻滞剂, 中枢α2?激