2025 年第 2 期 第 20 卷

难治性高血压和顽固性高血压鉴别和诊治进展

Progress in the differentiation, diagnosis and treatment of resistant hypertension and refractory hypertension

作者：屈丰雪1马琳琳1刘静华1王佐广2程文立1

英文作者：Qu Fengxue1 Ma Linlin1 Liu Jinghua1 Wang Zuoguang2 Cheng Wenli1

单位：1首都医科大学附属北京安贞医院心内科高血压中心,北京100029；2北京市心肺血管疾病研究所，北京100029

英文单位：1Hypertension Center of Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：难治性高血压；顽固性高血压；基因多态性；药物组学；诊治进展

英文关键词：Resistanthypertension;Refractoryhypertension;Genepolymorphism;Pharmacoomics;Progressindiagnosisandtreatment

• 摘要：

• 难治性高血压（RH）和顽固性高血压（RfH）是指抗高血压治疗失败或耐药，其患病率难以量化，但患者心血管风险显著增高。标准化的诊室血压测量、确认医疗依从性、寻找药物或物质引起的血压升高、药物相互作用、基因多态性、药物代谢组学、动态或居家血压监测及排除假性耐药是必要的。根据临床数据适当地进一步检查，排除继发性高血压。加强生活方式干预和调整合理的抗高血压药物治疗方案是RH管理的基石，若血压仍未达标，应考虑器械治疗，如肾动脉交感神经射频消融术等，但需严格评估适应证和安全性。在实践中，RH和RfH的管理应根据患者的特点进行个体化治疗。

• Resistant hypertension (RH) and refractory hypertension (RfH) refer to the failure or resistance of antihypertensive treatment. The prevalence of RH and RFH is difficult to quantify, but patients are at significantly increased cardiovascular risk. Standardized office blood-pressure measurements, confirmation of medical adherence, search for drug-or substant-induced blood-pressure elevations, drug-drug interactions, genetic polymorphisms, pharmacometabolomics, ambulatory or home blood-pressure monitoring, and rule out pseudoresistance are warranted. Secondary hypertension was excluded on the basis of further investigations appropriate to clinical data.Lifestyle intervention and reasonable antihypertensive drug therapy are the cornerstone of RH management. If blood pressure is still not under control, device therapy, such as renal artery sympathetic radiofrequency ablation, should be considered. Device therapy such as renal artery sympathetic radiofrequency ablation can be considered, but the indications and safety need to be strictly evaluated. In practice, the management of RH and RfH should be individualized according to the characteristics of patient.