切换至 "中华医学电子期刊资源库"

中华肾病研究电子杂志 ›› 2016, Vol. 05 ›› Issue (01) : 14 -18. doi: 10.3877/cma.j.issn.2095-3216.2016.01.004

所属专题: 文献

专家论坛

慢性肾衰竭合并难治性高血压的诊治
袁发焕1,(), 陈雨1   
  1. 1. 400037 重庆,全军肾脏病中心、重庆市肾脏病研究所、国家中医药管理局重点专科、第三军医大学新桥医院肾内科
  • 收稿日期:2015-12-17 出版日期:2016-02-28
  • 通信作者: 袁发焕

The diagnosis and treatment of resistant hypertension in chronic renal failure

Fahuan Yuan1,(), Yu Chen1   

  1. 1. Department of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
  • Received:2015-12-17 Published:2016-02-28
  • Corresponding author: Fahuan Yuan
  • About author:
    Corresponding author: Yuan Fahuan, Email:
引用本文:

袁发焕, 陈雨. 慢性肾衰竭合并难治性高血压的诊治[J]. 中华肾病研究电子杂志, 2016, 05(01): 14-18.

Fahuan Yuan, Yu Chen. The diagnosis and treatment of resistant hypertension in chronic renal failure[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2016, 05(01): 14-18.

慢性肾衰竭合并难治性高血压,仍是一个棘手的临床问题。在无肾脏疾病的高血压患者,难治性高血压的发生率为1.9%~12.8%。在慢性肾脏病(CKD)患者,肾功能越差、尿蛋白越多难治性高血压发生率越高。慢性肾衰竭患者发生难治性高血压主要与交感神经过度兴奋、一氧化氮(NO)降低、内皮素(ET)增高、血管紧张素II(AgII)活性增高、胰岛素抵抗、甲状旁腺激素功能亢进等机制有关。可从生活方式干预、病人依从性评估与管理、不同作用机制降压药物联合使用、透析方式的调整等方面来控制难治性高血压;通过上述措施仍不能控制血压者,可考虑去肾交感神经术或颈动脉窦压力感受器刺激术。

Resistant hypertension (RH) in chronic renal failure patients is a difficult clinical problem. In hypertension patients without kidney diseases, the RH incidence is 1.9% to 12.8%. In chronic kidney disease (CKD)patients, the poorer renal function, the higher incidence of RH; the more severe proteinuria, the higher incidence of RH. The RH in CKD patients is mainly due to sympathetic nerve over- excitation, nitric oxide (NO) decrease, endothelin (ET) increase, angiotensin Ⅱ activity increase, insulin resistance, and hyperparathyroidism, etc. To control RH needs life style improvement, patient compliance evaluation and management, combined use of different kinds of antihypertensive drugs, and dialysis style change, and so on. If the above measures are not able to control RH, renal sympathetic denervation or baroreflex activation therapy can be considered.

1
孙宁玲,霍勇,王继光,等.难治性高血压诊断治疗中国专家共识[J].中国医学前沿杂志.2013, 5(6): 5-10.
2
Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. a scientific statement from the American Heart Association professional education committee of the council for high blood pressure research [J]. Hypertension, 2008, 51(6): 1403-1419.
3
Persel SD. Prevalence of resistant hypertension in the United States, 2003- 2008 [J]. Hypertension, 2011, 57(6): 1076-1080.
4
De la Sierra A, Segura J, Banegas JR, et al. Clinical features of 8295patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring [J]. Hypertension, 2011, 57(5): 898-902.
5
Ma W, Zhang Y, HOT- CHINA working group. Low rate of resistant hypertension in Chinese patients with hypertension-an analysis of the HOT- CHINA study [J]. J Hypertens, 2013, 31(12): 2386-2390.
6
Daugherty SL, Powers JD, Magid DJ, et al. Incidence and prognosis of resistant hypertension in hypertensive patients [J]. Circulation, 2012, 125 (13): 1635-1642.
7
Kalaitzidis R, Li SY, Wang CC, et al. Hypertension in early- stage kidney disease: an update from the Kidney Early Evaluation Program (KEEP) [J]. Am J Kidney Dis, 2009, 53(4 Suppl 4): S22-S31.
8
Mailloux LU, Levey AS. Hypertension in patients with chronic renal disease [J]. Am J Kidney Dis, 1998, 32(5 Suppl 3): S120-S141.
9
Tanner RM. Prevalence of apparent treatment- resistant hypertension among individuals with CKD [J]. Clin J Am Soc Nephrol, 2013, 8(9): 1583-1590.
10
Feldman RD, Brass EP. From bad behaviour to bad biology: pitfalls and promises in the management of resistant hypertension [J]. Can J Cardiol, 2013, 29 (5): 549-556.
11
Shimbo D, Levitan EB, Booth JN, et al. The contribution of unhealthy lifestyle factors to apparent resistant hypertension: findings from the reasons for geographic and racial differences in stroke (REGARDS) study [J]. J Hypertens, 2013, 31(2): 370-376.
12
Schirpenbach C, Reincke M. Epidemiology and etiology of therapy- resistant hypertension [J]. Internist (Berl), 2009, 50 (1): 7-16.
13
Viera AJ. Resistant hypertension [J]. J Am Board Fam Med, 2012, 25 (4): 487-495.
14
Dudenbostel T, Calhoun DA. Resistant hypertension, obstructive sleep apnea and aldosterone [J]. J Hum Hypertens, 2012, 26 (5): 281-287.
15
Orth SR, Amann K, Strojek K, et al. Sympathetic overactivity and arterial hypertension in renal failure [J]. Nephrol Dial Transplant, 2001, 16(Suppl 1): 67-69.
16
Phillips JK. Pathogenesis of hypertension in renal failure: Role of the sympathetic nervous system and renal afferents [J]. Clin Exp Pharmacol Physiol, 2005, 32(5- 6): 415-418.
17
Boger RH. Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, explains the "L- arginine paradox" and acts as a novel cardiovascular risk factor [J]. J Nutr, 2004, 134(10 Suppl): 2842S-2847S.
18
Lariviere R, Lebel M. Endothelin- 1 in chronic renal failure and hypertension [J]. Can J Physiol Pharmacol, 2003, 81(6): 607-621.
19
Zhou MS, Schulman IH, Raij L. Nitric oxide, angiotensin Ⅱ, and hypertension [J]. Semin Nephrol, 2004, 24(4): 366-378.
20
Kincaid SP. Hypothesis: obesity and the insulin resistance syndrome play a major role in end- stage renal failure attributed to hypertension and labelled "hypertensive nephrosclerosis" [J]. J Hypertens, 2004, 22(6): 1051-1055.
21
夏运风,甘华.尿毒症难治性高血压的发生机制[J].山西医科大学学报,2002,33(5): 479-481.
22
Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. a scientific statement from the American Heart Association professional education committee of the council for high blood pressure research [J]. Hypertension, 2008, 51(6): 1403-1419.
23
Hanselin MR, Saseen JJ, Alen RR, et al. Description of antihypertensive use in patients with resistant hypertension prescribed four or more agents [J]. Hypertension, 2011, 58(6): 1008-1013.
24
第八届中华肾脏病学会慢性肾脏病高血压治疗专家协作组.α/β受体阻断剂在慢性肾脏病高血压治疗中的实践指南[J].中华医学杂志,2013,93(48): 3812-3816.
25
Di Bona GF. Translational medicine: the antihypertensive effect of renal denervation [J]. Am J Physiol Regul Integr Comp Physiol, 2010, 298(2): R245-R253.
26
Symplicity HTN- 1 Investigators. Catheter- based renal sympathetic denervation d for resistant hypertension: durability of blood pressure reduction out to 24 months [J]. Hypertension, 2011, 57(5): 911-917.
27
Esler MD. Renal sympathetic denervation for treatment of drug resistant hypertension: one- year results from the symplicity HTN- 2 randomized, controlled trial [J]. Circulation, 2012, 126(25): 2976-2982.
28
陈枫,黄云剑,李玉英,等.不同血液净化方案对尿毒症难治性高血压的疗效观察[J].重庆医学,2007,36(3): 426-427.
29
肖嘉.高通量血液透析治疗难治性高血压患者的临床效果[J].透析与人工器官,2013,24(1): 1-4.
30
Scheffers JJ, Kroon AA, Schmidli J, et al. Novel baroreflex activation therapy in resistant hypertension: results of a European Multicenter feasibility study [J]. J Am Col Cardiol, 2010, 56(15): 1254-1258.
31
Ng MM1, Sica DA, Frishman WH. Rheos: an implantable carotid sinus stimulation device for the nonpharmacologic treatment of resistant hypertension [J]. Cardiol Rev, 2011, 19(2): 52-57.
[1] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[2] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[3] 中华医学会骨科学分会关节外科学组, 广东省医学会骨质疏松和骨矿盐疾病分会, 广东省佛山市顺德区第三人民医院. 中国髋部脆性骨折术后抗骨质疏松药物临床干预指南(2023年版)[J]. 中华关节外科杂志(电子版), 2023, 17(06): 751-764.
[4] 许正文, 李振, 侯振扬, 苏长征, 朱彪. 富血小板血浆联合植骨治疗早期非创伤性股骨头坏死[J]. 中华关节外科杂志(电子版), 2023, 17(06): 773-779.
[5] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[6] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[7] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[8] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[9] 张海涛, 康婵娟, 翟静洁. 胰管支架置入治疗急性胆源性胰腺炎效果观察[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 654-657.
[10] 蓝冰, 王怀明, 王辉, 马波. 局部晚期结肠癌膀胱浸润的研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 505-511.
[11] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[12] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[13] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[14] 李变, 王莉娜, 桑田, 李珊, 杜雪燕, 李春华, 张兴云, 管巧, 王颖, 冯琪, 蒙景雯. 亚低温技术治疗缺氧缺血性脑病新生儿的临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 639-643.
[15] 戴俊, 李硕, 曹影, 汪守峰, 宋红毛, 蔡菁菁, 邵敏, 陈莉, 程雷, 怀德. 鼻内镜下改良高选择性翼管神经低温等离子消融术对中重度变应性鼻炎的效果研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 689-693.
阅读次数
全文


摘要