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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

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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/OL]. 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/OL]. 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.

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