顽固性高血压-交感神经活性增高作为抗高血压治疗失败原因的证据.pdf

Refractory Hypertension Refractory Hypertension Evidence of Heightened Sympathetic Activity as a Cause of Antihypertensive Treatment Failure Tanja Dudenbostel, Maria C. Acelajado, Roberto Pisoni, Peng Li, Suzanne Oparil, David A. Calhoun Abstract—Refractory hypertension is an extreme phenotype of treatment failure defined as uncontrolled blood pressure in spite of ≥5 classes of antihypertensive agents, including chlorthalidone and a mineralocorticoid receptor antagonist. A prospective evaluation of possible mechanisms of refractory hypertension has not been done. The goal of this study was to test for evidence of heightened sympathetic tone as indicated by 24-hour urinary normetanephrine levels, clinic and ambulatory heart rate (HR), HR variability, arterial stiffness as indexed by pulse wave velocity, and systemic vascular resistance compared with patients w