难治性高血压的诊疗进展
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摘要
难治性高血压是一种特殊类型的高血压,危害较大。合理的诊断和治疗对有效控制患者血压、预防心脑血管事件发生有重要的意义。正确的诊断需要明确或排除包括依从性差、继发性高血压等多种影响血压控制的因素。有效的降压治疗一方面需要强调生活方式的改善,另一方面要在肾素-血管紧张素系统抑制剂(RASI)、钙离子通道阻滞剂(CCB)和利尿剂治疗的基础上,根据血浆肾素水平调整药物剂量,并加用醛固酮拮抗剂等其他降压药物。
Resistant hypertension(RH) is a special type of hypertension,which is underscored by the associated risk of adverse outcomes compared with non-RH.Accurate diagnosis and treatment play an important role in control of blood pressure(BP) and prevention of cardiovascular events.Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect,evaluation includes identification of contributing lifestyle issues,detection of drugs interfering with antihypertensive medication effectiveness,screening for secondary hypertension,and assessment of target organ damage.Management of RH includes maximization of lifestyle interventions,use of long-acting thiazide-like diuretics and calcium channel blocker(CCB),addition of the renin-angiotensin system inhibitor(RASI) and a mineralocorticoid receptor antagonist according to the plasma renin level,and,if BP remains elevated,stepwise addition of antihypertensive drugs with complementary mechanisms of action is used to lower BP.
Resistant hypertension(RH) is a special type of hypertension,which is underscored by the associated risk of adverse outcomes compared with non-RH.Accurate diagnosis and treatment play an important role in control of blood pressure(BP) and prevention of cardiovascular events.Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect,evaluation includes identification of contributing lifestyle issues,detection of drugs interfering with antihypertensive medication effectiveness,screening for secondary hypertension,and assessment of target organ damage.Management of RH includes maximization of lifestyle interventions,use of long-acting thiazide-like diuretics and calcium channel blocker(CCB),addition of the renin-angiotensin system inhibitor(RASI) and a mineralocorticoid receptor antagonist according to the plasma renin level,and,if BP remains elevated,stepwise addition of antihypertensive drugs with complementary mechanisms of action is used to lower BP.
引文
1 Wang Z,Chen Z,Zhang L,et al.Status of Hypertension in China:Results from the China Hypertension Survey,2012-2015[J].Circulation,2018,137(22):2344-2356.
2 Egan BM,Zhao Y,Axon RN,et al.Uncontrolled and apparent treatment resistant hypertension in the United States,1988 to 2008[J].Circulation,2011,124(9):1046-1058.
3 Tanner RM,Calhoun DA,Bell EK,et al.Prevalence of apparent treatment-resistant hypertension among individuals with CKD[J].Clin J Am Soc Nephrol,2013,8(9):1583-1590.
4 Smith SM,Gong Y,Handberg E,et al.Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension[J].J Hypertens,2014,32(3):635-643.
5 Tsioufis C,Kasiakogias A,Kordalis A,et al.Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity:a 4-year prospective study[J].J Hypertens,2014,32(2):415-422.
6 Carey RM,Calhoun DA,Bakris GL,et al.Resistant Hypertension:Detection,Evaluation,and Management:A Scientific Statement From the American Heart Association[J].Hypertension,2018,72(5):e53-e90.
7中国高血压防治指南修订委员会,高血压联盟(中国)中华医学会心血管病学分会,中国医师协会高血压专业委员会,等.中国高血压防治指南2018年修订版[J].中国心血管杂志,2019,24(1):24-56.
8 Whelton PK,Carey RM,Aronow WS,et al.2017 ACC/AHA/AA-PA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention,Detection,Evaluation,and Management of High Blood Pressure in Adults:Executive Summary:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J].Hypertension,2018,71(6):1269-1324.
9 Doménech M,Sastre E,Camafort M,et al.Misdiagnosis of resistant hypertension:Real frequency of true resistant hypertension in patients with suspected resistance to treatment[J].Med Clin(Barc),2018,150(1):20-23.
10 Hall JE,do Carmo JM,da Silva AA,et al.Obesity-induced hypertension:interaction of neurohumoral and renal mechanisms[J].Circ Res,2015,116(6):991-1006.
11 Landsberg L,Aronne LJ,Beilin LJ,et al.Obesity-related hypertension:pathogenesis,cardiovascular risk,and treatment---a position paper of The Obesity Society and the American Society of Hypertension[J].Obesity(Silver Spring),2013,21(1):8-24.
12 Saneei P,Salehi-Abargouei A,Esmaillzadeh A,et al.Influence of Dietary Approaches to Stop Hypertension(DASH)diet on blood pressure:a systematic review and meta-analysis on randomized controlled trials[J].Nutr Metab Cardiovasc Dis,2014,24(12):1253-1261.
13 Oh YS,Appel LJ,Galis ZS,et al.National Heart,Lung,and Blood Institute Working Group Report on Salt in Human Health and Sickness:Building on the Current Scientific Evidence[J].Hypertension,2016,68(2):281-288.
14李师承,陈连凤,冯淑怡,等.高盐饮食对去甲肾上腺素诱导的Dahl盐敏感大鼠肠系膜动脉收缩反应的影响[J].中国心血管杂志,2018,23(3):264-269.
15 Husain K,Ansari RA,Ferder L.Alcohol-induced hypertension:Mechanism and prevention[J].World J Cardiol,2014,6(5):245-252.
16 Crump C,Sundquist J,Winkleby MA,et al.Interactive Effects of Physical Fitness and Body Mass Index on the Risk of Hypertension[J].JAMA Intern Med,2016,176(2):210-216.
17 Bhatt H,Siddiqui M,Judd E,et al.Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement[J].JAm Soc Hypertens,2016,10(6):493-499.
18 SPRINT Research Group,Wright JT Jr,Williamson JD,et al.ARandomized Trial of Intensive versus Standard Blood-Pressure Control[J].N Engl J Med,2015,373(22):2103-2116.
19李师承.盐摄入量对难治性高血压患者的影响及盐摄入量对阻力血管舒缩功能的影响[D].北京:北京协和医学院,2018.
20 Egan BM,Zhao Y,Li J,et al.Prevalence of optimal treatment regimens in patients with apparent treatment-resistant hypertension based on office blood pressure in a community-based practice network[J].Hypertension,2013,62(4):691-697.
21 Sayk F,Teckentrup C,Becker C,et al.Effects of selective slowwave sleep deprivation on nocturnal blood pressure dipping and daytime blood pressure regulation[J].Am J Physiol Regul Integr Comp Physiol,2010,298(1):R191-R197.
22 Jin ZN,Wei YX.Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system[J].J Geriatr Cardiol,2016,13(4):333-343.
23 Pepin JL,Borel AL,Tamisier R,et al.Hypertension and sleep:overview of a tight relationship[J].Sleep Med Rev,2014,18(6):509-519.
24杨子聪,施莹(综述),刘伶(审校).CD4+T淋巴细胞亚群在原发性高血压中作用的研究进展[J].中国临床新医学,2016,9(11):1038-1041.
25 Mitchell GF,Hwang SJ,Larson MG,et al.Transfer function-derived central pressure and cardiovascular disease events:the Framingham Heart Study[J].J Hypertens,2016,34(8):1528-1534.
26 Howard VJ,Tanner RM,Anderson A,et al.Apparent Treatmentresistant Hypertension Among Individuals with History of Stroke or Transient Ischemic Attack[J].Am J Med,2015,128(7):707-714.e2.
27 Aggarwal A,Rodriguez-Buritica D.Monogenic Hypertension in Children:A Review With Emphasis on Genetics[J].Adv Chronic Kidney Dis,2017,24(6):372-379.
28 Blumenthal JA,Sherwood A,Smith PJ,et al.Lifestyle modification for resistant hypertension:The TRIUMPH randomized clinical trial[J].Am Heart J,2015,170(5):986-994.e5.
29 Semlitsch T,Jeitler K,Berghold A,et al.Long-term effects of weight-reducing diets in people with hypertension[J].Cochrane Database Syst Rev,2016,3:CD008274.
30 Harsha DW,Bray GA.Weight Loss and Blood Pressure Control(Pro)[J].Hypertension,2008,51(6):1420-1425.
31 Mente A,O'Donnell M,Rangarajan S,et al.Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension:a pooled analysis of data from four studies[J].Lancet,2016,388(10043):465-475.
32 Mc Mahon EJ,Campbell KL,Bauer JD,et al.Altered dietary salt intake for people with chronic kidney disease[J].Cochrane Database Syst Rev,2015,(2):CD010070.
33 Shiga Y,Miura SI,Motozato K,et al.Comparison of Efficacy and Safety of Azilsartan and Olmesartan in Patients With Essential Hypertension[J].Int Heart J,2017,58(3):416-421.
34 Tanaka T,Miura S,Tanaka M,et al.Efficacies of Controlling Morning Blood Pressure and Protecting the Kidneys by Treatment With Valsartan and Nifedipine CR or Valsartan and Amlodipine(MONICA Study)[J].J Clin Med Res,2013,5(6):432-440.
35 Jeffers BW,Robbins J,Bhambri R.Efficacy of Calcium Channel Blockers Versus Other Classes of Antihypertensive Medication in the Treatment of Hypertensive Patients With Previous Stroke and/or Coronary Artery Disease:A Systematic Review and Meta-Analysis[J].Am J Ther,2017,24(1):e68-e80.
36 Roush GC,Sica DA.Diuretics for Hypertension:A Review and Update[J].Am J Hypertens,2016,29(10):1130-1137.
37 Williams B,Mac Donald TM,Morant S,et al.Spironolactone versus placebo,bisoprolol,and doxazosin to determine the optimal treatment for drug-resistant hypertension(PATHWAY-2):a randomised,double-blind,crossover trial[J].Lancet,2015,386(10008):2059-2068.
38 Julius S,Palatini P,Kjeldsen SE,et al.Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension[J].Am J Cardiol,2012,109(5):685-692.
39 Worthley SG,Tsioufis CP,Worthley MI,et al.Safety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension:the EnligHTN I trial[J].Eur Heart J,2013,34(28):2132-2140.
40 Mahfoud F,Ukena C,Schmieder RE,et al.Ambulatory blood pressure changes after renal sympathetic denervation in patients with resistant hypertension[J].Circulation,2013,128(2):132-140.
41 Bhatt DL,Kandzari DE,O'Neill WW,et al.A controlled trial of renal denervation for resistant hypertension[J].N Engl J Med,2014,370(15):1393-1401.
42 White WB,Galis ZS,Henegar J,et al.Renal denervation therapy for hypertension:pathways for moving development forward[J].JAm Soc Hypertens,2015,9(5):341-350.
43 Azizi M,Sapoval M,Gosse P,et al.Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension(DENERHTN):a multicentre,open-label,randomised controlled trial[J].Lancet,2015,385(9981):1957-1965.
44 Townsend RR,Mahfoud F,Kandzari DE,et al.Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications(SPYRAL HTN-OFF MED):a randomised,sham-controlled,proof-of-concept trial[J].Lancet,2017,390(10108):2160-2170.
45 Bisognano JD,Bakris G,Nadim MK,et al.Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension:results from the double-blind,randomized,placebo-controlled rheos pivotal trial[J].J Am Coll Cardiol,2011,58(7):765-773.
46 Clinical Trials.gov Identifier:NCT01911897.Controlling and Lowering Blood Pressure With The MOBIUSHDTM(CALM-FIM_EUR)(CALM-FIM_EUR).https://clinicaltrials.gov/ct2/show/NCT01911897?term=MOBIUSHD&rank=3.Accessed Feb.1st 2019.
47 Clinical Trials.gov Identifier:NCT01831895.Controlling and Lowering Blood Pressure With The MOBIUSHDTM(CALM-FIM_US).https://clinicaltrials.gov/ct2/show/NCT01831895?term=MOBIUSHD&rank=4.Accessed Feb.1st 2019.
48 Lobo MD,Sobotka PA,Stanton A,et al.Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension(the ROX CONTROL HTN study):a randomised controlled trial[J].Lancet,2015,385(9978):1634-1641.
49 Mabin T,Sapoval M,Cabane V,et al.First experience with endovascular ultrasound renal denervation for the treatment of resistant hypertension[J].Euro Intervention,2012,8(1):57-61.
50 O'Callaghan EL,Hart EC,Sims-Williams H,et al.Chronic Deep Brain Stimulation Decreases Blood Pressure and Sympathetic Nerve Activity in a Drug-and Device-Resistant Hypertensive Patient[J].Hypertension,2017,69(4):522-528.
51 Cernes R,Zimlichman R.RESPeRATE:the role of paced breathing in hypertension treatment[J].J Am Soc Hypertens,2015,9(1):38-47.
52 Azegami T,Yuki Y,Hayashi K,et al.Intranasal vaccination against angiotensin II type 1 receptor and pneumococcal surface protein A attenuates hypertension and pneumococcal infection in rodents[J].J Hypertens,2018,36(2):387-394.
2 Egan BM,Zhao Y,Axon RN,et al.Uncontrolled and apparent treatment resistant hypertension in the United States,1988 to 2008[J].Circulation,2011,124(9):1046-1058.
3 Tanner RM,Calhoun DA,Bell EK,et al.Prevalence of apparent treatment-resistant hypertension among individuals with CKD[J].Clin J Am Soc Nephrol,2013,8(9):1583-1590.
4 Smith SM,Gong Y,Handberg E,et al.Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension[J].J Hypertens,2014,32(3):635-643.
5 Tsioufis C,Kasiakogias A,Kordalis A,et al.Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity:a 4-year prospective study[J].J Hypertens,2014,32(2):415-422.
6 Carey RM,Calhoun DA,Bakris GL,et al.Resistant Hypertension:Detection,Evaluation,and Management:A Scientific Statement From the American Heart Association[J].Hypertension,2018,72(5):e53-e90.
7中国高血压防治指南修订委员会,高血压联盟(中国)中华医学会心血管病学分会,中国医师协会高血压专业委员会,等.中国高血压防治指南2018年修订版[J].中国心血管杂志,2019,24(1):24-56.
8 Whelton PK,Carey RM,Aronow WS,et al.2017 ACC/AHA/AA-PA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention,Detection,Evaluation,and Management of High Blood Pressure in Adults:Executive Summary:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J].Hypertension,2018,71(6):1269-1324.
9 Doménech M,Sastre E,Camafort M,et al.Misdiagnosis of resistant hypertension:Real frequency of true resistant hypertension in patients with suspected resistance to treatment[J].Med Clin(Barc),2018,150(1):20-23.
10 Hall JE,do Carmo JM,da Silva AA,et al.Obesity-induced hypertension:interaction of neurohumoral and renal mechanisms[J].Circ Res,2015,116(6):991-1006.
11 Landsberg L,Aronne LJ,Beilin LJ,et al.Obesity-related hypertension:pathogenesis,cardiovascular risk,and treatment---a position paper of The Obesity Society and the American Society of Hypertension[J].Obesity(Silver Spring),2013,21(1):8-24.
12 Saneei P,Salehi-Abargouei A,Esmaillzadeh A,et al.Influence of Dietary Approaches to Stop Hypertension(DASH)diet on blood pressure:a systematic review and meta-analysis on randomized controlled trials[J].Nutr Metab Cardiovasc Dis,2014,24(12):1253-1261.
13 Oh YS,Appel LJ,Galis ZS,et al.National Heart,Lung,and Blood Institute Working Group Report on Salt in Human Health and Sickness:Building on the Current Scientific Evidence[J].Hypertension,2016,68(2):281-288.
14李师承,陈连凤,冯淑怡,等.高盐饮食对去甲肾上腺素诱导的Dahl盐敏感大鼠肠系膜动脉收缩反应的影响[J].中国心血管杂志,2018,23(3):264-269.
15 Husain K,Ansari RA,Ferder L.Alcohol-induced hypertension:Mechanism and prevention[J].World J Cardiol,2014,6(5):245-252.
16 Crump C,Sundquist J,Winkleby MA,et al.Interactive Effects of Physical Fitness and Body Mass Index on the Risk of Hypertension[J].JAMA Intern Med,2016,176(2):210-216.
17 Bhatt H,Siddiqui M,Judd E,et al.Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement[J].JAm Soc Hypertens,2016,10(6):493-499.
18 SPRINT Research Group,Wright JT Jr,Williamson JD,et al.ARandomized Trial of Intensive versus Standard Blood-Pressure Control[J].N Engl J Med,2015,373(22):2103-2116.
19李师承.盐摄入量对难治性高血压患者的影响及盐摄入量对阻力血管舒缩功能的影响[D].北京:北京协和医学院,2018.
20 Egan BM,Zhao Y,Li J,et al.Prevalence of optimal treatment regimens in patients with apparent treatment-resistant hypertension based on office blood pressure in a community-based practice network[J].Hypertension,2013,62(4):691-697.
21 Sayk F,Teckentrup C,Becker C,et al.Effects of selective slowwave sleep deprivation on nocturnal blood pressure dipping and daytime blood pressure regulation[J].Am J Physiol Regul Integr Comp Physiol,2010,298(1):R191-R197.
22 Jin ZN,Wei YX.Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system[J].J Geriatr Cardiol,2016,13(4):333-343.
23 Pepin JL,Borel AL,Tamisier R,et al.Hypertension and sleep:overview of a tight relationship[J].Sleep Med Rev,2014,18(6):509-519.
24杨子聪,施莹(综述),刘伶(审校).CD4+T淋巴细胞亚群在原发性高血压中作用的研究进展[J].中国临床新医学,2016,9(11):1038-1041.
25 Mitchell GF,Hwang SJ,Larson MG,et al.Transfer function-derived central pressure and cardiovascular disease events:the Framingham Heart Study[J].J Hypertens,2016,34(8):1528-1534.
26 Howard VJ,Tanner RM,Anderson A,et al.Apparent Treatmentresistant Hypertension Among Individuals with History of Stroke or Transient Ischemic Attack[J].Am J Med,2015,128(7):707-714.e2.
27 Aggarwal A,Rodriguez-Buritica D.Monogenic Hypertension in Children:A Review With Emphasis on Genetics[J].Adv Chronic Kidney Dis,2017,24(6):372-379.
28 Blumenthal JA,Sherwood A,Smith PJ,et al.Lifestyle modification for resistant hypertension:The TRIUMPH randomized clinical trial[J].Am Heart J,2015,170(5):986-994.e5.
29 Semlitsch T,Jeitler K,Berghold A,et al.Long-term effects of weight-reducing diets in people with hypertension[J].Cochrane Database Syst Rev,2016,3:CD008274.
30 Harsha DW,Bray GA.Weight Loss and Blood Pressure Control(Pro)[J].Hypertension,2008,51(6):1420-1425.
31 Mente A,O'Donnell M,Rangarajan S,et al.Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension:a pooled analysis of data from four studies[J].Lancet,2016,388(10043):465-475.
32 Mc Mahon EJ,Campbell KL,Bauer JD,et al.Altered dietary salt intake for people with chronic kidney disease[J].Cochrane Database Syst Rev,2015,(2):CD010070.
33 Shiga Y,Miura SI,Motozato K,et al.Comparison of Efficacy and Safety of Azilsartan and Olmesartan in Patients With Essential Hypertension[J].Int Heart J,2017,58(3):416-421.
34 Tanaka T,Miura S,Tanaka M,et al.Efficacies of Controlling Morning Blood Pressure and Protecting the Kidneys by Treatment With Valsartan and Nifedipine CR or Valsartan and Amlodipine(MONICA Study)[J].J Clin Med Res,2013,5(6):432-440.
35 Jeffers BW,Robbins J,Bhambri R.Efficacy of Calcium Channel Blockers Versus Other Classes of Antihypertensive Medication in the Treatment of Hypertensive Patients With Previous Stroke and/or Coronary Artery Disease:A Systematic Review and Meta-Analysis[J].Am J Ther,2017,24(1):e68-e80.
36 Roush GC,Sica DA.Diuretics for Hypertension:A Review and Update[J].Am J Hypertens,2016,29(10):1130-1137.
37 Williams B,Mac Donald TM,Morant S,et al.Spironolactone versus placebo,bisoprolol,and doxazosin to determine the optimal treatment for drug-resistant hypertension(PATHWAY-2):a randomised,double-blind,crossover trial[J].Lancet,2015,386(10008):2059-2068.
38 Julius S,Palatini P,Kjeldsen SE,et al.Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension[J].Am J Cardiol,2012,109(5):685-692.
39 Worthley SG,Tsioufis CP,Worthley MI,et al.Safety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension:the EnligHTN I trial[J].Eur Heart J,2013,34(28):2132-2140.
40 Mahfoud F,Ukena C,Schmieder RE,et al.Ambulatory blood pressure changes after renal sympathetic denervation in patients with resistant hypertension[J].Circulation,2013,128(2):132-140.
41 Bhatt DL,Kandzari DE,O'Neill WW,et al.A controlled trial of renal denervation for resistant hypertension[J].N Engl J Med,2014,370(15):1393-1401.
42 White WB,Galis ZS,Henegar J,et al.Renal denervation therapy for hypertension:pathways for moving development forward[J].JAm Soc Hypertens,2015,9(5):341-350.
43 Azizi M,Sapoval M,Gosse P,et al.Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension(DENERHTN):a multicentre,open-label,randomised controlled trial[J].Lancet,2015,385(9981):1957-1965.
44 Townsend RR,Mahfoud F,Kandzari DE,et al.Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications(SPYRAL HTN-OFF MED):a randomised,sham-controlled,proof-of-concept trial[J].Lancet,2017,390(10108):2160-2170.
45 Bisognano JD,Bakris G,Nadim MK,et al.Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension:results from the double-blind,randomized,placebo-controlled rheos pivotal trial[J].J Am Coll Cardiol,2011,58(7):765-773.
46 Clinical Trials.gov Identifier:NCT01911897.Controlling and Lowering Blood Pressure With The MOBIUSHDTM(CALM-FIM_EUR)(CALM-FIM_EUR).https://clinicaltrials.gov/ct2/show/NCT01911897?term=MOBIUSHD&rank=3.Accessed Feb.1st 2019.
47 Clinical Trials.gov Identifier:NCT01831895.Controlling and Lowering Blood Pressure With The MOBIUSHDTM(CALM-FIM_US).https://clinicaltrials.gov/ct2/show/NCT01831895?term=MOBIUSHD&rank=4.Accessed Feb.1st 2019.
48 Lobo MD,Sobotka PA,Stanton A,et al.Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension(the ROX CONTROL HTN study):a randomised controlled trial[J].Lancet,2015,385(9978):1634-1641.
49 Mabin T,Sapoval M,Cabane V,et al.First experience with endovascular ultrasound renal denervation for the treatment of resistant hypertension[J].Euro Intervention,2012,8(1):57-61.
50 O'Callaghan EL,Hart EC,Sims-Williams H,et al.Chronic Deep Brain Stimulation Decreases Blood Pressure and Sympathetic Nerve Activity in a Drug-and Device-Resistant Hypertensive Patient[J].Hypertension,2017,69(4):522-528.
51 Cernes R,Zimlichman R.RESPeRATE:the role of paced breathing in hypertension treatment[J].J Am Soc Hypertens,2015,9(1):38-47.
52 Azegami T,Yuki Y,Hayashi K,et al.Intranasal vaccination against angiotensin II type 1 receptor and pneumococcal surface protein A attenuates hypertension and pneumococcal infection in rodents[J].J Hypertens,2018,36(2):387-394.
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