The double challenge of resistant hypertension and chronic kidney disease

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• 作者：Prof Patrick Rossignol ; MD^a ; ^b ; ^c ; ^d ; ^{p.rossignol@chu-nancy.fr" class="auth_mail" title="E-mail the corresponding author} ; Prof Ziad A Massy ; MD^e ; ^f ; Prof Michel Azizi ; MD^g ; ^h ; ⁱ ; Prof George Bakris ; MD^j ; Prof Eberhard Ritz ; MD^k ; Prof Adrian Covic ; FRCP^l ; Prof David Goldsmith ; FRCP^m ; Prof Gunnar H Heine ; MDⁿ ; Kitty J Jager ; MD^o ; Mehmet Kanbay ; MD^p ; Francesca Mallamaci ; MD^q ; ^r ; Prof Alberto Ortiz ; MD^s ; ^t ; ^u ; ^v ; Prof Raymond Vanholder ; MD^w ; Prof Andrzej Wiecek ; MD^x ; Prof Carmine Zoccali ; MD^r ; Prof Gé ; rard Michel London ; MD^y ; Bé ; né ; dicte Stengel ; MD^z ; Prof Denis Fouque ; MD^aa ; for the ERA-EDTA EURECA-m working group
• 刊名：The Lancet
• 出版年：2015
• 出版时间：17-23 October 2015
• 年：2015
• 卷：386
• 期：10003
• 页码：1588-1598
• 全文大小：134 K

文摘

Resistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3–5 (ie, patients with an estimated glomerular filtration rate below 60 mL/min per 1·73 m² and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.