Many patients with hypertension, in the early stages of diagnosis, are not nervous. When encountering friendly reminders, it will be easy to cope, there are so many patients with high blood pressure, what are you afraid of? This is a common disease, we take medicine on time, no big deal. However, before long, such patients will find that they are really in a big deal. Because, after taking several drugs, blood pressure is still uncontrolled, and it may also be diagnosed with refractory hypertension. Why can't drugs tame blood pressure? What are the causes of refractory hypertension? What should I do? Let's solve your doubts now.
According to the definition of the relevant guidelines, refractory hypertension is based on the rational and adequate application of 3 antihypertensive drugs on the basis of lifestyle changes, and after at least 4 weeks of treatment, blood pressure still does not meet the control criteria, systolic blood pressure exceeds 140 mmHg, or diastolic blood pressure exceeds 90 mmHg. If it is simple systolic hypertension in the elderly, the blood pressure value exceeds 160 mmHg, or more than 4 drugs are used to make the blood pressure up to standard, also known as refractory hypertension. Antihypertensive drugs in the definition include at least 1 diuretic.
Refractory hypertension is not uncommon. Studies have shown that about 20% to 35% of patients are refractory hypertension. However, this ratio will vary with time and place. The results of a survey in the United Kingdom showed that between 1996 and 2004, the prevalence of refractory hypertension rose from 0.93% to 2.07%. Here, by the end of 2021, a total of more than 35.53 million patients with hypertension have been managed, of which the blood pressure control rate is about 70% among patients who have been managed for 1 year. It should be noted that blood pressure is not controlled and refractory hypertension is a different concept.
The main causes of refractory hypertension can be simply divided into 3 categories, namely poor treatment adherence, differences in blood pressure measurements, and disease or drug effects. The so-called treatment compliance with the law, simply put, is disobedience, specifically, mainly reflected in 2 aspects, 1 is not to take medicine according to the norms, can not be punctual, think of taking medicine, or often take insufficient amount of medicine or missed. 2 is the lifestyle does not listen to advice, for example, excessive sodium intake, sedentary, often stay up late, smoke, drink. For such patients, patient persuasion is needed to help patients raise awareness.
Refractory hypertension may also be a manifestation of differences in blood pressure measurements, and the common case is laboratory hypertension. Such patients, when measuring themselves, can meet the standard, but when they go to the hospital for examination, the blood pressure rises beyond the range of the standard. Studies have found that about 25% of patients with refractory hypertension have a blood pressure value that meets the standard when undergoing 24-hour ambulatory blood pressure monitoring, with systolic blood pressure below 135 mmHg and diastolic blood pressure below 85 mmHg. Therefore, if diagnosed with refractory hypertension, self-measurement and recording can be strengthened, or 24-hour ambulatory blood pressure monitoring can be performed to avoid misdiagnosis. In addition, in some elderly patients, there may be severe atherosclerosis, which affects the accuracy of blood pressure measurements.
Refractory hypertension may also be a manifestation of secondary disease or drug effects. Secondary disease factors, mainly including diabetes mellitus, primary hyperaldosteronism, atherosclerotic renovascular disease, sleep apnea syndrome, chronic kidney disease. Factors influencing drugs, mainly include oral contraceptives, nonsteroidal anti-inflammatory drugs, erythropoietin, steroids, antitumor drugs, excessive licorice, ephedra and other herbs.
Through the above analysis, it is not difficult to see that the blood pressure is not up to standard, and there are a variety of influencing factors. A professional evaluation is required to confirm the diagnosis of refractory hypertension. Some scholars believe that the underlying cause of refractory hypertension is sodium retention, and the additional use of the diuretic spironolactone can help patients meet blood pressure control standards. Therefore, scholars recommend redefining refractory hypertension, only those who use a combination of 3 antihypertensive drugs, and the use of spironolactone, it is still difficult to make blood pressure up to standard, diagnosis of refractory hypertension. In recent years, coping strategies for refractory hypertension have become increasingly abundant, such as radiofrequency ablation and electrical stimulation of the carotid sinus. For ordinary people, if you take several drugs, blood pressure is still not up to standard, first of all, you need to review your own treatment compliance and lifestyle, while strengthening blood pressure monitoring, and timely communication with the doctor, comprehensive examination, and adjust the treatment plan, for example, take spironolactone diuretics, only by controlling blood pressure within the standard range, can you reduce the impact of complications.
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