邹金兵 韩津津 韩丽华

    【摘要】 自20世纪50年代末，难治性高血压(resistant hypertension，RH)这一概念被提出来至今已有60年余，人们对其研究也在不断深入。截至目前，难治性高血压被定义为：在改善生活方式前提下尽管同时使用3类抗高血压药物治疗4周后，但患者血压(blood pressure，BP)仍高于目标值的高血压患者。目前全球患病率9%～18%，其中优化药物治疗仍然是难治性高血压管理的基石，来自临床试验的可用数据表明，可使用基于器械的治疗方法控制大多数顽固性高血压，例如肾脏去神经支配、压力反射激活治疗或动静脉吻合，但安全性、有效性有待商榷。因此，器械治疗可能仍然是真正难治性高血压患者的最后手段。本文就难治性高血压的定义、流行病学、机制、预后、最新治疗进展等做一综述，旨在为临床治疗难治性高血压提供一定参考。

    【关键词】 难治性高血压 药物治疗 器械治疗 心血管风险

    [Abstract] Since the late 1950s， the concept of resistant hypertension has been proposed for more than 60 years， its research is also deepening. Up to now， resistant hypertension is defined as hypertensive patients whose blood pressure (BP) is still higher than the target value despite concurrent treatment with class 3 antihypertensive drugs for 4 weeks under the premise of lifestyle improvement. With a worldwide prevalence of approximately 9% to 18%， of which optimal medical therapy remains the cornerstone in the management of resistant hypertension， available data from clinical trials indicate that most refractory hypertension can be controlled with instrument-based therapies ......