頑固性高血壓的鑑別治療

Differential Diagnosis and Treatment of Resistant Hypertension

高血壓的控制對於患者相當重要，但是臨床上可以發現有部分患者已經使用三種以上且足量的降血壓藥物（其中必須包含利尿劑）其血壓值的控制仍未能順利達到目標血壓值，稱為頑固性高血壓（resistant hypertension）。頑固性高血壓的成因複雜，有時並未能切確釐清病因。然而，要診斷為頑固性高血壓前，首先要排除假性頑固性高血壓。假性頑固性高血壓的可能原因如血壓測量不準確引起的假性高血壓（pseudohypertension）、患者心理性的白袍性高血壓（white coat hypertension）、未給予患者最適當的藥物治療計劃使其血壓控制不良、患者服藥順從性差及不適當的生活習慣如攝取高鹽高油飲食等、生理性或藥物引起細胞外液體積膨脹、使用引發血壓上升藥物、或其他續發性高血壓等等。先排除假性頑固性高血壓後，並給予患者最適切的藥物治療計劃，才得以避免不必要的藥物治療及醫療資源的浪費。

The control of hypertension is very important for patients. Clinically, we find that some patients’ blood pressure still cannot reach target levels despite the use of three or more full dosage anti-hypertension drugs including diuretics. We call this form of hypertension “resistant hypertension”. The etiology of resistant hypertension is complicated and many times, there is no definitive etiology. However, before the diagnosis of resistant hypertension is made, we should exclude pseudo-resistant hypertension. Pseudo-resistant hypertension may be due to an incorrect blood pressure measurement, white coat hypertension, an unsuitable treatment plan, poor compliance, inadequate life style such as a high salt and fatty diet, the expansion of extra-cellular volume due to a drug, the physiological use of drug which increases blood pressure, or the presence of other secondary hypertension. To avoid unnecessary treatment and unnecessary medical resources, we should first rule out pseudo-resistant hypertension and provide the most adequate drug treatment plan based upon these findings.