David Parra    美国范德比尔特儿童医院   

    <International Circulation>: What’s the prevalence of true resistant hypertension? What are the clinical characteristics of resistant hypertension?

   《国际循环》：真性顽固性高血压的患病率是多少？顽固性高血压的临床特征是什么？

    Dr Parra:The prevalence of true resistant hypertension hasn’t really been well defined. A lot of the time， it is because the measurements were office-based blood pressure measurements and the presence of a significant white-coat effect or pseudo-resistance was not measured. Some of the best data we have has just recently come out and will be published in Circulation and soon to be published in JACC in May but it is available early online as of a couple of days ago. It comes from the Spanish Ambulatory Blood Pressure Monitoring Registry in which from the patients in the registry they identified a prevalence of resistant hypertension of about 12%. They used the definition of requiring three blood pressure medications including a diuretic and they confirmed the prevalence with the use of 24-hour ambulatory blood pressure monitoring sessions. Of note in that study， approximately 37% of patients who had been defined as resistant hypertension were found to have pseudo-resistance. When you look at the American Society of Hypertension Registry in the United States， the prevalence of resistant hypertension is about 30% in that registry but that registry is limited mainly to the south-east United States where we know we have a higher prevalence of hypertension and co-morbidities. Additionally， the protocols to define resistant hypertension aren’t the same between both registries. So I think you can say with some degree of confidence now looking at the data from the Spanish blood pressure registry， that the prevalence of true resistant hypertension is probably at least 12% and could range all the way up to 20 or 30% depending on the population that you are looking at. The key thing is that in patients who present with resistant hypertension， the prevalence of pseudo-resistance appears to range anywhere from about 25-30% up to 37% in that recent study.

    Parra博士：真性顽固性高血压的患病率尚未有明确的定论。因为很多时候其测定是基于诊室的血压检测，白大衣效应或假性顽固性高血压的情况的存在情况也未得到确定。我们最近得到的最佳数据即将在《循环》杂志上发表，很快还将在5月的JACC上刊登，但在几天前已经可以在线看到。数据来自西班牙动态血压监测注册研究，在这项研究中，他们通过注册患者中确定的顽固性高血压的患病率约为12%。他们采用了需要包括一种利尿剂在内的3种降压药物的定义，利用24小时动态血压监测对患病率进行测定。在该研究中值得注意的是，已被确定为顽固性高血压的患者中约37%的被发现为假性顽固性。美国的美国高血压学会注册研究中顽固性高血压的患病率约为30%，但该注册处主要限于美国东南部，我们知道在该区域高血压和合并症的患病率较高。另外，两项注册研究确定顽固性高血压的方法不同。因此我认为，目前根据来自西班牙血压注册研究的数据，你可以带着某种程度的自信说真性顽固性高血压的患病率可能至少是12%，且依据你所观察的人群，可一直升高至20%或30%。关键问题是，该项近期研究显示，在呈现顽固性高血压的患者中，假性顽固性的发生率范围可能为25%~30%直至37%。