Dirençli Hipertansiyon

Year 2017, Volume: 5 Issue: 5, 35 - 39, 04.05.2017

Uzm. Dr. Habil Yücel

Abstract

Öz

Dirençli hipertansiyon diüretik içeren en az 3 antihipertansif ilacın tam veya tolere edilebilen en yüksek dozuna rağmen kan basıncının en az 140/90mmHg olması olarak tarif edilir. Dirençli hipertansiyon hipertansif hastaların %9-18’inde gözüken ciddi bir tıbbi durumdur. Obezite, diabet ve kronik böbrek hastalığı gibi ko-morbid durumlarlasıklıkla ilişkilidir. Hipertansiyon ve özellikle dirençli hipertansiyon patogenezinde renin-anjiyotensin sistemi, böbrekler ve sempatik sinir sistemi gibi farklı mekanizmalar vardır. Dirençli hipertansiyon tedavisinde anjiyotensin-dönüştürücü enzim inhibitörleri, anjiyotensin II reseptör blokerleri, diüretikler, uzun-etkili kalsiyum kanal blokerlerive mineralokortikoid reseptör antagonistlerini içeren çoklu ilaç tedavisinin etkili olduğu gösterilmiştir. Bununla birlikte, renal denervasyon veya barorefleks aktivasyon tedavisi gibi yeni tedaviler kan basıncı düşürme süreçlerinde yeni bir yol yaratabilirler.

Keywords

dirençli hipertansiyon, renal denervasyon, barorefleks aktivasyon terapisi

Resistant Hypertension

Abstract

Abstract

Resistant hypertension is defined by a blood pressure of at least 140/90 mmHg despite treatment with full doses or maximum tolerated doses of at least three antihypertensive medications, including a diuretic. Resistant hypertension is a severe medical condition which is estimated to appear in 9-18% of hypertensive patients. Resistant HTNis frequently associated with comorbidities such as obesity, diabetes, and chronic kid-ney disease. Different mechanisms are involved in the pathogenesis of hypertension and particularly in resistant hypertension: the reninangiotensin-aldosterone system, the kidneys, and the sympathetic nervous system. A multidrug  therapy including angiotensin- converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, diuretics, long-acting calcium channel blockers and mineralocorticoid receptor antagonistshas been demonstrated to be effective in resistant hypertension treatment. Additionally, innovative therapies, e.g. a renal denervation or baroreflex activation therapy, may create a novel pathway of blood pressure lowering procedures.

Keywords

Resistant hypertension, renal denervation, baroreflexactivation therapy

References

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