Resistant HTN

三線利尿仍高 (BP >goal on ≥3 drugs incl diuretic; HTN 2018;72:e53)

參考➡️ Pharmacological Treatment of Hypertension: From the Golden Trio to the Octet

1. Exclude: 2° causes (see table) and pseudoresistance: inaccurate measure (cuff size), diet noncomp (↑ Na), poor Rx compliance/dosing, white coat HTN (✓ ABPM)
2. Ensure effective diuresis (chlorthalidone or indapamide >HCTZ; loop >thiazide if eGFR <30)
3. Can add aldosterone antagonist (Lancet 2015;386:2059), β-blocker (particularly vasodilators such as carvedilol, labetalol, or nebivolol), α-blocker, or direct vasodilator
4. Consider renal denervation therapy (Lancet 2018;391:2346; 2021;397:2476)

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1. 排除2nd原因、量錯、太鹹、沒吃藥、白袍
2. 利尿劑加爆
3. 再加藥
4. 考慮去腎神經治療（Lancet 2018；391：2346；2021；397：2476）

• Aldosterone and Treatment-Resistant Hypertension Figure: RAAS: Renin inhibitor ⇒ ACEi ⇒ angiotensin receptor blocker ⇒ spironolactone

Explain by ChatGPT

Resistant HTN:

• High blood pressure that does not respond well to treatment
• Exclude: 2° causes (see table) and pseudoresistance: inaccurate measure (cuff size), diet noncomp (↑ Na), poor Rx compliance/dosing, white coat HTN (✓ ABPM)
• Ensure effective diuresis (chlorthalidone or indapamide
• Can add aldosterone antagonist (Lancet 2015;386:2059), β-blocker (particularly vasodilators such as carvedilol, labetalol, or nebivolol), α-blocker, or direct vasodilator
• Consider renal denervation therapy (Lancet 2018;391:2346; 2021;397:2476)

窩的英文不太好

耐高溫：

• 對治療反應不佳的高血壓
• 排除：2° 原因（見表）和假性耐藥：測量不准確（袖帶尺寸）、飲食不良 (↑ Na)、不良的 Rx 依從性/劑量、白大衣 HTN (✓ ABPM)
• 確保有效利尿（氯噻酮或吲達帕胺
• 可以添加醛固酮拮抗劑 (Lancet 2015;386:2059)、β-受體阻滯劑（特別是卡維地洛、拉貝洛爾或奈必洛爾等血管擴張劑）、α-受體阻滯劑或直接血管擴張劑
• 考慮去腎神經治療（Lancet 2018；391：2346；2021；397：2476）