276.2 🩺 國考版

276.2.1 高頻考點

276.2.1.1 Definitions

  • ACC/AHA 2017: ≥ 130/80
  • ESC 2023: ≥ 140/90
  • ABPM diagnostic: 24h ≥ 130/80, day ≥ 135/85, night ≥ 120/70
  • HBPM diagnostic: ≥ 135/85

276.2.1.2 Secondary HTN — When to Test (Red Flags)

  • Young (< 30) or new severe HTN
  • Resistant HTN (3 drugs incl diuretic at max dose)
  • Hypokalemia without diuretic
  • Episodic
  • Target organ damage out of proportion

276.2.1.3 Top Secondary Causes

  1. Primary aldosteronism (5-10%) — aldosterone/renin ratio
  2. OSA (30-40% of HTN; treat with CPAP)
  3. Renal artery stenosis (atherosclerotic or FMD)
  4. Pheochromocytoma (24h urine or plasma metanephrines)
  5. CKD (eGFR + UA)
  6. Cushing’s (cortisol screening)
  7. Hyperthyroidism
  8. Coarctation (arm-leg BP gradient)

276.2.1.4 Drug-Induced HTN

  • NSAIDs, OCPs, steroids, decongestants, EPO, calcineurin inh, cocaine, alcohol

276.2.1.5 Key Trials

  • SPRINT (2015): intensive (< 120) vs standard (< 140) — ↓ MACE, ↓ mortality in non-DM
  • STEP (2021): similar benefit in elderly Chinese (60-80)
  • PATHWAY-2 (2015): spironolactone best add-on for resistant HTN
  • SYMPLICITY HTN-3 (2014): renal denervation initially negative, RADIANCE-HTN + SPYRAL-HTN-OFF MED (2018-2020) showed BP effect with new technology

276.2.2 易混淆比范

Type BP Pattern Same CV Risk?
Sustained HTN High office + High ABPM Highest
White coat High office + Normal ABPM Slightly ↑ (not normal)
Masked Normal office + High ABPM Same as sustained
Nocturnal High BP at night High (esp reverse dipper)

276.2.2.1 Hypertensive Retinopathy (Keith-Wagener-Barker)

  • Grade 1: arteriolar narrowing
  • Grade 2: AV nicking
  • Grade 3: hemorrhages, exudates, cotton wool spots
  • Grade 4: papilledema (malignant HTN)