首诊难治性高血压的全科诊治思路

高血压是威胁我国居民健康的主要慢性病之一。其中，难治性高血压（RH）是一种特殊类型的高血压，其发病机制及病因复杂，可使患者心血管风险和预后不良的概率增加，危害更大，需要得到全科医生的重点关注。目前虽然国内外已出台了一系列RH管理相关的指南，但是全科医生对此疾病的认知和理解水平参差不齐，在实际工作中对RH的诊断、治疗及管理不够规范。本研究报道了１例血压控制逐渐达标、首诊在社区的RH患者的诊疗经过，结合相关文献，通过介绍案例，分析诊疗过程，剖析诊疗思路，总结诊治经验，以期为在岗全科医生或参加全科住院医师规范化培训的学员诊治RH患者提供借鉴。

A General Practice-based Approach to the Management of Resistant Hypertension First Diagnosed in the Community

Hypertension is one major chronic disease that threatens the health of Chinese people. Resistant hypertension is a special type of hypertension with complex pathogenesis and etiology, which is more harmful since it can increase the probability of cardiovascular disease and poor prognosis, suggesting that it should be a focus of general practitioners. Although a series of guidelines on the management of resistant hypertension have been released, general practitioners' knowledge and understanding of this disease are various, and the diagnosis, treatment and management of resistant hypertension performed by them are not sufficiently standardized. We reported a case of resistant hypertension first diagnosed in the community, whose blood pressure gradually reached the target level after treatment. Based on the review of relevant literature, we analyzed the process and ideasof managementof this case, and gave a summary of the treatment experience, providing a reference for incumbent general practitioners and trainees attending the standardized general residency program to treat patients with resistant hypertension.