Достижения и вызовы в борьбе с артериальной гипертонией. По материалам конгресса «Человек и лекарство» и III Кардио-Саммита

Евсютина Ю.В. Достижения и вызовы в борьбе с артериальной гипертонией. По материалам конгресса «Человек и лекарство» и III Кардио-Саммита. CardioСоматика. 2019; 10 (4): 55–58. DOI: 10.26442/22217185.2019.4.190597

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Evsyutina Yu.V. Achievements and challenges in the fight against arterial hypertension. Based on “Human and Medicine Congress” and 3rd Cardiovascular Summit materials. Cardiosomatics. 2019; 10 (4): 55–58. DOI: 10.26442/22217185.2019.4.190597

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Аннотация

Артериальная гипертония (АГ) является лидирующей причиной кардиоваскулярной заболеваемости и смертности. По данным российских и зарубежных исследований, ее частота составляет примерно 40%. В ближайшие годы можно ожидать увеличения численности пациентов. АГ является основным независимым фактором риска ишемической болезни сердца для всех возрастных групп. Современные антигипертензивные препараты позволяют обеспечить хороший контроль артериального давления и снизить частоту осложнений АГ и смертность. При назначении антигипертензивной терапии необходимо стремиться к достижению целевого уровня артериального давления, для большинства пациентов – 130 и 80 мм рт. ст. и менее. При назначении комбинированной терапии предпочтение следует отдавать фиксированным комбинациям. Примерно у 10% пациентов с АГ наблюдается резистентность к проводимой терапии. Такие больные часто нуждаются в расширенном диагностическом поиске с целью исключения псевдорезистентности и вторичной АГ. Одной из основных причин псевдорезистентности является плохая приверженность терапии. Пациенты с резистентной АГ имеют более высокий риск неблагоприятных исходов по сравнению с пациентами без данной формы заболевания.

Ключевые слова: артериальная гипертония, ишемическая болезнь сердца, резистентная артериальная гипертония, антигипертензивная терапия.

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Arterial hypertension is the leading cause of cardiovascular morbidity and mortality. According to Russian and international studies, prevalence of hypertension is approximately 40%. In the next years an increase in the number of patients can be expected. Hypertension is the main independent risk factor for coronary heart disease for all age groups. Modern antihypertensive drugs can provide good control of blood pressure and reduce the incidence of complications and mortality. By prescribing antihypertensive therapy, it is necessary to achieve the target level of blood pressure, for most patients ≤130/80 mm Hg. When prescribing combination therapy, preference should be given to fixed combinations. Approximately 10% of patients with hypertension have resistance to therapy. Such patients often need an extended diagnostic search to exclude pseudoresistance and secondary hypertension. One of the main causes of pseudoresistance is poor adherence to therapy. Patients with resistant hypertension have a higher risk of adverse outcomes compared with patients without this type of disease.

Key words: arterial hypertension, coronary heart disease, resistant hypertension, antihypertensive drugs.

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Список литературы

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[Chazova I.E., Zhernakova Yu.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16 (1): 6–31 (in Russian).]
9. Lewington S, Clarke R, Qizilbash N et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–13.
10. Franklin SS, Larson MG, Khan SA et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001; 103: 1245–9.
11. Miura K, Daviglus ML, Dyer AR et al. Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Arch Intern Med 2001; 161: 1501–8.
12. Daugherty SL, Powers JD, Magid DJ et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012; 125: 1635–42.
13. Sim JJ, Bhandari SK, Shi J et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney Int 2015; 88: 622–32.
14. Thomas G, Xie D, Chen HY et al. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the Chronic Renal Insufficiency Cohort Study. Hypertension 2016; 67: 387–96.
15. Smith SM, Huo T, Delia Johnson B et al. Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study. J Am Heart Assoc 2014; 3: e000660
16. Smith SM, Gong Y, Handberg E et al. Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension. J Hypertens 2014; 32: 635–43.
17. Jin CN, Liu M, Sun JP et al. The prevalence and prognosis of resistant hypertension in patients with heart failure. PLoS One. 2014; 9: e114958
18. Irvin MR, Booth JN, Shimbo D et al. Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality. J Am Soc Hypertens 2014; 8: 405–13.
19. Egan BM, Kai B, Wagner CS et al. Blood pressure control provides less cardiovascular protection in adults with than without apparent treatment-resistant hypertension. J Clin Hypertens (Greenwich) 2016; 18: 817–24.
20. Carey RM, Calhoun DA, Bakris GL et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2018; 72 (5): e53–e90.

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1. WHO. Raised blood pressure. https://www.who.int/gho/ncd/risk_ factors/blood_pressure_prevalence_text/en/
2. Muromtseva G.A., Kontsevaia A.V., Konstantinov V.V. et al. Rasprostranennost' faktorov riska neinfektsionnykh zabolevaniĭ v rossiĭskoĭ populiatsii v 2012–2013 gg. Rezul'taty issledovaniia ESSE-RF. Kardiovaskuliarnaia terapiia i profilaktika. 2014; 13 (6): 4–11 (in Russian).
3. Chow CK, Teo KK, Rangarajan S et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310: 959–68.
4. Whelton P, He J, Appel L et al. Primary prevention of hypertension: clinical and public health advisory from the national high blood pressure education program. J Am Med Assoc 2002; 288: 1882–8.
5. Zhou D, Xi B, Zhao M et al. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep 2018; 8 (1): 9418.
6. Musini VM, Tejani AM, Bassett K et al. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database of Systematic Reviews 2019; 6: CD000028.
7. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39 (33): 3021–104.
8. Chazova I.E., Zhernakova Yu.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16 (1): 6–31 (in Russian).
9. Lewington S, Clarke R, Qizilbash N et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–13.
10. Franklin SS, Larson MG, Khan SA et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001; 103: 1245–9.
11. Miura K, Daviglus ML, Dyer AR et al. Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Arch Intern Med 2001; 161: 1501–8.
12. Daugherty SL, Powers JD, Magid DJ et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012; 125: 1635–42.
13. Sim JJ, Bhandari SK, Shi J et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney Int 2015; 88: 622–32.
14. Thomas G, Xie D, Chen HY et al. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the Chronic Renal Insufficiency Cohort Study. Hypertension 2016; 67: 387–96.
15. Smith SM, Huo T, Delia Johnson B et al. Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study. J Am Heart Assoc 2014; 3: e000660
16. Smith SM, Gong Y, Handberg E et al. Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension. J Hypertens 2014; 32: 635–43.
17. Jin CN, Liu M, Sun JP et al. The prevalence and prognosis of resistant hypertension in patients with heart failure. PLoS One. 2014; 9: e114958
18. Irvin MR, Booth JN, Shimbo D et al. Apparent treatment-resistant hypertension and risk for stroke, coronary heart disease, and all-cause mortality. J Am Soc Hypertens 2014; 8: 405–13.
19. Egan BM, Kai B, Wagner CS et al. Blood pressure control provides less cardiovascular protection in adults with than without apparent treatment-resistant hypertension. J Clin Hypertens (Greenwich) 2016; 18: 817–24.
20. Carey RM, Calhoun DA, Bakris GL et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2018; 72 (5): e53–e90.

Авторы

Ю.В. Евсютина

ФГБУ «Национальный медицинский исследовательский центр профилактической медицины» Минздрава России, Москва, Россия
evsyutina.yulia@gmail.com

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Yulia V. Evsyutina

National Medical Research Center for Preventive Medicine, Moscow, Russia
evsyutina.yulia@gmail.com

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