Актуализация подходов к ведению пациентов в свете новых европейских рекомендаций по артериальной гипертензии: аналитический обзор

Ларина В.Н., Вартанян Е.А., Фёдорова Е.В., Михайлусова М.П., Сайно О.В., Миронова Т.Н. Актуализация подходов к ведению пациентов в свете новых европейских рекомендаций по артериальной гипертензии: аналитический обзор // CardioСоматика. 2023. Т. 14, № 3. С. 187–196.
DOI: https://doi.org/10.17816/CS567844

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Larina VN, Vartanyan EA, Fedorova EV, Mikhaylusova MP, Sayno OV, Mironova TN. Updating approaches to patient management in the light of new European guidelines on arterial hypertension: analytical review. Cardiosomatics. 2023;14(3):187–196. DOI: https://doi.org/10.17816/CS567844

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Аннотация

Данные эпидемиологических исследований свидетельствуют о значительной распространённости сердечно-сосудистых заболеваний, в том числе артериальной гипертензии (АГ), и наличии высокого риска осложнений, что обусловливает необходимость модифицированного подхода к тактике контроля и лечения пациентов с АГ. В статье проанализированы основные направления обновлённых европейских рекомендаций по АГ, которые позволяют актуализировать в амбулаторной практике дифференцированный подход к лечению разных групп пациентов, обновлена информация о вспомогательных факторах риска сердечно-сосудистых заболеваний. Представлены новые фенотипы АГ, необходимость их идентификации с обновлённой информацией по диагностике и лечению истинно резистентной гипертензии и ночной АГ. По сравнению с предыдущими рекомендациями появились новые сведения об использовании и местоположении почечной денервации для антигипертензивного лечения у пациентов с хронической болезнью почек. Актуализированные изменения в новых европейских клинических рекомендациях отражают необходимость дифференцированного подхода к достижению целевых показателей амбулаторного артериального давления в разных возрастных группах, учитывающих функциональные уровни старения, сопутствующую патологию и фенотипы АГ, что имеет важное клиническое значение для врача первичного звена здравоохранения, а также позволяет значительно снизить риск сердечно-сосудистых осложнений.

Ключевые слова: артериальная гипертензия; сердечно-сосудистые заболевания; факторы риска; поражение органов-мишеней; фенотипы артериальной гипертензии; резистентная артериальная гипертензия; сердечно-сосудистые осложнения

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Data from epidemiological studies show a high prevalence of cardiovascular diseases, including arterial hypertension (AH) and the risk of complications, with changes in AH control and treatment techniques. The review article summarizes the main directions of the new European guidelines on hypertension, which help implement different patient groups in outpatient practice. Secondary risk factors for cardiovascular disease are revised in the new clinical guidelines. The recommendation outlines a diagnostic and therapeutic approach for resistant arterial hypertension, its associated phenotypes, and night-time hypertension. The use and position of renal denervation for antihypertensive treatment have been updated compared with previous recommendations. The new European clinical guidelines reflect a differentiated approach to target indicators of ambulatory blood pressure in different age groups, with functional levels of aging, comorbidity, and AH phenotypes, which is of great clinical importance for a primary care physician and can significantly reduce the risk of heart disease vascular complications.

Keywords: arterial hypertension; cardiovascular diseases; risk factors; target organ damage; arterial hypertension phenotypes; resistant arterial hypertension; cardiovascular complications

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Список литературы

1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants // Lancet. 2021. Vol. 398, N 10304. P. 957–980. doi: 10.1016/S0140-6736(21)01330-1
2. Zhou B., Perel P., Mensah G.A., Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension // Nat Rev Cardiol. 2021. Vol. 18, N 11. P. 785–802. doi: 10.1038/s41569-021-00559-8
3. Баланова Ю.А., Шальнова С.А., Куценко В.А., и др. Вклад артериальной гипертонии и других факторов риска в выживаемость и смертность в российской популяции // Кардиоваскулярная терапия и профилактика. 2021. Т. 20, № 5. С. 3003. doi: 10.15829/1728-8800-2021-3003
4. Mancia G., Kreutz Co-Chair R., Brunström M., et al. 2023 ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH) // J Hypertens. 2023. Epub ahead of print. doi: 10.1097/HJH.0000000000003480
5. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) // Eur Heart J. 2018. Vol. 39, N 33. P. 3021–3104. doi: 10.1093/eurheartj/ehy339
6. Unger T., Borghi C., Charchar F., et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines // Hypertension. 2020. Vol. 75, N 6. P. 1334–1357.
doi: 10.1161/HYPERTENSIONAHA.120.15026
7. Brunstrom M., Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis // JAMA Intern Med. 2018. Vol. 178, N 1. P. 28–36. doi: 10.1001/jamainternmed.2017.6015
8. Thomopoulos C., Parati G., Zanchetti A. Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with highnormal and normal blood pressure: overview and meta-analyses of randomized trials // J Hypertens. 2017. Vol. 35, N 11. P. 2150–2160. doi: 10.1097/HJH.0000000000001547
9. Xu W., Goldberg S.I., Shubina M., Turchin A. Optimal systolic blood pressure target, time to intensification, and time to follow-up in treatment of hypertension: population based retrospective cohort study // BMJ. 2015. N 350. P. h158. doi: 10.1136/bmj.h158
10. Parati G., Kjeldsen S., Coca A., et al. Adherence to single-pill versus free-equivalent combination therapy in hypertension: a systematic review and meta-analysis // Hypertension. 2021. Vol. 77, N 2. P. 692–705. doi: 10.1161/HYPERTENSIONAHA.120.15781
11. Egan B.M., Bandyopadhyay D., Shaftman S.R., et al. Initial monotherapy and combination therapy and hypertension control the first year // Hypertension. 2012. Vol. 59, N 6.
P. 1124–1131. doi: 10.1161/HYPERTENSIONAHA.112.194167
12. Бойцов С.А., Карпов Ю.А., Логунова Н.А., и др. Пути повышения приверженности к антигипертензивной терапии // Российский кардиологический журнал. 2022. Т. 27,
№ 9. С. 5202. doi: 10.15829/1560-4071-2022-5202
13. Mancia G., Rea F., Corrao G., Grassi G. Two-drug combinations as first-step antihypertensive treatment // Circ Res. 2019. Vol. 124, N 7. P. 1113–1123.
doi: 10.1161/CIRCRESAHA.118.313294
14. Egan B.M., Kjeldsen S.E., Narkiewicz K., et al. Single-pill combinations, hypertension control and clinical outcomes: potential, pitfalls and solutions // Blood Press. 2022. Vol. 31, N 1. P. 164–168. doi: 10.1080/08037051.2022.2095254
15. Gradman A.H., Parise H., Lefebvre P., et al. Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients: a matched cohort study // Hypertension. 2013. Vol. 61, N 2. P. 309–318. doi: 10.1161/HYPERTENSIONAHA.112.201566
16. De Nicola L., Gabbai F.B., Agarwal R., et al. Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients // J Am Coll Cardiol. 2013. Vol. 61, N 24.
P. 2461–2467. doi: 10.1016/j.jacc.2012.12.061
17. Salazar M.R., Espeche W.G., Balbin E., et al. Prevalence of isolated nocturnal hypertension according to 2018 European Society of Cardiology and European Society of Hypertension office blood pressure categories // J Hypertens. 2020. Vol. 38, N 3. P. 434–440. doi: 10.1097/HJH.0000000000002278
18. Cuspidi C., Paoletti F., Tadic M., et al. Nocturnal blood pressure: the dark side of white-coat hypertension // J Hypertens. 2020. Vol. 38, N 12. P. 2404–2408.
doi: 10.1097/HJH.0000000000002541
19. Cuspidi C., Sala C., Tadic M., et al. Nocturnal hypertension and subclinical cardiac and carotid damage: an updated review and meta-analysis of echocardiographic studies // J Clin Hypertens (Greenwich). 2016. Vol. 18, N 9. P. 913–920. doi: 10.1111/jch.12790
20. Carey R.M., Sakhuja S., Calhoun D.A., et al. Prevalence of apparent treatment-resistant hypertension in the United States // Hypertension. 2019. Vol. 73, N 2. P. 424–431.
doi: 10.1161/HYPERTENSIONAHA.118.12191
21. Egan B.M., Zhao Y., Li J., et al. Prevalence of optimal treatment regimens in patients with apparent treatment resistant hypertension based on office blood pressure in a community-based practice network // Hypertension. 2013. Vol. 62, N 4. P. 691–697. doi: 10.1161/HYPERTENSIONAHA.113.01448
22. Kario K., Hoshide S., Narita K., et al. Cardiovascular prognosis in drug-resistant hypertension stratified by 24-hour ambulatory blood pressure: the JAMP Study // Hypertension. 2021. Vol. 78, N 6. P. 1781–1790. doi: 10.1161/HYPERTENSIONAHA.121.18198
23. Li S., Schwartz J.E., Shimbo D., et al. Booth JN 3rd, et al. Estimated prevalence of masked asleep hypertension in US adults // JAMA Cardiol. 2021. Vol. 6, N 5. P. 568–573.
doi: 10.1001/jamacardio.2020.5212
24. Ruilope L.M., Rodriguez-Sanchez E., Navarro-Garcia J.A., et al. Resistant hypertension: new insights and therapeutic perspectives // Eur Heart J Cardiovasc Pharmacother. 2020.
Vol. 6, N 3. P. 188–193. doi: 10.1093/ehjcvp/pvz057
25. Fujiwara T., Hoshide S., Kanegae H., Kario K. Cardiovascular event risks associated with masked nocturnal hypertension defined by home blood pressure monitoring in the J-HOP Nocturnal Blood Pressure Study // Hypertension. 2020. Vol. 76, N 1. P. 259–266.
doi: 10.1161/HYPERTENSIONAHA.120.14790
26. Schmieder R.E. Renal denervation in patients with chronic kidney disease: current evidence and future perspectives // Nephrol Dial Transplant. 2022. Vol. 38, N 5. P. 1089–1096.
doi: 10.1093/ndt/gfac189
27. Grassi G., Seravalle G., Brambilla G., et al. Blood pressure responses to renal denervation precede and are independent of the sympathetic and baroreflex effects // Hypertension. 2015. Vol. 65, N 6. P. 1209–1216. doi: 10.1161/HYPERTENSIONAHA.114.04823
28. Biffi A., Dell’Oro R., Quarti-Trevano F., et al. Effects of renal denervation on sympathetic nerve traffic and correlates in drug-resistant and uncontrolled hypertension: a systematic review and meta-analysis // Hypertension. 2023. Vol. 80, N 3. P. 659–667. doi: 10.1161/HYPERTENSIONAHA.122.20503
29. Schmieder R.E., Mahfoud F., Mancia G., et al. Clinical Event Reductions in High-Risk Patients After Renal Denervation Projected from the Global SYMPLICITY Registry // Eur Heart J Qual Care Clin Outcomes. 2023. Vol. 9, N 6. P. 575–582. doi: 10.1093/ehjqcco/qcac056

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1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–980. doi: 10.1016/S0140-6736(21)01330-1
2. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol.
2021;18(11):785–802. doi: 10.1038/s41569-021-00559-8
3. Balanova YuA, Shalnova SA, Kutsenko VA, et al. Contribution of hypertension and other risk factors to survival and mortality in the Russian population. Cardiovascular Therapy and Prevention. 2021;20(5):3003. (In Russ). doi: 10.15829/1728-8800-2021-3003
4. Mancia G, Kreutz Co-Chair R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023. Epub ahead of print.
doi: 10.1097/HJH.0000000000003480
5. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–3104. doi: 10.1093/eurheartj/ehy339
6. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334–1357.
doi: 10.1161/HYPERTENSIONAHA.120.15026
7. Brunstrom M, Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(1):28–36. doi: 10.1001/jamainternmed.2017.6015
8. Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with highnormal and normal blood pressure: overview and meta-analyses of randomized trials. J Hypertens. 2017;35(11):2150–2160. doi: 10.1097/HJH.0000000000001547
9. Xu W, Goldberg SI, Shubina M, Turchin A. Optimal systolic blood pressure target, time to intensification, and time to follow-up in treatment of hypertension: population based retrospective cohort study. BMJ. 2015;350:h158. doi: 10.1136/bmj.h158
10. Parati G, Kjeldsen S, Coca A, et al. Adherence to single-pill versus free-equivalent combination therapy in hypertension: a systematic review and meta-analysis. Hypertension. 2021;77(2):692–705. doi: 10.1161/HYPERTENSIONAHA.120.15781
11. Egan BM, Bandyopadhyay D, Shaftman SR, et al. Initial monotherapy and combination therapy and hypertension control the first year. Hypertension. 2012;59(6):1124–1131.
doi: 10.1161/HYPERTENSIONAHA.112.194167
12. Boytsov SA, Karpov YuA, Logunova NA, et al. Ways to increase adherence to antihypertensive therapy. Russian Journal of Cardiology. 2022;27(9):5202. (In Russ).
doi: 10.15829/1560-4071-2022-5202
13. Mancia G, Rea F, Corrao G, Grassi G. Two-drug combinations as first-step antihypertensive treatment. Circ Res. 2019;124(7):1113–1123. doi: 10.1161/CIRCRESAHA.118.313294
14. Egan BM, Kjeldsen SE, Narkiewicz K, et al. Single-pill combinations, hypertension control and clinical outcomes: potential, pitfalls and solutions. Blood Press.
2022;31(1):164–168. doi: 10.1080/08037051.2022.2095254
15. Gradman AH, Parise H, Lefebvre P, et al. Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients: a matched cohort study. Hypertension. 2013;61(2):309–318. doi: 10.1161/HYPERTENSIONAHA.112.201566
16. De Nicola L, Gabbai FB, Agarwal R, et al. Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. J Am Coll Cardiol. 2013;61(24):2461–2467.
doi: 10.1016/j.jacc.2012.12.061
17. Salazar MR, Espeche WG, Balbin E, et al. Prevalence of isolated nocturnal hypertension according to 2018 European Society of Cardiology and European Society of Hypertension office blood pressure categories. J Hypertens. 2020;38(3):434–440. doi: 10.1097/HJH.0000000000002278
18. Cuspidi C, Paoletti F, Tadic M, et al. Nocturnal blood pressure: the dark side of white-coat hypertension. J Hypertens. 2020;38(12):2404–2408. doi: 10.1097/HJH.0000000000002541
19. Cuspidi C, Sala C, Tadic M, et al. Nocturnal hypertension and subclinical cardiac and carotid damage: an updated review and meta-analysis of echocardiographic studies. J Clin Hypertens (Greenwich). 2016;18(9):913–920. doi: 10.1111/jch.12790
20. Carey RM, Sakhuja S, Calhoun DA, et al. Prevalence of apparent treatment-resistant hypertension in the United States. Hypertension. 2019;73(2):424–431.
doi: 10.1161/HYPERTENSIONAHA.118.12191
21. Egan BM, Zhao Y, Li J, et al. Prevalence of optimal treatment regimens in patients with apparent treatment resistant hypertension based on office blood pressure in a community-based practice network. Hypertension. 2013;62(4):691–697. doi: 10.1161/HYPERTENSIONAHA.113.01448
22. Kario K, Hoshide S, Narita K, et al. Cardiovascular prognosis in drug-resistant hypertension stratified by 24-hour ambulatory blood pressure: the JAMP Study. Hypertension. 2021;78(6):1781–1790. doi: 10.1161/HYPERTENSIONAHA.121.18198
23. Li S, Schwartz JE, Shimbo D, et al. Booth JN 3rd, et al. Estimated prevalence of masked asleep hypertension in US adults. JAMA Cardiol. 2021;6(5):568–573.
doi: 10.1001/jamacardio.2020.5212
24. Ruilope LM, Rodriguez-Sanchez E, Navarro-Garcia JA, et al. Resistant hypertension: new insights and therapeutic perspectives. Eur Heart J Cardiovasc Pharmacother.
2020;6(3):188–193. doi: 10.1093/ehjcvp/pvz057
25. Fujiwara T, Hoshide S, Kanegae H, Kario K. Cardiovascular event risks associated with masked nocturnal hypertension defined by home blood pressure monitoring in the J-HOP Nocturnal Blood Pressure Study. Hypertension. 2020;76(1):259–266. doi: 10.1161/HYPERTENSIONAHA.120.14790
26. Schmieder RE. Renal denervation in patients with chronic kidney disease: current evidence and future perspectives. Nephrol Dial Transplant. 2022;38(5):1089–1096.
doi: 10.1093/ndt/gfac189
27. Grassi G, Seravalle G, Brambilla G, et al. Blood pressure responses to renal denervation precede and are independent of the sympathetic and baroreflex effects. Hypertension. 2015;65(6):1209–1216. doi: 10.1161/HYPERTENSIONAHA.114.04823
28. Biffi A, Dell’Oro R, Quarti-Trevano F, et al. Effects of renal denervation on sympathetic nerve traffic and correlates in drug-resistant and uncontrolled hypertension: a systematic review and meta-analysis. Hypertension. 2023;80(3):659–667. doi: 10.1161/HYPERTENSIONAHA.122.20503
29. Schmieder RE, Mahfoud F, Mancia G, et al. Clinical Event Reductions in High-Risk Patients After Renal Denervation Projected from the Global SYMPLICITY Registry. Eur Heart J Qual Care Clin Outcomes. 2023;9(6):575–582. doi: 10.1093/ehjqcco/qcac056

Авторы

В.Н. Ларина*, Е.А. Вартанян, Е.В. Фёдорова, М.П. Михайлусова, О.В. Сайно, Т.Н. Миронова

Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, Москва, Российская Федерация
*larinav@mail.ru

________________________________________________

Vera N. Larina*, Elena A. Vartanyan, Ekaterina V. Fedorova, Marina P. Mikhaylusova, Olga V. Sayno, Tatiyana N. Mironova

Pirogov Russian National Research Medical University, Moscow, Russian Federation
*larinav@mail.ru

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