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Резистентная артериальная гипертензия
Резистентная артериальная гипертензия
Родионов А.В., Юдин И.Г., Фомин В.В. Резистентная артериальная гипертензия. Consilium Medicum. 2021; 23 (1): 28–31. DOI: 10.26442/20751753.2021.1.200697
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Аннотация
В обзоре представлены современные данные о тактике обследования и лечения пациентов с резистентной артериальной гипертензией (РАГ). Распространенность РАГ составляет около 10–15%, при этом значительная часть случаев приходится на долю псевдорезистентности, связанной с низкой приверженностью терапии, нарушением техники измерения артериального давления, а также повышенной жесткостью артерий у пожилых людей. У большинства пациентов с РАГ необходимо исключать вторичные АГ, среди них чаще всего встречаются лекарственные АГ, связанные с приемом нестероидных противовоспалительных препаратов, назальных симпатомиметиков, оральных контрацептивов, а также синдром обструктивного апноэ сна и первичный гиперальдостеронизм. Вторичные АГ зачастую протекают малосимптомно, поэтому дообследование показано пациентам без классических признаков, свойственных этим заболеваниям. Фармакотерапия РАГ заключается в назначении высокодозовой комбинации антигипертензивных препаратов. К препаратами 1-й линии (блокаторы ренин-ангиотензиновой системы, антагонисты кальция, тиазидные диуретики) прежде всего следует добавлять антагонисты минералокортикоидных рецепторов, которые имеют хорошую доказательную базу (исследования PATHWAY-2, ReHOT), а затем другие препараты резерва. Продолжается изучение интервенционных методов лечения РАГ. На сегодняшней день доказана эффективность ренальной денервации. Продолжается изучение методики амплификации каротидного барорефлекса.
Ключевые слова: артериальная гипертензия, резистентная артериальная гипертензия, вторичная артериальная гипертензия, антигипертензивная терапия, ренальная денервация
Keywords: arterial hypertension, resistant arterial hypertension, secondary arterial hypertension, antihypertensive therapy, renal denervation
Ключевые слова: артериальная гипертензия, резистентная артериальная гипертензия, вторичная артериальная гипертензия, антигипертензивная терапия, ренальная денервация
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Keywords: arterial hypertension, resistant arterial hypertension, secondary arterial hypertension, antihypertensive therapy, renal denervation
Полный текст
Список литературы
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14. Williams B, Macdonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): A randomised, double-blind, crossover trial. Lancet 2015; 386 (10008): 2059–68.
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16. Yugar-Toledo JC, Modolo R, de Faria AP, Moreno H. Managing resistant hypertension: Focus on mineralocorticoid-receptor antagonists. Vasc Health Risk Manag 2017; 13: 403–11.
17. Oliveras A, Armario P, Clarà A, et al. Spironolactone versus sympathetic renal denervation to treat true resistant hypertension: Results from the DENERVHTA study – A randomized controlled trial. J Hypertens 2016; 34 (9): 1863–71.
18. Mahfoud F, Mancia G, Schmieder R, et al. Renal Denervation in High-Risk Patients With Hypertension. J Am Coll Cardiol 2020; 75 (23): 2879–88.
19. Bates MC, Stone GW, Chen CY, Spiering W. Device profile of the MobiusHD EVBA system for the treatment of resistant hypertension: overview of its mechanism of action, safety and efficacy. Expert Rev Med Devices 2020; 17 (7): 649–58. DOI: 10.1080/17434440.2020.1779054
2. Denolle T, Chamontin B, Doll G, et al. Management of resistant hypertension: Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology. J Hum Hypertens 2016; 30 (11): 657–63.
3. Sowers J, White W, Pitt B. The Effects of Cyclooxygenase-2 Inhibitors and Nonsteroidal Anti-inflammatory Therapy on 24-Hour Blood Pressure in Patients With Hypertension, Ostheoarthritis, and Type 2 Diabetes Mellitus. Arch Intern Med 2005; 165: 161–9.
4. Karateev AE, Nasonov EL, Yakhno NN, et al. Clinical guidelines “Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice“. Mod Rheumatol J 2015; 1: 4.
5. Combe B, Swergold G, McLay J, et al. Cardiovascular safety and gastrointestinal tolerability of etoricoxib vs diclofenac in a randomized controlled clinical trial (The MEDAL study). Rheumatology 2009; 48 (4): 425–32.
6. Frohlich ED. Classification of resistant hypertension. Hypertension 1988; 11 (3): II.67–70.
7. Gifford RW. An algorithm for the management of resistant hypertension. Hypertension 1988; 11 (3): II.101–5.
8. Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: The most common secondary cause of hypertension associated with resistant hypertension. Hypertension 2011; 58 (5): 811–7.
9. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117 (25): 510–26.
10. 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: 53–90.
11. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37 (36): 2768–801.
12. Acelajado MC, Hughes ZH, Oparil S, Calhoun DA. Treatment of Resistant and Refractory Hypertension. Circ Res 2019; 124 (7): 1061–70.
13. Bobrie G, Frank M, Azizi M, et al. Sequential nephron blockade versus sequential renin-angiotensin system blockade in resistant hypertension: A prospective, randomized, open blinded endpoint study. J Hypertens 2012; 30 (8): 1656–64.
14. Williams B, Macdonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): A randomised, double-blind, crossover trial. Lancet 2015; 386 (10008): 2059–68.
15. Krieger EM, Drager LF, Giorgi DMA, et al. Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension the REHOT randomized study (Resistant Hypertension Optimal Treatment). Hypertension 2018; 71 (4): 681–90.
16. Yugar-Toledo JC, Modolo R, de Faria AP, Moreno H. Managing resistant hypertension: Focus on mineralocorticoid-receptor antagonists. Vasc Health Risk Manag 2017; 13: 403–11.
17. Oliveras A, Armario P, Clarà A, et al. Spironolactone versus sympathetic renal denervation to treat true resistant hypertension: Results from the DENERVHTA study – A randomized controlled trial. J Hypertens 2016; 34 (9): 1863–71.
18. Mahfoud F, Mancia G, Schmieder R, et al. Renal Denervation in High-Risk Patients With Hypertension. J Am Coll Cardiol 2020; 75 (23): 2879–88.
19. Bates MC, Stone GW, Chen CY, Spiering W. Device profile of the MobiusHD EVBA system for the treatment of resistant hypertension: overview of its mechanism of action, safety and efficacy. Expert Rev Med Devices 2020; 17 (7): 649–58. DOI: 10.1080/17434440.2020.1779054
2. Denolle T, Chamontin B, Doll G, et al. Management of resistant hypertension: Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology. J Hum Hypertens 2016; 30 (11): 657–63.
3. Sowers J, White W, Pitt B. The Effects of Cyclooxygenase-2 Inhibitors and Nonsteroidal Anti-inflammatory Therapy on 24-Hour Blood Pressure in Patients With Hypertension, Ostheoarthritis, and Type 2 Diabetes Mellitus. Arch Intern Med 2005; 165: 161–9.
4. Karateev AE, Nasonov EL, Yakhno NN, et al. Clinical guidelines “Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice“. Mod Rheumatol J 2015; 1: 4.
5. Combe B, Swergold G, McLay J, et al. Cardiovascular safety and gastrointestinal tolerability of etoricoxib vs diclofenac in a randomized controlled clinical trial (The MEDAL study). Rheumatology 2009; 48 (4): 425–32.
6. Frohlich ED. Classification of resistant hypertension. Hypertension 1988; 11 (3): II.67–70.
7. Gifford RW. An algorithm for the management of resistant hypertension. Hypertension 1988; 11 (3): II.101–5.
8. Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: The most common secondary cause of hypertension associated with resistant hypertension. Hypertension 2011; 58 (5): 811–7.
9. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117 (25): 510–26.
10. 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: 53–90.
11. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37 (36): 2768–801.
12. Acelajado MC, Hughes ZH, Oparil S, Calhoun DA. Treatment of Resistant and Refractory Hypertension. Circ Res 2019; 124 (7): 1061–70.
13. Bobrie G, Frank M, Azizi M, et al. Sequential nephron blockade versus sequential renin-angiotensin system blockade in resistant hypertension: A prospective, randomized, open blinded endpoint study. J Hypertens 2012; 30 (8): 1656–64.
14. Williams B, Macdonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): A randomised, double-blind, crossover trial. Lancet 2015; 386 (10008): 2059–68.
15. Krieger EM, Drager LF, Giorgi DMA, et al. Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension the REHOT randomized study (Resistant Hypertension Optimal Treatment). Hypertension 2018; 71 (4): 681–90.
16. Yugar-Toledo JC, Modolo R, de Faria AP, Moreno H. Managing resistant hypertension: Focus on mineralocorticoid-receptor antagonists. Vasc Health Risk Manag 2017; 13: 403–11.
17. Oliveras A, Armario P, Clarà A, et al. Spironolactone versus sympathetic renal denervation to treat true resistant hypertension: Results from the DENERVHTA study – A randomized controlled trial. J Hypertens 2016; 34 (9): 1863–71.
18. Mahfoud F, Mancia G, Schmieder R, et al. Renal Denervation in High-Risk Patients With Hypertension. J Am Coll Cardiol 2020; 75 (23): 2879–88.
19. Bates MC, Stone GW, Chen CY, Spiering W. Device profile of the MobiusHD EVBA system for the treatment of resistant hypertension: overview of its mechanism of action, safety and efficacy. Expert Rev Med Devices 2020; 17 (7): 649–58. DOI: 10.1080/17434440.2020.1779054
________________________________________________
2. Denolle T, Chamontin B, Doll G, et al. Management of resistant hypertension: Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology. J Hum Hypertens 2016; 30 (11): 657–63.
3. Sowers J, White W, Pitt B. The Effects of Cyclooxygenase-2 Inhibitors and Nonsteroidal Anti-inflammatory Therapy on 24-Hour Blood Pressure in Patients With Hypertension, Ostheoarthritis, and Type 2 Diabetes Mellitus. Arch Intern Med 2005; 165: 161–9.
4. Karateev AE, Nasonov EL, Yakhno NN, et al. Clinical guidelines “Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice“. Mod Rheumatol J 2015; 1: 4.
5. Combe B, Swergold G, McLay J, et al. Cardiovascular safety and gastrointestinal tolerability of etoricoxib vs diclofenac in a randomized controlled clinical trial (The MEDAL study). Rheumatology 2009; 48 (4): 425–32.
6. Frohlich ED. Classification of resistant hypertension. Hypertension 1988; 11 (3): II.67–70.
7. Gifford RW. An algorithm for the management of resistant hypertension. Hypertension 1988; 11 (3): II.101–5.
8. Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: The most common secondary cause of hypertension associated with resistant hypertension. Hypertension 2011; 58 (5): 811–7.
9. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117 (25): 510–26.
10. 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: 53–90.
11. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37 (36): 2768–801.
12. Acelajado MC, Hughes ZH, Oparil S, Calhoun DA. Treatment of Resistant and Refractory Hypertension. Circ Res 2019; 124 (7): 1061–70.
13. Bobrie G, Frank M, Azizi M, et al. Sequential nephron blockade versus sequential renin-angiotensin system blockade in resistant hypertension: A prospective, randomized, open blinded endpoint study. J Hypertens 2012; 30 (8): 1656–64.
14. Williams B, Macdonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): A randomised, double-blind, crossover trial. Lancet 2015; 386 (10008): 2059–68.
15. Krieger EM, Drager LF, Giorgi DMA, et al. Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension the REHOT randomized study (Resistant Hypertension Optimal Treatment). Hypertension 2018; 71 (4): 681–90.
16. Yugar-Toledo JC, Modolo R, de Faria AP, Moreno H. Managing resistant hypertension: Focus on mineralocorticoid-receptor antagonists. Vasc Health Risk Manag 2017; 13: 403–11.
17. Oliveras A, Armario P, Clarà A, et al. Spironolactone versus sympathetic renal denervation to treat true resistant hypertension: Results from the DENERVHTA study – A randomized controlled trial. J Hypertens 2016; 34 (9): 1863–71.
18. Mahfoud F, Mancia G, Schmieder R, et al. Renal Denervation in High-Risk Patients With Hypertension. J Am Coll Cardiol 2020; 75 (23): 2879–88.
19. Bates MC, Stone GW, Chen CY, Spiering W. Device profile of the MobiusHD EVBA system for the treatment of resistant hypertension: overview of its mechanism of action, safety and efficacy. Expert Rev Med Devices 2020; 17 (7): 649–58. DOI: 10.1080/17434440.2020.1779054
Авторы
А.В. Родионов*, И.Г. Юдин, В.В. Фомин
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*avrodion@mail.ru
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*avrodion@mail.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*avrodion@mail.ru
________________________________________________
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*avrodion@mail.ru
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