Консенсус экспертов. Влияние антигипертензивной терапии на когнитивные функции

Консенсус экспертов. Влияние антигипертензивной терапии на когнитивные функции

Остроумова О.Д., Парфенов В.А., Остроумова Т.М., Яхно Н.Н., Чазова И.Е., Боголепова А.Н., Галявич А.С., Гераскина Л.А., Емелин А.Ю., Захаров В.В., Кисляк О.А., Кулеш А.А., Левин О.С., Подзолков В.И., Привалова Е.В., Ших Е.В. Консенсус экспертов. Влияние антигипертензивной терапии на когнитивные функции. Системные гипертензии. 2021; 18 (1): 5–12. DOI: 10.26442/2075082X.2021.1.200575

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Ostroumova OD, Parfenov VA, Ostroumova TM, Yakhno NN, Chazova IE, Bogolepova AN, Galyavich AS, Geraskina LA, Emelin AIu, Zakharov VV, Kislyak OA, Kulesh AA, Levin OS, Podzolkov VI, Privalova EV, Shikh EV. Expert consensus. Effect of antihypertensive therapy on cognitive functions. Systemic Hypertension. 2021; 18 (1): 5–12. DOI: 10.26442/2075082X.2021.1.200575

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Аннотация

Артериальная гипертензия (АГ) является основным модифицируемым фактором риска развития когнитивных нарушений (КН), включая деменцию, при цереброваскулярных и нейродегенеративных заболеваниях, в том числе при болезни Альцгеймера. К 2050 г. число лиц, страдающих деменцией, возрастет примерно в 3 раза в связи со старением населения и ограниченными возможностями лекарственной профилактики и лечения выраженных КН. В связи с изложенным представляется необходимым создание консенсуса экспертов, в котором были бы суммированы доступные на сегодняшний день данные доказательной медицины о влиянии антигипертензивной терапии (АГТ) на когнитивные функции (КФ). В консенсусе экспертов суммированы и проанализированы результаты проспективных рандомизированных клинических исследований, наблюдательных и популяционных исследований, метаанализов по влиянию АГТ на риск деменции и прогрессирование КН, в том числе отдельные КФ. Рассмотрены вопросы влияния антигипертензивных препаратов (АГП) на различные когнитивные домены. Литературные данные свидетельствуют о том, что АГТ снижает риск развития деменции, в том числе и сосудистой, уменьшает риск развития деменции при болезни Альцгеймера, а также снижает риск и может предотвратить прогрессирование недементных КН. Влияние АГТ на состояние разных КФ изучено мало. Большинство метаанализов не выявило преимущества какого-либо класса АГП, однако в одной работе было продемонстрировано преимущество блокаторов рецепторов ангиотензина, в то время как в другой – диуретиков. В консенсусе подчеркивается, что, учитывая высокую заболеваемость АГ в общей популяции, АГТ может являться одним из самых эффективных способов предотвращения развития и замедления прогрессирования КН. Крайне важным является своевременное назначение АГТ, особенно в молодом и среднем возрасте, что имеет большую вероятность влияния на риск развития и прогрессирования КН в пожилом возрасте. Влияние разных классов АГП на КФ требует дальнейшего изучения. Необходимо проведение большего числа правильно спланированных рандомизированных клинических исследований, в которых бы оценивалось состояние управляющих функций у пациентов с АГ.

Ключевые слова: артериальная гипертензия, когнитивные функции, когнитивное нарушение, деменция, антигипертензивная терапия, антигипертензивные препараты

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Arterial hypertension (AH) is the major modifiable risk factor for cognitive impairment (CI), including dementia, CI in cerebrovascular and neurodegenerative diseases, including Alzheimer's disease. By 2050, the number of people with dementia will approximately 3 times increase due to the aging population and limited opportunities for drug prevention and treatment of severe CI. In connection with the above, it seems necessary to create an expert consensus, which would summarize the evidence-based medicine data available to date on the effect of antihypertensive therapy (AHT) on cognitive function (CF). In the expert consensus, the data of prospective randomized clinical trials, observational and population studies, meta-analyzes on the effect of AHT on the risk of dementia and CI progression, including certain CF, were summarized and analyzed. The consensus considers the effect of antihypertensive drugs (AHD) on various cognitive domains. Literature data give evidence that AHT reduces the risk for dementia, including vascular dementia, reduces the risk of for dementia in Alzheimer's disease, as well as reduces the risk and can prevent the progression of non-dementia CI. The effect of AHT on various CF has been little studied. Most meta-analyzes did not reveal the benefits of any class of AHD; however, one study demonstrated the advantage of angiotensin receptor blockers, while another study - diuretics. The consensus emphasizes that, given the high incidence of AH in the general population, AHT may be one of the most effective ways to prevent CI or delay CI progression. The effect of different classes of AHD on CF requires further study. It is necessary to conduct a larger number of well-designed randomized clinical trials that would assess the state of executive functions in patients with AH.

Keywords: arterial hypertension, cognitive functions, cognitive impairment, dementia, antihypertensive therapy, antihypertensive drugs

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1. 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): 3021–104. DOI: 10.1093/eurheartj/ehy339
2. Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 2016; 134 (6): 441–50. DOI: 10.1161/CIRCULATIONAHA.115.018912
3. Vicario A, Coca A, Gasecki D, et al. Effects of antihypertensive treatment on cognitive decline. ESH Scientific Newsletter 2019; 20: nr. 73.
4. Prince M, Bryce R, Albanese E, et al. The global prevalence of dementia: a systematic review and meta-analysis. Alzheimers Dement 2013; 9: 63–75. DOI: 10.1016/j.jalz.2012.11.007
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American Psychiatric Publishing, 2013.
6. Zakharov VV. Cognitive impairment no dementia: classification, major causes, and treatment. Effective Pharmacotherapy. 2016; 1: 22–31 (in Russian).
7. Yakhno NN, Zakharov VV, Lokshina AB, et al. Dementia: a guide for doctors. 3rd ed. M.: MEDpress-inform, 2011 (in Russian).
8. Koberskaya NN, Ostroumova TM. Near-moderate cognitive decline. Neurology, Neuropsychiatry, Psychosomatics. 2020; 12 (2): 92–7 (in Russian). DOI: 10.14412/2074-2711-2020-2-92-97
9. Jessen F, Amariglio RE, van Boxtel M, et al. A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease. Alzheimers Dement 2014; 10 (6): 844–52. DOI: 10.1016/j.jalz.2014.01.001
10. Walker KA, Power MC, Gottesman RF. Defining the relationship between hypertension, cognitive decline, and dementia: a review. Curr Hypertens Rep 2017; 19 (3): 24. DOI: 10.1007/s11906-017-0724-3
11. Arbuthnott K, Frank J. Trail Making Test, Part B as a measure of executive control: validation using a set-switching paradigm. J Clin Exp Neuropsychol 2000; 22 (4): 518–28. DOI: 1380-3395(200008)22:4;1-0;FT518
12. Parfenov VA, Ostroumova TM, Perepelova EM, et al. Brain Perfusion, Cognitive Functions, and Vascular Age in Middle Aged Patients With Essential Arterial Hypertension. Kardiologiia. 2018; 58 (5): 23–31 (in Russian). DOI: 10.18087/cardio.2018.5.10117
13. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53 (4): 695. DOI: 10.1111/j.1532-5415.2005.53221.x
14. Chen ST, Siddarth P, Ercoli LM, et al. Modifiable risk factors for Alzheimer disease and subjective memory impairment across age groups. PLoS One 2014; 9 (6): e98630. DOI: 10.1371/journal.pone.0098630
15. Applegate WB, Pressel S, Wittes J, et al. Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. Arch Intern Med 1994; 154: 2154–60.
16. Forette F, Seux ML, Staessen JA, et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352 (9137): 1347–51. DOI: 10.1016/s0140-6736(98)03086-4
17. Bosch J, Yusuf S, Pogue J, et al. Use of ramipril in preventing stroke: double blind randomised trial. Br Med J 2002; 324: 699–702. DOI: 10.1136/bmj.324.7339.699
18. Tzourio C, Anderson C, Chapman N, et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 2003; 163: 1069–75. DOI: 10.1001/archinte.163.9.1069
19. Fogari R, Mugellini A, Zoppi A, et al. Effects of valsartan compared with enalapril on blood pressure and cognitive function in elderly patients with essential hypertension. Eur J Clin Pharmacol 2004; 59: 863–8. DOI: 10.1007/s00228-003-0717-9
20. Skoog I, Lithell H, Hansson L, et al. Effect of baseline cognitive function and antihypertensive treatment on cognitive and cardiovascular outcomes: study on cognition and prognosis in the elderly (SCOPE). Am J Hypertens 2005; 18: 1052–9. DOI: 10.1016/j.amjhyper.2005.02.013
21. Schrader J, Lüders S, Kulchewski A, et al. Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005; 36: 1218–24. DOI: 10.1161/01.STR.0000166048.35740.a9
22. Fogari R, Mugellini A, Zoppi A, et al. Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J Hum Hypertens 2006; 20: 177–85.
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Авторы

О.Д. Остроумова*1, В.А. Парфенов2, Т.М. Остроумова2, Н.Н. Яхно2, И.Е. Чазова3, А.Н. Боголепова4,5, А.С. Галявич6, Л.А. Гераскина7, А.Ю. Емелин8, В.В. Захаров2, О.А. Кисляк4, А.А. Кулеш9, О.С. Левин1, В.И. Подзолков2, Е.В. Привалова2, Е.В. Ших2

1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
3 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
4 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
5 ФГБУ «Федеральный центр мозга и нейротехнологий» ФМБА России, Москва, Россия;
6 ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России, Казань, Россия;
7 ФГБНУ «Научный центр неврологии», Москва, Россия;
8 ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, Санкт-Петербург, Россия;
9 ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера» Минздрава России, Пермь, Россия
*ostroumova.olga@mail.ru

________________________________________________

Olga D. Ostroumova*1, Vladimir A. Parfenov2, Tatiana M. Ostroumova2, Nikolay N. Yakhno2, Irina E. Chazova3, Anna N. Bogolepova4,5, Albert S. Galyavich6, Liudmila A. Geraskina7, Andrey Iu. Emelin8, Vladimir V. Zakharov2, Oxana A. Kislyak4, Aleksei A. Kulesh9, Oleg S. Levin1, Valery I. Podzolkov2, Elena V. Privalova2, Evgenia V. Shikh2

1 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
3 National Medical Research Center of Cardiology, Moscow, Russia;
4 Pirogov Russian National Research Medical University, Moscow, Russia;
5 Federal Center for Brain and Neurotechnologies, Moscow, Russia;
6 Kazan State Medical University, Kazan, Russia;
7 Scientific Center of Neurology, Moscow, Russia;
8 Kirov Military Medical Academy, Saint Petersburg, Russia;
9 Wagner Perm State Medical University, Perm, Russia
*ostroumova.olga@mail.ru

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