Особенности клиники и лечения больных артериальной гипертонией с ожирением (по данным Национального регистра артериальной гипертонии)
Особенности клиники и лечения больных артериальной гипертонией с ожирением (по данным Национального регистра артериальной гипертонии)
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Аннотация
Целью данного исследования явилось изучение клинической характеристики и оценка качества лечения больных артериальной гипертонией (АГ) с ожирением по данным Национального регистра АГ.
Материалы и методы. Частота ожирения в выборке больных АГ, наблюдаемых в 2010–2016 гг. в поликлиниках и кардиологических диспансерах по поводу сердечно-сосудистых заболеваний (ССЗ), составила 38,3%, из них частота выраженного ожирения (III степень) – 8%. Женщины составляют большую часть больных АГ с ожирением (72%).
Результаты. Проведенное исследование показало значительную отягощенность больных АГ с ожирением по факторам риска ССЗ: дислипидемия, гипергликемия и отягощенный анамнез ранних ССЗ. Достоверно чаще у больных АГ с ожирением встречались поражение органов-мишеней (гипертрофия левого желудочка, хроническая болезнь почек III стадии), ССЗ [ишемическая болезнь сердца (ИБС), хроническая сердечная недостаточность (ХСН) II–IV функционального класса NYHA] и сахарный диабет типа 2. Эти данные свидетельствуют о том, что больные АГ с ожирением относятся к высокому и очень высокому сердечно-сосудистому риску.
Заключение. Проводимая антигипертензивная и гиполипидемическая терапия (статины) у больных АГ с ожирением не оптимальна, только у 30% больных достигнут целевой уровень АД и у 23,6% – целевой уровень общего холестерина.
Ключевые слова: артериальная гипертония, ожирение, регистр артериальной гипертонии, диагностика, эффективность лечения.
Materials and methods. The frequency of obesity in a sample of patients with AH, observed in 2010-2016. in polyclinics and cardiological dispensaries for cardiovascular diseases (CVD), was 38.3%, of which the incidence of severe obesity (grade III) was 8%. Women account for the majority of obese AH patients (72%).
Results. The study revealed the burden of AH patients with obesity in the following risk factors for CVD: dyslipidemia, hyperglycemia and a history of early cardiovascular disease. Relatively often in patients with hypertension with obesity, there were lesions of target organs (hypertrophy of the left ventricle, chronic kidney disease of the third stage), CVD [ischemic heart disease (CHD), chronic heart failure (CHF) II–IV functional class NYHA] and diabetes mellitus type 2 These data indicate that patients with AH obesity refers to a high and very high cardiovascular risk.
The conclusion. Conducted antihypertensive and hypolipidemic therapy (statins) in patients with AH obesity was not optimal, only 30% of patients achieved the target level of BP and 23.6% – the target level of total cholesterol.
Keywords: arterial hypertension, obesity, register arterial hypertension, diagnosis, treatment effectiveness.
Материалы и методы. Частота ожирения в выборке больных АГ, наблюдаемых в 2010–2016 гг. в поликлиниках и кардиологических диспансерах по поводу сердечно-сосудистых заболеваний (ССЗ), составила 38,3%, из них частота выраженного ожирения (III степень) – 8%. Женщины составляют большую часть больных АГ с ожирением (72%).
Результаты. Проведенное исследование показало значительную отягощенность больных АГ с ожирением по факторам риска ССЗ: дислипидемия, гипергликемия и отягощенный анамнез ранних ССЗ. Достоверно чаще у больных АГ с ожирением встречались поражение органов-мишеней (гипертрофия левого желудочка, хроническая болезнь почек III стадии), ССЗ [ишемическая болезнь сердца (ИБС), хроническая сердечная недостаточность (ХСН) II–IV функционального класса NYHA] и сахарный диабет типа 2. Эти данные свидетельствуют о том, что больные АГ с ожирением относятся к высокому и очень высокому сердечно-сосудистому риску.
Заключение. Проводимая антигипертензивная и гиполипидемическая терапия (статины) у больных АГ с ожирением не оптимальна, только у 30% больных достигнут целевой уровень АД и у 23,6% – целевой уровень общего холестерина.
Ключевые слова: артериальная гипертония, ожирение, регистр артериальной гипертонии, диагностика, эффективность лечения.
________________________________________________
Materials and methods. The frequency of obesity in a sample of patients with AH, observed in 2010-2016. in polyclinics and cardiological dispensaries for cardiovascular diseases (CVD), was 38.3%, of which the incidence of severe obesity (grade III) was 8%. Women account for the majority of obese AH patients (72%).
Results. The study revealed the burden of AH patients with obesity in the following risk factors for CVD: dyslipidemia, hyperglycemia and a history of early cardiovascular disease. Relatively often in patients with hypertension with obesity, there were lesions of target organs (hypertrophy of the left ventricle, chronic kidney disease of the third stage), CVD [ischemic heart disease (CHD), chronic heart failure (CHF) II–IV functional class NYHA] and diabetes mellitus type 2 These data indicate that patients with AH obesity refers to a high and very high cardiovascular risk.
The conclusion. Conducted antihypertensive and hypolipidemic therapy (statins) in patients with AH obesity was not optimal, only 30% of patients achieved the target level of BP and 23.6% – the target level of total cholesterol.
Keywords: arterial hypertension, obesity, register arterial hypertension, diagnosis, treatment effectiveness.
Список литературы
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24. US Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2010.
25. Catapano A, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart J. 2016;37(39):2999-3058.
26. Aurigemma GP, de Simone GD, et al. Cardiac Remodeling in Obesity. Circ Cardiovasc Imaging. 2013;6:142-52.
27. Cuspidi C, Sala C, Negri F, et al. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343-9.
28. Салтыкова М.М., Ощепкова Е.В., Атауллаханова Д.М., Лазарева Н.В., Бобохонова А.С., Рогоза А.Н. Электрокардиографическая диагностика гипертрофии миокарда левого желудочка у пациентов с артериальной гипертензией. Терапевтический архив. 2006; 78(12):40-5. [Saltykova MM, Oshchepkova EV. Ataullakhanova DM, Lazareva NV, Bobokhonova AS, Rogoza AN. Electro cardiographs diagnosis of hypertrophyof left ventricular myocardium in patients with hypertension. Therapeutic Archive. 2006;78(12):40-5 (In Russ.)].
29. Muiesan ML, Salvetti M, et al. Obesity and ECG left ventricular hypertrophy. J Hypertension. 2017 Jan;35(1):162-9.
30. Messerli FH, Williams B, et al. Essential hypertension. Lancet. 2007;18; 370(9587):591-603.
31. Hall ME, Carmo JM, et al. Obesity, hypertension and chronic kidney disease. Intern J Nephrology and Renovascular Disease. 2014 Feb 18;7:75-88.
32. Travers K, Martin A, et al. Burden and management of chronic kidney disease in Japan: systematic review of literatureю. Intern J Nephrol and Renovascular Disease. 2013;6:1-13.
33. Landsberg L, Aronne LJ, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment – a position paper of the Obesity Society and the American Society of Hypertension. Obesity. 2013;21:8-24.
34. De Marco VG, Aror An R, et al. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014:10(6):364-76.
35. Wang Y, Wang QJ. The prevalence of prehypertension and hypertensionamong US adults according to the new Joint National Committee guidelines. Arch Intern Med. 2004;164:2126-34.
36. Wezel U, et al. Treatment of arterial hypertension in obese patients. Semin Nephol. 2013 Jan;33(1):66-74.
37. Чазова И.Е., Данилов Н.М., Литвин А.Ю. Рефрактерная артериальная гипертония: Монография. М.: Атмосфера, 2014. 256 с. [Chazova IE, Danilov NM, Litvin AYu. Refractory hypertension: Monograph. M.: Atmosphere, 2014; 256 (In Russ.)].
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39. De Souza F, Muхfeldt E, et al. Essicacy of spironolactone therapy in patients with true resistant hypertension. Hypertension. 2010;55:147-15.
40. Engbaek M, Hjerrild M, et al. The effect of low-dose spironolactone on resistant hypertension. J AM Soc Hypertens. 2010;4:290-4.
2. [Klinicheskie rekomendatsii “Diagnostika i lechenie arterial’noi gipertonii”. Rabochaia gruppa po podgotovke teksta: Chazova IE, Oshchepkova EV, Zhernakova IuV. Kardiologicheskii vestnik. 2015;1:5-30 (In Russ.)].
3. 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;31(7):1281-357.
4. WHO. Obesity and overweight. Fact sheet N 311. Updated January 2015. Available at: http://www.who.int/mediacentre/factsheets/ fs311/en/. Checked by 10.08.2016.
5. Gino Seravallea, Guido Grassi. Obesity and hypertension. J Pharmacological Research. 2017;122:1-7.
6. [Chazova IE, Zhernakova IuV, Oshchepkova EV, et al. Rasprostranennost’ FR serdechno-sosudistykhzabolevanii v rossiiskoi populiatsii bol’nykh arterial’noi gipertoniei. Kardiologiia. 2014;10:4-12 (In Russ.)].
7. Kannel WB, Brand N, et al. The relation of adiposity to blood pressure and development of hypertension. The Framingam study. Amer Intern Med. 1967;67:48-59.
8. Tanamas SK, Wong E, Backholer K, Abdullah A, Wolfe R, Barendregt J, Peeters A. Duration of obesity and incident hypertension in adults from the Framingham Heart Study. J Hypertens. 2015 Mar;33(3):542-5.
9. Stamler J, Rose G, Stamler R. INTERSALT study finding. Public health and medical care implications. Hypertension. 1989;14(5):570-7.
10. Landsberg L. Book chapter. Hypertension: A Companion to Braunwald`s Heart Disease (Third Edition). Obesity. 2018: 328-334.
11. Hall JE. The kidney, hypertension and obesity. Hypertension. 2003; 41(3):625-33.
12. Poirier P, Giles TD, Bray GA, et al. American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898-918.
13. Alpert MA. Obesity cardiomyopathy; pathophysiology and evolution of the clinical syndrome. Amer J Med Sci. 2001;321:225-36.
14. Aneja A, El-Atat F, McFarlane SI, Sowers JR. Hypertension and obesity. Recent Progr Horm Res. 2004;59:169-205.
15. Engeli S, Sharma AM. The renin-angiotensin system and natriuretic peptides in obesity-associated hypertension. J Mol Med. 2001;79:21-9.
16. Lafontan M, Moro C, Sengenes C, et al. An unsuspected metabolic role for atrial natriuretic peptides: the control of lipolysis, lipid mobilization, and systemic non esterified fatty acids levels in humans. Arterioscler Thromb Vasc Biol. 2005;25:2032-42.
17. Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S57-63.
18. Grassi G, Seravalle G, et al. Sympathetic activation in obese normotensive subjects. J Hypertension. 1995;25:560-3.
19. Seravalle G, Grassi G. Sympathetic nervous system, hypertension, obesity, and metabolic syndrome. High Blood Press. Cardiovasc Prev. 2016; 23:175-9.
20. Meyers MR, Gokce N. Endothelial dysfunction in obesity: etiological role in atherosclerosis. Curr Opin Endocrinol Diabetes Obes. 2007;14:365-9.
21. [Oshсhepkova EV, Lazareva NV, Chazova IE. The assessment of health care quality among patients with arterial hypertension in primary care (according to the Russian Register of arterial hypertension). Systemic Hypertension. 2017;2:29-34 (In Russ.)].
22. [Recommendation for management of AH patients with metabolic disorders. The Russian Medical Society on Arterial Hypertension. Moscow, 2013 (In Russ.)].
23. [National guidelines “Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches”. Working group to prepare the text: Smirnov AV, Shilov EM, et al. Nephrology. 2012;16(1):89-115 (In Russ.)].
24. US Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2010.
25. Catapano A, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart J. 2016;37(39):2999-3058.
26. Aurigemma GP, de Simone GD, et al. Cardiac Remodeling in Obesity. Circ Cardiovasc Imaging. 2013;6:142-52.
27. Cuspidi C, Sala C, Negri F, et al. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343-9.
28. [Saltykova MM, Oshchepkova EV. Ataullakhanova DM, Lazareva NV, Bobokhonova AS, Rogoza AN. Electro cardiographs diagnosis of hypertrophyof left ventricular myocardium in patients with hypertension. Therapeutic Archive. 2006;78(12):40-5 (In Russ.)].
29. Muiesan ML, Salvetti M, et al. Obesity and ECG left ventricular hypertrophy. J Hypertension. 2017 Jan;35(1):162-9.
30. Messerli FH, Williams B, et al. Essential hypertension. Lancet. 2007;18; 370(9587):591-603.
31. Hall ME, Carmo JM, et al. Obesity, hypertension and chronic kidney disease. Intern J Nephrology and Renovascular Disease. 2014 Feb 18;7:75-88.
32. Travers K, Martin A, et al. Burden and management of chronic kidney disease in Japan: systematic review of literatureю. Intern J Nephrol and Renovascular Disease. 2013;6:1-13.
33. Landsberg L, Aronne LJ, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment – a position paper of the Obesity Society and the American Society of Hypertension. Obesity. 2013;21:8-24.
34. De Marco VG, Aror An R, et al. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014:10(6):364-76.
35. Wang Y, Wang QJ. The prevalence of prehypertension and hypertensionamong US adults according to the new Joint National Committee guidelines. Arch Intern Med. 2004;164:2126-34.
36. Wezel U, et al. Treatment of arterial hypertension in obese patients. Semin Nephol. 2013 Jan;33(1):66-74.
37. [Chazova IE, Danilov NM, Litvin AYu. Refractory hypertension: Monograph. M.: Atmosphere, 2014; 256 (In Russ.)].
38. [Oshchepkova EV. Chapter in monograph of Chazov IE, Danilov NM, Litvin AYu. Refractory hypertension: Monograph. M.: Atmosphere, 2014:10-16 (In Russ.)].
39. De Souza F, Muхfeldt E, et al. Essicacy of spironolactone therapy in patients with true resistant hypertension. Hypertension. 2010;55:147-15.
40. Engbaek M, Hjerrild M, et al. The effect of low-dose spironolactone on resistant hypertension. J AM Soc Hypertens. 2010;4:290-4.
2. Клинические рекомендации «Диагностика и лечение артериальной гипертонии». Рабочая группа по подготовке текста: Чазова И.Е., Ощепкова Е.В., Жернакова Ю.В. Кардиологический вестник. 2015;1:5-30 [Klinicheskie rekomendatsii “Diagnostika i lechenie arterial’noi gipertonii”. Rabochaia gruppa po podgotovke teksta: Chazova IE, Oshchepkova EV, Zhernakova IuV. Kardiologicheskii vestnik. 2015;1:5-30 (In Russ.)].
3. 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;31(7):1281-357.
4. WHO. Obesity and overweight. Fact sheet N 311. Updated January 2015. Available at: http://www.who.int/mediacentre/factsheets/ fs311/en/. Checked by 10.08.2016.
5. Gino Seravallea, Guido Grassi. Obesity and hypertension. J Pharmacological Research. 2017;122:1-7.
6. Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014;10:4-12 [Chazova IE, Zhernakova IuV, Oshchepkova EV, et al. Rasprostranennost’ FR serdechno-sosudistykhzabolevanii v rossiiskoi populiatsii bol’nykh arterial’noi gipertoniei. Kardiologiia. 2014;10:4-12 (In Russ.)].
7. Kannel WB, Brand N, et al. The relation of adiposity to blood pressure and development of hypertension. The Framingam study. Amer Intern Med. 1967;67:48-59.
8. Tanamas SK, Wong E, Backholer K, Abdullah A, Wolfe R, Barendregt J, Peeters A. Duration of obesity and incident hypertension in adults from the Framingham Heart Study. J Hypertens. 2015 Mar;33(3):542-5.
9. Stamler J, Rose G, Stamler R. INTERSALT study finding. Public health and medical care implications. Hypertension. 1989;14(5):570-7.
10. Landsberg L. Book chapter. Hypertension: A Companion to Braunwald`s Heart Disease (Third Edition). Obesity. 2018: 328-334.
11. Hall JE. The kidney, hypertension and obesity. Hypertension. 2003; 41(3):625-33.
12. Poirier P, Giles TD, Bray GA, et al. American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898-918.
13. Alpert MA. Obesity cardiomyopathy; pathophysiology and evolution of the clinical syndrome. Amer J Med Sci. 2001;321:225-36.
14. Aneja A, El-Atat F, McFarlane SI, Sowers JR. Hypertension and obesity. Recent Progr Horm Res. 2004;59:169-205.
15. Engeli S, Sharma AM. The renin-angiotensin system and natriuretic peptides in obesity-associated hypertension. J Mol Med. 2001;79:21-9.
16. Lafontan M, Moro C, Sengenes C, et al. An unsuspected metabolic role for atrial natriuretic peptides: the control of lipolysis, lipid mobilization, and systemic non esterified fatty acids levels in humans. Arterioscler Thromb Vasc Biol. 2005;25:2032-42.
17. Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S57-63.
18. Grassi G, Seravalle G, et al. Sympathetic activation in obese normotensive subjects. J Hypertension. 1995;25:560-3.
19. Seravalle G, Grassi G. Sympathetic nervous system, hypertension, obesity, and metabolic syndrome. High Blood Press. Cardiovasc Prev. 2016; 23:175-9.
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19. Seravalle G, Grassi G. Sympathetic nervous system, hypertension, obesity, and metabolic syndrome. High Blood Press. Cardiovasc Prev. 2016; 23:175-9.
20. Meyers MR, Gokce N. Endothelial dysfunction in obesity: etiological role in atherosclerosis. Curr Opin Endocrinol Diabetes Obes. 2007;14:365-9.
21. [Oshсhepkova EV, Lazareva NV, Chazova IE. The assessment of health care quality among patients with arterial hypertension in primary care (according to the Russian Register of arterial hypertension). Systemic Hypertension. 2017;2:29-34 (In Russ.)].
22. [Recommendation for management of AH patients with metabolic disorders. The Russian Medical Society on Arterial Hypertension. Moscow, 2013 (In Russ.)].
23. [National guidelines “Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches”. Working group to prepare the text: Smirnov AV, Shilov EM, et al. Nephrology. 2012;16(1):89-115 (In Russ.)].
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25. Catapano A, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart J. 2016;37(39):2999-3058.
26. Aurigemma GP, de Simone GD, et al. Cardiac Remodeling in Obesity. Circ Cardiovasc Imaging. 2013;6:142-52.
27. Cuspidi C, Sala C, Negri F, et al. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343-9.
28. [Saltykova MM, Oshchepkova EV. Ataullakhanova DM, Lazareva NV, Bobokhonova AS, Rogoza AN. Electro cardiographs diagnosis of hypertrophyof left ventricular myocardium in patients with hypertension. Therapeutic Archive. 2006;78(12):40-5 (In Russ.)].
29. Muiesan ML, Salvetti M, et al. Obesity and ECG left ventricular hypertrophy. J Hypertension. 2017 Jan;35(1):162-9.
30. Messerli FH, Williams B, et al. Essential hypertension. Lancet. 2007;18; 370(9587):591-603.
31. Hall ME, Carmo JM, et al. Obesity, hypertension and chronic kidney disease. Intern J Nephrology and Renovascular Disease. 2014 Feb 18;7:75-88.
32. Travers K, Martin A, et al. Burden and management of chronic kidney disease in Japan: systematic review of literatureю. Intern J Nephrol and Renovascular Disease. 2013;6:1-13.
33. Landsberg L, Aronne LJ, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment – a position paper of the Obesity Society and the American Society of Hypertension. Obesity. 2013;21:8-24.
34. De Marco VG, Aror An R, et al. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014:10(6):364-76.
35. Wang Y, Wang QJ. The prevalence of prehypertension and hypertensionamong US adults according to the new Joint National Committee guidelines. Arch Intern Med. 2004;164:2126-34.
36. Wezel U, et al. Treatment of arterial hypertension in obese patients. Semin Nephol. 2013 Jan;33(1):66-74.
37. [Chazova IE, Danilov NM, Litvin AYu. Refractory hypertension: Monograph. M.: Atmosphere, 2014; 256 (In Russ.)].
38. [Oshchepkova EV. Chapter in monograph of Chazov IE, Danilov NM, Litvin AYu. Refractory hypertension: Monograph. M.: Atmosphere, 2014:10-16 (In Russ.)].
39. De Souza F, Muхfeldt E, et al. Essicacy of spironolactone therapy in patients with true resistant hypertension. Hypertension. 2010;55:147-15.
40. Engbaek M, Hjerrild M, et al. The effect of low-dose spironolactone on resistant hypertension. J AM Soc Hypertens. 2010;4:290-4.
Авторы
Е.В. ОЩЕПКОВА, Н.В. ЛАЗАРЕВА, И.Е. ЧАЗОВА
Институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
Myasnikov Research Institute of Clinical Cardiology. FSBI "National medical research center of Cardiology" of the Ministry of Health of Russia, Moscow, Russia
Институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
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Myasnikov Research Institute of Clinical Cardiology. FSBI "National medical research center of Cardiology" of the Ministry of Health of Russia, Moscow, Russia
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