Особенности медикаментозной терапии артериальной гипертонии у мужчин и женщин в реальной клинической практике по данным Национального регистра
Особенности медикаментозной терапии артериальной гипертонии у мужчин и женщин в реальной клинической практике по данным Национального регистра
Ощепкова Е.В., Аксенова А.В., Орловский А.А., Чазова И.Е. Особенности медикаментозной терапии артериальной гипертонии у мужчин и женщин в реальной клинической практике по данным Национального регистра. Терапевтический архив. 2019; 91 (9): 88–100. DOI: 10.26442/00403660.2019.09.000356
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Аннотация
Артериальная гипертония (АГ) – один из ведущих факторов, определяющих высокую смертность населения от сердечно-сосудистых заболеваний (ССЗ) во многих странах мира, включая Россию. Современные клинические рекомендации по диагностике и лечению АГ не предусматривают различные стратегии медикаментозной терапии для мужчин и женщин с АГ. Анализ гендерных и возрастных особенностей медикаментозной терапии у мужчин и женщин с АГ может выявить необоснованное и неоптимальное лечение больных АГ.
Целью данного исследования было изучение гендерных особенностей медикаментозной терапии больных АГ, применяемой врачами первичного звена здравоохранения.
Материалы и методы. Исследование проводилось методом регистра АГ, который функционирует с 2012 г. Методика его проведения описана ранее [1]. Медицинские данные из амбулаторных карт вводились врачами 53 городских поликлиник и 5 кардиологических диспансеров из 22 регионов Российской Федерации. Из базы данных регистра АГ в исследование вошли данные 33 564 больных старше 18 лет с диагнозом «артериальная гипертония». В регистре АГ использовалась единая компьютеризованная карта, в которую врачи вносили данные пациентов о половой принадлежности, возрасте, росте, массе тела, статусе курения, клиническом уровне артериального давления (АД), лабораторных и инструментальных методов обследования, диагностированных сердечно-сосудистых и цереброваскулярных заболеваниях и коморбидности в соответствии с Международной классификацией болезней 10-го пересмотра [ICD-10], а также о проводимом лечении (антигипертензивная и гиполипидемическая терапия).
Результаты и заключение. Выявлены гендерные различия в назначении врачами медикаментозной антигипертензивной терапии (АГТ) у мужчин и женщин с АГ. Одной из причин этих различий, по-видимому, являются особенности клинического течения, связанного с более частым и ранним развитием сердечно-сосудистых и цереброваскулярных осложнений АГ у мужчин, чем у женщин. Так, бета-адреноблокаторы (БАБ) и ингибиторы ангиотензинпревращающего фермента (ИАПФ) чаще назначаются мужчинам с АГ с ишемической болезнью сердца (ИБС), перенесенным инфарктом миокарда (ИМ) и хронической сердечной недостаточностью (ХСН). Женщинам с АГ чаще назначают блокаторы к ангиотензину II (БРА), тиазидные и тиазидоподобные диуретики. Исследование показало неоптимальность лечения больных АГ. В частности, у больных с АГ и ИБС, перенесенным ИМ и ХСН выявлено недостаточное назначение препаратов [ИАПФ/БРА, БАБ, антагонистов минералокортикоидных рецепторов], улучшающих прогноз заболевания. Обращает на себя внимание отсутствие записей в амбулаторных картах о проводимой АГТ у больных АГ всех возрастных категорий: в молодом возрасте – у 9,6%, в старческом возрасте – у 15,1%. Недостаточно назначается гиполипидемическая терапия (статины), несмотря на то, что большинство больных, наблюдаемых в первичном звене здравоохранения, относятся к высокому и очень высокому сердечно-сосудистому риску. Максимально большее назначение статинов наблюдалось у больных АГ с ИБС (50,1%) и перенесенным ИМ (62,7%).
Ключевые слова: артериальная гипертония, гендерные особенности, антигипертензивная терапия, регистр артериальной гипертонии.
The purpose of this study was to identify the gender features of antihypertensive therapy used by primary care physicians in patients with hypertension.
Materials and methods. The study is based on the Arterial Hypertension Registry established in 2012. The methodology of it has been described previously [1]. Medical data from outpatient cards were entered by doctors of 53 city primary care medical centers and 5 cardiology clinics from 22 regions of the Russian Federation. The study included the data of 33 564 patients from 18 years and older with diagnosis of arterial hypertension. Gender, age, height, body weight, smoking status, office blood pressure (BP), laboratory and instrumental examination methods, diagnosed cardiovascular and cerebrovascular diseases and comorbidities in accordance with the International Classification of Diseases of the 10th revision [ICD-10], as well as the treatment (antihypertensive and lipid-lowering therapy) were listed.
Results and conclusion. Gender differences in the prescription antihypertensive therapy (AHT) in men and women with hypertension were revealed. Apparently, one of the reasons for these differences is the earlier and more frequent development of cardiovascular and cerebrovascular complications of hypertension in men than in women. Beta-blockers (BB) and angiotensin-converting enzyme inhibitors (ACEi) are more often prescribed to men with hypertension and with coronary artery disease (CAD), myocardial infarction (MI) and chronic heart failure (CHF). Women with hypertension are more often prescribed angiotensin receptor blockers (ARB), thiazide and thiazide-like diuretics. The study also showed non-optimal treatment of patients with hypertension. Insufficient prescription of medication which could improve the prognosis of the disease (ACE inhibitors /ARB, BB, mineralocorticoid receptor antagonist) have been identified in patients with hypertension and CAD, MI, CHF. It is noteworthy that in the some outpatient cards of patients with AH there is no record of AHT prescription: at a young age – in 9.6%, at old age in 15.1% of cards. Despite the fact of high and very high cardiovascular risk of the majority of patients, lipid-lowering therapy (statins) was prescribed insufficiently. The most statin administration was observed in hypertensive patients with coronary artery disease (50.1%) and myocardial infarction (62.7%).
Keywords: arterial hypertension, gender characteristics, antihypertensive therapy, registry of arterial hypertension.
Целью данного исследования было изучение гендерных особенностей медикаментозной терапии больных АГ, применяемой врачами первичного звена здравоохранения.
Материалы и методы. Исследование проводилось методом регистра АГ, который функционирует с 2012 г. Методика его проведения описана ранее [1]. Медицинские данные из амбулаторных карт вводились врачами 53 городских поликлиник и 5 кардиологических диспансеров из 22 регионов Российской Федерации. Из базы данных регистра АГ в исследование вошли данные 33 564 больных старше 18 лет с диагнозом «артериальная гипертония». В регистре АГ использовалась единая компьютеризованная карта, в которую врачи вносили данные пациентов о половой принадлежности, возрасте, росте, массе тела, статусе курения, клиническом уровне артериального давления (АД), лабораторных и инструментальных методов обследования, диагностированных сердечно-сосудистых и цереброваскулярных заболеваниях и коморбидности в соответствии с Международной классификацией болезней 10-го пересмотра [ICD-10], а также о проводимом лечении (антигипертензивная и гиполипидемическая терапия).
Результаты и заключение. Выявлены гендерные различия в назначении врачами медикаментозной антигипертензивной терапии (АГТ) у мужчин и женщин с АГ. Одной из причин этих различий, по-видимому, являются особенности клинического течения, связанного с более частым и ранним развитием сердечно-сосудистых и цереброваскулярных осложнений АГ у мужчин, чем у женщин. Так, бета-адреноблокаторы (БАБ) и ингибиторы ангиотензинпревращающего фермента (ИАПФ) чаще назначаются мужчинам с АГ с ишемической болезнью сердца (ИБС), перенесенным инфарктом миокарда (ИМ) и хронической сердечной недостаточностью (ХСН). Женщинам с АГ чаще назначают блокаторы к ангиотензину II (БРА), тиазидные и тиазидоподобные диуретики. Исследование показало неоптимальность лечения больных АГ. В частности, у больных с АГ и ИБС, перенесенным ИМ и ХСН выявлено недостаточное назначение препаратов [ИАПФ/БРА, БАБ, антагонистов минералокортикоидных рецепторов], улучшающих прогноз заболевания. Обращает на себя внимание отсутствие записей в амбулаторных картах о проводимой АГТ у больных АГ всех возрастных категорий: в молодом возрасте – у 9,6%, в старческом возрасте – у 15,1%. Недостаточно назначается гиполипидемическая терапия (статины), несмотря на то, что большинство больных, наблюдаемых в первичном звене здравоохранения, относятся к высокому и очень высокому сердечно-сосудистому риску. Максимально большее назначение статинов наблюдалось у больных АГ с ИБС (50,1%) и перенесенным ИМ (62,7%).
Ключевые слова: артериальная гипертония, гендерные особенности, антигипертензивная терапия, регистр артериальной гипертонии.
________________________________________________
The purpose of this study was to identify the gender features of antihypertensive therapy used by primary care physicians in patients with hypertension.
Materials and methods. The study is based on the Arterial Hypertension Registry established in 2012. The methodology of it has been described previously [1]. Medical data from outpatient cards were entered by doctors of 53 city primary care medical centers and 5 cardiology clinics from 22 regions of the Russian Federation. The study included the data of 33 564 patients from 18 years and older with diagnosis of arterial hypertension. Gender, age, height, body weight, smoking status, office blood pressure (BP), laboratory and instrumental examination methods, diagnosed cardiovascular and cerebrovascular diseases and comorbidities in accordance with the International Classification of Diseases of the 10th revision [ICD-10], as well as the treatment (antihypertensive and lipid-lowering therapy) were listed.
Results and conclusion. Gender differences in the prescription antihypertensive therapy (AHT) in men and women with hypertension were revealed. Apparently, one of the reasons for these differences is the earlier and more frequent development of cardiovascular and cerebrovascular complications of hypertension in men than in women. Beta-blockers (BB) and angiotensin-converting enzyme inhibitors (ACEi) are more often prescribed to men with hypertension and with coronary artery disease (CAD), myocardial infarction (MI) and chronic heart failure (CHF). Women with hypertension are more often prescribed angiotensin receptor blockers (ARB), thiazide and thiazide-like diuretics. The study also showed non-optimal treatment of patients with hypertension. Insufficient prescription of medication which could improve the prognosis of the disease (ACE inhibitors /ARB, BB, mineralocorticoid receptor antagonist) have been identified in patients with hypertension and CAD, MI, CHF. It is noteworthy that in the some outpatient cards of patients with AH there is no record of AHT prescription: at a young age – in 9.6%, at old age in 15.1% of cards. Despite the fact of high and very high cardiovascular risk of the majority of patients, lipid-lowering therapy (statins) was prescribed insufficiently. The most statin administration was observed in hypertensive patients with coronary artery disease (50.1%) and myocardial infarction (62.7%).
Keywords: arterial hypertension, gender characteristics, antihypertensive therapy, registry of arterial hypertension.
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2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224-60.
3. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513-8. doi: 10.1016/S0140-6736(08)60655-8
4. [Chazova IE, Zhernakova YuV on behalf of experts. Clinical recommendations. Diagnostics and treatment of an arterial hypertension. System hypertensia. 2019;16(1):6-31 (In Russ.)]. doi: 10.26442/2075082X.2019.1.190179
5. Turnbull F, Woodward M, Neal B, et al Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J. 2008;29:2669-80.
6. Gu Q, Burt VL, Paulose-Ram R, Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens. 2008;21:789-98.
7. Qvarnstr€om M, Wettermark B, Ljungman C, Zarrinkoub R, Hasselstr€om J, Manhem K, et al. Antihypertensive treatment and control in a large primary care population of 21,167 patients. J Hum Hypertens. 2011;25:484-91.
8. Klungel OH, de Boer A, Paes AH, Seidell JC, Bakker A. Sex differences in antihypertensive drug use: determinants of the choice of medication for hypertension. J Hypertens. 1998;16:1545-53.
9. Keyhani S, Scobie JV, Hebert PL, McLaughlin MA.Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits. Hypertension. 2008;51:1149-55.
10. Fletcher A, Beevers DG, Bulpitt C, et al. Beta adrenoceptor blockade is associated with increased survival in male but not female hypertensive patients: a report from the DHSS Hypertension Care Computing Project (DHCCP). J Hum Hypertens. 1988;2:219-27.
11. Jansen J, Bonner C, McKinn S, et al. General practitioners' use of absolute risk versus individual risk factors in cardiovascular disease prevention: an experimental study. BMJ OPEN. 2014;4:e004812.
12. Kloner RA, Sowers JR, DiBona GF, et al. Sex- and age-related antihypertensive effects of amlodipine. The Amlodipine Cardiovascular Community Trial Study Group. Am J Cardiol.1996;77:713-22.
13. Igho Pemu P, Ofili E. Hypertension in women: part I. J Clin Hypertens (Greenwich). 2008;10:406-10.
14. [Chazova IE, Aksenova AV, Oshchepkova EV. Features of a course of an arterial hypertension at men and women (according to the National register of an arterial hypertension). Therapeutic Archive. 2019;91(01):4-12 (In Russ.)].
15. Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with high-normal and normal blood pressure: overview and meta-analyses of randomized trials. J Hypertens. 2017;35:2150-60.
16. [The recommendations of EOK about maintaining patients with an acute myocardial infarction with raising of a segment of ST 2017. Russian cardiological magazine. 2018;(5):103-58 (In Russ.)]. https://doi.org/10.15829/1560-4071-2018-5-103-158
17. Ponikowski P, Voors A, Anker DS, Bueno H, Cleland GFJ, Coats JSA, Falk V, González-Juanatey J, Harjola V, Jankowska AE, Jessup M, Linde C, Nihoyannopoulos P, Parissis TJ, Pieske B, Riley PJ, Rosano MCG, Ruilope ML, Ruschitzka F, Rutten HF, van der Meer P. [Recommendations of ESH about diagnostics and treatment of acute and chronic heart failure of 2016. Russian cardiological magazine. 2017;(1):7-81 (In Russ.)]. https://doi.org/10.15829/1560-4071-2017-1-7-81
18. National Institutes of Health NH, Lung, and Blood Institute. Morbidity & Mortality: 2012 Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethesda, MD: National Heart, Lung, and Blood Institute, 2012.
19. [Boytsov SA, Samorodskaya IV, Nikulin NN, Yakushin SS, Andreev EM, Zaratiants OV, Barbarash OL. Comparative analysis of mortality of the population from acute forms of ischemic heart disease in the fifteen-year period in the Russian Federation and the United States and formation of factors affecting it. Therapeutic Archive. 2017;89(9):53-9 (In Russ.)]. https://doi.org/10.17116/terarkh201789953-59
20. Ghosh M, Majumdar SR. Antihypertensive medications, bone mineral density, and fractures: a review of old cardiac drugs that provides new insights into osteoporosis. Endocrine. 2014;46:397-405.
21. Swedberg K, Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Shi H, Vincent J, Pitt B. Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol. 2012;59:1598-603.
22. [Chazova IE, Zhernakova YuV, Oshchepkova EV, Shalnova SA, Yarovaya EB, Konradi AO, Boytsov SA, Kaveshnikov VS, Serebryakova VN, Trubacheva IA. Prevalence of risk factors of cardiovascular diseases in the Russian population of patients with an arterial hypertension. Cardiology. 2014;54(10):4-12 (In Russ.)].
23. Cholesterol Treatment Trialists’ (CTT) Collaboration1, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A,Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81. doi: 10.1016/S0140-6736(10)61350-5. Epub 2010 Nov 8.
24. Gender differences in antihypertensive drug treatment: results from the Swedish Primary Care Cardiovascular Database (SPCCD) Charlotta Ljungman, MD, PhD, Thomas Kahan, MD, Linus Schi€oler, PhD, Per Hjerpe, MD, PhD, Jan Hasselstr€om, MD, PhD, Bj€orn Wettermark, MSc, PhD, Kristina Bengtsson Bostr€om, MD, PhD, and Karin Manhem, MD. J Am Society of Hypertension. 2014;8(12):882-90. http://dx.doi.org/10.1016/j.jash.2014.08.015
25. Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122:290-300. doi: 10.1016/j.amjmed.2008.09.038
26. Muntner P, Anderson A, Charleston J, Chen Z, Ford V, Makos G, O’Connor A, Perumal K, Rahman M, Steigerwalt S, Teal V, Townsend R, Weir M, Wright JT., Jr Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2010;55:441-51. doi: 10.1053/j.ajkd.2009.09.014
2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224-60.
3. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513-8. doi: 10.1016/S0140-6736(08)60655-8
4. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019;16(1): 6-31 [Chazova IE, Zhernakova YuV on behalf of experts. Clinical recommendations. Diagnostics and treatment of an arterial hypertension. System hypertensia. 2019;16(1):6-31 (In Russ.)]. doi: 10.26442/2075082X.2019.1.190179
5. Turnbull F, Woodward M, Neal B, et al Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J. 2008;29:2669-80.
6. Gu Q, Burt VL, Paulose-Ram R, Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens. 2008;21:789-98.
7. Qvarnstr€om M, Wettermark B, Ljungman C, Zarrinkoub R, Hasselstr€om J, Manhem K, et al. Antihypertensive treatment and control in a large primary care population of 21,167 patients. J Hum Hypertens. 2011;25:484-91.
8. Klungel OH, de Boer A, Paes AH, Seidell JC, Bakker A. Sex differences in antihypertensive drug use: determinants of the choice of medication for hypertension. J Hypertens. 1998;16:1545-53.
9. Keyhani S, Scobie JV, Hebert PL, McLaughlin MA.Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits. Hypertension. 2008;51:1149-55.
10. Fletcher A, Beevers DG, Bulpitt C, et al. Beta adrenoceptor blockade is associated with increased survival in male but not female hypertensive patients: a report from the DHSS Hypertension Care Computing Project (DHCCP). J Hum Hypertens. 1988;2:219-27.
11. Jansen J, Bonner C, McKinn S, et al. General practitioners' use of absolute risk versus individual risk factors in cardiovascular disease prevention: an experimental study. BMJ OPEN. 2014;4:e004812.
12. Kloner RA, Sowers JR, DiBona GF, et al. Sex- and age-related antihypertensive effects of amlodipine. The Amlodipine Cardiovascular Community Trial Study Group. Am J Cardiol.1996;77:713-22.
13. Igho Pemu P, Ofili E. Hypertension in women: part I. J Clin Hypertens (Greenwich). 2008;10:406-10.
14. Чазова И.Е., Аксенова А.В., Ощепкова Е.В. Особенности течения артериальной гипертонии у мужчин и женщин (по данным Национального регистра артериальной гипертонии). Терапевтический архив. 2019;91(01):4-12 [Chazova IE, Aksenova AV, Oshchepkova EV. Features of a course of an arterial hypertension at men and women (according to the National register of an arterial hypertension). Therapeutic Archive. 2019;91(01):4-12 (In Russ.)].
15. Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with high-normal and normal blood pressure: overview and meta-analyses of randomized trials. J Hypertens. 2017;35:2150-60.
16. Рекомендации ЕОК по ведению пациентов с острым инфарктом миокарда с подъемом сегмента ST 2017. Российский кардиологический журнал. 2018;(5):103-58 [The recommendations of EOK about maintaining patients with an acute myocardial infarction with raising of a segment of ST 2017. Russian cardiological magazine. 2018;(5):103-58 (In Russ.)]. https://doi.org/10.15829/1560-4071-2018-5-103-158
17. Ponikowski P, Voors A, Anker DS, Bueno H, Cleland GFJ, Coats JSA, Falk V, González-Juanatey J, Harjola V, Jankowska AE, Jessup M, Linde C, Nihoyannopoulos P, Parissis TJ, Pieske B, Riley PJ, Rosano MCG, Ruilope ML, Ruschitzka F, Rutten HF, van der Meer P. Рекомендации ESH по диагностике и лечению острой и хронической сердечной недостаточности 2016. Российский кардиологический журнал. 2017;(1):7-81 [Recommendations of ESH about diagnostics and treatment of acute and chronic heart failure of 2016. Russian cardiological magazine. 2017;(1):7-81 (In Russ.)]. https://doi.org/10.15829/1560-4071-2017-1-7-81
18. National Institutes of Health NH, Lung, and Blood Institute. Morbidity & Mortality: 2012 Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethesda, MD: National Heart, Lung, and Blood Institute, 2012.
19. Бойцов С.А., Самородская И.В., Никулина Н.Н., Якушин С.С., Андреев Е.М., Заратьянц О.В., Барбараш О.Л. Сравнительный анализ смертности населения от острых форм ишемической болезни сердца за пятнадцатилетний период в РФ и США и факторов, влияющих на ее формирование. Терапевтический архив. 2017;89(9):53-9 [Boytsov SA, Samorodskaya IV, Nikulin NN, Yakushin SS, Andreev EM, Zaratiants OV, Barbarash OL. Comparative analysis of mortality of the population from acute forms of ischemic heart disease in the fifteen-year period in the Russian Federation and the United States and formation of factors affecting it. Therapeutic Archive. 2017;89(9):53-9 (In Russ.)]. https://doi.org/10.17116/terarkh201789953-59
20. Ghosh M, Majumdar SR. Antihypertensive medications, bone mineral density, and fractures: a review of old cardiac drugs that provides new insights into osteoporosis. Endocrine. 2014;46:397-405.
21. Swedberg K, Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Shi H, Vincent J, Pitt B. Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol. 2012;59:1598-603.
22. Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В., Шальнова С.А., Яровая Е.Б., Конради А.О., Бойцов С.А., Кавешников В.С., Серебрякова В.Н., Трубачева И.А. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных с артериальной гипертонией. Кардиология. 2014;54(10):4-12 [Chazova IE, Zhernakova YuV, Oshchepkova EV, Shalnova SA, Yarovaya EB, Konradi AO, Boytsov SA, Kaveshnikov VS, Serebryakova VN, Trubacheva IA. Prevalence of risk factors of cardiovascular diseases in the Russian population of patients with an arterial hypertension. Cardiology. 2014;54(10):4-12 (In Russ.)].
23. Cholesterol Treatment Trialists’ (CTT) Collaboration1, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A,Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81. doi: 10.1016/S0140-6736(10)61350-5. Epub 2010 Nov 8.
24. Gender differences in antihypertensive drug treatment: results from the Swedish Primary Care Cardiovascular Database (SPCCD) Charlotta Ljungman, MD, PhD, Thomas Kahan, MD, Linus Schi€oler, PhD, Per Hjerpe, MD, PhD, Jan Hasselstr€om, MD, PhD, Bj€orn Wettermark, MSc, PhD, Kristina Bengtsson Bostr€om, MD, PhD, and Karin Manhem, MD. J Am Society of Hypertension. 2014;8(12):882-90. http://dx.doi.org/10.1016/j.jash.2014.08.015
25. Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122:290-300. doi: 10.1016/j.amjmed.2008.09.038
26. Muntner P, Anderson A, Charleston J, Chen Z, Ford V, Makos G, O’Connor A, Perumal K, Rahman M, Steigerwalt S, Teal V, Townsend R, Weir M, Wright JT., Jr Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2010;55:441-51. doi: 10.1053/j.ajkd.2009.09.014
________________________________________________
2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224-60.
3. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513-8. doi: 10.1016/S0140-6736(08)60655-8
4. [Chazova IE, Zhernakova YuV on behalf of experts. Clinical recommendations. Diagnostics and treatment of an arterial hypertension. System hypertensia. 2019;16(1):6-31 (In Russ.)]. doi: 10.26442/2075082X.2019.1.190179
5. Turnbull F, Woodward M, Neal B, et al Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J. 2008;29:2669-80.
6. Gu Q, Burt VL, Paulose-Ram R, Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens. 2008;21:789-98.
7. Qvarnstr€om M, Wettermark B, Ljungman C, Zarrinkoub R, Hasselstr€om J, Manhem K, et al. Antihypertensive treatment and control in a large primary care population of 21,167 patients. J Hum Hypertens. 2011;25:484-91.
8. Klungel OH, de Boer A, Paes AH, Seidell JC, Bakker A. Sex differences in antihypertensive drug use: determinants of the choice of medication for hypertension. J Hypertens. 1998;16:1545-53.
9. Keyhani S, Scobie JV, Hebert PL, McLaughlin MA.Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits. Hypertension. 2008;51:1149-55.
10. Fletcher A, Beevers DG, Bulpitt C, et al. Beta adrenoceptor blockade is associated with increased survival in male but not female hypertensive patients: a report from the DHSS Hypertension Care Computing Project (DHCCP). J Hum Hypertens. 1988;2:219-27.
11. Jansen J, Bonner C, McKinn S, et al. General practitioners' use of absolute risk versus individual risk factors in cardiovascular disease prevention: an experimental study. BMJ OPEN. 2014;4:e004812.
12. Kloner RA, Sowers JR, DiBona GF, et al. Sex- and age-related antihypertensive effects of amlodipine. The Amlodipine Cardiovascular Community Trial Study Group. Am J Cardiol.1996;77:713-22.
13. Igho Pemu P, Ofili E. Hypertension in women: part I. J Clin Hypertens (Greenwich). 2008;10:406-10.
14. [Chazova IE, Aksenova AV, Oshchepkova EV. Features of a course of an arterial hypertension at men and women (according to the National register of an arterial hypertension). Therapeutic Archive. 2019;91(01):4-12 (In Russ.)].
15. Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with high-normal and normal blood pressure: overview and meta-analyses of randomized trials. J Hypertens. 2017;35:2150-60.
16. [The recommendations of EOK about maintaining patients with an acute myocardial infarction with raising of a segment of ST 2017. Russian cardiological magazine. 2018;(5):103-58 (In Russ.)]. https://doi.org/10.15829/1560-4071-2018-5-103-158
17. Ponikowski P, Voors A, Anker DS, Bueno H, Cleland GFJ, Coats JSA, Falk V, González-Juanatey J, Harjola V, Jankowska AE, Jessup M, Linde C, Nihoyannopoulos P, Parissis TJ, Pieske B, Riley PJ, Rosano MCG, Ruilope ML, Ruschitzka F, Rutten HF, van der Meer P. [Recommendations of ESH about diagnostics and treatment of acute and chronic heart failure of 2016. Russian cardiological magazine. 2017;(1):7-81 (In Russ.)]. https://doi.org/10.15829/1560-4071-2017-1-7-81
18. National Institutes of Health NH, Lung, and Blood Institute. Morbidity & Mortality: 2012 Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethesda, MD: National Heart, Lung, and Blood Institute, 2012.
19. [Boytsov SA, Samorodskaya IV, Nikulin NN, Yakushin SS, Andreev EM, Zaratiants OV, Barbarash OL. Comparative analysis of mortality of the population from acute forms of ischemic heart disease in the fifteen-year period in the Russian Federation and the United States and formation of factors affecting it. Therapeutic Archive. 2017;89(9):53-9 (In Russ.)]. https://doi.org/10.17116/terarkh201789953-59
20. Ghosh M, Majumdar SR. Antihypertensive medications, bone mineral density, and fractures: a review of old cardiac drugs that provides new insights into osteoporosis. Endocrine. 2014;46:397-405.
21. Swedberg K, Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Shi H, Vincent J, Pitt B. Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol. 2012;59:1598-603.
22. [Chazova IE, Zhernakova YuV, Oshchepkova EV, Shalnova SA, Yarovaya EB, Konradi AO, Boytsov SA, Kaveshnikov VS, Serebryakova VN, Trubacheva IA. Prevalence of risk factors of cardiovascular diseases in the Russian population of patients with an arterial hypertension. Cardiology. 2014;54(10):4-12 (In Russ.)].
23. Cholesterol Treatment Trialists’ (CTT) Collaboration1, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A,Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81. doi: 10.1016/S0140-6736(10)61350-5. Epub 2010 Nov 8.
24. Gender differences in antihypertensive drug treatment: results from the Swedish Primary Care Cardiovascular Database (SPCCD) Charlotta Ljungman, MD, PhD, Thomas Kahan, MD, Linus Schi€oler, PhD, Per Hjerpe, MD, PhD, Jan Hasselstr€om, MD, PhD, Bj€orn Wettermark, MSc, PhD, Kristina Bengtsson Bostr€om, MD, PhD, and Karin Manhem, MD. J Am Society of Hypertension. 2014;8(12):882-90. http://dx.doi.org/10.1016/j.jash.2014.08.015
25. Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122:290-300. doi: 10.1016/j.amjmed.2008.09.038
26. Muntner P, Anderson A, Charleston J, Chen Z, Ford V, Makos G, O’Connor A, Perumal K, Rahman M, Steigerwalt S, Teal V, Townsend R, Weir M, Wright JT., Jr Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2010;55:441-51. doi: 10.1053/j.ajkd.2009.09.014
Авторы
Е.В. Ощепкова, А.В. Аксенова, А.А. Орловский, И.Е. Чазова
Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Moscow, Russia
Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
________________________________________________
Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Moscow, Russia
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