Консенсус экспертов Российского медицинского общества по артериальной гипертонии по диагностике и лечению резистентной артериальной гипертонии

Аксенова А.В., Сивакова О.А., Блинова Н.В., Данилов Н.М., Елфимова Е.М., Кисляк О.А., Литвин А.Ю., Ощепкова Е.В., Фомин В.В., Чихладзе Н.М., Щелкова Г.В., Чазова И.Е. Консенсус экспертов Российского медицинского общества по артериальной гипертонии по диагностике и лечению резистентной артериальной гипертонии. Терапевтический архив. 2021; 93 (9): 1018–1029. DOI: 10.26442/00403660.2021.09.201007

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Aksenova AV, Sivakova OA, Blinova NV, Danilov NM, Elfimova EM, Kisliak OA, Litvin AYu, Oshchepkova EV, Fomin VV, Chikhladze NM, Shelkova GV, Chazova IE. Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management. Terapevticheskii Arkhiv (Ter. Arkh). 2021; 93 (9): 1018–1029. DOI: 10.26442/00403660.2021.09.201007

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Аннотация

Диагностика резистентной артериальной гипертонии (РАГ) позволяет выделить отдельную группу больных, у которых необходимо использование специальных диагностических методов и подходов к лечению. Устранение обратимых факторов, приводящих к развитию РАГ, таких как неприверженность терапии, неоптимально подобранная терапия, вторичные формы артериальной гипертонии, приводит к улучшению прогноза больного. Большинство лиц с РАГ следует обследовать для исключения первичного альдостеронизма, стеноза почечной артерии, хронической болезни почек и обструктивного апноэ во сне. Алгоритм обследования больных, рекомендации по изменению образа жизни и поэтапный план терапии позволяют улучшить контроль уровня артериального давления. Желательно использование максимально упрощенной схемы лечения и комбинированных препаратов длительного действия. Отдельной категории больных целесообразно выполнение радиочастотной денервации почечных артерий.

Ключевые слова: резистентная артериальная гипертония, неприверженность терапии, лечение, вторичные формы, радиочастотная денервация

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The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

Keywords: resistant arterial hypertension, non-adherence to therapy, treatment, secondary forms, radiofrequency denervation

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Авторы

А.В. Аксенова*1, О.А. Сивакова1, Н.В. Блинова1, Н.М. Данилов1, Е.М. Елфимова1, О.А. Кисляк2, А.Ю. Литвин1,2, Е.В. Ощепкова1, В.В. Фомин3, Н.М. Чихладзе1, Г.В. Щелкова1, И.Е. Чазова1

1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
3 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*aksenovaannav@gmail.com

________________________________________________

Anna V. Aksenova*1, Olga A. Sivakova1, Nataliia V. Blinova1, Nikolai M. Danilov1, Evgeniia M. Elfimova1, Oksana A. Kisliak2, Aleksandr Yu. Litvin1,2, Elena V. Oshchepkova1, Victor V. Fomin3, Novella M. Chikhladze1, Galina V. Shelkova1, Irina E. Chazova1

1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia;
3 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*aksenovaannav@gmail.com

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