Рецепт. 2021; : 654-662
Артериальная гипертензия у пожилых: современные подходы в лечении
https://doi.org/10.34883/PI.2021.24.5.005Аннотация
Артериальная гипертензия (АГ) является одной из значимых проблем современной медицины. С возрастом наблюдается прогрессирующий рост распространенности АГ. Основой рациональной антигипертензивной терапии является достижение целевых уровней АД. Достижение целевого АД ведет к значимому уменьшению риска смерти, а также инфаркта миокарда, мозгового инсульта, сердечной недостаточности, поражения почек, деменции. Современным базовым принципом лечения взрослых пациентов с АГ является ориентация на биологический возраст, а не на хронологический (паспортный). Применение иАПФ или БРА в сочетании с небольшими дозами диуретиков или дигидропиридиновыми антагонистами кальция высокоэффективно у пациентов пожилого возраста. При этом лучшая переносимость БРА и меньшая вероятность развития гипотензии делают применение БРА несколько более предпочтительным в данной группе пациентов. Одним из представителей БРА является кандесартан. Эффективность и безопасность этого препарата у пациентов, в том числе пожилого возраста, с различной сердечно-сосудистой патологией изучены в многочисленных исследованиях.
Список литературы
1. Konradi A. (2014) Pozhiloj chelovek s arterial’noj gipertenziej: osobennosti lecheniya [Elderly person with arterial hypertension: features of treatment]. Arterial’naya gipertenziya. Flebologiya, vol. 20, no 5, pp. 406–414.
2. Chen-Yi Wu, Hsiao-Yun Hu, Yiing-Jenq Chou, Nicole Huang, Yi-Chang Chou, Chung-Pin Li (2015) High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults. Medicine (Baltimore), 94: e2160.
3. Pristrom M., Shtonda M., Semenenkov I. (2018) Izolirovannaya sistolicheskaya arterial’naya gipertenziya: vzglyad na lechenie v ambulatornoj praktike [Isolated systolic arterial hypertension: view of treatment in outpatient practice]. Lechebnoe delo, 5 (63), pp. 5–19.
4. (2018) 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). European Heart Journal, 39 (33), pp. 3021–3104.
5. (2020) Arterial’naya gipertenziya u vzroslyh. Klinicheskie rekomendacii 2020 [Arterial hypertension in adults. Clinical recommendations 2020]. Rossijskij kardiologicheskij zhurnal, 25 (3): 3786.
6. (2020) 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75, pp. 1334–1357.
7. Wright T. Jr, Williamson J.D., Whelton P.K. (2015) SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med., 373 (22), pp. 2103–2116.
8. Zhang W. (2021) Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. NEJM.org
9. Drapkina O., Vasilieva L. (2020) Spornye voprosy primeneniya ingibitorov angiotenzinprevrashchayushchego fermenta i antagonistov receptorov angiotenzina u pacientov s COVID-19 [Controversial issues of use of the angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists in patients with COVID-19]. Kardiovaskulyarnaya terapiya i profilaktika, vol. 19, no 3, pp. 319–326.
10. Dworakowska D., Grossman A.B. (2020) Renin-angiotensin system inhibitors in management of hypertension during the COVID-19 pandemic. Journal of physiology and pharmacology, 71 (2), pp. 173–178.
11. Podzolkov V., Dragomireckaya N. (2017) Vybor blokatora angiotenzinovyh receptorov na raznyh etapah serdechno-sosudistogo kontinuuma [Selection of angiotensin receptor blocker at different stages of cardiovascular continuum]. Kardiologiya, vol. 57, no 10, pp. 45–55.
12. O’Rourke M.F., Safar M.E., Dzau V. (2010) The Cardiovascular Continuum extended: aging effects on the aorta and microvasculature. Vasc Med., 15 (6), pp. 461–468.
13. Kim S.A., Park J.B., O’Rourkе М.F. (2015) Vasculopathy of aging and the revised cardiovascular continuum. Pulse (Basel), 3 (2), pp. 141–147.
14. Kareva E. (2016) Evolyuciya sartanov ili vse li sartany odinakovy? [Evolution of sartans or are all sartans the same?]. Klinicheskaya farmakologiya i terapiya, vol. 25, no 3, pp. 11–21.
15. Chulkov V., Lenec E. (2019) Sartany: ot korrekcii arterial’noj gipertenzii k upravleniyu serdechno-sosudistym riskom [Sartans: from correction of arterial hypertension to management of cardiovascular risk]. Terapiya, 7 (33), pp. 112–119.
16. Vanderheyden P.M.L., Fierens F.L.P., Vauquelin G. (2000) Angiotensin II type 1 receptor antagonists. Why do some of them produce insurmountable inhibition? Biochem. Pharmacol., 60: 1557.
17. Khawaja Z., Wilcox Ch.S. (2011) An overview of candesartan in clinical practice. Expert Rev Cardiovasc Ther., 9 (8), pp. 975–982.
18. Karpov YU., Melekhov A. (2019) Kandesartan: vyhod za predely serdechno-sosudistogo kontinuuma [Candesartan: going beyond the cardiovascular continuum]. Atmosfera. Novosti kariologii, no 2, pp. 31–40.
19. Kirichenko A. (2018) Sartany i problema komorbidnosti [Sartans and the problem of comorbidity]. RMZH, 1 (II), pp. 110–114.
20. Tsuguya Fukui, Mahbubur Rahman, Koichi Hayashi (2003) Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial of cardiovascular events in high-risk hypertensive patients: rationale, design, and methods. Hypertens Res, 26 (12), pp. 979–90.
21. Lithell Hans, Hansson Lennart, Skoog Ingmar (2003) The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens, 21 (5), pp. 875–86.
22. Weisser B. (2005) Investigations of the antihypertensive long-term action of candesartan cilexetil in different dosages under the influence of therapy-free intervals. Arzneimittelforschung, 55 (9), pp. 505–13.
23. Bakris G. (2001) Antihypertensive efficacy of candesartan in comparison to losartan: the CLAIM study. J Clin Hypertens (Greenwich), 3 (1), pp. 16–21.
Recipe. 2021; : 654-662
Arterial Hypertension in the Elderly: Modern Approaches in Treatment
https://doi.org/10.34883/PI.2021.24.5.005Abstract
The aim of work is to study the possibilities of retrograde cardioplegia in correction of valve disease Arterial hypertension (AH) is one of the significant problems of modern medicine. With age, there is a progressive increase in the prevalence of hypertension. The basis of rational antihypertensive therapy is the achievement of target blood pressure levels. Achieving the target blood pressure leads to a significant decrease in the risk of death, as well as myocardial infarction, cerebral stroke, heart failure, kidney damage, and dementia. The modern basic principle of treatment of adult patients with hypertension is to focus on biological age, rather than chronological one (passport age). The use of an ACE inhibitor or ARB in combination with small doses of diuretics or dihydropyridine calcium antagonists is highly effective in elderly patients. At the same time, better tolerability of ARBs and lower likelihood of development of hypotension make the use of ARBs more preferable in this group of patients. One of the representatives of the ARB is candesartan. The efficacy and safety of this drug in patients, including the elderly, with various cardiovascular pathologies have been studied in numerous researches.
References
1. Konradi A. (2014) Pozhiloj chelovek s arterial’noj gipertenziej: osobennosti lecheniya [Elderly person with arterial hypertension: features of treatment]. Arterial’naya gipertenziya. Flebologiya, vol. 20, no 5, pp. 406–414.
2. Chen-Yi Wu, Hsiao-Yun Hu, Yiing-Jenq Chou, Nicole Huang, Yi-Chang Chou, Chung-Pin Li (2015) High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults. Medicine (Baltimore), 94: e2160.
3. Pristrom M., Shtonda M., Semenenkov I. (2018) Izolirovannaya sistolicheskaya arterial’naya gipertenziya: vzglyad na lechenie v ambulatornoj praktike [Isolated systolic arterial hypertension: view of treatment in outpatient practice]. Lechebnoe delo, 5 (63), pp. 5–19.
4. (2018) 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). European Heart Journal, 39 (33), pp. 3021–3104.
5. (2020) Arterial’naya gipertenziya u vzroslyh. Klinicheskie rekomendacii 2020 [Arterial hypertension in adults. Clinical recommendations 2020]. Rossijskij kardiologicheskij zhurnal, 25 (3): 3786.
6. (2020) 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75, pp. 1334–1357.
7. Wright T. Jr, Williamson J.D., Whelton P.K. (2015) SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med., 373 (22), pp. 2103–2116.
8. Zhang W. (2021) Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. NEJM.org
9. Drapkina O., Vasilieva L. (2020) Spornye voprosy primeneniya ingibitorov angiotenzinprevrashchayushchego fermenta i antagonistov receptorov angiotenzina u pacientov s COVID-19 [Controversial issues of use of the angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists in patients with COVID-19]. Kardiovaskulyarnaya terapiya i profilaktika, vol. 19, no 3, pp. 319–326.
10. Dworakowska D., Grossman A.B. (2020) Renin-angiotensin system inhibitors in management of hypertension during the COVID-19 pandemic. Journal of physiology and pharmacology, 71 (2), pp. 173–178.
11. Podzolkov V., Dragomireckaya N. (2017) Vybor blokatora angiotenzinovyh receptorov na raznyh etapah serdechno-sosudistogo kontinuuma [Selection of angiotensin receptor blocker at different stages of cardiovascular continuum]. Kardiologiya, vol. 57, no 10, pp. 45–55.
12. O’Rourke M.F., Safar M.E., Dzau V. (2010) The Cardiovascular Continuum extended: aging effects on the aorta and microvasculature. Vasc Med., 15 (6), pp. 461–468.
13. Kim S.A., Park J.B., O’Rourke M.F. (2015) Vasculopathy of aging and the revised cardiovascular continuum. Pulse (Basel), 3 (2), pp. 141–147.
14. Kareva E. (2016) Evolyuciya sartanov ili vse li sartany odinakovy? [Evolution of sartans or are all sartans the same?]. Klinicheskaya farmakologiya i terapiya, vol. 25, no 3, pp. 11–21.
15. Chulkov V., Lenec E. (2019) Sartany: ot korrekcii arterial’noj gipertenzii k upravleniyu serdechno-sosudistym riskom [Sartans: from correction of arterial hypertension to management of cardiovascular risk]. Terapiya, 7 (33), pp. 112–119.
16. Vanderheyden P.M.L., Fierens F.L.P., Vauquelin G. (2000) Angiotensin II type 1 receptor antagonists. Why do some of them produce insurmountable inhibition? Biochem. Pharmacol., 60: 1557.
17. Khawaja Z., Wilcox Ch.S. (2011) An overview of candesartan in clinical practice. Expert Rev Cardiovasc Ther., 9 (8), pp. 975–982.
18. Karpov YU., Melekhov A. (2019) Kandesartan: vyhod za predely serdechno-sosudistogo kontinuuma [Candesartan: going beyond the cardiovascular continuum]. Atmosfera. Novosti kariologii, no 2, pp. 31–40.
19. Kirichenko A. (2018) Sartany i problema komorbidnosti [Sartans and the problem of comorbidity]. RMZH, 1 (II), pp. 110–114.
20. Tsuguya Fukui, Mahbubur Rahman, Koichi Hayashi (2003) Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial of cardiovascular events in high-risk hypertensive patients: rationale, design, and methods. Hypertens Res, 26 (12), pp. 979–90.
21. Lithell Hans, Hansson Lennart, Skoog Ingmar (2003) The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens, 21 (5), pp. 875–86.
22. Weisser B. (2005) Investigations of the antihypertensive long-term action of candesartan cilexetil in different dosages under the influence of therapy-free intervals. Arzneimittelforschung, 55 (9), pp. 505–13.
23. Bakris G. (2001) Antihypertensive efficacy of candesartan in comparison to losartan: the CLAIM study. J Clin Hypertens (Greenwich), 3 (1), pp. 16–21.
