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Рецепт. 2019; : 127-135

Современные представленияo резистентной артериальной гипертензии

Полянская А. В., Достанко Н. Ю., Апанасович В. Г., Сиденко В. М.

Аннотация

В статье приводится определение резистентной артериальной гипертензии, рассмотрены современные представления о распространенности различных ее форм, об основных причинах, факторах риска, генетических детерминантах и иммунологических механизмах развития. Освещена роль резистентной артериальной гипертензии в возникновении сердечно-сосудистых заболеваний и показаны причины неадекватного контроля артериального давления в популяции. Описаны самые частые ошибки при измерении артериального давления и показана необходимость соблюдения правил при его измерении в диагностике резистентной артериальной гипертензии, также рассмотрены эти правила. Показано значение проблемы комплаентности пациента, эффекта «белого халата», ригидности пораженной атеросклеротическим процессом сосудистой стенки артерии, возникающей у лиц пожилого и старческого возраста, в развитии псевдорезистентности. Описаны причины, которые могут снижать приверженность пациентов к назначенной врачом терапии артериальной гипертензии, и дан перечень лекарственных средств и веществ, способствующих повышению артериального давления. Описаны основные направления немедикаментозного, медикаментозного лечения резистентной артериальной гипертензии. В статье отмечена необходимость начинать терапию резистентной артериальной гипертензии с назначения в полной дозе трехкомпонентной схемы (диуретик, ингибитор ангиотензинпревращающего фермента или блокатор рецепторов к ангиотензину II и блокатор «медленных» кальциевых каналов), а при недостаточном эффекте следует дифференцированно добавлять в эту схему антагонисты минералокортикоидных рецепторов или петлевые диуретики и/или назначать на фоне трехкомпонентной схемы другие антигипертензивные препараты. Сделан акцент на преимуществах применения фиксированных комбинаций антигипертензивных препаратов в низких дозах в терапии резистентной артериальной гипертензии и необходимость индивидуального подхода к каждому пациенту. Отмечена возможность хирургических вмешательств в коррекции артериального давления.

Список литературы

1. Britov A.N. (2010) Rezistentnaya arterial’naya gipertoniya: sovremennie podhodi k diagnostike i lecheniyu [Resistant arterial hypertension: modern approaches to diagnosis and treatment]. Farmakoterapiya v kardiologii, vol. 16(2), pp. 206-211.

2. (2010) Diagnostika i lechenie arterial’noi gipertenzii (Rekomendatsii Rossiiskogo meditsinskogo obschestva po arterial’noi gipertonii i Vserossiiskogo nauchnogo obschestva kardiologov) [Diagnosis and treatment of arterial hypertension (Recommendations of Russian medical society on arterial hypertension and All-Russian scientific society of cardiology]. Sistemnie gipertenzii, vol. 3, pp. 5-27.

3. Kozlovskaya I. (2012) Lechenie rezistentnoi arterial’noi gipertonii: novie perspektivi [The arterial hypertension treatment: new perspectives]. Kardiologiya, vol. 25, pp. 1238-1243.

4. Liventseva M.M. (2013) Vidi refrakternosti k antigipertenzivnoi terapii i vozmozhnie puti ee preodoleniya [Types of refractoriness to antihypertensive therapy and possible ways of overcoming]. Meditsinskie novosti, vol. 4, pp. 33-37

5. Mrochek A.G. (2016) Metodologicheskie osnovi i apparatnoe obespechenie poiska parametrov elektricheskogo vozdeistviya na sinokarotidnie refleksogennie zoni [Methodological bases and

6. search hardware of the parameters of electrical impact on synocarotid reflexogenic zones].

7. Dokladi BGUIR, vol. 7 (101), pp. 155-158.

8. Oganov R., Timofeeva T., Koltunov I. (2011) Epidemiologiya arterial’noi gipertonii v Rossii. Rezul’tati federal’nogo monitoringa 2003-2010 gg. [Epidemiology of arterial hypertension in Russia. The results of federal monitoring 2003-2010]. Kardiovask. terapiya i profilaktika, vol. 10 (1), pp. 8-12.

9. Chazova I.E. (2009) Proekt Registr rezistentnoi AG (Regata) [Project Register of resistant arterial hypertension]. Klinicheskaya nefrologiya, vol. 2, pp. 52-54

10. Glibochko P.V. (2018) Renal’naya denervatsiya pri rezistentnoi arterial’noi gipertenzii: rezul’tati 5-letnego nablyudeniya [Renal denervation in resistant arterial hypertension: the results of 5-year observation]. Terapevticheskii arhiv, vol. 9, pp. 88-91.

11. Ripp T.M. (2017) Renal’naya denervatsiya: vzglyad kardiologa [Renal denervation: cardiologist view]. Kardiologiya: Novosti. Mneniya. Obuchenie, vol. 13, pp. 31-38.

12. Sirenko Yu. (2008) Simptomaticheskie formi arterial’noi gipertenzii [Symptomatic forms of arterial hypertension]. Rukovodstvo po kardiologii [Manual on cardiology]. Kiev: MORION, pp. 482-522. (in Russian)

13. Brown M.A., Buddle M.J., Martin A. (2001) Is resistant hypertension really resistant? Am J Hypertens., vol. 14 (12), pp. 1263-1269.

14. Calhoun D.A., Jones D., Textor S. (2008) Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension, vol. 51, pp. 1403-1419.

15. Cushman W.C., Ford C.E., Cutler J.A. (2002) ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering and Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin. Hypertens., vol. 4, pp. 393-404.

16. De la Sierra A., Segura J., Banegas J.R. (2011) Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension, vol. 57, pp. 171-174.

17. Fagard R.H. (2011) Exercise therapy in hypertensive cardiovascular disease. Prog Cardiovasc Dis.,

18. vol. 53, pp. 404-411.

19. Fagard R., Bryujan J., Staessen J. (1995) Heritability of conventional and ambulatory blood pressure. A study in twins. Hypertension, vol. 26, pp. 919-924.

20. Fromm M.F., Schmidt B.M., Pahl A. (2005) CYP 3A5 genotype is associated with elevated blood pressure. Pharmocodenet. Genomics, vol. 15 (10), pp. 737-741.

21. Garg J.P., Eliott W.J., Folker A. (2005) Resistant hypertension revisited: a comparison of two university-based cohorts. Am J. Hypertens., vol. 18 (5), pp. 619-626.

22. Hannila-Handelberg T., Kontula R., Tikkanen I. (2005) Common variants of the beta and gamma subunits of the epithelial sodium channel and their relation of the plasma renin and aldosterone levels in essential hypertension. BMC Medical Genetics, vol. 6, p. 4.

23. Kaplan N. (2004) Systolic Blood Pressure a determinant of Comorbidity. Dallas, USA: Science Press, 52 p.

24. Laurent S., Schlaich M., Esler M. (2012) New drugs, procedures and devices for hypertension.

25. Lancet, vol. 380, pp. 591-600.

26. Lloyd-Jones D.M., Evans J.C., Larson M.G. (2000) Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension, vol. 36, pp. 594-599.

27. Lufl F.C. (2001) Twins in cardiovascular genetic research. Hypertension, vol. 37, pp. 350-356.

28. Mancia G., Fagard R., Narkiewicz K. (2013) Guidelines management of arterial hypertension of European Society of the Hypertension (ESH) and European Society of Cardiology (ESH). J. Hypertens., vol. 31, pp. 1281-1357.

29. Mahfound F., Bohm M., Azizi M. (2015) Proceedings from the European Clinical Consensus Conference for Renal Denervation: considerations on future clinical trial design. Eur Heart J., vol. 36, pp. 2219-2227.

30. Narkiewicz K., Ratcliffe L.E., Hart E.C. (2016) Unilateral carotid body resection in resistant hypertension: a safety and feasibility trial. JACC Basic Transl Sci., vol. 1, pp. 313-324.

31. Ng F.L., Saxena M., Mahfound F. (2016) Devise-based therapy for hypertension. Curr. Hypertens Rep., vol. 18, pp. 61.

32. Rosa J., Widimsky P., Tousec P. (2015) Randomised comparison of renal denervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension: six month results from the Prague-15 study. Hypertension, vol. 65, pp. 407-413.

33. Slond J.A., Balakrishnan S.L., Fong M.W., Bisognano J.D. (2007) Evaluation and treatment of resistant hypertension. Cardio Cogy Journal, vol. 14 (4), pp. 329-339.

34. Wenzel K., Haase H., Wallukat G. (2008) Potential relevance of x1-adrenergic receptor autoantibodies in refractory hypertension. PloS ONE, vol. 3 (11), pp. e 3742.

35. Williams B., Mancia G., Spiering W. (2018) Guidelines management of arterial hypertension of European Society of the Hypertension (ESH) and European Society of Cardiology (ESH). European Heart Journal, vol. 39, pp. 3021-3104.

Recipe. 2019; : 127-135

Modern Views on Resistant Arterial Hypertension

Polyanskaya A. ., Dostanko N. ., Apanasovich V. ., Sidenko V. .

Abstract

The article gives definition of resistant arterial hypertension, modern ideas about the prevalence of its various forms, main causes, risk factors, genetic determinants, and immunological mechanisms of development. The role of resistant arterial hypertension in the occurrence of cardiovascular diseases is highlighted and the causes of inadequate control of blood pressure in the populationare shown. The most frequent errors in blood pressure measurement are described and the need to follow the rules when measuring it in the diagnosis of resistant arterial hypertension is shown, these rules are also given. The importance of the patient’s compliance problem, the effect of the “white coat”, rigidity of the arterial vascular wall affected by atherosclerotic process that occurs in elderly and old people in the development of pseudoresistance is shown. The reasons that may reduce the patient’s adherence to the prescribed medical treatment of arterial hypertension are described, and the list of drugs and substances that increase blood pressure is given. The main directions of non- drug, drug treatment of resistant arterial hypertension are given. It is indicated that it is necessary to begin treatment of resistant arterial hypertension with the appointment of the full dose of the three-component scheme (diuretic, an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker and a blocker of slow calcium channels), and if the effect is insufficient, antagonists of mineralocorticoid receptors or loop diuretics should be added differentially to this scheme, and/ or prescribe other antihypertensive drugs on the background of the three-component scheme. Emphasis is placed on the benefits of using fixed combinations of antihypertensive drugs in low doses in the treatment of resistant hypertension and the need of an individual approach to each patient. Attention is paid to the possibilities of surgical interventions in the correction of blood pressure.
References

1. Britov A.N. (2010) Rezistentnaya arterial’naya gipertoniya: sovremennie podhodi k diagnostike i lecheniyu [Resistant arterial hypertension: modern approaches to diagnosis and treatment]. Farmakoterapiya v kardiologii, vol. 16(2), pp. 206-211.

2. (2010) Diagnostika i lechenie arterial’noi gipertenzii (Rekomendatsii Rossiiskogo meditsinskogo obschestva po arterial’noi gipertonii i Vserossiiskogo nauchnogo obschestva kardiologov) [Diagnosis and treatment of arterial hypertension (Recommendations of Russian medical society on arterial hypertension and All-Russian scientific society of cardiology]. Sistemnie gipertenzii, vol. 3, pp. 5-27.

3. Kozlovskaya I. (2012) Lechenie rezistentnoi arterial’noi gipertonii: novie perspektivi [The arterial hypertension treatment: new perspectives]. Kardiologiya, vol. 25, pp. 1238-1243.

4. Liventseva M.M. (2013) Vidi refrakternosti k antigipertenzivnoi terapii i vozmozhnie puti ee preodoleniya [Types of refractoriness to antihypertensive therapy and possible ways of overcoming]. Meditsinskie novosti, vol. 4, pp. 33-37

5. Mrochek A.G. (2016) Metodologicheskie osnovi i apparatnoe obespechenie poiska parametrov elektricheskogo vozdeistviya na sinokarotidnie refleksogennie zoni [Methodological bases and

6. search hardware of the parameters of electrical impact on synocarotid reflexogenic zones].

7. Dokladi BGUIR, vol. 7 (101), pp. 155-158.

8. Oganov R., Timofeeva T., Koltunov I. (2011) Epidemiologiya arterial’noi gipertonii v Rossii. Rezul’tati federal’nogo monitoringa 2003-2010 gg. [Epidemiology of arterial hypertension in Russia. The results of federal monitoring 2003-2010]. Kardiovask. terapiya i profilaktika, vol. 10 (1), pp. 8-12.

9. Chazova I.E. (2009) Proekt Registr rezistentnoi AG (Regata) [Project Register of resistant arterial hypertension]. Klinicheskaya nefrologiya, vol. 2, pp. 52-54

10. Glibochko P.V. (2018) Renal’naya denervatsiya pri rezistentnoi arterial’noi gipertenzii: rezul’tati 5-letnego nablyudeniya [Renal denervation in resistant arterial hypertension: the results of 5-year observation]. Terapevticheskii arhiv, vol. 9, pp. 88-91.

11. Ripp T.M. (2017) Renal’naya denervatsiya: vzglyad kardiologa [Renal denervation: cardiologist view]. Kardiologiya: Novosti. Mneniya. Obuchenie, vol. 13, pp. 31-38.

12. Sirenko Yu. (2008) Simptomaticheskie formi arterial’noi gipertenzii [Symptomatic forms of arterial hypertension]. Rukovodstvo po kardiologii [Manual on cardiology]. Kiev: MORION, pp. 482-522. (in Russian)

13. Brown M.A., Buddle M.J., Martin A. (2001) Is resistant hypertension really resistant? Am J Hypertens., vol. 14 (12), pp. 1263-1269.

14. Calhoun D.A., Jones D., Textor S. (2008) Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension, vol. 51, pp. 1403-1419.

15. Cushman W.C., Ford C.E., Cutler J.A. (2002) ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering and Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin. Hypertens., vol. 4, pp. 393-404.

16. De la Sierra A., Segura J., Banegas J.R. (2011) Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension, vol. 57, pp. 171-174.

17. Fagard R.H. (2011) Exercise therapy in hypertensive cardiovascular disease. Prog Cardiovasc Dis.,

18. vol. 53, pp. 404-411.

19. Fagard R., Bryujan J., Staessen J. (1995) Heritability of conventional and ambulatory blood pressure. A study in twins. Hypertension, vol. 26, pp. 919-924.

20. Fromm M.F., Schmidt B.M., Pahl A. (2005) CYP 3A5 genotype is associated with elevated blood pressure. Pharmocodenet. Genomics, vol. 15 (10), pp. 737-741.

21. Garg J.P., Eliott W.J., Folker A. (2005) Resistant hypertension revisited: a comparison of two university-based cohorts. Am J. Hypertens., vol. 18 (5), pp. 619-626.

22. Hannila-Handelberg T., Kontula R., Tikkanen I. (2005) Common variants of the beta and gamma subunits of the epithelial sodium channel and their relation of the plasma renin and aldosterone levels in essential hypertension. BMC Medical Genetics, vol. 6, p. 4.

23. Kaplan N. (2004) Systolic Blood Pressure a determinant of Comorbidity. Dallas, USA: Science Press, 52 p.

24. Laurent S., Schlaich M., Esler M. (2012) New drugs, procedures and devices for hypertension.

25. Lancet, vol. 380, pp. 591-600.

26. Lloyd-Jones D.M., Evans J.C., Larson M.G. (2000) Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension, vol. 36, pp. 594-599.

27. Lufl F.C. (2001) Twins in cardiovascular genetic research. Hypertension, vol. 37, pp. 350-356.

28. Mancia G., Fagard R., Narkiewicz K. (2013) Guidelines management of arterial hypertension of European Society of the Hypertension (ESH) and European Society of Cardiology (ESH). J. Hypertens., vol. 31, pp. 1281-1357.

29. Mahfound F., Bohm M., Azizi M. (2015) Proceedings from the European Clinical Consensus Conference for Renal Denervation: considerations on future clinical trial design. Eur Heart J., vol. 36, pp. 2219-2227.

30. Narkiewicz K., Ratcliffe L.E., Hart E.C. (2016) Unilateral carotid body resection in resistant hypertension: a safety and feasibility trial. JACC Basic Transl Sci., vol. 1, pp. 313-324.

31. Ng F.L., Saxena M., Mahfound F. (2016) Devise-based therapy for hypertension. Curr. Hypertens Rep., vol. 18, pp. 61.

32. Rosa J., Widimsky P., Tousec P. (2015) Randomised comparison of renal denervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension: six month results from the Prague-15 study. Hypertension, vol. 65, pp. 407-413.

33. Slond J.A., Balakrishnan S.L., Fong M.W., Bisognano J.D. (2007) Evaluation and treatment of resistant hypertension. Cardio Cogy Journal, vol. 14 (4), pp. 329-339.

34. Wenzel K., Haase H., Wallukat G. (2008) Potential relevance of x1-adrenergic receptor autoantibodies in refractory hypertension. PloS ONE, vol. 3 (11), pp. e 3742.

35. Williams B., Mancia G., Spiering W. (2018) Guidelines management of arterial hypertension of European Society of the Hypertension (ESH) and European Society of Cardiology (ESH). European Heart Journal, vol. 39, pp. 3021-3104.