Новые возможности терапии неконтролируемой артериальной гипертензии


Л.О. Минушкина

Учебно-научный медицинский центр УД Президента РФ, Москва
В настоящее время широко обсуждается проблема новых подходов к лечению больных резистентной к обычной медикаментозной терапии артериальной гипертензией (АГ), под которой понимают отсутствие контроля за артериальным давлением (АД) при использовании трех антигипертензивных препаратов разных классов в оптимальных дозах, при этом один препарат должен быть диуретиком. В статье рассмотрены проблемы диагностики резистентной АГ, значение методы суточного мониторирования АД. Обсуждаются меры по немедикаментозной и лекарственной терапии неконтролируемой АГ. Приведены данные об эффективности новых инвазивных подходов к ведению этой группы больных.

Литература



  1. Brown M.A., Buddle M.L., Martin A. Is resistant hypertension really resistant? // Am. J. Hypertension. — 2001. — Vol. 14(12). — P. 1263—69.

  2. Persell S.D. Prevalence of resistant hypertension in the United States, 2003–2008 // Hypertension. — 2011. — Vol. 57(6). — P. 1076—80.

  3. Hanselin M.R., Saseen J.J., Allen R.R., et al. Description of antihypertensive use in patients with resistant hypertension prescribed four or more agents // Hypertension. — 2011. — Vol. 58(6). — P. 1008—13.

  4. Marui F.R., Bombig M.T., Francisco Y.A., et al. Assessment of resistant hypertension with home blood pressure monitoring // Arq. Bras. Cardiol. — 2010. — Vol. 95(4). — P. 536—40.

  5. Daugherty S.L., Powers J.D., Magid D.J., et al. Incidence and prognosis of resistant hypertension in hypertensive patients // Circulation. — 2012. — Vol. 125(13). — P. 1635—42.

  6. Gupta A.K., Nasothimiou E.G., Chang C.L., et al. Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk // J. Hypertens. — 2011. — Vol. 29(10). — P. 2004—13.

  7. Muxfeldt E.S., Fiszman R., de Souza F. Appropriate time interval to repeat ambulatory blood pressure monitoring in patients with white-coat resistant hypertension // Hypertension. — 2012. — Vol. 59(2). — P. 384—89.

  8. Ayala D.E., Gomara S., Sineiro E., et al. Hygia Project Investigators. Prevalence and clinical characteristics of isolated-office and true resistant hypertension determined by ambulatory blood pressure monitoring // Chronobiol. Int. — 2013. — Vol. 30(1–2). — P. 207—20.

  9. Llisterri J.L., Alonso F.J., Gorostidi M., et al. Differences between office and ambulatory control of hypertension in very elderly patients. The CARDIORISC – MAPAPRES project // Med. Clin. (Barc). — 2009. — Vol. 133(20). — P. 769—76.

  10. Hermida R.C., Rios M.T., Crespo J.J., et al Treatment-time regimen of hypertension medications significantly affects ambulatory blood pressure and clinical characteristics of patients with resistant hypertension // Chronobiol. Int. — 2013. — Vol. 30(1—2). — P. 192—206.

  11. Pimenta E., Gaddam K.K., Oparil S., et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: results from a randomized trial // Hypertension. — 2009. — Vol. 54(3). — P. 475—81.

  12. Johnson A.G., Nguyen T.V., Day R.O. Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis // Ann. Intern. Med. — 1994. — Vol. 121. — P. 289—300.

  13. Chobanian A.V., Bakris G.L., Black H.R., et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure // Hypertension. — 2003. — Vol. 42. — P. 1206—52.

  14. Mancia G., Laurent S., Agabiti-Rosei E., et al. Reappraisal of European guidelines on hypertension managements: a European Society of Hypertension Task Force document // J. Hum.Hypertens. — 2009. — Vol. 27. — P. 2121—58

  15. Krause T., Lovibond K., Caulfield M., McCormack T., Williams B.; Guideline Development Group. Management of hypertension: summary of NICE guidance // BMJ. — 2011;343:d4891.

  16. Circelli M., Nicolini G., Egan C.G., Cremonesi G. Efficacy and safety of delapril/indapamide compared to different ACE-inhibitor/hydrochlorothiazide combinations: a meta-analysis // Int. J. Gen. Med. — 2012. — Vol. 5. — P. 725—34.

  17. Pimenta E., Gaddam K.K., Pratt-Ubunama M.N., et al. Aldosterone excess and resistance to 24-h blood pressure control // J. Hypertens. — 2007. — Vol. 25(10). — P. 2131—37.

  18. Pisoni R., Acelajado M.C., Cartmill F.R., et al. Long-term effects of aldosterone blockade in esistant hypertension associated with chronic kidney disease // J. Hum. Hypertens. — 2012. — Vol. 26(8). — P. 502—06.

  19. Lane D.A., Shah S., Beevers D.G. Low-dose spironolactone in the management of resistant hypertension: a surveillance study // J. Hypertens. — 2007. — Vol. 25(4). — P. 891—94.

  20. Engbaek M., Hjerrild M., Hallas J., Jacobsen I.A. The effect of low-dose spironolactone on resistant hypertension // J. Am. Soc. Hypertens. — 2010. — Vol. 4(6). — P. 290—94.

  21. Clark D. 3rd, Ahmed M.I., Calhoun D.A. Resistant hypertension and aldosterone: an update // Can. J. Cardiol. — 2012. — Vol. 28(3). — P. 318—25.

  22. Gaddam K., Pimenta E., Thomas S.J., et al. Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report // J. Hum. Hypertens. — 2010. — Vol. 24(8). — P. 532—37.

  23. Vaclavik J., Sedlak R., Jarkovsky J., et al. Effect of spironolactone in patients with resistant arterial hypertension in relation to age and sex: Insights from the aspirant trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012 Dec 7. doi: 10.5507/bp.2012.105.

  24. Vaclavik J., Sedlak R., Jarkovsky J., et al. The effect of spironolactone in patients with resistant arterial hypertension in relation to baseline blood pressure and secondary causes of hypertension // Biomed. Pap. Med. Fac. Univ. Palacky Olomouc. Czech. Repub. — 2013. — Vol. 157(1). — P. 50—5.

  25. Rosenbaum D., Villeneuve F., Gury C., Girerd X. Frequency of hypertension resistant to treatment and indication for renal denervation // Ann. Cardiol. Angeiol. (Paris). — 2012. — Vol. 61(3). — P. 229—33. doi: 10.1016/j.ancard.2012.04.018.

  26. Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months // Hypertension. — 2011. — Vol. 57(5). — P. 911—17.

  27. Esler M.D., Krum H., Schlaich M., et al. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial // Circulation. — 2012. — Vol. 126(25). — P. 2976—82.

  28. Dorenkamp M., Bonaventura K., Leber A.W., et al. Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension // Eur. Heart. J. — 2013. — Vol. 34(6). — P. 451—61.

  29. Witkowski A., Prejbisz A., Florczak E., et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea // Hypertension. — 2011. — Vol. 58(4). — P. 559— 65.

  30. Mahfoud F., Cremers B., Janker J., et al. Renal hemodynamics and renal function after catheter-based renal sympathetic denervation in patients with resistant hypertension // Hypertension. — 2012. — Vol. 60(2). — P. 419—24.

  31. Alnima T., Scheffers I., De Leeuw P.W., et al. Sustained acute voltage-dependent blood pressure decrease with prolonged carotid baroreflex activation in therapy-resistant hypertension // J. Hypertens. — 2012. — Vol .30(8). — P. 1665—70.

  32. Heusser K., Tank J., Engeli S., et al. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients // Hypertension. — 2010. — Vol. 55(3). — P. 619—26.

  33. Wustmann K., Kucera J.P., Scheffers I., et al. Effects of chronic baroreceptor stimulation on the autonomic cardiovascular regulation in patients with drug-resistant arterial hypertension // Hypertension. — 2009. — Vol. 54(3). — P. 530—36.


Об авторах / Для корреспонденции


Л.О. Минушкина - доцент кафедры кардиологии и общей терапии ФГУ УНМЦ УД Президента РФ, Москва, minushkina@mail.ru


Похожие статьи


Бионика Медиа