Abstract
The review presents the important problem of resistant hypertension. Its real prevalence is unknown. According to population studies and metaanalyzes of clinical studies, the prevalence of this most severe form of hypertension reaches 12-15% in the general population and 15-18% in clinical cohorts. Over the past decades, an increase in its frequency among patients with hypertension has been noted. Based on the results of large-scale studies, risk factors are detected that allow to assess the risk for the resistance to antihypertensive drugs. Adherence to ongoing antihypertensive therapy is crucial to addressing the issue of hypertension resistance; there are acceptable ways to evaluate it in clinical practice. The review discusses the most common mistakes in the choice of therapy, which can cause resistance to antihypertensive treatment, namely irrational drug combinations, insufficient dosage of the drug, and the use of non-prolonged forms of drugs. The latest recommendations for the diagnosis and treatment of hypertension, including its resistant form, are analyzed. The review contains a rationale based on the results of randomized clinical trials, the choice antihypertensive strategy in this variant of arterial hypertension. The importance of fixed combination antihypertensive drugs, as well as thiazine-like diuretics and amlodipine is stressed. The results of studies demonstrate the rational for the use of antimineralcorticoid drugs, namely spironolactone, for this category of patients. The authors offer an updated algorithm for the diagnosis and treatment of resistant hypertension, based on the sections of the latest clinical recommendations on this problem.
Highlights
Представленный обзор литературы посвящен важной проблеме резистентной артериальной гипертензии (АГ)
The review presents the important problem of resistant hypertension
Adherence to ongoing antihypertensive therapy is crucial to addressing the issue of hypertension resistance; there are acceptable ways to evaluate it in clinical practice
Summary
С вопросом недостаточной эффективности лечения АГ тесно связана проблема резистентной АГ (РАГ). Под резистентной АГ понимают состояние, при котором целевые цифры АД не достигнуты на фоне адекватной терапии, включающей мероприятия по изменению образа жизни и использование не менее трех антигипертензивных препаратов (АГП), в том числе, ингибитора ангиотензин-превращающего фермента (ИАПФ)/блокатора рецепторов ангиотензина II (БРА)+антагониста кальция (АК)+диуретика в оптимальных или максимально переносимых дозах при условии подтверждения диагноза АГ методами суточного мониторирования или домашнего измерения АД [2]. По данным крупного популяционного исследования REasons for Geographic And Racial Differences in Stroke (REGARDS), в котором приняли участие 30239 пациентов, получающих АГП, 10-летний риск развития ИБС и инсульта у лиц с РАГ был выше, чем в целом у пациентов, получающих антигипертензивную терапию: 7,0 [95% доверительный интервал (95%ДИ) 4,6-9,5] и 8,1 (95%ДИ 5,9-10,3), соответственно [5]. Наличие РАГ было сопряжено с более высоким риском развития болезней системы кровообращения (относительный риск 1,47; 95%ДИ 1,33-1,62) [6]
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