milmedВоенная медицинаMilitary Medicine2074-5044Белорусский государственный медицинский университетmilmed-726Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESОсобенности лечения артериальной гипертензиив отдельных клинических ситуациях (Часть 1)Features of treatment of arterial hypertension in specific clinical situations (Part 1)РудойА. С.RudoyA. S.БоваА. А.BovaA. A.ЛивенцеваМ. М.LivencevaM. M.Кафедра военно-полевой терапии военно-медицинского факультета в УО «БГМУ»BelarusРНПЦ «Кардиология»Belarus20192410202603125131Copyright © Рудой А.С., Бова А.А., Ливенцева М.М., 20262026Рудой А.С., Бова А.А., Ливенцева М.М.Rudoy A.S., Bova A.A., Livenceva M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://milmed.ejournal.by/jour/article/view/726

В обзоре представлены обновленные Рекомендации по обследованию и лечению пациентов с артериальной гипертензией, принятые в июне 2018 года на конгрессе Европейского общества по артериальной гипертензии, а затем в августе 2018 года на ежегодном конгрессе Европейского общества кардиологов. Особенный интерес представляют различные вопросы, посвященные особенностям лечения артериальной гипертензии в отдельных клинических ситуациях. Несмотря на крайне высокие уровни доказательств, в новой версии Рекомендаций, многие позиции представленного документа профессиональному сообществу представляются спорными.

The review presents updated Guidelines for the management of arterial hypertension, adopted at the congress of the European Society of Hypertension in June 2018, and then at the annual congress of the European Society of Cardiology in August 2018. Of particular interest are various questions about the features of the treatment of arterial hypertension in certain clinical situations. In the new version of the Recommendations, many of the positions presented in the document to the professional community are contradictory, despite the extremely high level of evidence.

артериальная гипертензияантигипертензивная терапиясахарный диабетрефрактерная гипертензияобструктивное апноэметаболический синдромarterial hypertensionantihypertensive therapydiabetesrefractory hypertensionobstructive sleep apneametabolic syndromeReferencesWilliams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 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. Eur Heart J. 2018;39 (33):3021–3104. doi: 10.1093/eurheartj/ehy339Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 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. Eur Heart J. 2018;39 (33):3021–3104. doi: 10.1093/eurheartj/ehy339Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. Resistant hypertension: detection, evaluation, and management a scientific statement from the American Heart Association. Hypertension. 2018;72(5):1–38. doi: 10.1161/HYP.0000000000000084Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. Resistant hypertension: detection, evaluation, and management a scientific statement from the American Heart Association. Hypertension. 2018;72(5):1–38. doi: 10.1161/HYP.0000000000000084Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34 (28):2159–219. doi: 10.1093/eurheartj/eht151Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34 (28):2159–219. doi: 10.1093/eurheartj/eht151Диагностика и лечение артериальной гипертензии. Российские рекомендации. 4-й пересмотр. Системные гипертензии. 2010;3:5–26.Диагностика и лечение артериальной гипертензии. Российские рекомендации. 4-й пересмотр. Системные гипертензии. 2010;3:5–26.Thomopoulos C., Parati G., Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 13–benefits and adverse events in older and younger patients with hypertension overview, meta-analyses and meta-regression analyses of randomized trials //Journal of hypertension. – 2018. – Т. 36. – № 8. – С. 1622–1636.Thomopoulos C., Parati G., Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 13–benefits and adverse events in older and younger patients with hypertension overview, meta-analyses and meta-regression analyses of randomized trials //Journal of hypertension. – 2018. – Т. 36. – № 8. – С. 1622–1636.Williams B. High blood pressure in young people and premature death. BMJ 2011;342:d1104.Williams B. High blood pressure in young people and premature death. BMJ 2011;342:d1104.Beckett N, Peters R, Leonetti G, Duggan J, Fagard R, Thijs L, Narkiewicz K, McCormack T, Banya W, Fletcher A, Bulpitt C, HYVET Study Group. Subgroup and per-protocol analyses from the Hypertension in the Very Elderly Trial. J Hypertens 2014;32:1478–1487.Beckett N, Peters R, Leonetti G, Duggan J, Fagard R, Thijs L, Narkiewicz K, McCormack T, Banya W, Fletcher A, Bulpitt C, HYVET Study Group. Subgroup and per-protocol analyses from the Hypertension in the Very Elderly Trial. J Hypertens 2014;32:1478–1487.Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, Kitzman DW, Kostis JB, Krousel-Wood MA, Launer LJ, Oparil S, Rodriguez CJ, Roumie CL, Shorr RI, Sink KM, Wadley VG, Whelton PK, Whittle J, Woolard NF, Wright JT Jr, Pajewski NM, SPRINT Research Group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥ 75 years: a randomized clinical trial. JAMA 2016;315:2673–2682Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, Kitzman DW, Kostis JB, Krousel-Wood MA, Launer LJ, Oparil S, Rodriguez CJ, Roumie CL, Shorr RI, Sink KM, Wadley VG, Whelton PK, Whittle J, Woolard NF, Wright JT Jr, Pajewski NM, SPRINT Research Group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥ 75 years: a randomized clinical trial. JAMA 2016;315:2673–2682Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ 2016;352:i717.Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ 2016;352:i717.Margolis KL, O’Connor PJ, Morgan TM, Buse JB, Cohen RM, Cushman WC, Cutler JA, Evans GW, Gerstein HC, Grimm RH Jr, Lipkin EW, Narayan KM, Riddle MC Jr, Sood A, Goff DC Jr. Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes: the ACCORD randomized trial. Diabetes Care 2014;37:1721–1728Margolis KL, O’Connor PJ, Morgan TM, Buse JB, Cohen RM, Cushman WC, Cutler JA, Evans GW, Gerstein HC, Grimm RH Jr, Lipkin EW, Narayan KM, Riddle MC Jr, Sood A, Goff DC Jr. Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes: the ACCORD randomized trial. Diabetes Care 2014;37:1721–1728Liu L, Zhang Y, Liu G, Li W, Zhang X, Zanchetti A, Group FS. The Felodipine Event Reduction (FEVER) Study: a randomized long-term placebo-controlledtrial in Chinese hypertensive patients. J Hypertens 2005;23:2157–2172.Liu L, Zhang Y, Liu G, Li W, Zhang X, Zanchetti A, Group FS. The Felodipine Event Reduction (FEVER) Study: a randomized long-term placebo-controlledtrial in Chinese hypertensive patients. J Hypertens 2005;23:2157–2172.Patel A, ADVANCE Collaborative Group, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, Harrap S, Poulter N, Marre M, Cooper M, Glasziou P, Grobbee DE, Hamet P, Heller S, Liu LS, Mancia G, Mogensen CE, Pan CY, Rodgers A, Williams B. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007;370:829–840.Patel A, ADVANCE Collaborative Group, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, Harrap S, Poulter N, Marre M, Cooper M, Glasziou P, Grobbee DE, Hamet P, Heller S, Liu LS, Mancia G, Mogensen CE, Pan CY, Rodgers A, Williams B. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007;370:829–840.Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998;351:1755–1762.Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998;351:1755–1762.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317:703–713.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317:703–713.Cirillo M, Terradura-Vagnarelli O, Mancini M, Menotti A, Zanchetti A, Laurenzi M. Cohort profile: the Gubbio Population Study. Int J Epidemiol 2014;43:713–720Cirillo M, Terradura-Vagnarelli O, Mancini M, Menotti A, Zanchetti A, Laurenzi M. Cohort profile: the Gubbio Population Study. Int J Epidemiol 2014;43:713–720Mancia G, Schumacher H, Bohm M, Redon J, Schmieder RE, Verdecchia P, Sleight P, Teo K, Yusuf S. Relative and combined prognostic importance of ontreatment mean and visit-to-visit blood pressure variability in ONTARGET andTRANSCEND patients. Hypertension 2017;70:938–948.Mancia G, Schumacher H, Bohm M, Redon J, Schmieder RE, Verdecchia P, Sleight P, Teo K, Yusuf S. Relative and combined prognostic importance of ontreatment mean and visit-to-visit blood pressure variability in ONTARGET andTRANSCEND patients. Hypertension 2017;70:938–948.Nieto FJ, Young TB, Lind BK, Redline S, Agostino RBD, Newman AB, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a Large Community-Based Study for the Sleep Heart Health Study. 2012;284(14):1829–36.Nieto FJ, Young TB, Lind BK, Redline S, Agostino RBD, Newman AB, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a Large Community-Based Study for the Sleep Heart Health Study. 2012;284(14):1829–36.Xia W, Huang Y, Peng B, Zhang X, Wu Q, Sang Y, et al. Relationship between obstructive sleep apnoea syndrome and essential hypertension: a dose–response meta-analysis. Sleep Medicine [Internet]. Elsevier B. V.; 2018;47:11–8. doi:doi.org/10. 1016/j.sleep.2018.03.016Xia W, Huang Y, Peng B, Zhang X, Wu Q, Sang Y, et al. Relationship between obstructive sleep apnoea syndrome and essential hypertension: a dose–response meta-analysis. Sleep Medicine [Internet]. Elsevier B. V.; 2018;47:11–8. doi:doi.org/10. 1016/j.sleep.2018.03.016Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proceedings of the National Academy of Sciences. 2009;106(11):4453–8.Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proceedings of the National Academy of Sciences. 2009;106(11):4453–8.Губин Д. Г., Вайнерт Д., Соловьева С. В., Дуров А. М. Роль активности, сна и внешней освещенности в суточной динамике артериального давления. Медицинский алфавит. 2018; (3):20–3.Gubin DG, Vainert D, Solovyova SV, Durov AM. The role of activity, sleep and external light in the circadian dynamics of blood pressure. Meditsinskiy Alfavit = Medical Alphabet. 2018;(3):20–3. In Russian.Obayashi K, Saeki K, Tone N, Kurumatani N. Relationship between melatonin secretion and nighttime blood pressure in elderly individuals with and without antihypertensive treatment: a cross-sectional study of the HEIJO-KYO cohort. Hypertens Res. 2014;37(10):908–13. doi: dx.doi.org/10.1038/hr.2014.99Obayashi K, Saeki K, Tone N, Kurumatani N. Relationship between melatonin secretion and nighttime blood pressure in elderly individuals with and without antihypertensive treatment: a cross-sectional study of the HEIJO-KYO cohort. Hypertens Res. 2014;37(10):908–13. doi: dx.doi.org/10.1038/hr.2014.99Gubin DG, Weinert D, Rybina S V, Danilova LA, Solovieva SV, Durov AM et al. Activity, sleep and ambient light have a different impact on circadian blood pressure, heart rate and body temperature rhythms. Chronobiol. Intern. 2017;34(5):632–49.doi: dx.doi.org/10.1080/074205 28.2017.1288632Gubin DG, Weinert D, Rybina S V, Danilova LA, Solovieva SV, Durov AM et al. Activity, sleep and ambient light have a different impact on circadian blood pressure, heart rate and body temperature rhythms. Chronobiol. Intern. 2017;34(5):632–49.doi: dx.doi.org/10.1080/074205 28.2017.1288632Jarrin DC, Alvaro PK, Bouchard MA, Jarrin SD, Drake CL, Morin CM. Insomnia and hypertension: A systematic review. Sleep Med Rev. 2018;41:3–38. doi: doi.org/10.1016/j.smrv.2018.02.003Jarrin DC, Alvaro PK, Bouchard MA, Jarrin SD, Drake CL, Morin CM. Insomnia and hypertension: A systematic review. Sleep Med Rev. 2018;41:3–38. doi: doi.org/10.1016/j.smrv.2018.02.003Wing YK, Zhang J, Ho CKW, Au C‑T, Li AM. Periodic limb movement during sleep is associated with nocturnal hypertension in children. Sleep. 2010;33:759–65.Wing YK, Zhang J, Ho CKW, Au C‑T, Li AM. Periodic limb movement during sleep is associated with nocturnal hypertension in children. Sleep. 2010;33:759–65.2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–3241. doi: 10.1093/eurheartj/ehy3402018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–3241. doi: 10.1093/eurheartj/ehy340Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, Ford I, Cruickshank JK, Caulfield MJ, Padmanabhan S, Mackenzie IS, Salsbury J, Brown MJ, British Hypertension Society programme of Prevention And Treatment of Hypertension With Algorithm based Therapy (PATHWAY) Study Group. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Lancet Diabetes Endocrinol 2018;6:464–475.Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, Ford I, Cruickshank JK, Caulfield MJ, Padmanabhan S, Mackenzie IS, Salsbury J, Brown MJ, British Hypertension Society programme of Prevention And Treatment of Hypertension With Algorithm based Therapy (PATHWAY) Study Group. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Lancet Diabetes Endocrinol 2018;6:464–475.Liu L, Xu B, Ju Y. Addition of spironolactone in patients with resistant hypertension: a meta-analysis of randomized controlled trials. Clin Exp Hypertens 2017;39:257–263.Liu L, Xu B, Ju Y. Addition of spironolactone in patients with resistant hypertension: a meta-analysis of randomized controlled trials. Clin Exp Hypertens 2017;39:257–263.Wang C, Xiong B, Huang J. Efficacy and safety of spironolactone in patients with resistant hypertension: a meta-analysis of randomised controlled trials. Heart Lung Circ 2016;25:1021–1030Wang C, Xiong B, Huang J. Efficacy and safety of spironolactone in patients with resistant hypertension: a meta-analysis of randomised controlled trials. Heart Lung Circ 2016;25:1021–1030Zhao D, Liu H, Dong P, Zhao J. A meta-analysis of add-on use of spironolactone in patients with resistant hypertension. Int J Cardiol 2017;233:113–117.Zhao D, Liu H, Dong P, Zhao J. A meta-analysis of add-on use of spironolactone in patients with resistant hypertension. Int J Cardiol 2017;233:113–117.

The authors declare that there are no conflicts of interest present.