rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2019-15-3-416-423rpcardio-1965Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯHypertension and Headache: the Effect of Antihypertensive DrugsАртериальная гипертензия и головная боль: влияние антигипертензивных препаратовПарфеновВ. А.ParfenovV. A.

д.м.н., профессор, зав. кафедрой нервных болезней и нейрохирургии

Россия, 119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Professor, Head of Chair of Nervous Diseases and Neurosurgery

Trubetskaya ul. 8-2, Moscow, 119991 Russia

ОстроумоваТ. М.OstroumovaT. M.

аспирант, кафедра нервных болезней и нейрохирургии, лечебный факультет

Россия, 119991, Москва, ул. Трубецкая, 8 стр. 2

MD, Post-Graduate Student, Chair of Nervous Diseases and Neurosurgery

Trubetskaya ul. 8-2, Moscow, 119991 Russia

ОстроумоваО. Д.OstroumovaO. D.

д.м.н., профессор, кафедра клинической фармакологии и пропедевтики внутренних болезней, 

Россия, 119991, Москва, ул. Трубецкая, 8 стр. 2

Россия, 129226, Москва, ул. 1-ая Леонова, 16

MD, PhD, Professor, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine; Head of Laboratory of Clinical Pharmacology and Pharmacotherapy

Trubetskaya ul. 8-2, Moscow, 119991 Russia

Pervaya Leonova ul. 16, Moscow, 129226 Russia

ostroumova.olga@mail.ruПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет) Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, ОСП Российский геронтологический научно-клинический центрРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University) Pirogov Russian National Research Medical University, Russian Clinical and Research Center of GerontologyRussian Federation201903072019153416423Copyright © Parfenov V.A., Ostroumova T.M., Ostroumova O.D., 20192019Парфенов В.А., Остроумова Т.М., Остроумова О.Д.Parfenov V.A., Ostroumova T.M., Ostroumova O.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1965

Headache is considered to be one of the main symptoms of arterial hypertension (HT). Complaints of headache are presented by many patients with HT: from 44% to 87%. It is obvious that the majority of complaints of headache in patients with HT is not due to headaches due to increased blood pressure (BP), but multimorbidity (polymorbidity) – the presence of coexisting primary headaches, most often, as in the population as a whole, chronic tension headache (57-85%) and migraine (15-30%). On the other hand, the frequency of HT in patients with migraine ranges from 32% to 44%. The relationship between migraine and HT may be due to common exogenous (external) and endogenous (genetic) factors, as well as common pathophysiological mechanisms. External risk factors, which can be associated with both migraine and HT, include the nature of the diet (excessive consumption of table salt with food), low physical activity, chronic stress; both diseases are also associated with the presence of a connection with the metabolic syndrome. The role of hyperactivation of the renin-angiotensin-aldosterone and adrenergic system and endothelial dysfunction are actively discussed. Angiotensin-converting enzyme takes an active part in the BP control and vascular tone; it is known that some angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) have demonstrated efficacy in preventing migraine attacks. The presence of HT can contribute to the chronic course of primary headache, and effective treatment of HT with antihypertensive drugs, on the contrary, can have a positive effect on the course of primary headaches. Antihypertensive drugs reduce the frequency of headaches compared to placebo, but heterogeneity between different classes was revealed. There was a statistically significant decrease in the frequency of headaches compared to placebo during treatment with beta-blockers, ACEI, ARB, diuretics, while calcium antagonists did not reduce the frequency of headaches. According to a number of studies, the frequency of headaches during the treatment with ARB (candesartan) is comparable to that in the placebo group. Some antihypertensive drugs are used to prevent migraine attacks.

Головная боль считается одним из главных симптомов артериальной гипертонии (АГ). Жалобы на головную боль предъявляют многие пациенты с АГ: от 44% до 87%. Очевидно, что большинство жалоб на головную боль у пациентов с АГ обусловлено не головными болями вследствие повышения артериального давления (АД), а мультиморбидностью (полиморбидностью) – наличием сосуществующих первичных головных болей, чаще всего, как и в популяции в целом – хронической головной боли напряжения (57-85%) и мигрени (15-30%). С другой стороны, частота АГ у пациентов с мигренью составляет от 32% до 44%. Взаимосвязь между мигренью и АГ может быть обусловлена общими экзогенными (внешними) и эндогенными (генетическими) факторами, а также общими патофизиологическими механизмами. Внешние факторы риска, с которыми могут быть связаны как мигрень, так и АГ, включают характер питания (избыточное потребление поваренной соли с пищей), низкую физическую активность, хронический стресс; оба заболевания также ассоциируются c наличием связи с метаболическим синдромом. Активно обсуждается роль гиперактивации ренин-ангиотензин-альдостероновой системы, гиперсимпатикотонии и дисфункции эндотелия. Ангиотензинпревращающий фермент принимает активное участие в контроле АД и сосудистого тонуса, как известно, некоторые ингибиторы ангиотензинпревращающего фермента (иАПФ) и блокаторы рецепторов к ангиотензину II (БРА) продемонстрировали в ряде исследований эффективность в профилактике приступов мигрени. Наличие АГ может способствовать хроническому течению первичной головной боли, а эффективное лечение АГ антигипертензивными препаратами, напротив, может оказать положительное влияние и на течение первичных головных болей. Антигипертензивные препараты снижают частоту головных болей по сравнению с плацебо, однако выявлена гетерогенность между различными классами. Обнаружено статистически значимое снижение частоты головных болей по сравнению с плацебо на фоне лечения бета-адреноблокаторами, иАПФ, БРА, диуретиками, тогда как антагонисты кальция не уменьшали частоту головных болей. По данным ряда исследований частота головных болей на фоне лечения БРА (кандесартан) сопоставима с таковой в группе плацебо. Некоторые антигипертензивные препараты применяются для профилактики приступов мигрени. 

артериальная гипертензияголовная больмигреньантигипертензивные препаратыблокаторы рецепторов к ангиотензину IIкандесартанHeadache is considered to be one of the main symptoms of arterial hypertension (HT). Complaints of headache are presented by many patients with HT: from 44% to 87%. It is obvious that the majority of complaints of headache in patients with HT is not due to headaches due to increased blood pressure (BP)but multimorbidity (polymorbidity) – the presence of coexisting primary headachesmost oftenas in the population as a wholechronic tension headache (57-85%) and migraine (15-30%). On the other handthe frequency of HT in patients with migraine ranges from 32% to 44%. The relationship between migraine and HT may be due to common exogenous (external) and endogenous (genetic) factorsas well as common pathophysiological mechanisms. External risk factorswhich can be associated with both migraine and HTinclude the nature of the diet (excessive consumption of table salt with food)low physical activitychronic stressboth diseases are also associated with the presence of a connection with the metabolic syndrome. The role of hyperactivation of the renin-angiotensin-aldosterone and adrenergic system and endothelial dysfunction are actively discussed. Angiotensin-converting enzyme takes an active part in the BP control and vascular toneit is known that some angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) have demonstrated efficacy in preventing migraine attacks. The presence of HT can contribute to the chronic course of primary headacheand effective treatment of HT with antihypertensive drugson the contrarycan have a positive effect on the course of primary headaches. Antihypertensive drugs reduce the frequency of headaches compared to placebobut heterogeneity between different classes was revealed. There was a statistically significant decrease in the frequency of headaches compared to placebo during treatment with beta-blockersACEIARBdiureticswhile calcium antagonists did not reduce the frequency of headaches. According to a number of studiesthe frequency of headaches during the treatment with ARB (candesartan) is comparable to that in the placebo group. Some antihypertensive drugs are used to prevent migraine attacks.ReferencesWilliams B., Mancia G., Spiering W., et al.; Authors/Task Force Members. 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 and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041. 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The authors declare that there are no conflicts of interest present.