rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2019-15-4-568-577rpcardio-2011Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯResistant Hypertension: Questions and Contemporary AnswersРезистентная гипертензия: вопросы и современные ответыПодзолковВ. И.PodzolkovV. I.

Подзолков Валерий Иванович – д.м.н., профессор, заведующий кафедрой факультетской терапии №2, Сеченовский Университет 

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

Valery I. Podzolkov – MD, PhD, Professor, Head of Chair of Faculty Therapy №2, Sechenov University

Trubetskaya ul. 8-2, Moscow, 119991 Russia

БрагинаА. Е.BraginaA. E.

Брагина Анна Евгеньевна – д.м.н., профессор, кафедра факультетской терапии №2, Сеченовский Университет

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

Anna E. Bragina – MD, PhD, Professor, Chair of Faculty Therapy №2, Sechenov University

Trubetskaya ul. 8-2, Moscow, 119991 Russia

anna.bragina@mail.ruОсадчийК. К.OsadchiyK. K.

Осадчий Константин Константинович – к.м.н., доцент, кафедра факультетской терапии №2, Сеченовский Университет

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

Konstantin K. Osadchiy – MD, PhD, Associate Professor, Chair of Faculty Therapy №2, Sechenov University

Trubetskaya ul. 8-2, Moscow, 119991 Russia

Первый Московский Государственный Медицинский Университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation201902092019154568577Copyright © Podzolkov V.I., Bragina A.E., Osadchiy K.K., 20192019Подзолков В.И., Брагина А.Е., Осадчий К.К.Podzolkov V.I., Bragina A.E., Osadchiy K.K.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/2011

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.

Представленный обзор литературы посвящен важной проблеме резистентной артериальной гипертензии (АГ). Ее истинная распространенность неизвестна. По данным популяционных исследований и мета-анализов клинических исследований распространенность этой наиболее тяжелой формы АГ достигает 12-15% в общей популяции и 15-18% – в клинических когортах. За последние десятилетия отмечено нарастание ее частоты среди больных гипертензией. На основании результатов крупномасштабных исследований описаны факторы риска, позволяющие врачу оценить вероятность развития резистентности к проводимой антигипертензивной терапии. Важнейшее значение для решения вопроса резистентности АГ имеет приверженность к проводимой антигипертензивной терапии, существуют приемлемые способы ее оценки в клинической практике. В обзоре обсуждаются наиболее частые ошибки при выборе терапии, которые могут стать причиной резистентности к антигипертензивному лечению, в том числе – нерациональные комбинации препаратов, недостаточные дозировки лекарственных средств, использование непролонгированных форм препаратов. Проанализированы последние рекомендации по диагностике и лечению АГ, в том числе, и ее резистентной формы. Обзор содержит обоснование, основанное на результатах рандомизированных клинических исследований, выбора тактики антигипертензивной терапии при этом варианте АГ. Подчеркивается важное значение фиксированных комбинированных антигипертензивных препаратов, а также тиазиподобных диуретиков и амлодипина в преодолении резистентности к лечению. Приведены результаты исследований, обосновывающие целесообразность включения в схему терапии АГ у данной категории пациентов антиминералкортикоидных препаратов, а именно – спиронолактона. Авторами предложен обновленный алгоритм диагностики и лечения резистентной АГ, базирующийся на разделах последних клинических рекомендаций, посвященных данной проблеме.

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