rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2022-08-14rpcardio-2791Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯRefractory Arterial Hypertension: Features of Neurohormonal and Water-salt Imbalanceand Approaches to Antihypertensive Drug TherapyРефрактерная артериальная гипертензия: особенности нейрогормонального и водно-солевого дисбаланса и подходы к повышению эффективности антигипертензивной медикаментозной терапииhttps://orcid.org/0000-0003-3730-3665КузьминО. Б.KuzminO. B.

Кузьмин Олег Борисович.

460014, Оренбург, ул. Советская, 6.

Oleg B. Kuzmin.

Orenburg.

kuzmin.orgma@mail.ruhttps://orcid.org/0000-0003-1321-2101ЖежаВ. В.ZhezhaV. V.

Жежа Владислав Викторович.

460014, Оренбург, ул. Советская, 6.

Vladislav V. Zhezha.

Orenburg.

Оренбургский государственный медицинский университетРоссияOrenburg State Medical UniversityRussian Federation202207092022184467472Copyright © Kuzmin O.B., Zhezha V.V., 20222022Кузьмин О.Б., Жежа В.В.Kuzmin O.B., Zhezha V.V.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/2791

Refractory arterial hypertension is characterized by a lack of control of target blood pressure, despite the prolonged use >5 antihypertensive drugs with different mechanisms of action, including longacting diuretic chlorthalidone and the mineralcorticoid receptor antagonists (spironolactone or eplerenone). The review presents the results of clinical studies devoted the elucidating peculiarities of the neurohormonal status and water-salt balance in such patients and developing new approaches to antihypertensive drug therapy based on them. According to these studies, individuals with refractory hypertension differ from patients with resistant hypertension with the higher of sympathetic nervous system activity and the absence of an increased of intrathoracic fluid volume, which indirectly indicates a significant decrease in the intravascular fluid volume. In this regard, the review focuses on the data obtained in assessing the clinical efficacy of sympatholytics clonidine and reserpine in patients with resistant and refractory hypertension, as well as renal sodium-glucose co-transporter type 2 inhibitors, which suppress the sympathetic nervous system activity and can be used to overcome refractory hypertension in patients with type 2 diabetes.

Рефрактерная артериальная гипертензия (АГ) характеризуется отсутствием контроля целевого АД, несмотря на длительное применение >5 разных по механизму гипотензивного действия лекарственных препаратов, включая диуретик длительного действия хлорталидон и антагонист минералокортикоидных рецепторов (спиронолактон или эплеренон). В обзоре представлены результаты клинических исследований, посвященных выяснению особенностей нейрогормонального статуса и водно-солевого баланса у таких пациентов и разработке на их основе новых подходов к антигипертензивной лекарственной терапии. По данным этих исследований лица с рефрактерной АГ отличались от больных с резистентной АГ более высокой активностью симпатической нервной системы и отсутствием повышенного объема внутригрудной жидкости, что косвенно свидетельствует о значительном снижении у них объема внутрисосудистой жидкости. В связи с этим в обзоре особое внимание уделено результатам, полученным у пациентов с резистентной и рефрактерной АГ при оценке клинической эффективности симпатолитиков клонидина и резерпина, а также ингибиторов почечного натрий-глюкозного ко-транспортера 2 типа, которые подавляют активность симпатической нервной системы и могут быть использованы для преодоления рефрактерной АГ у больных сахарным диабетом 2 типа.

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