rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2024-3136MXMTYVrpcardio-3136Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯBlood pressure variability — 15 years laterВариабельность артериального давления — 15 лет спустяhttps://orcid.org/0000-0001-5195-8997ГорбуновВ. М.GorbunovV. M.

Горбунов Владимир Михайлович

Москва

Vladimir M. Gorbunov

Moscow

Vgorbunov@gnicpm.ruhttps://orcid.org/0000-0003-3506-6168ПлатоноваЕ. В.PlatonovaE. V.

Платонова Елена Вячеславовна

Москва

Elena V. Platonova

Moscow

EPLatonova@gnicpm.ruНациональный медицинский исследовательский центр терапии и профилактической медицины Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian Federation202406012025206645651Copyright © Gorbunov V.M., Platonova E.V., 20252025Горбунов В.М., Платонова Е.В.Gorbunov V.M., Platonova E.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/3136

Blood pressure variability (BPV) has been studied for a long time, and recently important new information has been obtained about the prognostic value of BPV and the influence of antihypertensive therapy on it. There are three groups of VBP characteristics that are most important from a practical point of view: 24-hour BPV, BPV of average duration and visit-to-visit variability (VVV). VVV has attracted the attention of scientists in recent years. In a recent study in patients who participated in the ASCOT-BPLA cohort (mean follow-up 17.4 years) it was shown that 1) SBP VVV proved to be a strong predictor of cardiovascular complications (CVC), independent of mean BP (and possibly stronger than the latter) including in patients with well-controlled AH; 2) the CVC risk (including stroke and coronary events) remained significantly lower in the amlodipine treatment group. This finding seems particularly interesting in view of the fact that during such a long follow-up period many patients changed their treatment regimen; baseline values of office BP in both groups did not differ significantly. Thus, the independent prognostic value of VVV has received new convincing confirmation. Amlodipine may be the optimal drug for the treatment of patients with elevated BPV, but further studies are required to prove this point.

Вариабельность артериального давления (ВАД) изучается в течение длительного времени, в последнее время получены новые важные сведения о прогностическом значении показателей ВАД и влиянии на них антигипертензивной терапии. Можно выделить три наиболее важные с практической точки зрения группы характеристик ВАД: 24-часовая, ВАД средней продолжительности и вариабельность "от визита к визиту" (visit-to-visit variability, VVV). VVV в последние годы привлекает наибольшее внимание ученых. В недавнем исследовании у больных, входивших в когорту ASCOT-BPLA (средний срок наблюдения 17,4 года), было показано, что: 1) VVV САД оказалась сильным предиктором сердечно-сосудистых осложнений (ССО), независимым от среднего уровня АД (и, возможно, более сильным, чем последний), в том числе у пациентов с хорошо контролируемой АГ; 2) риск ССО, в том числе инсульта и коронарных событий, оставался значимо более низким в группе лечения амлодипином. Эта находка представляется особо интересной в связи с тем, что на протяжении столь длительного периода наблюдения у многих пациентов изменилась схема лечения; исходные значения офисного АД в обеих группах значимо не различались. Таким образом, независимое прогностическое значение VVV получило новое убедительное подтверждение. Амлодипин, возможно, является оптимальным препаратом для лечения больных с повышенной ВАД, однако для доказательства этого положения требуются дополнительные исследования.

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