rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2012-8-6-810-818rpcardio-641Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯMODERN VIEWS ON THE VARIABILITY OF BLOOD PRESSUREСОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ВАРИАБЕЛЬНОСТИ АРТЕРИАЛЬНОГО ДАВЛЕНИЯГорбуновВ. М.GorbunovV. M.

д.м.н., профессор, руководитель лаборатории применения амбулаторных диагностических методов в профилактике хронических неинфекционных заболеваний

Vgorbunov@gnicpm.ruГосударственный научно-исследовательский центр профилактической медициныРоссияState Research Center for Preventive MedicineRussian Federation20120901201686810818Copyright © Gorbunov V.M., 20152015Горбунов В.М.Gorbunov V.M.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/641

Nowadays conception of blood pressure (BP) variability (BPV) includes a number of indicators related to various physiological factors. All the indexes are calculated with the standard deviation (SD) or more complex formulas, including SD. BPV main varieties are considered a 24-hour BPV (measured by ambulatory BP monitoring – ABPM), midterm BPV (BP self-control or home BP – HBP), and long-term, visit-to-visit, BPV (traditional BP measurement or office BP – OBP). The 24-hour BPV was the main subject of study for many years. Recently significant attention has been paid to the visit-to-visit BPV assessment. Retrospective meta-analysis showed that in a cohort of patients after stroke or transient ischemic attack, this index was a strong and independent (from the average BP level) predictor of stroke. In ASCOT-BPLA study visit-to-visit systolic BPV also was a strong predictor of stroke and coronary events. Long-term BPV in patients of amlodipine/perindopril treatment group was significantly lower than this in patients of atenolol/diuretic group during the follow-up that was associated with a lower risk of cardiovascular complications. However , the concept of visit-to-visit BPV use for risk stratification and monitoring of antihypertensive therapy efficacy is associated with significant limitations (basic data is obtained in the post hoc analysis, difficulties in objective evaluation of prognostic significance of indicators, their dependence on medication adherence, etc.). The HBP self-control is a promising approach to the BPV analysis; it may be the "happy medium" between ABPM and OPB. New-designed prospective comparative studies are needed to evaluate the clinical significance of the various BPV parameters.

Вариабельность артериального давления (ВАД) в современном представлении охватывает несколько показателей, связанных с различными физиологическими факторами. Все эти индексы объединяет расчет с использованием стандартного отклонения от среднего (SD) или более сложных формул, включающих SD. Основными разновидностями ВАД в настоящее время считаются: 24-часовая (определяется на основании суточного мониторирования АД – СМАД), ВАД средней продолжительности (самоконтроль АД – СКАД), долгосрочная ВАД «от визита к визиту» (традиционные измерения АД). В течение многих лет предметом изучения была преимущественно 24-часовая ВАД. В последнее время в научной литературе существенное внимание уделяется оценке ВАД «от визита к визиту». Ретроспективный мета-анализ показал, что в когортах пациентов, перенесших мозговой инсульт либо транзиторную ишемическую атаку , данный показатель был сильным и независимым от среднего уровня АД предиктором инсульта. В исследовании ASCOT-BPLA вариабельность систолического АД «от визита к визиту» также оказалась сильным предиктором инсульта и коронарных событий. В течение всего срока наблюдения в группе лечения амплодипином/периндоприлом долгосрочная ВАД была значительно ниже, чем в группе лечения атенололом/диуретиком, что ассоциировалось с меньшим риском сердечно-сосудистых осложнений. Однако, концепция использования ВАД «от визита к визиту» для стратификации риска и контроля эффективности антигипертензивной терапии связана с серьезными ограничениями (основные данные получены в анализах post hoc, трудности объективной оценки прогностической значимости показателей, их зависимость от приверженности лечению и др.). Перспективным методом для анализа ВАД является метод СКАД, который, возможно, представляет собой «золотую середину» между СМАД и традиционными измерениями АД. Для оценки клинической значимости различных параметров ВАД требуются новые, специально спланированные проспективные сравнительные исследования.

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