rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2010-6-2-206-211rpcardio-822Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯREFRACTORY HYPERTENSION – MODERN APPROACHES TO DIAGNOSTICS AND TREATMENTРЕЗИСТЕНТНАЯ АРТЕРИАЛЬНАЯ ГИПЕРТОНИЯ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ И ЛЕЧЕНИЮБритовА. Н.BritovA. N.

д.м.н., профессор, вед.н.с. отдела вторичной профилактики хронических неинфекционных заболеваний 

101990 Москва, Петроверигский пер., 10

Petroverigsky per. 10, Moscow, 101990

БыстроваМ. М.BystrovaM. M.

к.м.н., с.н.с. отдела вторичной профилактики хронических неинфекционных заболеваний 

101990 Москва, Петроверигский пер., 10

Petroverigsky per. 10, Moscow, 101990

drbystrova@hotmail.comГосударственный научно-исследовательский центр профилактической медицины РосмедтехнологийРоссияState Research Center for Preventive Medicine of RosmedtechnologyRussian Federation20101801201662206211Copyright © Britov A.N., Bystrova M.M., 20162016Бритов А.Н., Быстрова М.М.Britov A.N., Bystrova M.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/822

The refractory arterial hypertension (HT) is diagnosed, if therapy with three antihypertensive drugs from different classes (including a diuretic) in optimal doses did not provide target blood pressure (BP) level. Prevalence of a refractory HT is high and reaches up 10-30% among hypertensive patients. However, poor BP control is often caused by patient non-compliance with the medical recommendations, an inadequate estimation of BP level, and "white coat" HT. It is classified as a pseudo resistance. Obesity, salt and alcohol overconsumption, taking some drugs worsen BP control. Secondary HT causes (sleep apnea syndrome, kidney diseases, renal artery stenosis, and primary hyperaldosteronism) are more possible in patients with refractory HT. Specific treatment of these diseases improves BP control and long-term prognosis. Successful treatment of refractory HT includes detection and correction of reversible risk factors and reasons of the secondary HT, use of the effective combined therapy with the aldosterone antagonist. Improvement of patient compliance is one of key factors of effective treatment.

Резистентную артериальную гипертонию (АГ) диагностируют, если при приеме трех антигипертензивных препаратов разных классов (включая диуретик) в оптимальных дозах не удается достичь целевого артериального давления (АД). Распространенность резистентной АГ высока и достигает 10-30% у больных АГ. Однако зачастую отсутствие контроля АД связано с невыполнением пациентами врачебных рекомендаций, неадекватной оценкой уровня АД либо эффектом «белого халата», что относится к случаям псевдорезистентности. Ожирение, избыточное употребление соли, алкоголя и прием некоторых лекарственных препаратов ухудшает контроль АД. У больных резистентной АГ чаще выявляют вторичные причины АГ - синдром ночного апноэ, заболевания почек, стеноз почечной артерии, первичный альдостеронизм. Специфическое лечение этих заболеваний улучшает контроль АД и отдаленный прогноз. Успешное лечение резистентной АГ требует выявления и коррекции обратимых факторов риска и причин вторичной АГ, использования эффективной комбинированной терапии, включающей антагонисты альдостерона. Повышение приверженности больных является одним из ключевых факторов эффективного лечения.

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