evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2018-3-76-87evrazkar-301Research ArticleОБЗОРREVIEWРЕЗИСТЕНТНАЯ АРТЕРИАЛЬНАЯ ГИПЕРТОНИЯRESISTANT ARTERIAL HYPERTENSIONЕсауловаТ. Е.EsaulovaT. E.

ординатор отдела гипертонии 

+7(495)4145127

 

resident of the Department of Hypertension

+7(495)4145127

yestatyana@gmail.comАксеноваА. В.AksenovaA. V.

кандидат медицинских наук, младший научный сотрудник отдела гипертонии

+7(495)4146186

121552, г. Москва, 3-я Черепковская 15А

PhD, Junior Researcher of the Department of Hypertension 

+7(495)4146186

121552, Moscow, 3rd Cherepkovsky, 15 A

aksenovaannav@gmail.comСиваковаО. А.SivakovaO. A.

кандидат медицинских наук, заведующая отделением гипертонии 

+7(495)4146609

PhD, Head of the 5-th clinical department of Hypertension

+7(495)4146609

ya.olga-siv2012@ya.ruЧазоваИ. Е.ChazovaI. Ye.

академик РАН, профессор, доктор медицинских наук, руководитель отдела гипертонии, заместитель генерального директора, директор 

+7(495)4146305

Academician of the Russian Academy of Sciences, Professor, MD, Head of the Department of Hypertension, Deputy Director General, Director 

+7(495)4146305

c34h@yandex.ruФедеральное государственное бюджетное учреждение Национальный Медицинский Исследовательский Центр Кардиологии Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Center of Cardiology of the Ministry of Health of RussiaRussian Federation201830092018037687Copyright © Есаулова Т.Е., Аксенова А.В., Сивакова О.А., Чазова И.Е., 20182018Есаулова Т.Е., Аксенова А.В., Сивакова О.А., Чазова И.Е.Esaulova T.E., Aksenova A.V., Sivakova O.A., Chazova I.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/301

Резистентная артериальная гипертония (АГ) определяется как недостижение целевых цифр артериального давления при одновременном использовании 3 антигипертензивных препаратов разных классов, включая диуретик, у пациентов, приверженных терапии. Распространенность резистентной АГ колеблется от 5 до 50% в различных группах пациентов. Для постановки диагноза требуется определение истинной резистентности к лечению, что требует исключения «гипертонии белого халата», оценки приверженности лечению. Необходимо также выявление возможных модифицируемых причин, приводящих к развитию резистентной АГ. В последнее время проводится ряд исследо ваний для выявления возможных биомаркеров резистентной гипертензии. Лечение включает в себя изменение образа жизни, улучшение приверженности лечению и оптимизацию дозировок принимаемых препаратов. Инвазивные методы лечения резистентной АГ проводятся в тщательно отобранной группе пациентов в специализированных центрах. Данная статья освещает подходы к диагностике и лечению резистентной АГ на основе современных рекомендаций доказательной медицины.

Resistant hypertension is defined as a lack to lower 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) values of ambulatory blood pressure (BP) response using 3 antihypertensive agents of different classes, one of which should be a diuretic in patients fully adherent to antihypertensive therapy. Prevalence of resistant hypertension is ranging from about 5 to 50 % in various cohorts. Initial management requires identification of true treatment resistance by out-of-office BP measurements, assessment of adherence and screening for treatable causes of uncontrolled BP. Recent studies try to indicate possible biomarkers of resistance hypertension. Treatment include lifestyle changes, enhancing treatment adherence and optimization of the doses. An invasive approach to resistant hypertension should be kept for persistently severe cases managed in a specialized hypertension center. This article aims to familiarize readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.

артериальное давлениеартериальная гипертониярезистентная артериальная гипертониялечение резистентной гипертониибиомаркеры резистентной гипертонииинвазивный подходblood pressurearterial hypertensionresistant hypertensiontreatment of resistant hypertensionbiomarkers of resistance hypertensioninvasive approachReferencesЧазова И.Е., Жернакова Ю.В., Ощепкова Е.В., Шальнова С.А., Яровая Е.Б., Конради А.О., Бойцов С.А. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014. 54(10):4-12.Chazova I.E., Zhernakova Yu. V., Oshchepkova E.V., Shalnova S.A., Yarovaya E.B., Konradi A.O., Boytsov S.A., et al. Prevalence of Cardiovascular Risk Factors in Russian Population of Patients With Arterial Hypertension. Kardiologiia. 2014; 54(10): 4–12 [in Russian].AmericanHeart Association. Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. 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The authors declare that there are no conflicts of interest present.