evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2025-2-36-43evrazkar-6516Research ArticleОБЗОРREVIEWАртериальная гипертония при сердечно-сосудисто-почечном метаболическом синдроме: новые цели и испытанные подходы к лечениюArterial Hypertension in Cardio-Renal-Metabolic Syndrome: New Targets and Proven Treatment Approacheshttps://orcid.org/0000-0002-8505-1848ГиляревскийС. Р.GilyarevskyS. R.

Гиляревский Сергей Руджерович, д.м.н., профессор, ведущий научный сотрудник

129226, Москва, ул. 1-я Леонова, д. 16.

Sergey R. Gilyarevsky, Dr. of Sci. (Med.), professor

1st Leonova street, building 16, Moscow 129226

sgilarevsky@rambler.ruОСП «Российский геронтологический научно-клинический центр»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияCardiology center of the Russian gerontological scientific and clinical center; N.I. Pirogov Russian national research medical universityRussian Federation202502062025023643Copyright © Гиляревский С.Р., 20252025Гиляревский С.Р.Gilyarevsky S.R.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/6516

Статья посвящена проблемам лечения артериальной гипертонии (АГ) у пациентов с сердечно-сосудисто-почечным метаболическим синдромом (ССПМС). Рассматриваются патофизиологические звенья развития АГ у пациентов с ССПМС. Приводятся доказательные данные, подтверждающие важную роль метаболических факторов риска в развитии осложнений сердечно-сосудистых заболеваний (ССЗ). Среди таких факторов выделяют абдоминальное ожирение, дисгликемию, атерогенную дислипидемию и АГ, которые действуют как независимые факторы риска, влияющие на функцию эндотелия, развитие атеросклероза, тромбоза, повреждения миокарда, фиброза и ремоделирование сердца. Такие факторы, в свою очередь, влияют на риск развития практически всех осложнений ССЗ, включая ишемическую болезнь сердца, цереброваскулярные заболевания, заболевания периферических артерий, аритмии и сердечную недостаточность. Обсуждается обоснованность более раннего начала антигипертензивной терапии у пациентов ССПМС как для снижения риска развития осложнений ССЗ, так и профилактики прогрессирования хронической болезни почек. Приводятся научные данные, которые служат основанием для выбора оптимальной антигипертензивной терапии при ССПМС. Подробно рассматриваются доказательные основы, свидетельствующие о том, что начальная и поддерживающая терапия комбинированным препаратом, содержащим периндоприл и индапамид, положительно влияет на функцию микрососудов у пациентов с АГ и снижает выраженность поражения органов-мишеней при ССПМС Подчеркивается необходимость гибкого подхода к выбору доз такого препарата для обеспечения как эффективности, так и безопасности терапии, особенно в так называемых уязвимых группах пациентов с АГ.

The article focuses on the treatment challenges of arterial hypertension (AH) in patients with cardio-renal-metabolic syndrome (CRMS). It examines the pathophysiological mechanisms of AH development in CRMS patients. Evidence is provided to highlight the critical role of metabolic risk factors in the progression of cardiovascular disease (CVD) complications. These factors include abdominal obesity, dysglycemia, atherogenic dyslipidemia, and AH, which independently affect endothelial function, atherosclerosis, thrombosis, myocardial damage, fibrosis, and cardiac remodeling, influencing the risk of almost all CVD complications, including coronary heart disease, cerebrovascular disease, peripheral artery disease, arrhythmias, and heart failure. The rationale for earlier initiation of antihypertensive therapy in CRMS patients is discussed, aiming both to reduce CVD complication risks and prevent the progression of chronic kidney disease. Scientific data are provided to support the selection of optimal antihypertensive therapy in CRMS. The evidence emphasizes the initial and maintenance therapy with a combination drug containing perindopril and indapamide has a positive effect on microvascular function in patients with AH and reduces the severity of target organ damage in CRMS. The necessity of a flexible approach to dosing such medications is highlighted to ensure both efficacy and safety, especially in vulnerable patient groups with AH.

артериальная гипертониясердечно-сосудисто-почечный метаболический синдромфиксированная комбинацияпериндоприлиндапамидосложнения сердечно-сосудистых заболеванийхроническая болезнь почекarterial hypertensioncardio-renal-metabolic syndromefixed combinationperindoprilindapamidecardiovascular disease complicationschronic kidney diseaseПубликация подготовлена при информационной и финансовой поддержке фармацевтической компании Сервье, что не повлияло на мнение автора.Manuscript was prepared with the Servier pharmaceutical company informational and financial support that did not impact on author’s opinion.ReferencesIHME, Global Burden of Disease (2024). Death rate from obesity. Available at: https://ourworldindata.org/obesity.IHME, Global Burden of Disease (2024). Death rate from obesity. Available at: https://ourworldindata.org/obesity.Ndumele C.E., Neeland I.J., Tuttle K.R., et al.; American Heart Association. 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The authors declare that there are no conflicts of interest present.