Артериальная гипертония при сердечно-сосудисто-почечном метаболическом синдроме: новые цели и испытанные подходы к лечению

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.

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