cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2019.8.n337cardio-337Research ArticleПРАКТИЧЕСКАЯ КАРДИОЛОГИЯ ПРИЛОЖЕНИЕ ДЛЯ ПРАКТИЧЕСКИХ ВРАЧЕЙ КЛИНИЧЕСКИЕ СЕМИНАРЫPRACTICAL CARDIOLOGY SUPPLEMENT FOR PRACTISING PHYSICIANS CLINICAL SEMINARSЦелевые уровни артериального давления у пациентов с артериальной гипертензией, перенесших острое нарушение мозгового кровообращенияTarget Levels of Arterial Pressure in Patients with Arterial Hypertension and Strokehttps://orcid.org/0000-0001-7474-7922ЛопинаЕ. А.LopinaE. A.

Екатерина Анатольевна Лопина - кандидат медицинских наук, доцент кафедры госпитальной терапии им. Р.Г. Межебовского

Ekaterina Anatolyevna Lopina - Ph.D., Associate Professor of the Hospital Therapy Department

ekaterina_lopina@mail.ruhttps://orcid.org/0000-0001-5776-0295ДушинаА. Г.DushinaA. G.

Алена Геннадьевна Душина - кандидат медицинских наук, доцент кафедры госпитальной терапии им. Р.Г. Межебовского

Alena Gennadievna Dushina - Ph.D., Associate Professor of the Hospital Therapy Department

al.dushina@yandex.ruhttps://orcid.org/0000-0003-0130-990XЛибисР. А.LibisR. A.

Роман Аронович Либис - доктор медицинских наук, профессор, заведующий кафедры госпитальной терапии им. Р.Г. Межебовского

Roman Aronovich Libis - Doctor of Medical Sciences, Professor, Head of the Department of Hospital Therapy

rlibis@gmail.comФГБОУ ВО "Оренбургский государственный медицинский университет" МЗ РФРоссияFederal State Budgetary Educational Institution of Higher Education «Orenburg State Medical University» of the Ministry of Health of the Russian FederationRussian Federation2019080820195987276Copyright © Kardiomag, 20192019KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/337

Число пациентов с артериальной гипертензией (АГ), перенесших острое нарушение мозгового кровообращения, неуклонно растет. Несмотря на это, целевые уровни артериального давления (АД) для пациентов, перенесших мозговой инсульт, окончательно не установлены. В обзорной статье представлены результаты клинических исследований и данные мета-анализов по изучаемой проблеме. Вопросы целевых уровней АД для пациентов, перенесших острое нарушение мозгового кровообращения, также рассмотрены в рамках российских (2010), европейских (2018) и американских (2017) рекомендаций по диагностике и лечению АГ.

Number of patients with arterial hypertension and stroke steadily grows. “Target” levels of arterial pressure are not established in patients after stroke. In this review, we present results of clinical trials and data of meta-analyses on this problem. Problems related to target levels of arterial pressure after stroke are also covered in a framework of present Russian (2010), European (2018) and American (2017) recommendations on diagnosis and treatment of arterial hypertension.

артериальная гипертензияострое нарушение мозгового кровообращенияцелевой уровень артериального давленияarterial hypertensionstrokearterial pressuretarget levelАвторы заявляют об отсутствии конфликта интересов.ReferencesЧазова И. Е., Жернакова Ю. В., Ощепкова Е. В., Шальнова С. А., Яровая Е. Б., Конради А. О. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014;54(10):4-12Chazova I.E., Zhernakova Yu.V., Oschepkova E.V., Shal'nova S.A., Yarovaya E.B., Konradi A.O. et al. Prevalence of Cardiovascular Risk Factors in Russian Population of Patients With Arterial Hypertension. Kardiologiia. 2014;54(10):4-12.. Парфенов В.А., Старчина Ю.А. Когнитивные нарушения у пациентов с артериальной гипертонией и их лечение. Неврология, нейропсихиатрия, психосоматика. 2011;1:27-33. Parfenov V.A., Starchina Yu.A. Cognitive disorders in patients with essential hypertension and their treatment. Neurology, neuropsychiatry, psychosomatics. 2011;1:27-33.Vishram JKK, Borglykke A, Andreasen AH, Jeppesen J, Ibsen H, Jorgensen T et al. Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project. Hypertension. 2012;60(5):1117-23. DOI: 10.1161/HYPERTENSIONAHA.112.201400Vishram JKK, Borglykke A, Andreasen AH, Jeppesen J, Ibsen H, Jorgensen T et al. Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project. Hypertension. 2012;60(5):1117-23. DOI: 10.1161/HYPERTENSIONAHA.112.201400Недогода С.В., Сабанов А.В. Достижение целевого артериального давления у пациентов с артериальной гипертензией на фоне антигипертензивной терапии в условиях реальной клинической практики. Российский кардиологический журнал. 2018;23(11):100-9. DOI: 10.15829/1560-4071-2018-11-100-109Nedogoda S.V., Sabanov A.V. Achievement of target blood pressure in patients with arterial hypertension on the background of antihypertensive therapy in real clinical practice. Russian Journal of Cardiology. 2018;23(11):100-9. DOI: 10.15829/1560-4071-2018-11-100-109Бойцов С. А., Баланова Ю. А., Шальнова С. А., Деев А. Д., Артамонова Г. В., Гагатонова Т. М. и др. Артериальная гипертония среди лиц 25-64 лет: распространенность, осведомленность, лечение и контроль по материалам исследования ЭССЕ. Кардиоваскулярная терапия и профилактика. 2014;13(4):4-14. DOI: 10.15829/1728-8800-2014-4-4-14Boytsov S.A., Balanova Yu.A., Shal'nova S.A., Deev A.D., Artamonova G.V., Gatagonova T.M. et al. Arterial hypertension among persons aged 25-64: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;13(4):4-14. DOI: 10.15829/1728-8800-2014-4-4-14PATS Collaborating Group. Post-stroke antihypertensive treatment study. A preliminary result. Chinese Medical Journal. 1995;108(9):710-7. PMID: 8575241PATS Collaborating Group. Post-stroke antihypertensive treatment study. A preliminary result. Chinese Medical Journal. 1995;108(9):710-7. PMID: 8575241Bangalore S, Messerli FH, Wun C-C, Zuckerman AL, DeMicco D, Kostis JB et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in NT) Trial. European Heart Journal. 2010;31(23):2897-908. DOI: 10.1093/eurheartj/ehq328Bangalore S, Messerli FH, Wun C-C, Zuckerman AL, DeMicco D, Kostis JB et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in NT) Trial. European Heart Journal. 2010;31(23):2897-908. DOI: 10.1093/eurheartj/ehq328Zanchetti A. Blood pressure targets of antihypertensive treatment: up and down the J-shaped curve. European Heart Journal. 2010;31(23):2837-40. DOI: 10.1093/eurheartj/ehq281Zanchetti A. Blood pressure targets of antihypertensive treatment: up and down the J-shaped curve. European Heart Journal. 2010;31(23):2837-40. DOI: 10.1093/eurheartj/ehq281Hansson L, Hedner T, Lund-J ohansen P, Kj eldsen SE, Lindholm LH, Syvertsen JO et al. Randomised trial of effects of calcium antagonists compared with diuretics and p-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. The Lancet. 2000;356(9227):359-65. DOI: 10.1016/S0140-6736(00)02526-5Hansson L, Hedner T, Lund-J ohansen P, Kj eldsen SE, Lindholm LH, Syvertsen JO et al. Randomised trial of effects of calcium antagonists compared with diuretics and p-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. The Lancet. 2000;356(9227):359-65. DOI: 10.1016/S0140-6736(00)02526-5Zanchetti A. Evidence and wisdom: recommendations for forthcoming guidelines: Journal of Hypertension. 2011;29(1):1-3. DOI: 10.1097/HJH.0b013e328341fb35Zanchetti A. Evidence and wisdom: recommendations for forthcoming guidelines: Journal of Hypertension. 2011;29(1):1-3. DOI: 10.1097/HJH.0b013e328341fb35Беленков Ю.Н., Мареев В.Ю. Лечение сердечной недостаточности в XXI веке: достижения, вопросы и уроки доказательной медицины. Кардиология. 2008;48(2):6—16Belenkov Yu.N., Mareev V.Yu. The treatment of congestive heart failure in XXI century: questions and lessons of evidence based medicine. Cardiology. 2008;48(2):6-16.PROGRESS Collaborative Group. Randomised trial of a perindo-pril-based blood-pressure-lowering regimen among 6 105 individuals with previous stroke or transient ischaemic attack. The Lancet. 2001;358(9287):1033-41. DOI: 10.1016/S0140-6736(01)06178-5PROGRESS Collaborative Group. Randomised trial of a perindo-pril-based blood-pressure-lowering regimen among 6 105 individuals with previous stroke or transient ischaemic attack. The Lancet. 2001;358(9287):1033-41. DOI: 10.1016/S0140-6736(01)06178-5Russian: Чазова И. Е., Ратова Л. Г., Бойцов С. А., Небиеридзе Д. В., Карпов Ю. А., Белоусов Ю. Б. и др. Диагностика и лечение артериальной гипертензии (Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов). Системные гипертензии. 2010;3:5-26Chazova I.E., Ratova L.G., Boytsov S.A., Nebieridze D.V., Karpov Yu.A., Belousov Yu.B. et al. Diagnosis and treatment of arterial hypertension (Recommendations of the Russian Medical S ociety on Arterial Hypertension and the All-Russian Scientific Society of Cardiology). Systemic Hypertensions. 2010;3:5-26.Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227-76. DOI: 10.1161/STR.0b013e3181f7d043Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227-76. DOI: 10.1161/STR.0b013e3181f7d043Денисов И.Н., Кандыба Д.В., Кузнецова О.Ю. Диагностика и тактика при инсульте в условиях общей врачебной практики, включая первичную и вторичную профилактику. Клинические рекомендации утверждены на IV Всероссийском съезде врачей общей практики (семейных врачей) Российской Федерации 15 ноября 2013 года, г. Казань. 2013. - 33с. Доступно на: www.roszdravnadzor.ru/i/upload/imag-es/2015/9/17/1442485136.0604-1-23992.docDenisov I.N., Kandyba D.V., Kuznetsova O.Yu. Diagnostics and tactics at stroke in conditions of general medical practice, including primary and secondary prevention. Clinical recommendations. Kazan. 2013. - 33p.The Dutch TIA Trial Study Group. Trial of secondary prevention with atenolol after transient ischemic attack or nondisabling ischemic stroke. Stroke. 1993;24(4):543-8. PMID: 8465360The Dutch TIA Trial Study Group. Trial of secondary prevention with atenolol after transient ischemic attack or nondisabling ischemic stroke. Stroke. 1993;24(4):543-8. PMID: 8465360Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet (London, England). 2000;355(9200):253-9. PMID: 10675071Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet (London, England). 2000;355(9200):253-9. PMID: 10675071Rashid P, Leonardi-Bee J, Bath P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events: A Systematic Review. Stroke. 2003;34(11):2741-8. DOI: 10.1161/01.STR.0000092488.40085.15Rashid P, Leonardi-Bee J, Bath P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events: A Systematic Review. Stroke. 2003;34(11):2741-8. DOI: 10.1161/01.STR.0000092488.40085.15Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology. 2018;71(19):e127-248. DOI: 10.1016/j.jacc.2017.11.006Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology. 2018;71(19):e127-248. DOI: 10.1016/j.jacc.2017.11.006Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. New England Journal of Medicine. 2010;362(17):1575-85. DOI: 10.1056/NEJMoa1001286Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. New England Journal of Medicine. 2010;362(17):1575-85. DOI: 10.1056/NEJMoa1001286The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. New England Journal of Medicine. 2015;373(22):2103-16. DOI: 10.1056/NEJMoa1511939The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. New England Journal of Medicine. 2015;373(22):2103-16. DOI: 10.1056/NEJMoa1511939MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party. BMJ. 1985;291(6488):97-104. DOI: 10.1136/bmj.291.6488.97MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party. BMJ. 1985;291(6488):97-104. DOI: 10.1136/bmj.291.6488.97Hypertension Detection and Follow-up Program Cooperative Group*. The Effect of Treatment on Mortality in Mild Hypertension: Results of the Hypertension Detection and Follow-up Program. New England Journal of Medicine. 1982;307(16):976-80. DOI: 10.1056/NEJM198210143071603Hypertension Detection and Follow-up Program Cooperative Group*. The Effect of Treatment on Mortality in Mild Hypertension: Results of the Hypertension Detection and Follow-up Program. New England Journal of Medicine. 1982;307(16):976-80. DOI: 10.1056/NEJM198210143071603Zhang Y, Zhang X, Liu L, Zanchetti A, for the FEVER Study Group. Is a systolic blood pressure target <140 mmHg indicated in all hypertensives? Subgroup analyses of findings from the randomized FEVER trial. European Heart Journal. 2011;32(12):1500-8. DOI: 10.1093/eurheartj/ehr039Zhang Y, Zhang X, Liu L, Zanchetti A, for the FEVER Study Group. Is a systolic blood pressure target <140 mmHg indicated in all hypertensives? Subgroup analyses of findings from the randomized FEVER trial. European Heart Journal. 2011;32(12):1500-8. DOI: 10.1093/eurheartj/ehr039Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet. 2016;387(10022):957-67. DOI: 10.1016/S0140-6736(15)01225-8Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet. 2016;387(10022):957-67. DOI: 10.1016/S0140-6736(15)01225-8Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2014;45(7):2160-236. DOI: 10.1161/STR.0000000000000024Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2014;45(7):2160-236. DOI: 10.1161/STR.0000000000000024Arima H, Chalmers J, Woodward M, Anderson C, Rodgers A, Davis S et al. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial: Journal of Hypertension. 2006;24(6):1201-8. DOI: 10.1097/01.hjh.0000226212.34055.86Arima H, Chalmers J, Woodward M, Anderson C, Rodgers A, Davis S et al. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial: Journal of Hypertension. 2006;24(6):1201-8. DOI: 10.1097/01.hjh.0000226212.34055.86

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