cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2019.11.n803cardio-803Research ArticleКЛИНИЧЕСКИЕ СЕМИНАРЫCLINICAL SEMINARSМеханизмы формирования вариабельности артериального давления и возможности антигипертензивных препаратов в ее коррекцииMechanisms for the Development of Blood Pressure Variability and the Potential of Antihypertensive Drugs in Their Correctionhttps://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

Москва

SPIN 9212-6010

Moscow

ak_info@list.ruhttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Ostroumova Olga D. – MD, PhD, professor

Moscow

ostroumova.olga@mail.ruБорисоваЕ. В.BorisovaE. V.ekaterina-vikt@mail.ruПиксинаГ. Ф.PiksinaG. F.galina-piksina@yandex.ruФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России – ОСП «Российский геронтологический научно-клинический центр»РоссияPirogov Russian National Research Medical University, Russian Gerontology Clinical Research CenterRussian FederationГБУЗ «ГКБ им. Е. О. Мухина» Департамента здравоохранения г. МосквыРоссияCity Clinical Hospital named after E. O. MukhinRussian Federation20191112201959115665Copyright © Kardiomag, 20192019KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/803

Вариабельность артериального давления (ВАД) – это колебания артериального давления (АД) за определенный промежуток времени под воздействием различных факторов. Актуальность вопроса повышенной ВАД обусловлена предиктивной ценностью данного параметра как фактора риска развития фатальных и нефатальных сердечно-сосудистых, цереброваскулярных и почечных осложнений. Доказано, что в возникновении повышенной ВАД ведущую роль играют нарушения в функционировании барорефлекторного аппарата магистральных артерий, которые, в свою очередь, опосредованы повышением жесткости сосудистого русла, эффектами ангиотензина II и симпатической части вегетативной нервной системы, дисфункцией эндотелия, дефицитом оксида азота и процессами старения в том числе сосудистого. Преимущества в коррекции повышенной ВАД имеют антигипертензивные препараты, воздействующие на максимальное количество патофизиологических звеньев ее повышения. Такими препаратами являются периндоприл и амлодипин, которые способны влиять практически на весь спектр причин возникновения повышенной ВАД и оптимальным образом снижать риск развития сердечно-сосудистых осложнений.

Blood pressure variability (BPV) is the fluctuations of blood pressure over a certain period of time under the influence of various factors. The issue of increased BPV is of particular clinical importance due to high predictive value of this parameter as a risk factor for fatal and non-fatal cardiovascular, cerebrovascular and renal events. It is proved that in the BPV increasing, the key role is played by impairments in arterial baroreflexes, which, in turn, are mediated by increased vascular stiffness, impact of angiotensin II and the sympathetic nervous system, endothelial dysfunction, nitric oxide deficiency and aging, including the vascular aging. Antihypertensive drugs that targeting largest amount of pathophysiological mechanisms in BPV increasing have a most advantages in correcting excessive pressure fluctuations. In this regard such drugs are perindopril and amlodipine, which can eliminate almost the entire spectrum of increased BPV causes and, therefore, optimally reduce the cardiovascular risk.

Вариабельность артериального давлениясердечно-сосудистый рискбарорефлексжесткость артерийстарениебрадикининпериндоприламлодипинBlood pressure variabilitycardiovascular riskbaroreflexarterial stiffnessageingbradykininperindoprilamlodipineReferencesParati G, Ochoa JE, Salvi P, Schillaci G. Arterial Stiffness and Blood Pressure Variability. Elsevier, 2015. ­ P.117­128. ISBN: 978­0­12­801387­8. DOI: 10.1016/B978­0­12­801387­8.00012­0. In: Early Vascular Aging (EVA) Elsevier;Parati G, Ochoa JE, Salvi P, Schillaci G. Arterial Stiffness and Blood Pressure Variability. Elsevier, 2015. ­ P.117­128. ISBN: 978­0­12­801387­8. DOI: 10.1016/B978­0­12­801387­8.00012­0. In: Early Vascular Aging (EVA) Elsevier;Parati G, Stergiou GS, Dolan E, Bilo G. Blood pressure variability: clinical relevance and application. The Journal of Clinical Hypertension. 2018;20(7):1133–7. DOI: 10.1111/jch.13304Parati G, Stergiou GS, Dolan E, Bilo G. Blood pressure variability: clinical relevance and application. The Journal of Clinical Hypertension. 2018;20(7):1133–7. DOI: 10.1111/jch.13304Mancia G, Grassi G. Mechanisms and Clinical Implications of Blood Pressure Variability: Journal of Cardiovascular Pharmacology. 2000;35 (7 Suppl 4):S15–9. DOI: 10.1097/00005344­200000004­00003Mancia G, Grassi G. Mechanisms and Clinical Implications of Blood Pressure Variability: Journal of Cardiovascular Pharmacology. 2000;35 (7 Suppl 4):S15–9. DOI: 10.1097/00005344­200000004­00003Остроумова О.Д., Борисова Е.В., Павлеева Е.Е. Вариабельность артериального давления. Межвизитная вариабельность артериального давления. Кардиология. 2017;57(11):68­75. DOI: 10.18087/cardio.2017.11.10056Ostroumova O.D., Borisova E.V., Pavleeva E.E. Blood Pressure Variability. Visit­to­Visit Blood Pressure Variability. Kardiologiia. 2017;17(11):68–75. DOI: 10.18087/cardio.2017.11.10056Остроумова О.Д., Кочетков А.И., Гусева Т.Ф. Вариабельность артериального давления при артериальной гипертензии в сочетании с ишемической болезнью сердца: прогностическая значимость и возможности коррекции в реальной клинической практике. Артериальная гипертензия. 2018;24(2):246­56. DOI: 10.18705/1607­419X­2018­24­2­246­256Ostroumova O.D., Kochetkov A.I., Guseva T.F. Blood pressure variability in hypertension associated with coronary heart disease: prognostic value and management approaches. Arterial Hypertension. 2018;24(2):246–56. DOI: 10.18705/1607­419X­2018­24­2­246­256Conway J. Hemodynamic aspects of hypertension. Labile hypertension: the problem. Circulation Research. 1970;27(1 Suppl 1):43–7. PMID: 5423301Conway J. Hemodynamic aspects of hypertension. Labile hypertension: the problem. Circulation Research. 1970;27(1 Suppl 1):43–7. PMID: 5423301Watson RD, Stallard TJ, Flinn RM, Littler WA. Factors determining direct arterial pressure and its variability in hypertensive man. Hypertension. 1980;2(3):333–41. DOI: 10.1161/01.HYP.2.3.333Watson RD, Stallard TJ, Flinn RM, Littler WA. Factors determining direct arterial pressure and its variability in hypertensive man. Hypertension. 1980;2(3):333–41. DOI: 10.1161/01.HYP.2.3.333Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24­Hour Blood Pressure Mean and Variability to Severity of Target­Organ Damage in Hypertension: Journal of Hypertension. 1987;5(1):93–8. DOI: 10.1097/00004872­198702000­00013Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24­Hour Blood Pressure Mean and Variability to Severity of Target­Organ Damage in Hypertension: Journal of Hypertension. 1987;5(1):93–8. DOI: 10.1097/00004872­198702000­00013Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24­hour blood pressure variability. Journal of Hypertension. 1993;11(10):1133–7. DOI: 10.1097/00004872­199310000­00019Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24­hour blood pressure variability. Journal of Hypertension. 1993;11(10):1133–7. DOI: 10.1097/00004872­199310000­00019Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B et al. Prognostic significance of visit­to­visit variability, maximum systolic blood pressure, and episodic hypertension. The Lancet. 2010;375(9718):895–905. DOI: 10.1016/S0140­6736(10)60308­XRothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B et al. Prognostic significance of visit­to­visit variability, maximum systolic blood pressure, and episodic hypertension. The Lancet. 2010;375(9718):895–905. DOI: 10.1016/S0140­6736(10)60308­XRothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B et al. Effects of β blockers and calcium­channel blockers on within­individual variability in blood pressure and risk of stroke. The Lancet Neurology. 2010;9(5):469–80. DOI: 10.1016/S1474­4422(10)70066­1Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B et al. Effects of β blockers and calcium­channel blockers on within­individual variability in blood pressure and risk of stroke. The Lancet Neurology. 2010;9(5):469–80. DOI: 10.1016/S1474­4422(10)70066­1Stevens SL, Wood S, Koshiaris C, Law K, Glasziou P, Stevens RJ et al. Blood pressure variability and cardiovascular disease: systematic review and meta­analysis. BMJ. 2016;354:i4098. DOI: 10.1136/bmj.i4098Stevens SL, Wood S, Koshiaris C, Law K, Glasziou P, Stevens RJ et al. Blood pressure variability and cardiovascular disease: systematic review and meta­analysis. BMJ. 2016;354:i4098. DOI: 10.1136/bmj.i4098Mena LJ, Felix VG, Melgarejo JD, Maestre GE. 24-Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta-Analysis. Journal of the American Heart Association. 2017;6(10):e006895. DOI: 10.1161/JAHA.117.006895Mena LJ, Felix VG, Melgarejo JD, Maestre GE. 24‐Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta‐Analysis. Journal of the American Heart Association. 2017;6(10):e006895. DOI: 10.1161/JAHA.117.006895Vidal­Petiot E, Stebbins A, Chiswell K, Ardissino D, Aylward PE, Cannon CP et al. Visit­to­visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial. European Heart Journal. 2017;38(37):2813–22. DOI: 10.1093/eurheartj/ehx250Vidal­Petiot E, Stebbins A, Chiswell K, Ardissino D, Aylward PE, Cannon CP et al. Visit­to­visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial. European Heart Journal. 2017;38(37):2813–22. DOI: 10.1093/eurheartj/ehx250Gosmanova EO, Mikkelsen MK, Molnar MZ, Lu JL, Yessayan LT, Kalantar­Zadeh K et al. Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease. Journal of the American College of Cardiology. 2016;68(13):1375–86. DOI: 10.1016/j.jacc.2016.06.054Gosmanova EO, Mikkelsen MK, Molnar MZ, Lu JL, Yessayan LT, Kalantar­Zadeh K et al. Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease. Journal of the American College of Cardiology. 2016;68(13):1375–86. DOI: 10.1016/j.jacc.2016.06.054Остроумова О.Д., Борисова Е.В., Остроумова Т.М., Кочетков А.И. Вариабельность артериального давления в течение суток: прогностическое значение, методы оценки и влияние антигипертензивной терапии. Кардиология. 2017;57(12):62­72. DOI: 10.18087/cardio.2017.12.10068Ostroumova O.D., Borisova E.V., Ostroumova T.M., Kochetkov A.I. 24­Hour Arterial Pressure Variability: Prognostic Significance, Methods of Evaluation, Effect of Antihypertensive Therapy. Kardiologiia. 2017;57(12):62–72. DOI: 10.18087/cardio.2017.12.10068Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G et al. Awake Systolic Blood Pressure Variability Correlates With Target­Organ Damage in Hypertensive Subjects. Hypertension. 2007;50(2):325–32. DOI: 10.1161/HYPERTENSIONAHA.107.090084Tatasciore A, Renda G, Zimarino M, Soccio M, Bilo G, Parati G et al. Awake Systolic Blood Pressure Variability Correlates With Target­Organ Damage in Hypertensive Subjects. Hypertension. 2007;50(2):325–32. DOI: 10.1161/HYPERTENSIONAHA.107.090084Ozawa M, Tamura K, Okano Y, Matsushita K, Ikeya Y, Masuda S et al. Blood Pressure Variability As Well As Blood Pressure Level is Important for Left Ventricular Hypertrophy and Brachial­Ankle Pulse Wave Velocity in Hypertensives. Clinical and Experimental Hypertension. 2009;31(8):669–79. DOI: 10.3109/10641960903407033Ozawa M, Tamura K, Okano Y, Matsushita K, Ikeya Y, Masuda S et al. Blood Pressure Variability As Well As Blood Pressure Level is Important for Left Ventricular Hypertrophy and Brachial­Ankle Pulse Wave Velocity in Hypertensives. Clinical and Experimental Hypertension. 2009;31(8):669–79. DOI: 10.3109/10641960903407033Кастанаян А.А., Железняк Е.И., Хагуш А.К., Демидова А.А., Карташова Е.А., Жулитов А.Ю. Взаимосвязь вариабельности артериального давления и сердечно­сосудистого ремоделирования при развитии артериальной гипертензии в пожилом возрасте. Артериальная гипертензия 2016;22(4):389­400. DOI: 10.18705/1607­419X­2016­22­4­389­400Kastanayan A.A., Zheleznjak E.I., Hagush A.K., Demidova A.A., Kartashova E.A., Zhulitov A.Yu. The relationship between blood pressure variability and cardiovascular remodeling in hypertension developed in the elderly. Arterial Hypertension. 2016;22(4):389–400. DOI: 10.18705/1607­419X­2016­22­4­389­400Juhanoja EP, Niiranen TJ, Johansson JK, Puukka PJ, Jula AM. Agreement between ambulatory, home, and office blood pressure variability. Journal of Hypertension. 2016;34(1):61–7. DOI: 10.1097/HJH.0000000000000772Juhanoja EP, Niiranen TJ, Johansson JK, Puukka PJ, Jula AM. Agreement between ambulatory, home, and office blood pressure variability. Journal of Hypertension. 2016;34(1):61–7. DOI: 10.1097/HJH.0000000000000772Madden JM, O’Flynn AM, Fitzgerald AP, Kearney PM. Correlation between short­term blood pressure variability and left­ventricular mass index: a meta­analysis. Hypertension Research. 2016;39(3):171–7. DOI: 10.1038/hr.2015.126Madden JM, O’Flynn AM, Fitzgerald AP, Kearney PM. Correlation between short­term blood pressure variability and left­ventricular mass index: a meta­analysis. Hypertension Research. 2016;39(3):171–7. DOI: 10.1038/hr.2015.126Kawai T, Ohishi M, Kamide K, Nakama C, Onishi M, Ito N et al. Differences between daytime and nighttime blood pressure variability regarding systemic atherosclerotic change and renal function. Hypertension Research. 2013;36(3):232–9. DOI: 10.1038/hr.2012.162Kawai T, Ohishi M, Kamide K, Nakama C, Onishi M, Ito N et al. Differences between daytime and nighttime blood pressure variability regarding systemic atherosclerotic change and renal function. Hypertension Research. 2013;36(3):232–9. DOI: 10.1038/hr.2012.162Ichihara A, Kaneshiro Y, Takemitsu T, Sakoda M, Hayashi M. Ambulatory blood pressure variability and brachial–ankle pulse wave velocity in untreated hypertensive patients. Journal of Human Hypertension. 2006;20(7):529–36. DOI: 10.1038/sj.jhh.1002023Ichihara A, Kaneshiro Y, Takemitsu T, Sakoda M, Hayashi M. Ambulatory blood pressure variability and brachial–ankle pulse wave velocity in untreated hypertensive patients. Journal of Human Hypertension. 2006;20(7):529–36. DOI: 10.1038/sj.jhh.1002023Schillaci G, Bilo G, Pucci G, Laurent S, Macquin­Mavier I, Boutouyrie P et al. Relationship Between Short­Term Blood Pressure Variability and Large­Artery Stiffness in Human Hypertension: Findings From 2 Large Databases. Hypertension. 2012;60(2):369–77. DOI: 10.1161/HYPERTENSIONAHA.112.197491Schillaci G, Bilo G, Pucci G, Laurent S, Macquin­Mavier I, Boutouyrie P et al. Relationship Between Short­Term Blood Pressure Variability and Large­Artery Stiffness in Human Hypertension: Findings From 2 Large Databases. Hypertension. 2012;60(2):369–77. DOI: 10.1161/HYPERTENSIONAHA.112.197491Eguchi K, Hoshide S, Schwartz JE, Shimada K, Kario K. Visit­to­Visit and Ambulatory Blood Pressure Variability as Predictors of Incident Cardiovascular Events in Patients With Hypertension. American Journal of Hypertension. 2012;25(9):962–8. DOI: 10.1038/ajh.2012.75Eguchi K, Hoshide S, Schwartz JE, Shimada K, Kario K. Visit­to­Visit and Ambulatory Blood Pressure Variability as Predictors of Incident Cardiovascular Events in Patients With Hypertension. American Journal of Hypertension. 2012;25(9):962–8. DOI: 10.1038/ajh.2012.75Pringle E, Phillips C, Thijs L, Davidson C, Staessen JA, de Leeuw PW et al. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population: Journal of Hypertension. 2003;21(12):2251–7. DOI: 10.1097/00004872­200312000­00012Pringle E, Phillips C, Thijs L, Davidson C, Staessen JA, de Leeuw PW et al. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population: Journal of Hypertension. 2003;21(12):2251–7. DOI: 10.1097/00004872­200312000­00012Verdecchia P, Angeli F, Gattobigio R, Rapicetta C, Reboldi G. Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension. American Journal of Hypertension. 2007;20(2):154–61. DOI: 10.1016/j.amjhyper.2006.07.017Verdecchia P, Angeli F, Gattobigio R, Rapicetta C, Reboldi G. Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension. American Journal of Hypertension. 2007;20(2):154–61. DOI: 10.1016/j.amjhyper.2006.07.017Mena LJ, Maestre GE, Hansen TW, Thijs L, Liu Y, Boggia J et al. How Many Measurements Are Needed to Estimate Blood Pressure Variability Without Loss of Prognostic Information? American Journal of Hypertension. 2014;27(1):46–55. DOI: 10.1093/ajh/hpt142Mena LJ, Maestre GE, Hansen TW, Thijs L, Liu Y, Boggia J et al. How Many Measurements Are Needed to Estimate Blood Pressure Variability Without Loss of Prognostic Information? American Journal of Hypertension. 2014;27(1):46–55. DOI: 10.1093/ajh/hpt142Васюк Ю.А., Иванова С.В., Школьник Е.Л., Котовская Ю.В., Милягин В.А., Олейников В.Э. и др. Согласованное мнение российских экспертов по оценке артериальной жесткости в клинической практике. Кардиоваскулярная терапия и профилактика. 2016;15(2):4­19. DOI: 10.15829/1728­8800­2016­2­4­19Vasyuk Yu.A., Ivanova S.V., Shkolnik E.L., Kotovskaya Yu.V., Milyagin V.A., Oleynikov V.E. et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovascular Therapy and Prevention. 2016;15(2):4–19. DOI: 10.15829/1728­8800­2016­2­4­19Grassi G, Turri C, Vailati S, Dell’Oro R, Mancia G. Muscle and Skin Sympathetic Nerve Traffic During the “White­Coat” Effect. Circulation. 1999;100(3):222–5. DOI: 10.1161/01.CIR.100.3.222Grassi G, Turri C, Vailati S, Dell’Oro R, Mancia G. Muscle and Skin Sympathetic Nerve Traffic During the “White­Coat” Effect. Circulation. 1999;100(3):222–5. DOI: 10.1161/01.CIR.100.3.222Mancia G, Parati G, Pomidossi G, Casadei R, Di Rienzo M, Zanchetti A. Arterial baroreflexes and blood pressure and heart rate variabilities in humans. Hypertension. 1986;8(2):147–53. DOI: 10.1161/01.HYP.8.2.147Mancia G, Parati G, Pomidossi G, Casadei R, Di Rienzo M, Zanchetti A. Arterial baroreflexes and blood pressure and heart rate variabilities in humans. Hypertension. 1986;8(2):147–53. DOI: 10.1161/01.HYP.8.2.147Heusser K, Tank J, Engeli S, Diedrich A, Menne J, Eckert S et al. Carotid Baroreceptor Stimulation, Sympathetic Activity, Baroreflex Function, and Blood Pressure in Hypertensive Patients. Hypertension. 2010;55(3):619–26. DOI: 10.1161/HYPERTENSIONAHA.109.140665Heusser K, Tank J, Engeli S, Diedrich A, Menne J, Eckert S et al. Carotid Baroreceptor Stimulation, Sympathetic Activity, Baroreflex Function, and Blood Pressure in Hypertensive Patients. Hypertension. 2010;55(3):619–26. DOI: 10.1161/HYPERTENSIONAHA.109.140665Neves MF, Cunha AR, Cunha MR, Gismondi RA, Oigman W. The Role of Renin–Angiotensin–Aldosterone System and Its New Components in Arterial Stiffness and Vascular Aging. High Blood Pressure & Cardiovascular Prevention. 2018;25(2):137–45. DOI: 10.1007/s40292­018­0252­5Neves MF, Cunha AR, Cunha MR, Gismondi RA, Oigman W. The Role of Renin–Angiotensin–Aldosterone System and Its New Components in Arterial Stiffness and Vascular Aging. High Blood Pressure & Cardiovascular Prevention. 2018;25(2):137–45. DOI: 10.1007/s40292­018­0252­5Avolio AP, Ke Xu, Butlin M. Effect of large arteries on blood pressure variability. 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). ­ Osaka: IEEE, 2013. ­ P.4078­4081. DOI: 10.1109/EMBC.2013.6610441.Avolio AP, Ke Xu, Butlin M. Effect of large arteries on blood pressure variability. 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). ­ Osaka: IEEE, 2013. ­ P.4078­4081. DOI: 10.1109/EMBC.2013.6610441.Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive­drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta­analysis. The Lancet. 2010;375(9718):906–15. DOI: 10.1016/S0140­6736(10)60235­8Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive­drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta­analysis. The Lancet. 2010;375(9718):906–15. DOI: 10.1016/S0140­6736(10)60235­8Webb AJS, Rothwell PM. Effect of Dose and Combination of Antihypertensives on Interindividual Blood Pressure Variability: A Systematic Review. Stroke. 2011;42(10):2860–5. DOI: 10.1161/STROKEAHA.110.611566Webb AJS, Rothwell PM. Effect of Dose and Combination of Antihypertensives on Interindividual Blood Pressure Variability: A Systematic Review. Stroke. 2011;42(10):2860–5. DOI: 10.1161/STROKEAHA.110.611566Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021–104. DOI: 10.1093/eurheartj/ehy339Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021–104. DOI: 10.1093/eurheartj/ehy339Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D et al. Treatment of Hypertension in Patients 80 Years of Age or Older. New England Journal of Medicine. 2008;358(18):1887–98. DOI: 10.1056/NEJMoa0801369Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D et al. Treatment of Hypertension in Patients 80 Years of Age or Older. New England Journal of Medicine. 2008;358(18):1887–98. DOI: 10.1056/NEJMoa0801369PROGRESS Collaborative Group. Randomised trial of a perindopril­based blood­pressure­lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. The Lancet. 2001;358(9287):1033–41. DOI: 10.1016/S0140­6736(01)06178­5PROGRESS Collaborative Group. Randomised trial of a perindopril­based blood­pressure­lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. The Lancet. 2001;358(9287):1033–41. DOI: 10.1016/S0140­6736(01)06178­5Patel A. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. The Lancet. 2007;370(9590):829–40. DOI: 10.1016/S0140­6736(07)61303­8Patel A. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. The Lancet. 2007;370(9590):829–40. DOI: 10.1016/S0140­6736(07)61303­8Fox KM, EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double­blind, placebo­controlled, multicentre trial (the EUROPA study). Lancet (London, England). 2003;362(9386):782–8. DOI: 10.1016/s0140­6736(03)14286­9Fox KM, EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double­blind, placebo­controlled, multicentre trial (the EUROPA study). Lancet (London, England). 2003;362(9386):782–8. DOI: 10.1016/s0140­6736(03)14286­9Rodriguez­Granillo GA, Vos J, Bruining N, Garcia­Garcia HM, de Winter S, Ligthart JMR et al. Long­Term Effect of Perindopril on Coronary Atherosclerosis Progression (from the PERindopril’s Prospective Effect on Coronary aTherosclerosis by Angiography and IntraVascular Ultrasound Evaluation [PERSPECTIVE] Study). The American Journal of Cardiology. 2007;100(2):159–63. DOI: 10.1016/j.amjcard.2007.02.073Rodriguez­Granillo GA, Vos J, Bruining N, Garcia­Garcia HM, de Winter S, Ligthart JMR et al. Long­Term Effect of Perindopril on Coronary Atherosclerosis Progression (from the PERindopril’s Prospective Effect on Coronary aTherosclerosis by Angiography and IntraVascular Ultrasound Evaluation [PERSPECTIVE] Study). The American Journal of Cardiology. 2007;100(2):159–63. DOI: 10.1016/j.amjcard.2007.02.073Bots ML, Remme WJ, Lüscher TF, Fox KM, Bertrand M, Ferrari R et al. ACE Inhibition and Endothelial Function: Main Findings of PERFECT, a Sub­Study of the EUROPA Trial. Cardiovascular Drugs and Therapy. 2007;21(4):269–79. DOI: 10.1007/s10557­007­6041­3Bots ML, Remme WJ, Lüscher TF, Fox KM, Bertrand M, Ferrari R et al. ACE Inhibition and Endothelial Function: Main Findings of PERFECT, a Sub­Study of the EUROPA Trial. Cardiovascular Drugs and Therapy. 2007;21(4):269–79. DOI: 10.1007/s10557­007­6041­3Daly CA, Fox KM, Remme WJ, Bertrand ME, Ferrari R, Simoons ML. The effect of perindopril on cardiovascular morbidity and mortality in patients with diabetes in the EUROPA study: results from the PERSUADE substudy. European Heart Journal. 2005;26(14):1369–78. DOI: 10.1093/eurheartj/ehi225Daly CA, Fox KM, Remme WJ, Bertrand ME, Ferrari R, Simoons ML. The effect of perindopril on cardiovascular morbidity and mortality in patients with diabetes in the EUROPA study: results from the PERSUADE substudy. European Heart Journal. 2005;26(14):1369–78. DOI: 10.1093/eurheartj/ehi225Scientific Committee of the PERTINENT Sub­Study, EUROPAPERTINENT Investigators. PERTINENT – perindopril­thrombosis, inflammation, endothelial dysfunction and neurohormonal activation trial: a sub­study of the EUROPA study. Cardiovascular Drugs and Therapy. 2003;17(1):83–91. PMID: 12843690Scientific Committee of the PERTINENT Sub­Study, EUROPAPERTINENT Investigators. PERTINENT – perindopril­thrombosis, inflammation, endothelial dysfunction and neurohormonal activation trial: a sub­study of the EUROPA study. Cardiovascular Drugs and Therapy. 2003;17(1):83–91. PMID: 12843690Недогода С.В., Чумачек Е.В., Ледяева А.А., Цома В.В., Саласюк А.С., Смирнова В.О. и др. Оптимизация контроля артериального давления, органопротекции и метаболических нарушений с помощью фиксированной комбинации периндоприла и индапамида у пациентов с артериальной гипертензией. Кардиология 2017;57(2):5­11. DOI: 10.18565/cardio.2017.2.5­11Nedogoda S.V., Chumachek E.V., Ledyaeva A.A., Tsoma V.V., Salasyuk A.S., Smirnova V.O. et al. Optimization of Control of Blood Pressure, Metabolic Disorders and Target Organs Protection With Fixed Perindopril and Indapamide Combination in Treated Patients With Arterial Hypertension. Kardiologiia. 2017;57(2):5–11. DOI: 10.18565/cardio.2017.2.5­11Koz C, Baysan O, Yokusoglu M, Uzun M, Yildirim M, Hasimi A et al. The effects of perindopril on aortic elasticity and inflammatory markers in hypertensive patients. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2009;15(7):PI41­45. PMID: 19564839Koz C, Baysan O, Yokusoglu M, Uzun M, Yildirim M, Hasimi A et al. The effects of perindopril on aortic elasticity and inflammatory markers in hypertensive patients. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2009;15(7):PI41­45. PMID: 19564839Sesso HD. C­Reactive Protein and the Risk of Developing Hypertension. JAMA. 2003;290(22):2945–51. DOI: 10.1001/jama.290.22.2945Sesso HD. C­Reactive Protein and the Risk of Developing Hypertension. JAMA. 2003;290(22):2945–51. DOI: 10.1001/jama.290.22.2945Blake GJ, Rifai N, Buring JE, Ridker PM. Blood Pressure, C­Reactive Protein, and Risk of Future Cardiovascular Events. Circulation. 2003;108(24):2993–9. DOI: 10.1161/01.CIR.0000104566.10178.AFBlake GJ, Rifai N, Buring JE, Ridker PM. Blood Pressure, C­Reactive Protein, and Risk of Future Cardiovascular Events. Circulation. 2003;108(24):2993–9. DOI: 10.1161/01.CIR.0000104566.10178.AFRocha R, Rudolph AE, Frierdich GE, Nachowiak DA, Kekec BK, Blomme EAG et al. Aldosterone induces a vascular inflammatory phenotype in the rat heart. American Journal of Physiology­Heart and Circulatory Physiology. 2002;283(5):H1802–10. DOI: 10.1152/ajpheart.01096.2001Rocha R, Rudolph AE, Frierdich GE, Nachowiak DA, Kekec BK, Blomme EAG et al. Aldosterone induces a vascular inflammatory phenotype in the rat heart. American Journal of Physiology­Heart and Circulatory Physiology. 2002;283(5):H1802–10. DOI: 10.1152/ajpheart.01096.2001Rocha R, Martin­Berger CL, Yang P, Scherrer R, Delyani J, McMahon E. Selective Aldosterone Blockade Prevents Angiotensin II/Salt­Induced Vascular Inflammation in the Rat Heart. Endocrinology. 2002;143(12):4828–36. DOI: 10.1210/en.2002­220120Rocha R, Martin­Berger CL, Yang P, Scherrer R, Delyani J, McMahon E. Selective Aldosterone Blockade Prevents Angiotensin II/Salt­Induced Vascular Inflammation in the Rat Heart. Endocrinology. 2002;143(12):4828–36. DOI: 10.1210/en.2002­220120Fernandez­Real JM, Vayreda M, Richart C, Gutierrez C, Broch M, Vendrell J et al. Circulating interleukin 6 levels, blood pressure, and insulin sensitivity in apparently healthy men and women. The Journal of Clinical Endocrinology and Metabolism. 2001;86(3):1154–9. DOI: 10.1210/jcem.86.3.7305Fernandez­Real JM, Vayreda M, Richart C, Gutierrez C, Broch M, Vendrell J et al. Circulating interleukin 6 levels, blood pressure, and insulin sensitivity in apparently healthy men and women. The Journal of Clinical Endocrinology and Metabolism. 2001;86(3):1154–9. DOI: 10.1210/jcem.86.3.7305Park S, Lakatta EG. Role of Inflammation in the Pathogenesis of Arterial Stiffness. Yonsei Medical Journal. 2012;53(2):258–61. DOI: 10.3349/ymj.2012.53.2.258Park S, Lakatta EG. Role of Inflammation in the Pathogenesis of Arterial Stiffness. Yonsei Medical Journal. 2012;53(2):258–61. DOI: 10.3349/ymj.2012.53.2.258Malik EZ, Abdulhadi B, Mezue KN, Lerma EV, Rangaswami J. Clinical hypertension: Blood pressure variability. Disease­a­Month. 2018;64(1):5–13. DOI: 10.1016/j.disamonth.2017.08.003Malik EZ, Abdulhadi B, Mezue KN, Lerma EV, Rangaswami J. Clinical hypertension: Blood pressure variability. Disease­a­Month. 2018;64(1):5–13. DOI: 10.1016/j.disamonth.2017.08.003Wang M, Zhang J, Jiang L­Q, Spinetti G, Pintus G, Monticone R et al. Proinflammatory Profile Within the Grossly Normal Aged Human Aortic Wall. Hypertension. 2007;50(1):219–27. DOI: 10.1161/HYPERTENSIONAHA.107.089409Wang M, Zhang J, Jiang L­Q, Spinetti G, Pintus G, Monticone R et al. Proinflammatory Profile Within the Grossly Normal Aged Human Aortic Wall. Hypertension. 2007;50(1):219–27. DOI: 10.1161/HYPERTENSIONAHA.107.089409Kukes V.G. Clinical pharmacology: Textbook. 3rd edition, revised and enlarged.­M.: GEOTAR­Media; 944 p.Kukes V.G. Clinical pharmacology: Textbook. 3rd edition, revised and enlarged.­M.: GEOTAR­Media; 944 p. ISBN 5­9704­0287­7Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nature Reviews Immunology. 2011;11(2):85–97. DOI: 10.1038/nri2921Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nature Reviews Immunology. 2011;11(2):85–97. DOI: 10.1038/nri2921Ceconi C, Francolini G, Bastianon D, Gitti GL, Comini L, Ferrari R. Differences in the Effect of Angiotensin­converting Enzyme Inhibitors on the Rate of Endothelial Cell Apoptosis: In Vitro and In Vivo Studies. Cardiovascular Drugs and Therapy. 2007;21(6):423–9. DOI: 10.1007/s10557­007­6068­5Ceconi C, Francolini G, Bastianon D, Gitti GL, Comini L, Ferrari R. Differences in the Effect of Angiotensin­converting Enzyme Inhibitors on the Rate of Endothelial Cell Apoptosis: In Vitro and In Vivo Studies. Cardiovascular Drugs and Therapy. 2007;21(6):423–9. DOI: 10.1007/s10557­007­6068­5Ferrari R. Treatment with angiotensin­converting enzyme inhibitors: insight into perindopril cardiovascular protection. European Heart Journal Supplements. 2008;10(Suppl G):G13–20. DOI: 10.1093/eurheartj/sun025Ferrari R. Treatment with angiotensin­converting enzyme inhibitors: insight into perindopril cardiovascular protection. European Heart Journal Supplements. 2008;10(Suppl G):G13–20. DOI: 10.1093/eurheartj/sun025Partovian C, Benetos A, Pommiès J­P, Mischler W, Safar ME. Effects of a chronic high­salt diet on large artery structure: role of endogenous bradykinin. American Journal of Physiology­Heart and Circulatory Physiology. 1998;274(5):H1423–8. DOI: 10.1152/ajpheart.1998.274.5.H1423Partovian C, Benetos A, Pommiès J­P, Mischler W, Safar ME. Effects of a chronic high­salt diet on large artery structure: role of endogenous bradykinin. American Journal of Physiology­Heart and Circulatory Physiology. 1998;274(5):H1423–8. DOI: 10.1152/ajpheart.1998.274.5.H1423Safar M. Factors influencing arterial stiffness in systolic hypertension in the elderly: role of sodium and the renin­angiotensin system. American Journal of Hypertension. 2003;16(3):249–58. DOI: 10.1016/S0895­7061(02)03259­4Safar M. Factors influencing arterial stiffness in systolic hypertension in the elderly: role of sodium and the renin­angiotensin system. American Journal of Hypertension. 2003;16(3):249–58. DOI: 10.1016/S0895­7061(02)03259­4Esler M. Looking at the sympathetic nervous system as a primary source. In: Hypertension in the twentieth century: concepts and achievements. Birkenhäger WH, Robertson JIS, Zanchetti A, Reid JL, editors ­Amsterdam: Elsevier; 580 p. [P. 81­103]. ISBN 978­0­444­51450­9Esler M. Looking at the sympathetic nervous system as a primary source. In: Hypertension in the twentieth century: concepts and achievements. Birkenhäger WH, Robertson JIS, Zanchetti A, Reid JL, editors ­Amsterdam: Elsevier; 580 p. [P. 81­103]. ISBN 978­0­444­51450­9Остроумова О.Д., Викентьев В.В., Абросимов А.Г., Смолярчук Е.А. Дигидропиридиновые антагонисты кальция: осознанный выбор. Системные гипертензии. 2017;14(1):61­8Ostroumova O.D., Vikentev V.V., Abrosimov A.G., Smoliarchuk E.A. Dihydropyridine calcium antagonists: conscious choice. Systemic Hypertension. 2017;14(1):61–8.Nissen SE, Tuzcu EM, Libby P, Thompson PD, Ghali M, Garza D et al. Effect of Antihypertensive Agents on Cardiovascular Events in Patients With Coronary Disease and Normal Blood Pressure: The CAMELOT Study: A Randomized Controlled Trial. JAMA. 2004;292(18):2217–25. DOI: 10.1001/jama.292.18.2217Nissen SE, Tuzcu EM, Libby P, Thompson PD, Ghali M, Garza D et al. Effect of Antihypertensive Agents on Cardiovascular Events in Patients With Coronary Disease and Normal Blood Pressure: The CAMELOT Study: A Randomized Controlled Trial. JAMA. 2004;292(18):2217–25. DOI: 10.1001/jama.292.18.2217Brener SJ, Ivanc TB, Poliszczuk R, Chen M, Tuzcu EM, Hu T et al. Antihypertensive therapy and regression of coronary artery disease: Insights from the Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) and Norvasc for Regression of Manifest Atherosclerotic Lesions by Intravascular Sonographic Evaluation (NORMALISE) trials. American Heart Journal. 2006;152(6):1059–63. DOI: 10.1016/j.ahj.2006.07.022Brener SJ, Ivanc TB, Poliszczuk R, Chen M, Tuzcu EM, Hu T et al. Antihypertensive therapy and regression of coronary artery disease: Insights from the Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) and Norvasc for Regression of Manifest Atherosclerotic Lesions by Intravascular Sonographic Evaluation (NORMALISE) trials. American Heart Journal. 2006;152(6):1059–63. DOI: 10.1016/j.ahj.2006.07.022Pitt B, Byington RP, Furberg CD, Hunninghake DB, Mancini GBJ, Miller ME et al. Effect of Amlodipine on the Progression of Atherosclerosis and the Occurrence of Clinical Events. Circulation. 2000;102(13):1503–10. DOI: 10.1161/01.CIR.102.13.1503Pitt B, Byington RP, Furberg CD, Hunninghake DB, Mancini GBJ, Miller ME et al. Effect of Amlodipine on the Progression of Atherosclerosis and the Occurrence of Clinical Events. Circulation. 2000;102(13):1503–10. DOI: 10.1161/01.CIR.102.13.1503Загидуллин Н.Ш., Зулкарнеев Р.Х., Щербакова Е.С., Сафина Ю.Ф., Загидуллин Ш.З. Артериальная жесткость как маркер риска сердечно­сосудистых событий и возможности ее снижения при современной антигипертензивной терапии. Казанский медицинский журнал. 2014;95(4):575­81Zagidullin N.Sh., Zulkarneev R.Kh., Scherbakova E.S., Safina Yu.F., Zagidullin Sh.Z. Arterial stiffness as a cardiovascular events risk marker and possibilities for its downregulation by contemporary antihypertensive medications. Kazan medical journal. 2014;95(4):575–81.Dudenbostel T, Glasser SP. Effects of Antihypertensive Drugs on Arterial Stiffness. Cardiology in Review. 2012;20(5):259–63. DOI: 10.1097/CRD.0b013e31825d0a44Dudenbostel T, Glasser SP. Effects of Antihypertensive Drugs on Arterial Stiffness. Cardiology in Review. 2012;20(5):259–63. DOI: 10.1097/CRD.0b013e31825d0a44Mason RP, Walter MF, Trumbore MW, Olmstead Jr EG, Mason PE. Membrane Antioxidant Effects of the Charged Dihydropyridine Calcium Antagonist Amlodipine. Journal of Molecular and Cellular Cardiology. 1999;31(1):275–81. DOI: 10.1006/jmcc.1998.0867Mason RP, Walter MF, Trumbore MW, Olmstead Jr EG, Mason PE. Membrane Antioxidant Effects of the Charged Dihydropyridine Calcium Antagonist Amlodipine. Journal of Molecular and Cellular Cardiology. 1999;31(1):275–81. DOI: 10.1006/jmcc.1998.0867Takami T, Shigemasa M. Efficacy of Various Antihypertensive Agents as Evaluated by Indices of Vascular Stiffness in Elderly Hypertensive Patients. Hypertension Research. 2003;26(8):609–14. DOI: 10.1291/hypres.26.609Takami T, Shigemasa M. Efficacy of Various Antihypertensive Agents as Evaluated by Indices of Vascular Stiffness in Elderly Hypertensive Patients. Hypertension Research. 2003;26(8):609–14. DOI: 10.1291/hypres.26.609

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