Доказательные факты, которые могли повлиять на тактику лечения больных артериальной гипертонией в период после опубликования результатов исследования SPRINT

Статья посвящена обсуждению результатов вторичных анализов данных, полученных в исследовании SPRINT, которые были опубликованы в последние годы. Обсуждаются нерешенные вопросы тактики лечения пациентов с артериальной гипертонией, в частности проблемы выбора оптимального уровня артериального давления (АД) в подгруппе пациентов с определенными характеристиками, включая пациентов пожилого и старческого возраста, пациентов с хронической болезнью почек, а также пациентов с артериальной гипертонией, которые продолжают курить. Обсуждаются проблемы порогового рассчитанного риска развития осложнений сердечно-сосудистых заболеваний, при котором достигаются наибольшие преимущества при использовании более интенсивных режимов антигипертензивной терапии. Кроме того, в статье рассматривается вопрос о подходах к выбору антигипертензивных препаратов в современных условиях. Обсуждается роль кандесартана в лечении артериальной гипертонии как сартана, наиболее изученного у широкого круга пациентов. Рассматривается проблема быстрого выраженного повышения АД в отсутствие поражений органов-мишеней, приводятся данные о роли каптоприла в такой клинической ситуации.

1. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527–30. DOI: 10.1136/bmj.318.7182.527

2. Boudoulas KD, Leier CV, Geleris P, Boudoulas H. The Shortcomings of Clinical Practice Guidelines. Cardiology. 2015;130(3):187–200. DOI: 10.1159/000371572

3. The SPRINT Research Group, Wright JTJr, Williamson JD, Whelton PK, Snyder JK, Sink KM et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. New England Journal of Medicine. 2015;373(22):2103–16. DOI: 10.1056/NEJMoa1511939

4. Ambrosius WT, Sink KM, Foy CG, Berlowitz DR, Cheung AK, Cushman WC et al. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: The Systolic Blood Pressure Intervention Trial (SPRINT). Clinical Trials. 2014;11(5):532–46. DOI: 10.1177/1740774514537404

5. Whelton 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: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13–115. DOI: 10.1161/HYP.0000000000000065

6. Williams 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/ehy339

7. ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr et al. Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. New England Journal of Medicine. 2010;362(17):1575–85. DOI: 10.1056/NEJMoa1001286

8. SPS3 Study Group, Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382(9891):507– 15. DOI: 10.1016/S0140-6736(13)60852-1

9. Perkovic V, Rodgers A. Redefining Blood-Pressure Targets – SPRINT Starts the Marathon. New England Journal of Medicine. 2015;373(22):2175–8. DOI: 10.1056/NEJMe1513301

10. Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387(10017):435–43. DOI: 10.1016/S0140-6736(15)00805-3

11. Verdecchia P, Angeli F, Gentile G, Reboldi G. More Versus Less Intensive Blood Pressure–Lowering Strategy: Cumulative Evidence and Trial Sequential Analysis. Hypertension. 2016;68(3):642–53. DOI: 10.1161/HYPERTENSIONAHA.116.07608

12. Bangalore S, Toklu B, Gianos E, Schwartzbard A, Weintraub H, Ogedegbe G et al. Optimal Systolic Blood Pressure Target After SPRINT: Insights from a Network Meta-Analysis of Randomized Trials. The American Journal of Medicine. 2017;130(6):707-719.e8. DOI: 10.1016/j.amjmed.2017.01.004

13. Bundy JD, Li C, Stuchlik P, Bu X, Kelly TN, Mills KT et al. Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis. JAMA Cardiology. 2017;2(7):775–81. DOI: 10.1001/jamacardio.2017.1421

14. Ettehad 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. Lancet. 2016;387(10022):957–67. DOI: 10.1016/S0140-6736(15)01225-8

15. Kjeldsen SE, Lund-Johansen P, Nilsson PM, Mancia G. Unattended Blood Pressure Measurements in the Systolic Blood Pressure Intervention Trial: Implications for Entry and Achieved Blood Pressure Values Compared With Other Trials. Hypertension. 2016;67(5):808–12. DOI: 10.1161/HYPERTENSIONAHA.116.07257

16. Agarwal R. Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT). Journal of the American Heart Association. 2017;6(2):e004536. DOI: 10.1161/JAHA.116.004536

17. Johnson KC, Whelton PK, Cushman WC, Cutler JA, Evans GW, Snyder JK et al. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(5):848–57. DOI: 10.1161/HYPERTENSIONAHA.117.10479

18. Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with high-normal and normal blood pressure: overview and meta-analyses of randomized trials. Journal of Hypertension. 2017;35(11):2150–60. DOI: 10.1097/HJH.0000000000001547

19. Blood Pressure Lowering Treatment Trialists’ Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a metaanalysis of individual patient data. Lancet. 2014;384(9943):591–8. DOI: 10.1016/S0140-6736(14)61212-5

20. Sundström J, Arima H, Jackson R, Turnbull F, Rahimi K, Chalmers J et al. Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis. Annals of Internal Medicine. 2015;162(3):184–91. DOI: 10.7326/M14-0773

21. Karmali KN, Lloyd-Jones DM. Global Risk Assessment to Guide Blood Pressure Management in Cardiovascular Disease Prevention. Hypertension. 2017;69(3):e2–9. DOI: 10.1161/HYPERTENSIONAHA.116.08249

22. Muntner P, Whelton PK. Using Predicted Cardiovascular Disease Risk in Conjunction With Blood Pressure to Guide Antihypertensive Medication Treatment. Journal of the American College of Cardiology. 2017;69(19):2446–56. DOI: 10.1016/j.jacc.2017.02.066

23. Phillips RA, Xu J, Peterson LE, Arnold RM, Diamond JA, Schussheim AE. Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension. Journal of the American College of Cardiology. 2018;71(15):1601–10. DOI: 10.1016/j.jacc.2018.01.074

24. Vaduganathan M, Claggett BL, Juraschek SP, Solomon SD. Assessment of Long-term Benefit of Intensive Blood Pressure Control on Residual Life Span: Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). JAMA Cardiology. 2020;5(5):576. DOI: 10.1001/jamacardio.2019.6192

25. Beckett 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/NEJMoa0801369

26. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. JAMA. 2016;315(24):2673–82. DOI: 10.1001/jama.2016.7050

27. The SPRINT MIND Investigators for the SPRINT Research Group, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019;321(6):553– 61. DOI: 10.1001/jama.2018.21442

28. Juraschek SP, Taylor AA, Wright JT, Evans GW, Miller ER, Plante TB et al. Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT. Hypertension. 2020;75(3):660– 7. DOI: 10.1161/HYPERTENSIONAHA.119.14309

29. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee ( JNC 8). JAMA. 2014;311(5):507–20. DOI: 10.1001/jama.2013.284427

30. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal. 2013;34(28):2159–219. DOI: 10.1093/eurheartj/eht151

31. Kovesdy CP, Alrifai A, Gosmanova EO, Lu JL, Canada RB, Wall BM et al. Age and Outcomes Associated with BP in Patients with Incident CKD. Clinical Journal of the American Society of Nephrology. 2016;11(5):821–31. DOI: 10.2215/CJN.08660815

32. Weiss JW, Peters D, Yang X, Petrik A, Smith DH, Johnson ES et al. Systolic BP and Mortality in Older Adults with CKD. Clinical Journal of the American Society of Nephrology. 2015;10(9):1553–9. DOI: 10.2215/CJN.11391114

33. Zhang WR, Craven TE, Malhotra R, Cheung AK, Chonchol M, Drawz P et al. Kidney Damage Biomarkers and Incident Chronic Kidney Disease During Blood Pressure Reduction: A Case–Control Study. Annals of Internal Medicine. 2018;169(9):610–8. DOI: 10.7326/M18-1037

34. Bress AP, King JB, Kreider KE, Beddhu S, Simmons DL, Cheung AK et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care. 2017;40(10):1401–8. DOI: 10.2337/dc17-0885

35. Buckley LF, Dixon DL, Wohlford GF, Wijesinghe DS, Baker WL, Van Tassell BW. Intensive Versus Standard Blood Pressure Control in SPRINT-Eligible Participants of ACCORD-BP. Diabetes Care. 2017;40(12):1733–8. DOI: 10.2337/dc17-1366

36. Scarpa J, Bruzelius E, Doupe P, Le M, Faghmous J, Baum A. Assessment of Risk of Harm Associated With Intensive Blood Pressure Management Among Patients With Hypertension Who Smoke: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial. JAMA Network Open. 2019;2(3):e190005. DOI: 10.1001/jamanetworkopen.2019.0005

37. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366(9489):895–906. DOI: 10.1016/S0140-6736(05)67185-1

38. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V et al. Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients. New England Journal of Medicine. 2008;359(23):2417–28. DOI: 10.1056/NEJMoa0806182

39. Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons With Isolated Systolic Hypertension: Final Results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265(24):3255–64. DOI: 10.1001/jama.1991.03460240051027

40. Julius S, Kjeldsen SE, Weber M, Brunner HR, Ekman S, Hansson L et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004;363(9426):2022–31. DOI: 10.1016/S0140-6736(04)16451-9

41. Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. Journal of Hypertension. 2003;21(5):875–86. DOI: 10.1097/01.hjh.0000059028.82022.89

42. Kjeldsen SE, Stålhammar J, Hasvold P, Bodegard J, Olsson U, Russell D. Effects of losartan vs candesartan in reducing cardiovascular events in the primary treatment of hypertension. Journal of Human Hypertension. 2010;24(4):263–73. DOI: 10.1038/jhh.2009.77

43. Julius S, Nesbitt SD, Egan BM, Weber MA, Michelson EL, Kaciroti N et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker. The New England Journal of Medicine. 2006;354(16):1685–97. DOI: 10.1056/NEJMoa060838

44. van den Born B-JH, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E et al. ESC Council on hypertension position document on the management of hypertensive emergencies. European Heart Journal – Cardiovascular Pharmacotherapy. 2019;5(1):37–46. DOI: 10.1093/ehjcvp/pvy032

45. Patel KK, Young L, Howell EH, Hu B, Rutecki G, Thomas G et al. Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. JAMA Internal Medicine. 2016;176(7):981–8. DOI: 10.1001/jamainternmed.2016.1509

46. Peixoto AJ. Acute Severe Hypertension. New England Journal of Medicine. 2019;381(19):1843–52. DOI: 10.1056/NEJMcp1901117

47. Campos CL, Herring CT, Ali AN, Jones DN, Wofford JL, Caine AL et al. Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review. Journal of General Internal Medicine. 2018;33(4):539–50. DOI: 10.1007/s11606- 017-4277-6

48. Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276(16):1328– 31. PMID: 8861992

49. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2015;63(11):2227–46. DOI: 10.1111/jgs.13702

50. Alshami A, Romero C, Avila A, Varon J. Management of hypertensive crises in the elderly. Journal of Geriatric Cardiology. 2018;15(7):504– 12. DOI: 10.11909/j.issn.1671-5411.2018.07.007

51. Varon J. Treatment of Acute Severe Hypertension: Current and Newer Agents. Drugs. 2008;68(3):283–97. DOI: 10.2165/00003495- 200868030-00003 52. Van Harten J, Danhof M, Burggraaf K, Van Brummelen P, Breimer DouweD. Negligible sublingual absorption of nifedipine. Lancet. 1987;330(8572):1363–5. DOI: 10.1016/S0140-6736(87)91258-X

52. Kaya A, Tatlisu MA, Kaplan Kaya T, Yildirimturk O, Gungor B, Karatas B et al. Sublingual vs. Oral Captopril in Hypertensive Crisis. The Journal of Emergency Medicine. 2016;50(1):108–15. DOI: 10.1016/j.jemermed.2015.07.017

53. Saladini F, Mancusi C, Bertacchini F, Spannella F, Maloberti A, Giavarini A et al. Diagnosis and treatment of hypertensive emergencies and urgencies among Italian emergency and intensive care departments. Results from an Italian survey: Progetto GEAR (Gestione dell’Emergenza e urgenza in ARea critica). European Journal of Internal Medicine. 2020;71:50–6. DOI: 10.1016/j.ejim.2019.10.004

54. Komsuoglu B, Şengün B, Bayram A, Komsuoglu SŞ. Treatment of Hypertensive Urgencies with Oral Nifedipine, Nicardipine, and Captopril. Angiology. 1991;42(6):447–54. DOI: 10.1177/000331979104200603

55. Woisetschläger C, Bur A, Vlcek M, Derhaschnig U, Laggner AN, Hirschl MM. Comparison of intravenous urapidil and oral captopril in patients with hypertensive urgencies. Journal of Human Hypertension. 2006;20(9):707–9. DOI: 10.1038/sj.jhh.1002063

56. Maleki A, Sadeghi M, Zaman M, Tarrahi MJ, Nabatchi B. Nifedipine, Captopril or Sublingual Nitroglycerin, Which can Reduce Blood Pressure the Most? ARYA atherosclerosis. 2011;7(3):102–5. PMID: 22577455

57. Sruamsiri K, Chenthanakij B, Wittayachamnankul B. Management of patients with severe hypertension in emergency department, Maharaj Nakorn Chiang Mai hospital. Journal of the Medical Association of Thailand. 2014;97(9):917–22. PMID: 25536708

58. Sahasranam KV, Ravindran KN. Sublingual captopril in severe hypertension. The Journal of the Association of Physicians of India. 1988;36(11):643–4. PMID: 3074076

59. del Castillo AC, Rodriguez M, Gonzalez E, Rodriguez F, Estruch J. Dose-Response Effect of Sublingual Captopril in Hypertensive Crises. The Journal of Clinical Pharmacology. 1988;28(7):667–70. DOI: 10.1002/j.1552-4604.1988.tb03196.x

60. Salkic S, Brkic S, Batic-Mujanovic O, Ljuca F, Karabasic A, Mustafic S. Emergency Room Treatment of Hypertensive Crises. Medical Archives (Sarajevo, Bosnia and Herzegovina). 2015;69(5):302–6. DOI: 10.5455/medarh.2015.69.302-306

61. Терещенко С.Н., Гапонова Н.И., Абдрахманов В.Р. РАндомизированное многоцентровое сраВнительное исследование эффЕктивности мокСонидина у больных с неосложненным гипертоническим кризом (АВЕС). Артериальная гипертензия. 2011;17(4):316-24. DOI: 10.18705/1607-419X-2011-17-4-316-324

62. Reynolds HR, Adhikari S, Pulgarin C, Troxel AB, Iturrate E, Johnson SB et al. Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19. New England Journal of Medicine. 2020;NEJMoa2008975. [Epub ahead of print]. DOI: 10.1056/NEJMoa2008975