Кардио-рено-гепато-метаболический синдром и артериальная гипертензия: от патофизиологических механизмов к персонифицированной защите органов-мишеней

Кардио-рено-гепато-метаболический синдром (КРГМС) объединяет артериальную гипертензию (АГ), ожирение, инсулинорезистентность и поражение органов-­мишеней в единую патофизиологическую систему. В работе последовательно изложены ключевые патофизиологические механизмы КРГМС, включающие гиперактивацию ренин-ангиотензин-альдостероновой системы и симпатической нервной системы, метавоспаление, липотоксичность, дисрегуляцию адипокинов и дисфункцию эндотелия, на основе которых проанализированы особенности течения АГ и обоснованы современные подходы к ее фармакотерапии. Показано, что традиционный органоцентричный подход часто бывает неэффективен, оставляет высокий остаточный риск развития сердечно-­сосудистых осложнений (ССО), даже при достижении целевых уровней артериального давления (АД). Фиксированная комбинация индапамид/периндоприл не только обеспечивает стабильный 24‑часовой контроль АД, но и снижает частоту развития ССО и ренальных осложнений, не оказывая негативного влияния на углеводный обмен. У пациентов с КРГМС приоритетом должна стать персонализированная органопротективная стратегия. Фиксированная комбинация индапамид/периндоприл представляет собой обоснованный выбор первого ряда, сочетающий высокую эффективность, метаболическую нейтральность и комплексную защиту органов-­мишеней.

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