Статья
Неконтролируемая артериальная гипертензия: почка, нейрогормональный дисбаланс и подходы к антигипертензивной лекарственной терапии
Резистентная и рефрактерная артериальная гипертензии (АГ) представляют собой два разных клинических фенотипа неконтролируемой АГ, которые отличаются по чувствительности к антигипертензивной лекарственной терапии. В обзоре представлены данные, полученные в клинических исследованиях, посвященных выяснению участия нарушения нейрогормонального статуса и функции почек в формировании резистентной и рефрактерной АГ, и новые подходы к повышению эффективности антигипертензивной терапии (АГТ) в этих популяциях пациентов. Результаты этих исследований показывают, что у больных с неконтролируемой АГ, несмотря на длительный прием ≥3 антигипертензивных препаратов с разными механизмами действия, включая диуретик, сохраняется избыточная реабсорбция натрия в дистальных сегментах нефрона, причиной которой являются повышенная активность альдостерона и гиперактивность симпатической части вегетативной нервной системы. В связи с этим в обзоре особое внимание уделено данным, полученным в исследованиях PATHWAY-2, PATHWAY-3 и ReHOT при изучении у пациентов с резистентной АГ клинической эффективности спиронолактона, амилорида и антиадренергических препаратов бисопролола, доксазозина и клонидина, подавляющих активность симпатической части вегетативной нервной системы.
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