Статья
Артериальная гипертензия у больных ревматоидным артритом. Что нужно знать для диагностики и учитывать при лечении?
Риск развития сердечно-сосудистых событий у больных ревматоидным артритом (РА) выше, чем в популяции в 3,96 раза. Одним из модифицируемых факторов риска является артериальная гипертензия (АГ). Согласно данным литературы у 10-30% больных АГ является «маскированной», т.е. выявляется только при суточном мониторировании артериального давления (АД). По данным собственного исследования распространенность «маскированной» АГ среди больных РА составляет 28,2%. В группе больных с сочетанием АГ и РА 7,5% пациентов имели резистентную АГ, 36,8% больных регулярно не контролировали уровень АД. При суточном мониторировании жесткости артерий, по нашим данным, у больных РА в сочетании с АГ амбулаторный индекс ригидности достоверно выше, чем у больных эссенциальной АГ (p<0,05). Известно, что базисные противовоспалительные препараты снижают сердечно-сосудистый риск, однако данные в отношении симптоматической терапии нестероидными противовоспалительными препаратами (НПВП) и глюкокортикоидами не однозначны. Гипотензивная терапия больных АГ в сочетании с РА должна подбираться с учетом проводимой противовоспалительной терапии. Наиболее оправдано назначение блокаторов кальциевых каналов, которые не снижают свою эффективность при одновременном назначении с НПВП.
1. Balabanova RM, Erdes SF. The incidence and prevalence of rheumatic diseases in Russia in 2012-2013. Nauchno-Prakticheskaya Revmatologiya. 2015;53(2):120-4. (In Russian).
2. Breedweld FC, Weisman MH, Kavanaugh AF, et al. The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone it patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 2006;54:26-37. doi: 10.1002/art.21519.
3. Boers M, Dijkmans B, Gabriel S, et al. Making an impact on mortality in rheumatoid arthritis. Targeting cardiovascular comotbidity. Arthritis Rheum. 2004;50:1734-9. doi: 10.1002/art.20306.
4. Gabriel SE, Crowson CS, Kremers HM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48:54-8. doi: 10.1002/art.10705.
5. Kitas GD, Erb N. Tackling ischemic heart disease in rheumatoid arthritis. Rheumatology (Oxford). 2003;42: 607-13. doi: 10.1093/rheumatology/keg175.
6. Rincon D, Williams K, Stern MP, et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum. 2001;44 (12):2737-45.
7. Avina-Zubieta JA, Thomas J, Sadatsafavi M, et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71(9):1524-9. doi: 10.1136/annrheumdis-2011-200726.
8. Belenkov YuN, Fomin IV, Badin YuV, et al. Gender differences in the prevalence and treatment of hypertension in the European part of the Russian Federation: results of a study of the EHPOHA-2007. Problemy Zhenskogo Zdorov'ya. 2011;6(4):5-11. (In Russian).
9. Shal'nova SA, Kukushkin SK, Manoshkina EM, et al. Arterial hypertension and adherence to therapy. Vrach. 2009;12:39-42. (In Russian).
10. Protogerou AD, Panagiotakos DB, Zampeli E, et al. Arterial hypertension assessed “out-of-office” in a contemporary cohort of rheumatoid arthritis patients free of cardiovascular disease is characterized by high prevalence, low awareness, poor control and increased vascular damage-associated “white coat” phenomenon. Arthritis Res Ther. 2013; 15(5): R142. doi: 10.1186/ar4324.
11. Nikitina NM, Rebrov AP. Arterial hypertension in patients with rheumatoid arthritis. Rational Pharmacotherapy in Cardiology. 2009;5(3):67-70. (In Russian). doi: 10.20996/1819-6446-2009-5-3-67-70.
12. Park S, Lakatta EG. Role of Inflammation in the Pathogenesis of Arterial Stiffness. Yonsei Med J. 2012;53(2): 258-61. doi: 10.3349/ymj.2012.53.2.258.
13. Rebrov AP, Nikitina NM, Gaidukova IZ. The risk factors for cardiovascular disease in psoriatic and rheumatoid arthritis. Terapevticheskii Arkhiv. 2011;(83)5:20-4. (In Russian).
14. Smirnova MI, Platonova EM, Britov AN, et al. The rate and characters of masked arterial hypertension and masked ineffectiveness of hypertension treatment in industrial workers according to the preventive examination. Rational Pharmacotherapy in Cardiology. 2014;10(5):481-7. (In Russian). doi: 10.20996/1819-6446-2014-10-5-481-487.
15. Hermida RC, Smolensky MH, Ayala DE, Portaluppi F. Ambulatory Blood Pressure Monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults. Chronobiol Int. 2015; 32(10):1329-42. doi: 10.3109/07420528.2015.1113804.
16. Antropova OV, Osipova IV. High normal blood pressure: the prevalence and prognostic value. Profilakticheskaya Medicina. 2015;18(5):60-2. (In Russian).
17. Parati G, Stergion G, O`Brien E, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32(7):1359-66. doi: 10.1097/HJH.0000000000000221.
18. Owens P, Lyons S, O`Brien E. Ambulatory blood pressure in the hypertensive population: patterns and prevalence of hypertensive sub-forms. J Hypertens. 1998;16:1735-43.
19. Hermida RC, Smolensky MH, Ayala DE, et al. 2013 Ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension- associated risk, and attainment of therapeutic goals (summary). Clin Investig Arterioscler. 2013;25(2):74-82. doi: 10.1016/j.arteri.2013.03.002.
20. Myasoedova E, Crowson CS, Green AB, et al. Longterm blood pressure variability in patients with rheumatoid arthritis and its effect on cardiovascular events and all-cause mortality in RA: a population-based comparative cohort study. J Rheumatol. 2014;41(8):1638-44. doi: 10.3899/jrheum.131170.
21. Nikitina NM, Lobanova OS, Rebrov AP. Data of daily blood pressure monitoring in patients with rheumatoid arthritis. Saratovskij Nauchno-Medicinskij Zhurnal. 2009;5(5):190- 4. (In Russian).
22. Laurent S. Arterial stiffness in arterial hypertension. Curr Hypertens Rep. 2006;8(3):179-80.
23. Sliem H, Nasr G. Change of the aortic elasticity in rheumatoid arthritis: relationship to associated cardiovascular risk factors. Journal of Cardiovascular Disease Research. 2010;1(3):110-5. doi: 10.4103/0975-3583.70901.
24. Kalinina AM, Parfyonov AS, Kondrat'eva NV, et al. The relationship of risk factors for cardiovascular disease and subclinical markers of functional and structural vascular disorders. Profilakticheskaya Medicina. 2014;17(3):11-7. (In Russian).
25. Dolan E, Thijs L, Li Y, et al. Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in the Dublin Outcome Study. Hypertension. 2006;47(3):365-370. doi: 10.1161/01.HYP.0000200699.74641.c5.
26. Ambrosino P, Tasso M, Lupoli R, et al. Non-invasive assessment of arterial stiffness in patients with rheumatoid arthritis: a systematic review and meta-analysis of literature studies. Ann Med. 2015;47(6):457- 67. doi: 10.3109/07853890.2015.1068950.
27. Nikitina NM, Romanova TA, Rebrov AP. 24-hours monitoring of blood pressure and arterial stiffness in women with combined rheumatoid arthritis and hypertension (Abstract). Materials XV anniversary northwest scientific-practical conference "Days of Rheumatology in St. Petersburg 2015". Saint-Petersburg: Chelovek i ego zdorov'e; 2015. P.119-20. (In Russian).
28. Smolen JS, Aletaha D, Bijlsma JW, et al. T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631-7. doi: 10.1136/annrheumdis-2015-207524.
29. Karateev AE, Alekseeva LI, Bratygina EA, et al. Evaluation of the incidence of side effects with prolonged use of nimesulide in real clinical practice. Russkiy Meditsinskiy Zhurnal. 2009;17(21):1466-72. (In Russian).
30. Antman EM, Bennett JS, Daugherty A, et al. Use of nonsteroidal anti-inflammatory drugs: an update for clinicians: A scientific statement from the American Heart Association. Circulation. 2007; 115(12):1634-42. doi: 10.1161/CIRCULATIONAHA.106.181424.
31. Aw TJ, Haas S, Liew D. Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Arch Intern Med. 2005; 165:490-96. doi: 10.1001/archinte.165.5.IOI50013.
32. Karateev AE, Nasonov EL, Yakhno NN. Clinical guidelines «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice». Sovremennaya Revmatologiya. 2015;9(1):4-23. (In Russian).
33. Souverein PC, Berard A, Van Staa TP, et al. Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart. 90(8):859-65. doi: 10.1136/hrt.2003.020180.
34. Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004;141:764-70. doi: 10.7326/0003-4819-141-10-200411160-00007.
35. Davis 3rd JM, Maradit Kremers H, Crowson CS, et al. Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population- based cohort study. Arthritis Rheum. 2007;56:820-30. doi: 10.1002/art.22418.
36. Ruyssen-Witrand A, Fautrel B, Saraux A, et al. Cardiovascular risk induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review. Joint Bone Spine. 2011;78(1):23-30. doi: 10.1016/j.jbspin.2010.02.040.
37. Nasonov EL, Karateev DE, Chichasova NV. EULAR recommendations for the treatment of rheumatoid arthritis - 2013: general characteristics and disputable problems. Nauchno- Prakticheskaya Revmatologiya. 2013;51(6):609-22. (In Russian).
38. Bernatsky S, Hudson M, Suissa S. Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis. Rheumatology (Oxford). 2005; 44(5):677- 80. doi: 10.1093/rheumatology/keh610.
39. Choi H.K., Hernan M.A., Seeger J.D. et al. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet. 2002; 359(9313):1173-7. doi: 10.1016/S0140-6736(02)08213-2.
40. Westlake SL, Colebatch AN, Baird J, et al. The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford). 2010;49(2):295-307. doi: 10.1093/rheumatology/kep366.
41. Micha R, Imamura F, Wyler von Ballmoos M, et al. Systemic review and meta-analysis of methotrexate use and risk of cardiovascular disease. Am J Cardiol. 2011; 108(9):1362-70. doi: 10.1016/j.amjcard.2011.06.054.
42. Suissa S, Bernatsky S, Hudson M. Antirheumatic drug use and the risk of acute myocardial infarction. Arthritis Rheum. 2006; 55(4):531-6. doi: 10.1002/art.22094.
43. Naranjo A, Sokka T, Descalzo MA, et al. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther. 2008; 10(2):R30. doi: 10.1186/ar2383.
44. Peters MJ, van Sijl AM, Voskuyl AE, et al. The effects of tumor necrosis factor inhibitors on cardiovascular risk in rheumatoid arthritis. Curr Pharm Des. 2012;18(11):1502-11. doi: 10.2174/138161212799504786.
45. Maki-Petaja KM, Elkhawad M, Cheriyan J, et al. Anti-tumor necrosis factor-alpha therapy reduces aortic inflammation and stiffness in patients with rheumatoid arthritis. Circulation. 2012;126(21):2473-80. doi: 10.1161/CIRCULATIONAHA.112.120410.
46. Protogerou AD, Zampeli E, Fragiadaki K, et al. A pilot study of endothelial dysfunction and aortic stiffness after interleukin-6 receptor inhibition in rheumatoid arthritis. Atherosclerosis. 2011;219(2):734- 6. doi: 10.1016/j.atherosclerosis.2011.09.015.
47. Chazova IE, Ratova LG, Boitsov SA, et al. Diagnostic and treatment of arterial hypertension. Recommendations of Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Sistemnyye Gipertenzii. 2010; (3):5-26. (In Russian).
48. Ezhov MV. Arterial hypertension and nonsteroidal anti-inflammatory drugs: the benefits of amlodipine. Sistemnyye Gipertenzii. 2009;1:23-5. (In Russian).
49. Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomised to double blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet. 2000; 356: 366-72. doi: 10.1016/S0140-6736(00)02527-7.
50. Rosei EA, Dal Palu C, Leonetti G, et al. Clinical results of the Verapamil in Hypertension and Atherosclerosis Study. VHAS Investigators. J Hypertens. 1997;15:1337-44.
51. Mercuri M, Tang R, Phillips RM, Bond MG. Ultrasound protocol and quality control procedures in the European Lacidipine Study on Atherosclerosis (ELSA). Blood Pressure. 1996;5(4):20-3.