Статья
Артериальная гипертензия у пациентов пожилого и старческого возраста в свете новых Европейских рекомендаций 2018 года
Тенденция старения населения и, вместе с ней, увеличение распространенности артериальной гипертонии (АГ) определяет необходимость изучения особенности лечения АГ у пациентов пожилого и старческого возраста. В связи с этим в новых рекомендациях Европейского общества кардиологов по диагностике и лечению АГ (2018) авторы выделили группы пожилых пациентов (в возрасте 65-79 лет) и очень пожилых пациентов (в возрасте ≥80 лет), для которых установили уровни артериального давления (АД) для начала антигипертензивной терапии и целевого АД, а также рекомендовали принципы медикаментозной антигипертензивной терапии. В новых рекомендациях ESH/ESC (2018) были также представлены особенности ведения пожилых пациентов с АГ. Подчеркивается необходимость обязательного выявления у пожилых пациентов синдрома старческой астении и определение степени независимости их от посторонней помощи. У всех пациентов пожилого возраста, особенно у очень пожилых или «хрупких» пациентов, рекомендовано оценивать наличие или развитие в процессе лечения ортостатической гипотензии, а также активно выявлять эпизоды гипотонии методом суточного мониторирования АД. Для медикаментозной антигипертензивной терапии у пожилых пациентов рекомендуются те же пять основных классов антигипертензивных препаратов и их комбинации. Подчеркивается, что, если этого не требуется для лечения сопутствующих заболеваний, необходимо избегать применения петлевых диуретиков и альфа-блокаторов из-за того, что их применение ассоциировано с повышенным риском падений. Рекомендуется чаще исследовать уровень креатинина в сыворотке крови для оценки функции почек и выявления возможного снижения скорости клубочковой фильтрации в результате снижения АД и перфузии почек. В качестве целевых цифр указаны значения систолического АД 130-139 мм рт.ст. и диастолического АД 70-80 мм рт.ст. при условии хорошей переносимости. В рекомендациях 2018 г. подчеркивается, что у пожилых пациентов необходимо тщательное мониторирование любых неблагоприятных побочных реакций антигипертензивных лекарственных средств.
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