Статья
Современные рекомендации по артериальной гипертонии: согласованные и несогласованные позиции
Неуклонный рост распространенности артериальной гипертонии (АГ) и ассоциированных с ней сердечно-сосудистых заболеваний диктует необходимость новых подходов к диагностике и лечению АГ. Опубликованные в 2017 г. рекомендации Американской коллегии кардиологов (ACC/AHA) и опубликованные в 2018 г. рекомендации Европейского кардиологического общества (ESC/ESH), несмотря на некоторые отличия, как никогда раньше сходятся по ключевым вопросам лечения пациентов с АГ. Цель обзора – обсудить позиции сходства и отличия двух документов. В обзоре представлен подробный анализ разделов рекомендаций, касающихся важности оценки сердечно-сосудистого риска для начала и выбора терапии, пороговых уровней артериального давления (АД) для инициации медикаментозного лечения, препаратов выбора для стартовой терапии АГ, целевых значений АД на фоне лечения (в том числе у пожилых). Среди позиций различия подробно проанализированы разделы, касающиеся классификации АД и диагностики АГ, взглядов на лечение АГ при хронической болезни почек. Обсуждаются возможные причины введения нижней границы безопасности снижения АД в европейских рекомендациях. В заключение подчеркивается, что рекомендации ESC/ESH (2018 г.) и ACC/AHA (2017 г.) по многим позициям представляют собой разную трактовку результатов одних и тех же исследований и мета-анализов. Нет сомнений в необходимости снижения повышенного АД и параллельной глобальной оценке и коррекции сердечно-сосудистого риска, причем одной из главных целей рекомендаций 2017 и 2018 гг. является привлечение внимания к данной проблеме у молодых лиц.
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