Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.

Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.



СІМЕЙНІ ЛІКАРІ ТА ТЕРАПЕВТИ

НЕВРОЛОГИ, НЕЙРОХІРУРГИ, ЛІКАРІ ЗАГАЛЬНОЇ ПРАКТИКИ, СІМЕЙНІ ЛІКАРІ

КАРДІОЛОГИ, СІМЕЙНІ ЛІКАРІ, РЕВМАТОЛОГИ, НЕВРОЛОГИ, ЕНДОКРИНОЛОГИ

СТОМАТОЛОГИ

ІНФЕКЦІОНІСТИ, СІМЕЙНІ ЛІКАРІ, ПЕДІАТРИ, ГАСТРОЕНТЕРОЛОГИ, ГЕПАТОЛОГИ

ТРАВМАТОЛОГИ

ОНКОЛОГИ, (ОНКО-ГЕМАТОЛОГИ, ХІМІОТЕРАПЕВТИ, МАМОЛОГИ, ОНКО-ХІРУРГИ)

ЕНДОКРИНОЛОГИ, СІМЕЙНІ ЛІКАРІ, ПЕДІАТРИ, КАРДІОЛОГИ ТА ІНШІ СПЕЦІАЛІСТИ

ПЕДІАТРИ ТА СІМЕЙНІ ЛІКАРІ

АНЕСТЕЗІОЛОГИ, ХІРУРГИ

"Hypertension" Том 15, №1-2, 2022

Back to issue

The treatment of arterial hypertension at the present stage of medical practice

Authors: Тащук В.К., Хребтій Г.І.
Буковинський державний медичний університет, м. Чернівці, Україна

Categories: Cardiology

Sections: Specialist manual

print version


Summary

Мета роботи — об’єктивізація результатів опублікованих клінічних досліджень впливу лікування на перебіг артеріальної гіпертензії. Результати. Оптимізація профілактики та лікування артеріальної гіпертензії вимагає зміни парадигми на ступінчасту допомогу та використання ефективних стратегій контролю артеріального тиску. Висновки. Сучасне ефективне лікування артеріальної гіпертензії повинно базуватися на корекції факторів ризику, модифікації способу життя, використанні медикаментозних препаратів на основі фактичних даних щодо їх впливу на запобігання захворюваності/смертності; підборі режиму терапії, який забезпечує цілодобовий контроль АТ. Ступенева концепція лікування артеріальної гіпертензії є пріоритетною стратегією ведення пацієнтів з підвищеним артеріальним тиском. Лікування повинно бути доступним та/або економічно вигідним, мати високий профіль безпеки, перевагу слід надавати фіксованим комбінаціям антигіпертензивних препаратів.

The purpose of the work is to objectify the results of the published clinical studies on the impact of treatment on the course of hypertension. Results. Optimizing the prevention and treatment of hypertension requires a paradigm shift to step-by-step care and the use of effective blood pressure control strategies. Conclusions. The modern effective treatment of hypertension should be based on the correction of risk factors, lifestyle modifications, the use of drugs based on the evidence of their impact on the prevention of morbidity/mortality; selection of the mode of therapy which provides round-the-clock control of BP. The step-by-step concept of treating hypertension is a priority strategy for managing patients with a high blood pressure. The treatment should be affordable and/or cost-effective, have a high safety profile, the fixed combinations of antihypertensive drugs should be preferred.


Keywords

артеріальна гіпертензія; фактори ризику; ступінчаста терапія; огляд

arterial hypertension; risk factors; step-by-step therapy; review


For the full article you need to subscribe to the magazine.


Bibliography

1. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018 Sep 1. 39(33). 3021-3104.
2. Wang C., Yuan Y., Zheng M., Pan A., Wang M., Zhao M., et al. Association of age of onset of hypertension with cardiovascular diseases and mortality. J. Am. Coll. Cardiol. 2020. 75. 2921-2930.
3. Guzik T.J., Mohiddin S.A., Dimarco A., Patel V., Savvatis K., Marelli-Berg F.M., et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc. Res. 2020. 116. 1666-1687. 
4. Guan W., Ni Z., Hu Y., Liang W., Ou C., He J., et al. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020. 382. 1708-1720.
5. Gao C., Gao C., Cai Y., Cai Y., Zhang K., Zhang K., et al. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur. Heart J. 2020. 41. 2058-2066. 
6. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2016. 390. 1345-422. 
7. Unger T., Borghi C., Charchar F., et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020. 75. 1334-1357.
8. Forouzanfar M.H., Liu P., Roth G.A., et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017. 317. 165-82. 
9. Fox C.S., Larson M.G., Leip E.P., Culleton B., Wilson P.W., Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004. 291. 844-50.
10. Hsu C.Y., McCulloch C.E., Darbinian J., Go A.S., Iribarren C. Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Arch. Intern. Med. 2005. 165. 923-8. [
11. Hwang S., Jayadevappa R., Zee J., et al. Concordance between clinical diagnosis and medicare claims of depression among older primary care patients. Am. J. Geriatr. Psychiatry. 2015. 23. 726-34.
12. Mills K.T., Bundy J.D., Kelly T.N., et al. Global Disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016. 134. 441-50. 
13. Whelton P.K., Appel L.J., Sacco R.L., et al. Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Circulation. 2012. 126. 2880-9.
14. Ineke Neutel C., Campbell N.R.C. Changes in lifestyle after hypertension diagnosis in Canada. Can. J. Cardiol. 2008. 24. 199-204. 
15. Hinderliter A.L., Sherwood A., Craighead L.W., et al. The long-term effects of lifestyle change on blood pressure: one-year follow-up of the ENCORE study. Am. J. Hypertens. 2014. 27. 734-41.
16. Appel L.J., Moore T.J., Obarzanek E., et al.; DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N. Engl. J. Med. 1997. 336. 1117-24. 
17. Van Horn L., Carson J.A.S., Appel L.J., et al.; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Di-sease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Stroke Council. Re-commended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: a scientific statement from the American Heart Association [Published correction appears in: Circulation. 2016. 134. e534]. Circulation. 2016. 134. e505-e529.
18. Sacks F.M., Svetkey L.P., Vollmer W.M., et al.; DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N. Engl. J. Med. 2001. 344. 3-10. 
19. Juraschek S.P., Miller E.R. III, Weaver C.M., Appel L.J. Effects of sodium reduction and the DASH diet in relation to baseline blood pressure. J. Am. Coll. Cardiol. 2017. 70. 2841-8. 
20. O’Donnell M., Mente A., Yusuf S. Sodium intake and cardiovascular health. Circ. Res. 2015. 116. 1046-57. 
21. Klag M.J., He J., Coresh J. et al. The contribution of urinary cations to the blood pressure differences associated with migration. Am. J. Epidemiol. 1995. 142. 295-303. 
22. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ. 1988. 297. 319-28. 
23. Mente A., O’Donnell M.J., Rangarajan S., et al.; PURE Investigators. Association of urinary sodium and potassium excretion with blood pressure. N. Engl. J. Med. 2014. 371. 601-11. 
24. Harnack L.J., Cogswell M.E., Shikany J.M., et al. Sources of sodium in US adults from 3 geographic regions. Circulation. 2017. 135. 1775-83. 
25. Bibbins-Domingo K., Chertow G.M., Coxson P.G., et al. Projected effect of dietary salt reductions on future cardiovascular disease. N. Engl. J. Med. 2010. 362. 590-9. 
26. Whelton P.K., He J., Cutler J.A., et al. Effects of oral potassium on blood pressure. Metaanalysis of randomized controlled clinical trials. JAMA. 1997. 277. 1624-32. 
27. Geleijnse J.M., Kok F.J., Grobbee D.E. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. J. Hum. Hypertens. 2003. 17. 471-80. 
28. Aburto N.J., Ziolkovska A., Hooper L., Elliott P., Cappuccio F.P., Meerpohl J.J. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013. 346. f1326. 
29. Filippini T., Violi F., D’Amico R., Vinceti M. The effect of potassium supplementation on blood pressure in hypertensive subjects: a systematic review and meta-analysis. Int. J. Cardiol. 2017. 230. 127-35. 
30. Poorolajal J., Zeraati F., Soltanian A.R., Sheikh V., Hooshmand E., Maleki A. Oral potassium supplementation for management of essential hypertension: a meta-analysis of randomized controlled trials. PLoS ONE. 2017. 12. e0174967. 
31. Brancati F.L., Appel L.J., Seidler A.J., Whelton P.K. Effect of potassium supplementation on blood pressure in African Americans on a low-potassium diet. A randomized, double-blind, placebo-controlled trial. Arch. Intern. Med. 1996. 156. 61-7. 
32. Vinceti M., Filippini T., Crippa A., de Sesmaisons A., Wise L.A., Orsini N. Meta-analysis of potassium intake and the risk of stroke. J. Am. Heart Assoc. 2016. 5. e004210. 
33. Huai P., Xun H., Reilly K.H., Wang Y., Ma W., Xi B. Physical activity and risk of hypertension: a meta-analysis of prospective cohort studies. Hypertension. 2013. 62. 1021-6. 
34. Hayashi T., Tsumura K., Suematsu C., Okada K., Fujii S., Endo G. Walking to work and the risk for hypertension in men: the Osaka Health Survey. Ann. Intern. Med. 1999. 131. 21-6. 
35. Dimeo F., Pagonas N., Seibert F., Arndt R., Zidek W., Westhoff T.H. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012. 60. 653-8. 
36. Blumenthal J.A., Siegel W.C., Appelbaum M. Failure of exercise to reduce blood pressure in patients with mild hypertension. Results of a randomized controlled trial. JAMA. 1991. 266. 2098-104. 
37. Arakawa K. Antihypertensive mechanism of exercise. J. Hypertens. 1993. 11. 223-9. 
38. Hall J.E. The kidney, hypertension, and obesity. Hypertension. 2003. 41. 625-33. 
39. Jayedi A., Rashidy-Pour A., Khorshidi M., Shab-Bidar S. Body mass index, abdominal adiposity, weight gain and risk of developing hypertension: a systematic review and dose-response meta-analysis of more than 2.3 million participants. Obes. Rev. 2018. 19. 654-67. 
40. Egan B.M., Li J., Hutchison F.N., Ferdinand K.C. Hypertension in the United States, 1999 to 2012: progress toward Healthy People 2020 goals. Circulation. 2014. 130. 1692-9. 
41. Saydah S., Bullard K.M., Cheng Y., et al. Trends in cardiovascular disease risk factors by obesity level in adults in the United States, NHANES 1999–2010. Obesity (Silver Spring). 2014. 22. 1888-95. 
42. Jones D.W., Miller M.E., Wofford M.R., et al. The effect of weight loss intervention on antihypertensive medication requirements in the Hypertension Optimal Treatment (HOT) study. Am. J. Hypertens. 1999. 12. 1175-80. 
43. Stevens V.J., Obarzanek E., Cook N.R., et al.; Trials of Hypertension Prevention Research Group. Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann. Intern. Med. 2001. 134. 1-11. 
44. Hall J.E., do Carmo J.M., da Silva A.A., Wang Z., Hall M.E. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ. Res. 2015. 116. 991-1006. 
45. DeMarco V.G., Aroor A.R., Sowers J.R. The pathophysiology of hypertension in patients with obesity. Nat. Rev. Endocrinol. 2014. 10. 364-76. 
46. Peacock E., Krousel-Wood M. Adherence to antihypertensive therapy. Med. Clin. North Am. 2017. 101. 229-45. 
47. Tajeu G.S., Kent S.T., Kronish I.M., et al. Trends in antihypertensive medication discontinuation and low adherence among Medicare beneficiaries initiating treatment from 2007 to 2012. Hypertension. 2016. 68. 565-75. 
48. Krousel-Wood M., Hyre A., Muntner P., Morisky D. Methods to improve medication adherence in patients with hypertension: current status and future directions. Curr. Opin. Cardiol 2005. 20. 296-300. 
49. Krousel-Wood M.A., Muntner P., Islam T., Morisky D.E., Webber L.S. Barriers to and determinants of medication adherence in hypertension management: perspective of the Cohort Study of Medication Adherence Among Older Adults. Med. Clin. North Am. 2009. 93. 753-69. 
50. Krousel-Wood M., Islam T., Muntner P., et al. Association of depression with antihypertensive medication adherence in older adults: cross-sectional and longitudinal findings from CoSMO. Ann. Behav. Med. 2010. 40. 248-57.
51. Cushman W.C., Ford C.E., Cutler J.A., Margolis K.L., Davis B.R., Grimm R.H., et al.; ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J. Clin. Hypertens. (Greenwich). 2002. 4. 393-404. 
52. Dahlöf B., Sever P.S., Poulter N.R., Wedel H., Beevers D.G., Caulfield M, et al.; ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005. 366. 895-906. 
53. Wright J.T., Jr, Williamson J.D., Whelton P.K., Snyder J.K., Sink K.M., Rocco M.V., et al.; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 2015. 373. 2103-16. 
54. UK Prospective Diabetes Study Group Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998. 317. 703-13. 
55. Law M.R., Wald N.J., Morris J.K., Jordan R.E. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ. 2003. 326. 1427. 
56. Wald D.S., Law M., Morris J.K., Bestwick J.P., Wald N.J. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am. J. Med. 2009. 122. 290-300. 
57. Gupta P., Patel P., Štrauch B., Lai F.Y., Akbarov A., Gulsin G.S., et al. Biochemical screening for nonadherence is associated with blood pressure reduction and improvement in adherence. Hypertension. 2017. 70. 1042-8. 
58. Gupta A.K., Arshad S., Poulter N.R. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension. 2010. 55. 399-407. 
59. Cappuccio F.P., Markandu N.D., Sagnella G.A., Sin-ger D.R., Buckley M.G., Miller M.A., et al. Effects of amlodipine on urinary sodium excretion, renin-angiotensin-aldosterone system, atrial natriuretic peptide and blood pressure in essential hypertension. J. Hum. Hypertens. 1991. 5. 115-9. 
60. Vaduganathan M., Vardeny Orly, Michel Thomas, Mcmurray J.J.V., Pfeffer M.A., Ph D., et al. Renin-angiotensin-aldosterone system inhibitors in patients with COVID-19. N. Engl. J. Med. 2020. 382(17). 1653-1659.
61. Kintscher U., Slagman A., Domenig O., Röhle R., Konietschke F., Poglitsch M., et al. Plasma angiotensin peptide profi-ling and ACE2-activity in COVID-19 patients treated with pharmacological blockers of the renin angiotensin system. Hypertension. 2020. 76. e34-e36.
62. Giovanni de Simone. 2020. Position statement of the ESC council on hypertension on ACE-inhibitors and angiotensin receptor blockers. https. //www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang.
63. Mancia G., Rea F., Ludergnani M., Apolone G., Corrao G. Renin-angiotensin-aldosterone system blockers and the risk of COVID-19. N. Engl. J. Med. 2020. 382. 2431-2440. 
64. Reynolds H.R., Adhikari S., Pulgarin C., Troxel A.B., Iturrate E., Johnson S.B., et al. Renin-angiotensin-aldosterone system inhibitors and risk of COVID-19. N. Engl. J. Med. 2020. 382. 2441-2448.
65. Semenzato L., Botton J., Drouin J., Baricault B., Vabre C., Cuenot F., et al. Antihypertensive drugs and COVID-19 risk. Hypertension. 2021. 833-842. 
66. Cohen J.B., Hanff T.C., William P., Sweitzer N., Rosado-Santander N.R., Medina C., et al. Continuation versus discontinuation of renin-angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial. Lancet Respir. Med. 2021. 9. 275-284. 
67. Lopes R.D., Macedo A.V.S., De Barros E Silva P.G.M., Moll-Bernardes R.J., Dos Santos T.M., Mazza L., et al. Effect of discontinuing vs continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on days alive and out of the hospital in patients admitted with COVID-19: a randomized clinical trial. JAMA, J. Am. Med Assoc. 2021. 325. 254-264.

Back to issue