medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-12-18-25medsovet-2014Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯARTERIAL HYPERTENSIONХРОНИЧЕСКАЯ БОЛЕЗНЬ ПОЧЕК: ФАКТОРЫ РИСКА, РАННЕЕ ВЫЯВЛЕНИЕ, ПРИНЦИПЫ АНТИГИПЕРТЕНЗИВНОЙ ТЕРАПИИCHRONIC RENAL DISEASE: RISK FACTORS, EARLY DETECTION, PRINCIPLES OF ANTIHYPERTENSIVE THERAPYЕсаянА. М.EasyanA. M.

д.м.н., профессор

MD., Prof.

Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияPavlov First Saint-Petersburg State Medical UniversityRussian Federation2017031120170121825Copyright © Есаян А.М., 20172017Есаян А.М.Easyan A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2014

В обзорной статье представлены сведения о распространенности хронической болезни почек (ХБП) в мире и в Российской Федерации, основных причинах роста числа лиц с ХБП. Особое внимание уделено критериям ранней диагностики ХБП и современным подходам к замедлению темпов прогрессирования, основанным на результатах ключевых международных контролируемых клинических исследований. Представлено обоснование строгого контроля артериального давления и применения в первую очередь классов антигипертензивных средств, воздействующих на ренин-анигиотензин-альдосте-роновую систему для целей нефропротекции.

 

 

 

 

The review article provides data on prevalence of the chronic renal disease in the world and in the Russian Federation, major growth factors of persons with chronic renal disease (CRD). Special attention is focused on criteria of early CRD diagnostics and modern approaches to deceleration of progression rates based on results of key international clinical studies. A justification of the strict control of the arterial pressure and application of the antihypertensive agents affecting rennin-angiotensin-aldosterone system for the purposes of nephroprotection is demonstrated.

хроническая болезнь почекскорость клубочковой фильтрацииальбуминурияантигипертензивная терапияренин-ангиотензин-альдостероновая системаchronic renal diseaseglomerular filtration ratealbuminuriaantihypertensive therapyrennin-angiotensin-aldosterone systemReferencesNational Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 2002, 39: S1-266.National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 2002, 39: S1-266.Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl., 2013, 3: 1-150.Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl., 2013, 3: 1-150.Рабочая группа Научного общества нефрологов России. Национальные рекомендации. Хроническая болезнь почек: основные положения, определение, диагностика, скрининг, подходы к профилактике и лечению. СПб.: Левша, 2012. 52 с.Рабочая группа Научного общества нефрологов России. Национальные рекомендации. Хроническая болезнь почек: основные положения, определение, диагностика, скрининг, подходы к профилактике и лечению. СПб.: Левша, 2012. 52 с.Rossing P, Hougaard P, Borch-Johnsen K et al. Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study. BMJ, 1996, 313: 779-784.Rossing P, Hougaard P, Borch-Johnsen K et al. Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study. BMJ, 1996, 313: 779-784.Jager A, Kostense PJ, Ruhe HG et al. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: five-year follow-up of the Hoorn Study. Arterioscler Thromb Vasc Biol, 1999, 19: 617-624.Jager A, Kostense PJ, Ruhe HG et al. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: five-year follow-up of the Hoorn Study. Arterioscler Thromb Vasc Biol, 1999, 19: 617-624.Gerstein HC, Mann JF, Pogue J et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study: the HOPE Study Investigators. Diabetes Care, 2000, 23(suppl 2): B35–B39.Gerstein HC, Mann JF, Pogue J et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study: the HOPE Study Investigators. Diabetes Care, 2000, 23(suppl 2): B35–B39.Matsushita K, van der Velde, M, Astor, BC et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet, 2010, 375: 2073-2081.Matsushita K, van der Velde, M, Astor, BC et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet, 2010, 375: 2073-2081.Hillege HL, Fidler V, Diercks GFH et al. Urinary Albumin Excretion Predicts Cardiovascular and Noncardiovascular Mortality in General Population. Circulation, 2002, 106: 1777-1782.Hillege HL, Fidler V, Diercks GFH et al. Urinary Albumin Excretion Predicts Cardiovascular and Noncardiovascular Mortality in General Population. Circulation, 2002, 106: 1777-1782.Мосина Н.В., Есаян А.М. Артериальная гипертензия и протеинурия – важнейшие факторы прогрессирования почечной недостаточности. Нефрология, 2004, 8(1): 22-28.Мосина Н.В., Есаян А.М. Артериальная гипертензия и протеинурия – важнейшие факторы прогрессирования почечной недостаточности. Нефрология, 2004, 8(1): 22-28.Palatini P. Glomerular hyperfiltration: a marker of early renal damage in pre-diabetes and pre-hypertension. NDT, 2012, 27(Issue 5); 1708-1714.Palatini P. Glomerular hyperfiltration: a marker of early renal damage in pre-diabetes and pre-hypertension. NDT, 2012, 27(Issue 5); 1708-1714.Карабаева А.Ж., Есаян А.М., Каюков И.Г. Дисфункция эндотелия в патогенезе кардиоренальной патологии. Клинико-лабораторный консилиум, 2007, 17: 15-21.Карабаева А.Ж., Есаян А.М., Каюков И.Г. Дисфункция эндотелия в патогенезе кардиоренальной патологии. Клинико-лабораторный консилиум, 2007, 17: 15-21.Clausen P, Feldt-Rasmussen B, Jensen G et al. Endothelial haemostatic factors are associated with progression of urinary albumin excretion in clinically healthy subjects: a 4-year prospective study. Clin Sci (Colch), 1999, 97: 37-43.Clausen P, Feldt-Rasmussen B, Jensen G et al. Endothelial haemostatic factors are associated with progression of urinary albumin excretion in clinically healthy subjects: a 4-year prospective study. Clin Sci (Colch), 1999, 97: 37-43.Ochodnicky P, Henning RH, van Dokkum RPE, de Zeeuw D. Microalbuminuria and endothelial dysfunction: Emerging targets for primary prevention of end-organ damage. J Cardiovasc Pharmacol, 2006, 47: S151-S162.Ochodnicky P, Henning RH, van Dokkum RPE, de Zeeuw D. Microalbuminuria and endothelial dysfunction: Emerging targets for primary prevention of end-organ damage. J Cardiovasc Pharmacol, 2006, 47: S151-S162.Jha V, Garcia-Garci G, Iseki K et al. Chronic kidney disease: global dimension and perspectives. Lancet, 2013, 382(7): 260-272.Jha V, Garcia-Garci G, Iseki K et al. Chronic kidney disease: global dimension and perspectives. Lancet, 2013, 382(7): 260-272.James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet, 2010, 375: 1296-1309.James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet, 2010, 375: 1296-1309.Coresh J, Selvin E, Stevens LA et al. Prevalence of chronic kidney disease in the United States. JAMA, 2007, 298: 2038-2047.Coresh J, Selvin E, Stevens LA et al. Prevalence of chronic kidney disease in the United States. JAMA, 2007, 298: 2038-2047.Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2013, 380: 2095-2128.Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2013, 380: 2095-2128.Rao C, Adair T, Bain C, Doi SA. Mortality from diabetic renal disease: a hidden epidemic. Eur J Public Health, 2012, 22: 280-284.Rao C, Adair T, Bain C, Doi SA. Mortality from diabetic renal disease: a hidden epidemic. Eur J Public Health, 2012, 22: 280-284.Hill NR, Fatoba ST, Oke JL et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One, 2016, 11: e0158765. doi: 10.1371/journal.pone.0158765.Hill NR, Fatoba ST, Oke JL et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One, 2016, 11: e0158765. doi: 10.1371/journal.pone.0158765.IDF IDF. IDF Diabetes Atlas. 6th ed, 2013.IDF IDF. IDF Diabetes Atlas. 6th ed, 2013.Helmchen LA and Henderson RM. Changes in the distribution of body mass index of white US men, 1890–2000. Ann Hum Biol, 2004, 31: 174-181.Helmchen LA and Henderson RM. Changes in the distribution of body mass index of white US men, 1890–2000. Ann Hum Biol, 2004, 31: 174-181.Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status in developing countries: a systematic review. Obes Rev, 2012, 13: 1067-1079.Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status in developing countries: a systematic review. Obes Rev, 2012, 13: 1067-1079.United States Renal Data System. Atlas of end-stage renal disease in the United States. National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Annual Data Report, 2004.United States Renal Data System. Atlas of end-stage renal disease in the United States. National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Annual Data Report, 2004.USRDS, 2015.USRDS, 2015.Бикбов Б.Т., Томилина Н.А. Состав больных и показатели качества лечения на заместительной терапии терминальной хронической почечной недостаточности в Российской Федерации в 1998–2013 гг. Нефрология и диализ, 2016, 18(2): 98-164.Бикбов Б.Т., Томилина Н.А. Состав больных и показатели качества лечения на заместительной терапии терминальной хронической почечной недостаточности в Российской Федерации в 1998–2013 гг. Нефрология и диализ, 2016, 18(2): 98-164.Ничик Т.Е., Каюков И.Г., Есаян А.М. Морфологические изменения почек при артериальной гипертензии в сочетании с умеренной протеинурией. Нефрология, 2006, 10(4): 66-71.Ничик Т.Е., Каюков И.Г., Есаян А.М. Морфологические изменения почек при артериальной гипертензии в сочетании с умеренной протеинурией. Нефрология, 2006, 10(4): 66-71.Дедов И.И., Шестакова М.В., Викулова О.К. Государственный регистр сахарного диабета в Российской Федерации: статус 2014 г. и перспективы развития. Сахарный диабет, 2015, 18(3): 5-23.Дедов И.И., Шестакова М.В., Викулова О.К. Государственный регистр сахарного диабета в Российской Федерации: статус 2014 г. и перспективы развития. Сахарный диабет, 2015, 18(3): 5-23.Чирин А.С. Артериальная гипертензия как социальнозначимая проблема современной России. Бюллетень медицинских интернет-конференций, 2016, 6(1).Чирин А.С. Артериальная гипертензия как социальнозначимая проблема современной России. Бюллетень медицинских интернет-конференций, 2016, 6(1).Herzog CA, Asinger RW, Berger AK et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 2011, 80: 572-586.Herzog CA, Asinger RW, Berger AK et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 2011, 80: 572-586.Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization. N Engl J Med, 2004, 351: 1296-1305.Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization. N Engl J Med, 2004, 351: 1296-1305.Manjunath G, Tighiouart H, Ibrahim H et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2003, 41(1): 47-55.Manjunath G, Tighiouart H, Ibrahim H et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2003, 41(1): 47-55.Matsushita K, van der Velde M, Astor BC et al. Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet, 2010, 375(9731): 2073-2081.Matsushita K, van der Velde M, Astor BC et al. Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet, 2010, 375(9731): 2073-2081.MRFIT study. JAMA, 2008, 300(11): 1343-1345.MRFIT study. JAMA, 2008, 300(11): 1343-1345.Peterson JC, Adler S, Burkart JM et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease study. Ann Intern Med, 1995, 123: 754-762.Peterson JC, Adler S, Burkart JM et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease study. Ann Intern Med, 1995, 123: 754-762.Appel LJ, Wright JT, Jr, Greene T et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med, 2010, 363(37): 918-929.Appel LJ, Wright JT, Jr, Greene T et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med, 2010, 363(37): 918-929.Sarnak MJ, Greene T, Wang X et al. The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med, 2005, 142: 342-351.Sarnak MJ, Greene T, Wang X et al. The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med, 2005, 142: 342-351.Berl T, Hunsicker LG, Lewis JB et al. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol, 2005, 16: 2170-2179.Berl T, Hunsicker LG, Lewis JB et al. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol, 2005, 16: 2170-2179.The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med, 2015, 373: 2103-2016.The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med, 2015, 373: 2103-2016.Ettehad D, Emdin CA, Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet, 2016, 387(5): 957-967.Ettehad D, Emdin CA, Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet, 2016, 387(5): 957-967.Есаян А.М., Титова В.А. Влияние ингибитора ангиотензин-I конвертирующего фермента (эналаприла) на функцию почки при экспериментальном уменьшении массы действующих нефронов у спонтанно гипертензивных крыс. Физиол. Журнал, 1993, 8: 76-78.Есаян А.М., Титова В.А. Влияние ингибитора ангиотензин-I конвертирующего фермента (эналаприла) на функцию почки при экспериментальном уменьшении массы действующих нефронов у спонтанно гипертензивных крыс. Физиол. Журнал, 1993, 8: 76-78.Turner JM, Bauer C, Abramowitz MK, Melamed ML, Hostetter TH. Treatment of chronic kidney disease. Kidney Int, 2012, 81: 351-362.Turner JM, Bauer C, Abramowitz MK, Melamed ML, Hostetter TH. Treatment of chronic kidney disease. Kidney Int, 2012, 81: 351-362.Есаян А.М. Эссенциальная гипертензия с нефропатией: насколько это актуально в наши дни? Нефрология, 2008, 12(2): 16-20.Есаян А.М. Эссенциальная гипертензия с нефропатией: насколько это актуально в наши дни? Нефрология, 2008, 12(2): 16-20.Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA, 2010, 303: 2043-2050.Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA, 2010, 303: 2043-2050.Оганов Р.Г., Тимофеева Т.Н., Колтунов И.Е. и соавт. Эпидемиология артериальной гипертонии в России. Результаты федерального мониторинга 2003–2010 гг. КВТИТ, 2012, 10(1): 8-12.Оганов Р.Г., Тимофеева Т.Н., Колтунов И.Е. и соавт. Эпидемиология артериальной гипертонии в России. Результаты федерального мониторинга 2003–2010 гг. КВТИТ, 2012, 10(1): 8-12.Thomas G, Xie D, Chen H et al. Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease. Report from the CRIC Study. Hypertension, 2016, 67(2): 387-396.Thomas G, Xie D, Chen H et al. Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease. Report from the CRIC Study. Hypertension, 2016, 67(2): 387-396.Mann JF, Schmieder RE, McQueen M et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet, 2008 Aug 16, 372(9638): 547-553.Mann JF, Schmieder RE, McQueen M et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet, 2008 Aug 16, 372(9638): 547-553.Fried LF, Duckworth W, Zhang JH et al. Design of combination angiotensin receptor blocker and angiotensin-converting enzyme inhibitor for treatment of diabetic nephropathy (VA NEPHRON-D). Clin J Am Soc Nephrol, 2009, 4: 361-368.Fried LF, Duckworth W, Zhang JH et al. Design of combination angiotensin receptor blocker and angiotensin-converting enzyme inhibitor for treatment of diabetic nephropathy (VA NEPHRON-D). Clin J Am Soc Nephrol, 2009, 4: 361-368.Parving HH, Brenner BM, McMurray JJ et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med, 2012, 367: 2204-2213.Parving HH, Brenner BM, McMurray JJ et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med, 2012, 367: 2204-2213.Williams B, MacDonald ThM, Morant C et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet, 2015, 386(10080): 2059-2068.Williams B, MacDonald ThM, Morant C et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet, 2015, 386(10080): 2059-2068.Navaneethan SD, Bravo E. Aldosterone Breakthrough during Angiotensin Receptor Blocker Use: More Questions than Answers? CJASN, 2013, 10: 1637-1639.Navaneethan SD, Bravo E. Aldosterone Breakthrough during Angiotensin Receptor Blocker Use: More Questions than Answers? CJASN, 2013, 10: 1637-1639.Navaneethan SD, Nigwekar SU, Sehgal AR, Strippoli GFM. Aldosterone Antagonists for Preventing the Progression of Chronic Kidney Disease: A Systematic Review and Meta-analysis. CJASN, 2009, 3: 542-551.Navaneethan SD, Nigwekar SU, Sehgal AR, Strippoli GFM. Aldosterone Antagonists for Preventing the Progression of Chronic Kidney Disease: A Systematic Review and Meta-analysis. CJASN, 2009, 3: 542-551.Карабаева А.Ж., Есаян А.М., Каюков И.Г. Характеристика ремоделирования левого желудочка у больных с хронической болезнью почек по данным эхокардиографии и влияние на него терапии спиронолактоном. Клиническая медицина, 2007, 12: 44-48.Карабаева А.Ж., Есаян А.М., Каюков И.Г. Характеристика ремоделирования левого желудочка у больных с хронической болезнью почек по данным эхокардиографии и влияние на него терапии спиронолактоном. Клиническая медицина, 2007, 12: 44-48.Карабаева А.Ж., Есаян А.М., Каюков И.Г., Эммануэль В.Л., Кадинская М.И. Влияние спиронолактона на показатели системы гемостаза и эндотелиальной функции у больных на программном гемодиализе. Вестник Санкт-Петербургского университета, 2007, 4(серия 11): 47-53.Карабаева А.Ж., Есаян А.М., Каюков И.Г., Эммануэль В.Л., Кадинская М.И. Влияние спиронолактона на показатели системы гемостаза и эндотелиальной функции у больных на программном гемодиализе. Вестник Санкт-Петербургского университета, 2007, 4(серия 11): 47-53.De Galan BE, Perkovic V, Ninomiya T et al. ADVANCE Collaborative Group. Lowering blood pressure reduces renal events in type 2 diabetes. JASN, 2009, 20: 883-892.De Galan BE, Perkovic V, Ninomiya T et al. ADVANCE Collaborative Group. Lowering blood pressure reduces renal events in type 2 diabetes. JASN, 2009, 20: 883-892.PROGRESS Collaborative Group. Lancet, 2001, 358: 1033-1041.PROGRESS Collaborative Group. Lancet, 2001, 358: 1033-1041.Bruining N et al. Coron Artery Dis, 2009, 20: 409-414.Bruining N et al. Coron Artery Dis, 2009, 20: 409-414.Ceconi C, Francolini G, Bastianon D et al. Differences in the effect of angiotensin-converting enzime inhibitors on the endothelial cell apoptosis: in vivo and in vitro studies. Cardiovasc Drugs Ther, 2007, 21: 423-429.Ceconi C, Francolini G, Bastianon D et al. Differences in the effect of angiotensin-converting enzime inhibitors on the endothelial cell apoptosis: in vivo and in vitro studies. Cardiovasc Drugs Ther, 2007, 21: 423-429.Ferrari R. Preserving bradykinin or blocking angiotensin II: the cardiovascular dilemma. Dialog Cardiovasc Med, 2004, 9: 71-89.Ferrari R. Preserving bradykinin or blocking angiotensin II: the cardiovascular dilemma. Dialog Cardiovasc Med, 2004, 9: 71-89.Roush GC, Ernst ME, Kostis JB et al. Head-to-Head Comparisons of Hydrochlorothiazide With Indapamide and Chlorthalidone. Hypertension, 2015, 65: 1041-1046.Roush GC, Ernst ME, Kostis JB et al. Head-to-Head Comparisons of Hydrochlorothiazide With Indapamide and Chlorthalidone. Hypertension, 2015, 65: 1041-1046.Di Nicolantonio JJ. Hydrochlorothiazide: is it a wise choice? Expert Opinion on Pharmacotherapy, 2012, 13(6).Di Nicolantonio JJ. Hydrochlorothiazide: is it a wise choice? Expert Opinion on Pharmacotherapy, 2012, 13(6).Calhoun DA, Jones D, Textor S et al. American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation, 2008, 117: e510-e526.Calhoun DA, Jones D, Textor S et al. American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation, 2008, 117: e510-e526.Acchiardo SR, Skoutakis VA. Clinical efficacy, safety, and pharmacokinetics of indapamide in renal impairment. Am Heart J, 1983, 106(1 Pt 2): 237-244.Acchiardo SR, Skoutakis VA. Clinical efficacy, safety, and pharmacokinetics of indapamide in renal impairment. Am Heart J, 1983, 106(1 Pt 2): 237-244.Zoungas S et al. September 19, 2014, at NEJM. org. doi: 10.1056/NEJMoa1407963.Zoungas S et al. September 19, 2014, at NEJM. org. doi: 10.1056/NEJMoa1407963.Кобалава Ж.Д., Котовская Ю.В., Ходорович Н.А. Оптимизация лечения больных артериальной гипертонией в реальной клинической практике: роль фиксированной комбинации перин-доприла А/амлодипина (результаты россий-ской наблюдательной программы КОНСТАНТА). Тер. архив, 2015, 87(3): 66-70.Кобалава Ж.Д., Котовская Ю.В., Ходорович Н.А. Оптимизация лечения больных артериальной гипертонией в реальной клинической практике: роль фиксированной комбинации перин-доприла А/амлодипина (результаты россий-ской наблюдательной программы КОНСТАНТА). Тер. архив, 2015, 87(3): 66-70.Jamerson K, Weber MA, Barkis GL et al. ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorthiazide for hypertension in high-risk patients. N Engl J Med, 2008, 359: 2417-2428.Jamerson K, Weber MA, Barkis GL et al. ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorthiazide for hypertension in high-risk patients. N Engl J Med, 2008, 359: 2417-2428.Assaad-Khalil SH, Nashaat N. Real-life Effectiveness and Safety of Amlodipine/ Valsartan Single-pill Combination in Patients with Hypertension in Egypt: Results from the EXCITE Study. Drugs Real World Outcomes, 2016 Sep, 3(3): 307-315.Assaad-Khalil SH, Nashaat N. Real-life Effectiveness and Safety of Amlodipine/ Valsartan Single-pill Combination in Patients with Hypertension in Egypt: Results from the EXCITE Study. Drugs Real World Outcomes, 2016 Sep, 3(3): 307-315.Chalmers J, Arima H, Woodward M et al. Effects of Combination of Perindopril, Indapamide, and Calcium Channel Blockers in Patients With Type 2 Diabetes Mellitus Results From the Action in Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) Trial. Hypertension, 2014, 63: 259-264.Chalmers J, Arima H, Woodward M et al. Effects of Combination of Perindopril, Indapamide, and Calcium Channel Blockers in Patients With Type 2 Diabetes Mellitus Results From the Action in Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) Trial. Hypertension, 2014, 63: 259-264.Toth H. Antihypertensive efficacy of triple combination perindopril/indapamide plus amlodi-pine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high risk hyperTensive patients). Am J Cardiovascular Drugs, 2014, 14(2): 137-145.Toth H. Antihypertensive efficacy of triple combination perindopril/indapamide plus amlodi-pine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high risk hyperTensive patients). Am J Cardiovascular Drugs, 2014, 14(2): 137-145.

The authors declare that there are no conflicts of interest present.