medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-090medsovet-8219Research ArticleКАРДИОЛОГИЯCARDIOLOGYЕвропейские рекомендации по лечению артериальной гипертензии 2023 года: новые тенденцииEuropean guidelines for the treatment of arterial hypertension 2023: new trendshttps://orcid.org/0000-0001-8228-1114ЛеоноваМ. В.LeonovaM. V.

Леонова Марина Васильевна, д.м.н., профессор, член-корр. РАЕН, клинический фармаколог, член Московского регионального отделения

400005, Волгоград, ул. Коммунистическая, д. 50

Marina V. Leonova, Dr. Sci. (Med.), Professor, Corr. Member RAEN, Clinical Pharmacologist, Member of the Moscow Regional Branch

50, Kommunisticheskaya St., Volgograd, 400005

anti23@mail.ruМежрегиональная общественная организация «Ассоциация клинических фармакологов»РоссияInterregional Public Organization “Association of Clinical Pharmacologists”Russian Federation202409052024053039Copyright © Леонова М.В., 20242024Леонова М.В.Leonova M.V.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/8219

Тактика лечения артериальной гипертензии направлена на контроль уровня артериального давления, а также на предотвращение тяжелых сердечно-сосудистых осложнений и влияния на прогноз заболевания в целом. Поэтому фармакотерапии артериальной гипертензии придается важное значение как руководству по лечению пациентов в реальной практике. Новые рекомендации Европейского общества по диагностике и лечению артериальной гипертензии 2023 г. разработаны после тщательного анализа исследований в области гипертонии, причем не ограничивались только рандомизированными контролируемыми исследованиями, но и включали реалистичные исследования (обсервационные, когортные, административные базы данных). Рекомендации 2023 г. подтверждают доказанную значимость 5 основных классов антигипертензивных препаратов: тиазидных/тиазидоподобных диуретиков, ингибиторов ангиотензинпревращающего фермента, блокаторов рецепторов ангиотензина, антагонистов кальция и β-блокаторов. Новые данные метаанализов подтверждают большую клиническую значимость в предотвращении исходов, связанных с артериальной гипертензией, для блокаторов ренин-ангиотензиновой системы, антагонистов кальция и тиазидных/тиазидоподобных диуретиков, что легло в основу их предпочтительного использования в фармакотерапии артериальной гипертензии, включая их различные комбинации. Новой тенденцией в фармакотерапии артериальной гипертензии явилось включение β-блокаторов в число основных антигипертензивных препаратов, в том числе для их предпочтительного применения при целом ряде клинических состояний. Упоминаются новые классы лекарств, такие как ингибиторы натрий-глюкозного котранспортера 2-го типа и нестероидные антагонисты минералокортикоидных рецепторов, которые проявляют эффекты снижения артериального давления и по которым получены убедительные доказательства в снижении сердечно-сосудистых и почечных исходов у пациентов с сахарным диабетом 2-го типа и в случае ингибиторов натрий-глюкозного котранспортера 2-го типа – у пациентов без диабета. В рекомендациях 2023 г. существенно обновлена информация о доступных комбинированных стратегиях лечения артериальной гипертензии и дополнены данные по эффективности фиксированных комбинаций, включая квадропиллы и полипиллы.

The treatment strategy for arterial hypertension is aimed at controlling blood pressure levels, as well as preventing serious cardiovascular complications and affecting the prognosis of the disease. Therefore, pharmacotherapy of arterial hypertension is given great importance as a guide to the treatment of patients in real practice. The new 2023 European Society Guidelines for the diagnosis and treatment of hypertension were developed after a thorough analysis of studies in the field of arterial hypertension, and were not limited to RCTs only, but also included realistic studies (observational, cohort, administrative databases). The 2023 Guidelines support the proven value of five major classes of antihypertensive drugs: thiazide/thiazide-like diuretics, ACEIs, ARBs, calcium antagonists, and β-blockers. New data from meta-analyses support the greater clinical relevance of RAS blockers, calcium channel blockers, and thiazide/thiazide-like diuretics in preventing hypertension-related outcomes, leading to their preferred use in the pharmacotherapy of arterial hypertension, including various combinations of drugs. A new trend in the pharmacotherapy of arterial hypertension has been the inclusion of β-blockers among the main antihypertensive drugs, including their preferred use for a number of clinical conditions. New classes of drugs, such as SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, are cited as having BP-lowering effects and with strong evidence of reduced cardiovascular and renal outcomes in patients with type 2 diabetes and, in the case of SGLT2 inhibitors, in non-diabetic patients. The 2023 Guidelines significantly updated information on available combination strategies for the treatment of arterial hypertension, and added data on the effectiveness of fixed combinations, including quadropills and polypills. 

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