medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-277medsovet-8498Research ArticleКАРДИОЛОГИЯCARDIOLOGYАнтигипертензивная терапия у беременных с хронической артериальной гипертензиейAntihypertensive therapy in pregnant women with chronic hypertensionhttps://orcid.org/0000-0002-0952-6856ЧулковВ. С.ChulkovV. S.

Чулков Василий Сергеевич - д.м.н., доцент, профессор кафедры внутренних болезней.

173003, Великий Новгород, ул. Б. Санкт-Петербургская, д. 41

Vasiliy S. Chulkov - Dr. Sci. (Med.), Associate Professor, Professor of the Department of Internal Medicine, Yaroslav the Wise Novgorod State University.

41, B. St Petersburg St., Velikiy Novgorod, 173003

vschulkov@rambler.ruhttps://orcid.org/0000-0003-4958-4695НиколенкоЕ. С.NikolenkoE. S.

Николенко Екатерина Сергеевна - ассистент кафедры факультетской терапии.

454092, Челябинск, ул. Воровского, д. 64

Ekaterina S. Nikolenko - Assistant of the Department of Faculty Therapy, South Ural State Medical University.

64, Vorovskiy St., Chelyabinsk, 454092

nikolenkokate@yandex.ruhttps://orcid.org/0000-0002-0881-4952НиколаеваВ. Д.NikolaevaV. D.

Николаева Валерия Дмитриевна – студент.

454092, Челябинск, ул. Воровского, д. 64

Valeria D. Nikolaeva - Student, South Ural State Medical University.

64, Vorovskiy St., Chelyabinsk, 454092

qpawz@mail.ruhttps://orcid.org/0000-0002-1405-251XМининаЕ. Е.MininaE. E.

Минина Елена Евгеньевна - к.м.н., старший лаборант кафедры факультетской педиатрии имени Н.С. Тюриной.

454092, Челябинск, ул. Воровского, д. 64

Elena E. Minina - Cand. Sci. (Med.), Senior Laboratory Assistant at the Department of Faculty Pediatrics named after N.S. Tyurina, South Ural State Medical University.

64, Vorovskiy St., Chelyabinsk, 454092

eminina79@mail.ruhttps://orcid.org/0000-0002-1948-8523ЧулковВ. С.ChulkovV. S.

Чулков Владислав Сергеевич - к.м.н., доцент кафедры факультетской терапии.

454092, Челябинск, ул. Воровского, д. 64

Vladislav S. Chulkov - Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy, South Ural State Medical University.

64, Vorovskiy St., Chelyabinsk, 454092

vlad.chulkov.1989@mail.ruНовгородский государственный университет имени Ярослава МудрогоРоссияYaroslav the Wise Novgorod State UniversityRussian FederationЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian Federation2024010920240133444Copyright © Чулков В.С., Николенко Е.С., Николаева В.Д., Минина Е.Е., Чулков В.С., 20242024Чулков В.С., Николенко Е.С., Николаева В.Д., Минина Е.Е., Чулков В.С.Chulkov V.S., Nikolenko E.S., Nikolaeva V.D., Minina E.E., Chulkov V.S.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/8498

Хроническая артериальная гипертензия (ХАГ) осложняет течение беременности в 1-2% случаев с четкой тенденцией к ее увеличению. По сравнению с нормотензивными женщинами, женщины с ХАГ имеют высокий риск материнских и перинатальных осложнений. Лечение ХАГ с применением антигипертензивных препаратов вдвое снижает риск тяжелой АГ, но не уменьшает частоту преэклампсии или серьезных материнских осложнений, что, возможно, связано с небольшим количеством наблюдений в проведенных исследованиях. Кроме того, лечение ХАГ не влияет на смертность или заболеваемость плода и/или новорожденного независимо от срока старта антигипертензивной терапии. Традиционно используемые антигипертензивные препараты доказанно не являются тератогенными, при этом может наблюдаться увеличение частоты врожденных пороков развития, связанных, прежде всего, с неконтролируемой хронической АГ. Хотя назначение разрешенных антигипертензивных препаратов всем женщинам во время беременности эффективно для снижения артериального давления в большинстве случаев, остается неясным, существует ли оптимальный лекарственный препарат для монотерапии и какие лучше всего использовать комбинации антигипертензивных препаратов. Альтернативный подход заключается в индивидуализации лечения с использованием характеристик матери и особенностей артериального давления, помимо уровня артериального давления (например, вариабельности АД), которые также имеют прогностическую ценность. В данном обзоре рассмотрены современные данные о лечении беременных с ХАГ с позиции актуальных национальных и международных рекомендаций. Обсуждение существующих нерешенных вопросов может служить основой для персонализированного подхода в ведении и лечении беременных с ХАГ.

Chronic hypertension (CH) complicates the course of pregnancy in 1-2% of cases, and it is increasingly common. Compared with normotensive women, women with CH have a high risk of maternal and perinatal complications. Antihypertensive treatment of CH halves the risk of severe hypertension but does not reduce the incidence of preeclampsia or serious maternal complications, which may be due to the small number of observations in the studies conducted. In addition, the treatment of CH does not affect the mortality or morbidity of the fetus and/or newborn, regardless of the start date of antihypertensive therapy. Traditionally used antihypertensive drugs have been proven not to be teratogenic, while there may be an increase in the frequency of congenital malformations associated primarily with uncontrolled chronic hypertension. Although prescribing approved antihypertensive agents for all women during pregnancy are effective in lowering blood pressure in the most cases, it remains unclear whether there is an optimal drug for monotherapy and which combinations of antihypertensive drugs are best used. An alternative approach is to individualize treatment using maternal characteristics and blood pressure characteristics, in addition to blood pressure levels (for example, blood pressure variability), which also have prognostic value. This review examines current data on the treatment of pregnant women with CH from the perspective of current national and international recommendations. Discussion of the existing unresolved issues can serve as a basis for a personalized approach in the management and treatment of pregnant women with CH.

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