medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-089medsovet-9112Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯARTERIAL HYPERTENSIONПодходы к первичной и вторичной профилактике церебральных осложнений у пациентов с артериальной гипертензией и мультифокальным атеросклерозомApproaches to the primary and secondary prevention of cerebral complications in patients with arterial hypertension and multifocal atherosclerosishttps://orcid.org/0000-0001-5219-9216ВеденскаяС. С.VedenskayaS. S.

Веденская Светлана Сергеевна, к.м.н., доцент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Россия, Екатеринбург, ул. Репина, д. 3 

Svetlana S. Vedenskaya, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repina St., Ekaterinburg, 620028, Russia

ssveden@yandex.ruhttps://orcid.org/0000-0003-2485-2243БельтюковЕ. К.BeltyukovE. K.

Бельтюков Евгений Кронидович, чл.- корр. РАН, д.м.н., профессор, профессор кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Россия, Екатеринбург, ул. Репина, д. 3 

Evgeny K. Beltyukov, Corr. Member RAS, Dr. Sci. (Med.), Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repina St., Ekaterinburg, 620028, Russia

asthma@mail.ruhttps://orcid.org/0000-0002-3028-2657НаумоваВ. В.NaumovaV. V.

Наумова Вероника Викторовна, к.м.н., доцент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Россия, Екатеринбург, ул. Репина, д. 3 

Veronika V. Naumova, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repina St., Ekaterinburg, 620028, Russia

nika.naumova@gmail.comhttps://orcid.org/0009-0000-5986-9913ВеденскийВ. А.VedenskiiV. A.

Веденский Всеволод Александрович, студент

119991, Россия, Москва, Ленинские Горы, д. 1 

Vsevolod A. Vedenskii, Student

1, Leninskie Hills, Moscow, 119991, Russia

vsevolod.vedensky@yandex.ruhttps://orcid.org/0000-0002-0705-6651СмоленскаяО. Г.SmolenskayaO. G.

Смоленская Ольга Георгиевна, д.м.н., профессор, заведующая кафедрой факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Россия, Екатеринбург, ул. Репина, д. 3 

Olga G. Smolenskaya, Dr. Sci. (Med.), Professor, Head of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repina St., Ekaterinburg, 620028, Russia

o.smolenskaya@mail.ruУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationМосковский государственный университет имени М.В. ЛомоносоваРоссияLomonosov Moscow State UniversityRussian Federation20252405202506124132Copyright © Веденская С.С., Бельтюков Е.К., Наумова В.В., Веденский В.А., Смоленская О.Г., 20252025Веденская С.С., Бельтюков Е.К., Наумова В.В., Веденский В.А., Смоленская О.Г.Vedenskaya S.S., Beltyukov E.K., Naumova V.V., Vedenskii V.A., Smolenskaya O.G.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/9112

Введение. Пациенты с артериальной гипертензией (АГ) и мультифокальным атеросклерозом (МФА) остаются в группе высокого риска повторных ишемических событий.Цель. Показать эффективность использования двойной антитромботической терапии (ацетилсалициловая кислота (АСК) 100 мг/сут + ривароксабан 2,5 мг 2 раза в сутки) у пациентов с АГ и МФА.Материалы и методы. В исследование включено 219 пациентов (средний возраст 59,4 ± 8,01 лет) с контролируемой АГ и МФА, из них 110 – АГ 1–2-й стадии (группа 1), 109 – АГ 3-й стадии и атеротромботический ишемический инсульт (ИИ) в анамнезе (группа 2). Всем контролировали коагуляционный гемостаз, уровень высокочувствительного С-реактивного белка (вчСРБ) и интерлейкина-6 (ИЛ-6). Пациентов рандомизировали в основную группу – прием АСК 100 мг/сут + ривароксабан 2,5 мг 2 раза в сутки и группу сравнения – АСК 100 мг/сут. Период лечения составил 6 мес. Качество жизни (КЖ) оценивали по краткой форме опросника SF-36 до рандомизации и через 6 мес. лечения. Через 18 мес. оценивали первичные конечные точки (острая сосудистая катастрофа, сердечно-сосудистая смерть, госпитализация).Результаты. Добавление ривароксабана к АСК привело к улучшению локальных, глобальных показателей гемостаза и маркеров воспаления, повышению показателей КЖ по физическим и психическим компонентам и снижению риска развития первичных конечных точек. При приеме ривароксабана регистрировалась низкая частота побочных эффектов: малые кровотечения отмечались у 4 (3,7%) пациентов на терапии АСК + ривароксабан. Они проявлялись кровотечениями из десен, геморроидальных узлов и не требовали специального лечения. Большого кровотечения не зарегистрировано ни у одного пациента.Выводы. Применение двойной антитромбоцитарной терапии (АСК + ривароксабан) приводит к улучшению показателей гемостаза, маркеров воспаления и КЖ, а также к снижению риска развития сердечно-сосудистых осложнений.

Introduction. Patients with arterial hypertension (AH) and multifocal atherosclerosis (MFA) remain at a high risk of recurrent ischemic events.Aim. To show the effectiveness of using dual antithrombotic therapy (acetylsalicylic acid (ASA) 100 mg per day + rivaroxaban 2.5 mg twice daily) in patients with AH and MFA.Materials and methods. The study included 219 patients (mean age 59 ± 8 years) with controlled AH and MFA, 110 of them were stage 1–2 AH (group 1), 109 were stage 3 AH and a history of atherothrombotic ischemic stroke (IS) (group 2). Coagulation hemostasis, high‐sensitivity reactive protein (hs‐CRP) and interleukin‐6 (IL-6) levels were monitored in all patients. Patients were randomized into the main group – ASA 100 mg/day + rivaroxaban 2.5 mg 2 times a day and the comparison group – ASA 100 mg/day. The treatment period was 6 months. Quality of life (QOL) was assessed using the short form of the SF-36 questionnaire before randomization and after 6 months of treatment. After 18 months, the primary endpoints (acute vascular accident, cardiovascular death, hospitalization) were evaluated.Results. The addition of rivaroxaban to ASA led to an improvement in local and global indicators of hemostasis and markers of inflammation, an increase in QOL indicators for physical and mental components, and a reduction in the risk of primary endpoints. When taking rivaroxaban, a low incidence of side effects was recorded: minor bleeding was observed in 4 (3.7%) patients on ASA + rivaroxaban therapy. They were manifested by bleeding from the gums and hemorrhoids and did not require special treatment. No major bleeding has been reported in any patient.Conclusions. The use of dual antiplatelet therapy (ASA + rivaroxaban) leads to an improvement in hemostasis, markers of inflammation and QOL, as well as to a reduction in the risk of cardiovascular complications.

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