Европейские рекомендации по лечению артериальной гипертензии 2023 года: новые тенденции

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.

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