Когнитивные риски при артериальной гипертензии: от механизмов к профилактике

Деменция является одной из ведущих причин смертности и инвалидизации в мире. 40% случаев деменции потенциально можно предотвратить или отсрочить, воздействуя на модифицируемые факторы риска, включая артериальную гипертензию (АГ). В данном обзоре анализируется взаимосвязь между АГ и когнитивными нарушениями (КН), а также рассматриваются практические аспекты ведения таких пациентов. Многочисленные эпидемиологические исследования подтверждают роль АГ как значимого фактора риска КН, которые выявляются у 73,7% пациентов с АГ. Повышение систолического артериального давления (САД) на каждые 10 мм рт. ст. увеличивает риск КН на 7–16%, а при САД ≥160 мм рт. ст. риск деменции возрастает в 4,8 раза. Патогенетические механизмы когнитивной дисфункции включают церебральную микроангиопатию, поражение белого вещества и нейродегенеративные изменения, что особенно выражено при длительной неконтролируемой АГ. Влияние антигипертензивной терапии на когнитивные функции неоднозначно: исследования демонстрируют снижение риска деменции при качественном контроле АД, при этом интенсивное снижение давления у пожилых пациентов может ухудшать церебральную перфузию. У пациентов с АГ для обеспечения «прокогнитивного» эффекта перспективным направлением является применение комплексного нейропротективного препарата, содержащего комбинацию экстракта листьев гинкго двулопастного (ЭГБ) и никотиноил гамма-аминомасляной кислоты (никотиноил ГАМК) и сочетающего вазотропное, нейропротективное и метаболическое действие. Клиническое исследование и наблюдения показали, что комбинация никотиноил ГАМК и ЭГБ улучшает когнитивные функции, уменьшает тревожность и нормализует сон. Препарат хорошо сочетается с антигипертензивной терапией, не требует коррекции доз базовой терапии сердечно-сосудистых заболеваний и может применяться у пациентов разного возраста. Своевременное включение комплексного препарата, содержащего никотиноил ГАМК и ЭГБ, в схему лечения пациентов с АГ способствует не только коррекции когнитивных нарушений, но и снижению риска их прогрессирования.

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