kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2017-6-4-80-88kpccz-339Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОТБОР БОЛЬНЫХ РЕЗИСТЕНТНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ ДЛЯ ВЫПОЛНЕНИЯ РЕНАЛЬНОЙ ДЕНЕРВАЦИИSELECTION OF PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION FOR RENAL DENERVATIONЧичковаТ. Ю.ChichkovaT. Y.

Кемерово

Kemerovo

МамчурС. Е.MamchurS. E.

Кемерово

Kemerovo

ХоменкоЕ. А.KhomenkoE. A.

Кемерово

Kemerovo

РомановаМ. П.RomanovaM. P.

Кемерово

Kemerovo

МамчурИ. Н.MamchurI. N.

Мамчур Сергей Евгеньевич.

650002, Кемерово, Сосновый бульвар, д. 6, 8 (3842) 64-35-38

Mamchur Sergey.

6, Sosnoviy blvd., Kemerovo, 650002, +7 (3842) 64-35-38

mamchse@kemcardio.ruТришкинаН. Н.TrishkinaN. N.

Кемерово

Kemerovo

Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияFederal State Budgetary Institution «Research Institute for Complex Issues of Cardiovascular Diseases»Russian Federation201730112017648088Copyright © Чичкова Т.Ю., Мамчур С.Е., Хоменко Е.А., Романова М.П., Мамчур И.Н., Тришкина Н.Н., 20172017Чичкова Т.Ю., Мамчур С.Е., Хоменко Е.А., Романова М.П., Мамчур И.Н., Тришкина Н.Н.Chichkova T.Y., Mamchur S.E., Khomenko E.A., Romanova M.P., Mamchur I.N., Trishkina N.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/339Цель

Цель. Разработка оптимизированного научно-обоснованного подхода к лечебно-диагностическим мероприятиям перед выполнением РД.

Материалы и методы

Материалы и методы. В исследование включен 91 пациент с ранее диагностированной первичной АГ в возрасте 54,2 (52,0; 69,3) лет. Длительность анамнеза АГ составила 11,4±4,2 года. 57 (62,6%) пациентов имели признаки бессимптомного поражения органов-мишеней, 34 (37,4%) ассоциированные клинические состояния. Среднее количество классов принимаемых антигипертензивных средств составило 4±1,2; 18 человек (19,8%) получали антагонисты альдостерона. Всем пациентам выполнялись стандартные клинико-анамне-стические, лабораторные и инструментальные тесты, производилась оценка качества жизни с применением опросника SF-36 и оценка комплаенса с использованием теста Мориски-Грина. После оптимизации терапии и ряда дополнительных диагностических процедур, истинная резистентная АГ была выявлена у 19 пациентов, 9 из которых были исключены из дальнейшего исследования, 4 по анатомическому критерию, 5 ввиду наличия в анамнезе аллергических реакций на контрастное вещество.

Результаты

Результаты. Оптимизация диагностического и лечебного алгоритма ведения пациентов с АГ по-зволила выявить пациентов с вторичными вари-антами АГ, которые составили 8,8% в исследуемой выборке, а также достичь значимой динамики сни-жения АД по данным СМАД: САД на 34±12 мм рт. ст, ДАД на 12±4 мм рт. ст. от исходного (р=0,046). Результаты сопоставимы в группах с высоким и низким комплаенсом. У 54 человек (77,1%) удалось достичь целевых значений АД. Была выявлена до-стоверная динамика улучшения показателей каче-ства жизни и уровня приверженности к лечению в исследуемой группе. Также была выявлена целевая для выполнения РД группа пациентов с истинной резистентной АГ.

Выводы

Выводы. Представленный алгоритм отбора па-циентов для выполнения вмешательства позволяет оптимизировать тактику ведения пациентов, у ко-торых предполагается наличие резистентной АГ, и позволяет более целенаправленно применять ин-тервенционный подход.

Aim

Aim. To develop an optimized scientifically based approach to medical and diagnostic measures before renal denervation.

Methods

Methods. 91 patients with a previously diagnosed primary arterial hypertension aged 54.2 (52.0, 69.3) years

history of arterial hypertension was 11.4±4.2 years. 57 (62.6%) patients had asymptomatic lesions of target or-gans. 34 (37.4%) were present with associated clinical conditions. The average number of classes of antihyper-tensive drugs taken by patients was 4±1.2. 18 patients (19.8%) received aldosterone antagonists. All patients were included in the study. The duration of the positive underwent standard clinical, laboratory and instrumental tests. The quality of life was assessed using the SF-36 questionnaire. Patients’ adherence to treatment was eval-uated using the Morisky-Green test. After therapy optimi-zation and a number of additional diagnostic procedures, true resistant arterial hypertension was detected in 19 pa-tients, of whom 9 were excluded from the study. 4 patients were excluded because of specific anatomy, and 5 patients were allergic to the contrast media.

Results

Results. Optimization of the diagnostic and medical algorithm for managing patients with arterial hy-pertension allowed identifying patients with secondary arterial hypertension, accounted to 8.8% of the study sample, as well as achieving significant reduction of blood pressure according to the 24-hour blood pressure monitoring findings: SBP by 34 ± 12 mm Hg, and DBP by 12 ± 4 mm Hg, compared to the initial values (p = 0.046). The obtained results are comparable in the groups with high and low adherence. 54 patients (77.1%) achieved blood pressure targets. The study groups demonstrated significant improvements of the quality of life and adherence to treatment. The proportion of patients with true resistant arterial hypertension has been identified.

Conclusion

Conclusion. The presented algorithm of selecting patients for renal denervation allows to optimize the management strategy inpatients, who are suspected to suffer from resistant arterial hypertension, and to per-form targeted interventions.

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