Неконтролируемая артериальная гипертензия и синдром обструктивного апноэ сна: комплексный подход к лечению

Достижение целевых цифр артериального давления (АД) является основной целью при лечении артериальной гипертонии (АГ), поскольку ведет к снижению сердечно-сосудистого риска. Известно, что должный контроль уровня АД достигается менее чем в половине процентов случаев. Кроме того, в популяции пациентов с АГ есть фенотипы, при которых уровень АД особенно трудно контролировать, что еще более повышает риск сердечно-сосудистых осложнений. В частности, речь идет о так называемой неконтролируемой АГ, а именно – ее резистентной (РАГ) и рефрактерной (РФГ) формах течения.

Недавние результаты исследований свидетельствуют о том, что РАГ может быть связана с изменениями в ренин-ангиотензин-альдостероновой системе, в то время как РФГ, по-видимому, более тесно связана с симпатической гиперактивацией. Эти патофизиологические механизмы также активируются у пациентов с синдромом обструктивного апноэ сна (СОАС). Поэтому неудивительно, что распространенность СОАС у пациентов с РАГ и РФГ очень высока, а лечение постоянным положительным давлением в дыхательных путях (ПАП-терапия) позволяет клинически значимо снизить уровень артериального давления у пациентов обеих групп. Последнее позволяет рассматривать ПАП-терапию как дополнительное средство достижения целевого уровня АД у пациентов с неконтролируемой АГ и СОАС.

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