Консенсус по диагностике и лечению реноваскулярной артериальной гипертонии

Клиническое значение реноваскулярной артериальной гипертонии обусловлено высокой распространенностью данного заболевания, а также его отрицательным влиянием на прогноз. Самыми частыми причинами развития реноваскулярной артериальной гипертонии являются атеросклеротический стеноз почечных артерий и фибромышечная дисплазия. Для реноваскулярной артериальной гипертонии характерно развитие резистентного к антигипертензивной терапии артериального давления с неблагоприятным прогнозом ухудшения функции почек и сердечно- сосудистых осложнений. В настоящее время наиболее доступным скрининговым методом в диагностике реноваскулярной артериальной гипертонии является ультразвуковое дуплексное сканирование почечных артерий. В числе неинвазивных методов имеются также магнитно-резонансная и мультиспиральная компьютерная томография с контрастированием. «Золотым стандартом» диагностики реноваскулярной артериальной гипертонии и определения показаний к хирургическому лечению остается рентгенконтрастная ангиография, которая в совокупности с использованием таких методов диагностики, как измерение постстенотического градиента и фракционного резерва кровотока позволяет оценить функциональную значимость стенозов почечных артерий. Лечение реноваскулярной артериальной гипертонии представляет собой сложный процесс, направленный на нормализацию артериального давления, улучшение функции почек, снижение смертности и сердечно-сосудистых событий. Вопрос о целесообразности проведения эндоваскулярного лечения на сегодняшний день остаётся открытым, чаще предпочтение отдаётся медикаментозной терапии. Показания к реваскуляризации почечных артерий менее очевидны, а имеющиеся клинические рекомендации и результаты крупных исследований неоднозначны.

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