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Системные гипертензии

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Клинические рекомендации Российского медицинского общества по артериальной гипертонии (РМОАГ) и Евразийской Ассоциации Кардиологов (ЕАК) по диагностике и лечению артериальной гипертонии (2024)

https://doi.org/10.38109/2075-082X-2024-4-5-109

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Аннотация

В клинических рекомендациях представлены основные подходы к ведению пациентов с артериальной гипертонией (АГ) с использованием принципов доказательной медицины. Рекомендации включают разделы, содержащие расширенную и обновленную информацию по основным аспектам диагностики, лечения, методам профилактики и диспансерного наблюдения при гипертонической болезни с учетом фенотипов заболевания и различных клинических ситуаций, а также при вторичных формах АГ различного генеза.

Для цитирования:


Чазова И.Е., Чихладзе Н.М., Блинова Н.В., Аксенова А.В., Алексеева Т.А., Амбатьелло Л.Г., Баланова Ю.А., Брагина А.Е., Данилов Н.М., Драпкина О.М., Дроздова Л.Ю., Ежов М.В., Елфимова Е.М., Жернакова Ю.В., Жиров И.В., Кисляк О.А., Литвин А.Ю., Небиеридзе Д.В., Остроумова О.Д., Подзолков В.И., Сергиенко И.В., Сивакова О.А., Стародубова А.В., Стрюк Р.И., Терещенко С.Н., Трушина О.Ю., Щелкова Г.В. Клинические рекомендации Российского медицинского общества по артериальной гипертонии (РМОАГ) и Евразийской Ассоциации Кардиологов (ЕАК) по диагностике и лечению артериальной гипертонии (2024). Системные гипертензии. 2024;21(4):5-110. https://doi.org/10.38109/2075-082X-2024-4-5-109

For citation:


Chazova I.E., Chikhladze N.M., Blinova N.V., Aksenova A.V., Alekseeva T.A., Ambatiello L.G., Balanova Yu.A., Bragina A.E., Danilov N.M., Drapkina O.M., Drozdova L.Yu., Ezhov M.V., Elfimova E.M., Zhernakova Yu.V., Zhirov I.V., Kislyak O.A., Litvin A.Yu., Nebieridze D.V., Ostroumova O.D., Podzolkov V.I., Sergienko I.V., Sivakova O.A., Starodubova A.V., Stryuk R.I., Tereshchenko S.N., Trushina O.Yu., Shchelkova G.V. Clinical guidelines of the Russian Medical Society on arterial Hypertension (RSH) and the Eurasian association of Cardiologists (EaC) for the diagnosis and treatment of arterial hypertension (2024). Systemic Hypertension. 2024;21(4):5-110. (In Russ.) https://doi.org/10.38109/2075-082X-2024-4-5-109

СОСТАВ РАБОЧЕЙ ГРУППЫ

Чазова Ирина Евгеньевна, академик РАН, профессор, д.м.н., заместитель генерального директора по научно-экспертной работе, руководитель отдела гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова», Москва, Российская Федерация. ORCID: 0000-0002- 9822-4357

Чихладзе Новелла Михайловна, д.м.н., профессор, ведущий научный сотрудник, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-8826-9690

Блинова Наталия Владимировна, к.м.н., старший научный сотрудник, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова», Москва, Российская Федерация. ORCID: 0000-0001-5215-4894

Аксенова Анна Владимировна, к.м.н., старший научный сотрудник, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0001-8048-4882

Алексеева Татьяна Анатольевна, к.м.н., отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0001-5499-0482

Амбатьелло Лали Гурамовна, к.м.н., старший научный сотрудник, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0003-1138-3361

Баланова Юлия Андреевна, д.м.н., ведущий научный сотрудник, отдел эпидемиологии хронических неинфекционных заболеваний, ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0001-8011-2798

Брагина Анна Евгеньевна, д.м.н., профессор кафедры факультетской терапии №2, ФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-2699-1610

Данилов Николай Михайлович, д.м.н., ведущий научный сотрудник, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-2534-84636

Драпкина Оксана Михайловна, академик РАН, профессор, д.м.н., директор, ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0001-8011-2798

Дроздова Любовь Юрьевна, к.м.н., руководитель лаборатории поликлинической терапии, ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-4529-3308

Ежов Марат Владиславович, д.м.н., профессор, главный научный сотрудник, руководитель лаборатории нарушений липидного обмена, отдел проблем атеросклероза, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-1518-6552

Елфимова Евгения Михайловна, к.м.н., старший научный сотрудник, лаборатория апноэ сна, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-3140-5030

Жернакова Юлия Валерьевна, д.м.н., профессор, ученый секретарь, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация (Yuliya V. Zhernakova, Dr. of Sci. (Med.), Professor, scientific secretary, A.L. Myasnikov Institute of Clinical Cardiology, E.I. Chazov National Medical Research Center of Cardiology, Moscow, Russian Federation). ORCID: 0000-0001-7895-9068

Жиров Игорь Витальевич, д.м.н., ведущий научный сотрудник, отдел заболеваний миокарда и сердечной недостаточности, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-4066-2661

Кисляк Оксана Андреевна, д.м.н., профессор, профессор кафедры факультетской терапии, Институт клинической медицины, ФГАОУ ВО РНИМУ им. Н.И. Пирогова, Москва, Российская Федерация. ORCID: 0000-0002-2028-8748

Литвин Александр Юрьевич, д.м.н., руководитель лаборатории апноэ сна, главный научный сотрудник, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России; профессор, кафедра поликлинической терапии лечебного факультета, ФГАОУ ВО «РНИМУ им. Н.И. Пирогова», Москва, Российская Федерация. ORCID: 0000-0001-5918-9969

Небиеридзе Давид Васильевич, д.м.н., профессор, руководитель отдела профилактики метаболических нарушений, ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-5265-3164

Остроумова Ольга Дмитриевна, д.м.н., профессор, заведующая кафедрой терапии и полиморбидной патологии имени академика М.С. Вовси, ФГБОУ ДПО РМАНПО, Москва, Российская Федерация. ORCID: 0000-0002-0795-8225

Подзолков Валерий Иванович, д.м.н., профессор, заведующий кафедрой факультетской терапии №2, Институт клинической медицины им. Н.В. Склифосовского, ФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-0758-5609

Сергиенко Игорь Владимирович, д.м.н., доцент, главный научный сотрудник, руководитель лаборатории фенотипов атеросклероза, отдел проблем атеросклероза, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0003-1534-3965

Сивакова Ольга Анатольевна, к.м.н., заведующая 5 кардиологическим отделением, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация). ORCID: 0000-0002-0060-095X

Стародубова Антонина Владимировна, д.м.н., доцент, заместитель директора по научной и лечебной работе, ФГБУН «Федеральный исследовательский центр питания и биотехнологии»; заведующая кафедрой факультетской терапии, Институт клинической медицины, ФГАОУ ВО РНИМУ им. Н.И. Пирогова, Москва, Российская Федерация. ORCID: 0000-0001-9262-9233

Стрюк Раиса Ивановна, д.м.н., профессор, заведующая кафедрой внутренних болезней, Московский Государственный Медико-Стоматологический Университет имени А.И. Евдокимова, Москва, Российская Федерация. ORCID: 0000-0002-2848-046X

Терещенко Сергей Николаевич, д.м.н., профессор, главный научный сотрудник, отдел заболеваний миокарда и сердечной недостаточности, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0001-9234-6129

Трушина Ольга Юрьевна, д.м.н., профессор кафедры факультетской терапии №1, Институт клинической медицины им. Н.В. Склифосовского, ФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-5820-1759

Щелкова Галина Владимировна, к.м.н., старший научный сотрудник, руководитель научно-экспертного отдела, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. акад. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-9053-6030

ЭКСПЕРТНАЯ ГРУППА

Сергей Анатольевич Бойцов, академик РАН, профессор, д.м.н., генеральный директор, ФГБУ «Национальный медицинский исследовательский центр кардиологии им. ак. Е.И. Чазова»; заведующий кафедрой поликлинической терапии, ФГБОУ ВО «МГМСУ им. А.И. Евдокимова», Москва, Российская Федерация. ORCID: 0000-0001-6998-8406

Галявич Альберт Сарварович, д.м.н., профессор, академик Академии наук Республики Татарстан, заведующий кафедрой кардиологии, Факультет повышения квалификации и профессиональной переподготовки специалистов, Казанский государственный медицинский университет, Казань, Российская Федерация.

Гусейнова Наргиз Нусрет кызы, доцент кафедры терапии Азербайджанский государственный институт усовершенствования врачей им. А.Алиева, Баку, Республика Азербайджан.

Кобалава Жанна Давидовна, член-корреспондент РАН, д.м.н., профессор кафедры внутренних болезней с курсом кардиологии и функциональной диагностики имени В.С. Моисеева, Медицинский институт, Российский университет дружбы народов, Москва, Российская Федерация. ORCID: 0000-0002-5873-1768

Нарзуллаева Адолат Рахматуллаевна, к.м.н., заведующая кафедрой кардиологии с курсом клинической фармакологии, Институт последипломного образования в сфере здравоохранения, Душанбе, Республика Таджикистан. ORCID: 0000-0001-5728-3804

Недогода Сергей Владимирович, д.м.н., профессор, заведующий кафедрой внутренних болезней, Института непрерывного медицинского и фармацевтического образования, Волгоградский государственный медицинский университет, Волгоград, Российская Федерация. ORCID: 0000-0001-5981-1754

Павлова Ольга Степановна, д.м.н., доцент, руководитель лаборатории артериальной гипертонии, Республиканский научно-практический центр «Кардиология», Минск, Республика Беларусь (Olga S. Pavlova, Dr. of Sci. (Med.), Associate Professor, Head of the Laboratory of Arterial Hypertension, Republican Scientific and Practical Center “Cardiology”, Minsk, Republic of Belarus). ORCID: 0000-0002-1397-0108

Полупанов Андрей Геннадьевич, д.м.н., профессор, старший научный сотрудник, Национальный центр кардиологии и терапии им. академика М.М. Миррахимова при Минздраве Киргизской Республики, Бишкек, Кыргызская Республика.

Рогоза Анатолий Николаевич, д.б.н., профессор, руководитель отдела новых методов диагностики, Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Российская Федерация. ORCID: 0000-0002-0543-3089

Сарыбаев Акпай Шогаибович, д.м.н., профессор, Национальный центр кардиологии и терапии им. академика М. Миррахимова, Бишкек, Кыргызская Республика. ORCID: 0000-0003-2172-9776

Фозилов Хуршид Гайратович, к.м.н., директор, Республиканский специализированный научно-практический медицинский центр кардиологии, Ташкент, Республика Узбекистан. ORCID: 0000-0001-9195-7649

Хамидуллаева Гульноз Абдусаттаровна, д.м.н., профессор, заместитель директора по научным вопросам, Республиканский специализированный научно-практический медицинский центр кардиологии, Ташкент, Узбекистан. ORCID: 0000-0001-9671-9287

 

ОГЛАВЛЕНИЕ

Предисловие.........................................................................................13
1. Общая информация по заболеванию...................................... 14
1.1 Определение артериальной гипертонии.......................... 14
1.2 Эпидемиология артериальной гипертонии........................
1.3 Этиология и патогенез артериальной гипертонии.......15
1.4 Классификация артериальной гипертонии....................15
1.5 Кодирование по Международной классификации
болезней 10 пересмотра................................................................ 16
2. Диагностика артериальной гипертонии................................ 16
2.1 Измерение артериального давления.................................. 16
2.1.1 Клиническое (офисное) измерение
артериального давления.........................................................17
2.1.2 Суточное мониторирование артериального
давления.......................................................................................17
2.1.3 Самоконтроль артериального давления..................20
2.1.4 Приборы для измерения клинического
артериального давления ........................................................21
2.2 Общеклиническое обследование........................................21
2.2.1 Анамнез..............................................................................22
2.2.2 Физикальное обследование.........................................22
2.3 Лабораторные и инструментальные методы
исследования...................................................................................23
2.3.1 Исследование органов-мишеней................................23
2.3.2 Лабораторные методы исследования.......................24
2.3.3 Инструментальные методы исследования.............25
2.4 Оценка общего (суммарного)
сердечно-сосудистого риска.......................................................27
2.5 Формулировка диагноза ....................................................... 31
3. Вторичные (симптоматические) артериальные
гипертонии ......................................................................................... 31
3.1 Общие подходы к диагностике и лечению....................... 31
3.2 Вторичные почечные АГ........................................................32
3.3 Реноваскулярная АГ...............................................................34
3.4 Первичный гиперальдостеронизм.....................................36
3.5 Эндогенный гиперкортицизм.
Болезнь и синдром Иценко-Кушинга......................................38
3.6 Феохромоцитома/ параганглиома......................................39
4. Лечение артериальной гипертонии..........................................40
4.1 Показания к назначению антигипертензивной
терапии .........................................................................................40
4.2 Целевые уровни артериального давления.......................42
4.3 Немедикаментозные методы лечения ..............................43
4.4 Медикаментозная антигипертензивная терапия.........45
4.4.1 Основные принципы медикаментозной
терапии артериальной гипертонии....................................45
4.4.2 Классы антигипертензивных препаратов
для лечения артериальной гипертонии............................46
4.4.2.1 Основные классы антигипертензивных препаратов..............................................................................46
4.4.2.2 Дополнительные классы
антигипертензивных препаратов...................................47
4.4.3 Тактика антигипертензивной терапии....................47
4.5 Терапия для коррекции факторов риска
и сопутствующих заболеваний..................................................48
4.6 Инструментальное лечение артериальной
гипертонии.......................................................................................50
5. Резистентная и рефрактерная артериальная
гипертония .........................................................................................51
6. Фенотипы артериальной гипертонии.....................................54
6.1 Артериальная гипертония «белого халата»....................54
6.2 «Маскированная» артериальная гипертония................54
6.3 Неконтролируемая артериальная гипертония
«белого халата» и неконтролируемая маскированная
артериальная гипертония...........................................................55
6.4 Изолированная систолическая артериальная
гипертония.......................................................................................55
6.5 Изолированная диастолическая артериальная
гипертония.......................................................................................56
7. Артериальная гипертония в отдельных
демографических группах...............................................................56
7.1 Артериальная гипертония у детей и подростков..........56
7.2 Артериальная гипертония у лиц молодого
возраста (моложе 50 лет) .............................................................57
7.3 Артериальная гипертония у лиц пожилого
и старческого возраста..................................................................58
7.4 Артериальная гипертония у женщин................................58
7.4.1 Артериальная гипертония при беременности
и лактации...................................................................................58
7.4.2 Лечение АГ у женщин в послеродовом
периоде и при лактации..........................................................61
7.4.3 Пероральные контрацептивы и АГ ..........................61
7.4.4 Менопаузальная гормональная терапия ................61
7.4.5 Вспомогательные репродуктивные
технологии..................................................................................61
8. Артериальная гипертония
в отдельных клинических ситуациях..........................................61
8.1 Артериальная гипертония у пациентов
с ожирением.....................................................................................61
8.2 Артериальная гипертония у пациентов
с сахарным диабетом и предиабетом ......................................63
8.3 Артериальная гипертония у пациентов
с хронической болезнью почек..................................................64
8.4 Артериальная гипертония у пациентов с
бессимптомной гиперурикемией и подагрой......................67
8.5 Артериальная гипертония при бронхиальной астме
и хронической обструктивной болезни легких....................67
8.6 Артериальная гипертония у пациентов
с ишемической болезнью сердца...............................................69
8.7. Артериальная гипертония у пациентов
с хронической сердечной недостаточностью........................70
8.8 Артериальная гипертония у пациентов
с фибрилляцией предсердий......................................................72
8.9 Артериальная гипертония у пациентов
с цереброваскулярными заболеваниями...............................75
8.9.1 Лечение артериальной гипертонии
при остром геморрагическом инсульте ............................75
8.9.2 Лечение артериальной гипертонии
при остром ишемическом инсульте...................................77
8.9.3 Лечение артериальной гипертонии
у пациентов, перенесших инсульт
или транзиторную ишемическую атаку............................77
8.9.4 Ведение пациентов с когнитивными
нарушениями и деменцией...................................................78
8.10 Артериальная гипертония у пациентов
с клапанными пороками сердца................................................79
8.11 Артериальная гипертония
и периферическое поражение сосудов....................................79
8.12 Артериальная гипертония
и обструктивное апноэ сна.........................................................80
8.13 Артериальная гипертония
и эректильная дисфункция.........................................................82
8.14 Артериальная гипертония
и ревматические заболевания....................................................82
8.15 Артериальная гипертония
и онкологические заболевания..................................................83
8.16 Артериальная гипертония
и коронавирусная инфекция......................................................84
9. Экстренные и неотложные состояния, обусловленные
артериальной гипертонией (гипертонические кризы)..........85
10. Профилактика и диспансерное наблюдение.......................88
Приложения.........................................................................................91

ПРЕДИСЛОВИЕ

Артериальная гипертония (АГ), как в нашей стране, так и за рубежом, является одной из актуальных медико-социальных проблем, что обусловлено широкой распространенностью этого заболевания, высоким риском сердечно-сосудистых осложнений (ССО) и недостаточным контролем за проводимой медикаментозной терапией.

Всероссийское научное общество кардиологов (ВНОК) в 2001 г. опубликовало первую версию Российских рекомендаций по профилактике, диагностике и лечению АГ. С этого времени были получены новые данные, требующие пересмотра рекомендаций, и в последующие годы были опубликованы новые версии документа. До настоящего времени в странах Евразийского содружества отсутствовали единые рекомендации по диагностике и лечению АГ, и по инициативе Российского медицинского общества по АГ (РМОАГ) и экспертов стран Евразийского содружества были разработаны данные Евразийские рекомендации по диагностике и лечению АГ у взрослых.

При разработке настоящих рекомендаций по диагностике и лечению АГ проведен анализ последних версий национальных и международных рекомендаций, руководств по проблеме АГ, данных современных многоцентровых рандомизированных контролируемых исследований (РКИ), консенсусных документов и монографий, опубликованных за последние годы, с целью оптимизации диагностического процесса и лечения данной категории больных.

В основу настоящего документа легли рекомендации по лечению АГ Европейского общества по АГ 2023 года, одобренные Международным обществом по АГ (ISH) и Европейской почечной ассоциацией (ERA). Данные рекомендации Европейского общества по АГ являются юбилейными: в 2023 году исполнилось 20 лет рекомендациям ESH, которые были впервые опубликованы в 2003 году.

Как и в рекомендациях Европейского общества по АГ 2023 года, данный документ содержит некоторые новые данные, полученные в результате исследований, проведенных после опубликованных рекомендаций 2018 года; более подробно представлены темы, которые в прошлом рассматривались лишь вкратце, а также включены сведения о клинических состояниях, которые ранее не рассматривались в руководствах, хотя часто сопутствуют АГ и нуждаются в особых подходах к их ведению. В состав новых тематических рубрик или обновленной, по сравнению с рекомендациями 2019 года, информацией включены разделы по измерению АД разными методами и в разных условиях; новые факторы риска (ФР) сердечно-сосудистых заболеваний (ССЗ) и обновленная информация об оценке риска ССЗ; новые сведения о клиническом значении поражения органов-мишеней при АГ; обновленная информация о модификации образа жизни у пациентов с АГ; обновленная и расширенная информация о вторичных формах АГ; обновленная информация о диагностике и лечении резистентной АГ, о пороговых значениях и целевых показателях АД при проведении антигипертензивной терапии; обновленные данные о ведении пациентов с гипертоническими кризами (ГК), лечении АГ при хронической сердечной недостаточности, сахарном диабета 2 типа, у пациентов с АГ и фибрилляцией предсердий, с цереброваскулярными заболеваниями; более подробная и обновленная информация о ведении пациентов с различными фенотипами АГ и АГ в различных демографических группах; приведены сведения о клинических состояниях, которые не рассматривались или были представлены сжато в предыдущих рекомендациях (АГ и ревматологические состояния, клапанные пороки сердца, эректильная дисфункция, онкологические заболевания, новая коронавирусная инфекция). Даны подробные рекомендации по профилактике и диспансерному наблюдению пациентов с АГ.

Необходимо подчеркнуть, что в рекомендациях изложены основные принципы лечения пациентов с АГ, в том числе и в ряде клинических ситуаций, которые были получены в рандомизированных контролируемых исследованиях, вместе с тем важно учитывать индивидуальные особенности механизмов развития и течения АГ, что обосновывает важность и целесообразность осуществлять подбор антигипертензивной терапии (АГТ) у пациента с учетом его индивидуальных особенностей.

В ходе разработки рекомендаций использованы принципы доказательной медицины. В зависимости от обоснованности, рекомендации различаются по классам и уровням доказательности в соответствии с руководствами Европейского общества кардиологов (ЕОК), Европейского общества по артериальной гипертонии (ЕОАГ) и Российского медицинского общества по артериальной гипертонии (РМОАГ). При отсутствии по некоторым вопросам убедительной доказательной базы доказательность данных основывается на согласованном мнении экспертов. Обновлены критерии рекомендаций по классификации доказательств, на этот пересмотр критериев повлияли опубликованные упрощенные определения доказательств [1]. Классы рекомендаций и уровни доказательности представлены в таблице 1.

Разработанные клинические рекомендации предназначены для широкого круга специалистов – врачей общей практики, терапевтов, кардиологов, неврологов, эндокринологов, нефрологов, акушеров-гинекологов, геронтологов, хирургов.

Таблица 1. Классы рекомендаций и уровни доказательности данных [1]

Table 1. Recommendation classes and evidence levels [1]

Классы рекомендаций

Определение

Предлагаемая формулировка

I

Данные и/или всеобщее согласие, что конкретный метод лечения или процедура полезны, эффективны, имеют преимущества

Рекомендуется/показано

II

Противоречивые данные и/или расхождение мнений о пользе эффективности конкретного метода лечения или процедуры

Целесообразно применять

III

Данные и/или всеобщее согласие, что конкретный метод лечения или процедура не являются полезными или эффективными, а в некоторых случаях могут приносить вред

Не рекомендовано

Уровни доказательности

А

Данные многочисленных рандомизированных клинических исследований или метаанализов

В

Данные одного рандомизированного контролируемого исследования или крупных нерандомизированных исследований

 

 

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Об авторах

И. Е. Чазова
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова»
Россия

Чазова Ирина Евгеньевна, академик РАН, профессор, д.м.н., заместитель генерального директора по научно-экспертной работе, руководитель отдела гипертонии

Москва



Н. М. Чихладзе
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Чихладзе Новелла Михайловна, д.м.н., профессор, ведущий научный сотрудник, отдел гипертонии 

Москва



Н. В. Блинова
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова»
Россия

Блинова Наталия Владимировна, к.м.н., старший научный сотрудник, отдел гипертонии 

ул. Академика Чазова, д. 15 а, г. Москва 121552,  тел. +7 (495) 414-61-8



А. В. Аксенова
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова»
Россия

Аксенова Анна Владимировна, к.м.н., старший научный сотрудник, отдел гипертонии 

Москва



Т. А. Алексеева
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова»
Россия

Алексеева Татьяна Анатольевна, к.м.н., отдел гипертонии 

Москва



Л. Г. Амбатьелло
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Амбатьелло Лали Гурамовна, к.м.н., старший научный сотрудник, отдел гипертонии

Москва



Ю. А. Баланова
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Баланова Юлия Андреевна, д.м.н., ведущий научный сотрудник, отдел эпидемиологии хронических неинфекционных заболеваний

Москва



А. Е. Брагина
ФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава России
Россия

Брагина Анна Евгеньевна, д.м.н., профессор кафедры факультетской терапии №2

Москва



Н. М. Данилов
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Данилов Николай Михайлович, д.м.н., ведущий научный сотрудник, отдел гипертонии 

Москва



О. М. Драпкина
ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России
Россия

Драпкина Оксана Михайловна, академик РАН, профессор, д.м.н., директор 

Москва



Л. Ю. Дроздова
ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России
Россия

Дроздова Любовь Юрьевна, к.м.н., руководитель лаборатории поликлинической терапии 

Москва



М. В. Ежов
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Ежов Марат Владиславович, д.м.н., профессор, главный научный сотрудник, руководитель лаборатории нарушений липидного обмена, отдел проблем атеросклероза

Москва



Е. М. Елфимова
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Елфимова Евгения Михайловна, к.м.н., старший научный сотрудник, лаборатория апноэ сна, отдел гипертонии 

Москва



Ю. В. Жернакова
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Жернакова Юлия Валерьевна, д.м.н., профессор, ученый секретарь 

Москва



И. В. Жиров
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава России
Россия

Жиров Игорь Витальевич, д.м.н., ведущий научный сотрудник, отдел заболеваний миокарда и сердечной недостаточности

Москва



О. А. Кисляк
ФГАОУ ВО РНИМУ им. Н.И. Пирогова, Москва, Российская Федерация
Россия

Кисляк Оксана Андреевна, д.м.н., профессор, профессор кафедры факультетской терапии, Институт клинической медицины

Москва



А. Ю. Литвин
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России ; ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»
Россия

Литвин Александр Юрьевич, д.м.н., руководитель лаборатории апноэ сна, главный научный сотрудник, отдел гипертонии; профессор, кафедра поликлинической терапии лечебного факультета

Москва



Д. В. Небиеридзе
ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России
Россия

Небиеридзе Давид Васильевич, д.м.н., профессор, руководитель отдела профилактики метаболических нарушений

Москва



О. Д. Остроумова
ФГБОУ ДПО РМАНПО
Россия

Остроумова Ольга Дмитриевна, д.м.н., профессор, заведующая кафедрой терапии и полиморбидной патологии имени академика М.С. Вовси

Москва



В. И. Подзолков
Институт клинической медицины им. Н.В. Склифосовского, ФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава России
Россия

Подзолков Валерий Иванович, д.м.н., профессор, заведующий кафедрой факультетской терапии №2

Москва



И. В. Сергиенко
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России
Россия

Сергиенко Игорь Владимирович, д.м.н., доцент, главный научный сотрудник, руководитель лаборатории фенотипов атеросклероза, отдел проблем атеросклероза

Москва



О. А. Сивакова
ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России
Россия

Сивакова Ольга Анатольевна, к.м.н., заведующая 5 кардиологическим отделением 

Москва



А. В. Стародубова
ФГБУН «Федеральный исследовательский центр питания и биотехнологии» ; ФГАОУ ВО РНИМУ им. Н.И. Пирогова
Россия

Стародубова Антонина Владимировна, д.м.н., доцент, заместитель директора по научной и лечебной работе; заведующая кафедрой факультетской терапии, Институт клинической медицины

Москва



Р. И. Стрюк
Московский Государственный Медико-Стоматологический Университет имени А.И. Евдокимова
Россия

Стрюк Раиса Ивановна, д.м.н., профессор, заведующая кафедрой внутренних болезней

Москва



С. Н. Терещенко
ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России
Россия

Терещенко Сергей Николаевич, д.м.н., профессор, главный научный сотрудник, отдел заболеваний миокарда и сердечной недостаточности

Москва



О. Ю. Трушина
Институт клинической медицины им. Н.В. Склифосовского, ФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава России
Россия

Трушина Ольга Юрьевна, д.м.н., профессор кафедры факультетской терапии №1

Москва



Г. В. Щелкова
Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. акад. Е.И. Чазова» Минздрава России
Россия

Щелкова Галина Владимировна, к.м.н., старший научный сотрудник, руководитель научно-экспертного отдела 

Москва



Рецензия

Для цитирования:


Чазова И.Е., Чихладзе Н.М., Блинова Н.В., Аксенова А.В., Алексеева Т.А., Амбатьелло Л.Г., Баланова Ю.А., Брагина А.Е., Данилов Н.М., Драпкина О.М., Дроздова Л.Ю., Ежов М.В., Елфимова Е.М., Жернакова Ю.В., Жиров И.В., Кисляк О.А., Литвин А.Ю., Небиеридзе Д.В., Остроумова О.Д., Подзолков В.И., Сергиенко И.В., Сивакова О.А., Стародубова А.В., Стрюк Р.И., Терещенко С.Н., Трушина О.Ю., Щелкова Г.В. Клинические рекомендации Российского медицинского общества по артериальной гипертонии (РМОАГ) и Евразийской Ассоциации Кардиологов (ЕАК) по диагностике и лечению артериальной гипертонии (2024). Системные гипертензии. 2024;21(4):5-110. https://doi.org/10.38109/2075-082X-2024-4-5-109

For citation:


Chazova I.E., Chikhladze N.M., Blinova N.V., Aksenova A.V., Alekseeva T.A., Ambatiello L.G., Balanova Yu.A., Bragina A.E., Danilov N.M., Drapkina O.M., Drozdova L.Yu., Ezhov M.V., Elfimova E.M., Zhernakova Yu.V., Zhirov I.V., Kislyak O.A., Litvin A.Yu., Nebieridze D.V., Ostroumova O.D., Podzolkov V.I., Sergienko I.V., Sivakova O.A., Starodubova A.V., Stryuk R.I., Tereshchenko S.N., Trushina O.Yu., Shchelkova G.V. Clinical guidelines of the Russian Medical Society on arterial Hypertension (RSH) and the Eurasian association of Cardiologists (EaC) for the diagnosis and treatment of arterial hypertension (2024). Systemic Hypertension. 2024;21(4):5-110. (In Russ.) https://doi.org/10.38109/2075-082X-2024-4-5-109

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ISSN 2075-082X (Print)
ISSN 2542-2189 (Online)