systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2024-4-5-109systhiper-832Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESКлинические рекомендации Российского медицинского общества по артериальной гипертонии (РМОАГ) и Евразийской Ассоциации Кардиологов (ЕАК) по диагностике и лечению артериальной гипертонии (2024)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)https://orcid.org/0000-0002-9822-4357ЧазоваИ. Е.ChazovaI. E.

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

Москва

Irina E. Chazova, Academician of RAS, Professor, Dr. of Sci. (Med.), Deputy General Director for Scientific and Expert Work, Head of Hypertension Department

Moscow

https://orcid.org/0000-0002-8826-9690ЧихладзеН. М.ChikhladzeN. M.

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

Москва

Novella M. Chikhladze, Dr. of Sci. (Med.), Professor, Leading Researcher of Department of Hypertension

Moscow 

https://orcid.org/0000-0001-5215-4894БлиноваН. В.BlinovaN. V.

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

Nataliya V. Blinova, Cand. of Sci. (Med.), Senior Researcher of Department of Hypertension

St. academician Chazova, 15 a, Moscow 121552,  tel. +7 (495) 414-61-86

nat-cardio1@ya.ruhttps://orcid.org/0000-0001-8048-4882АксеноваА. В.AksenovaA. V.

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

Москва

Anna V. Aksenova, Cand. Of Sc. (Med.), Senior Researcher, Department of Hypertension

Moscow

https://orcid.org/0000-0001-5499-0482АлексееваТ. А.AlekseevaT. A.

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

Москва

Tatiana A. Alekseeva, Cand. Sci. (Med.), Hypertension Department 

Moscow 

https://orcid.org/0000-0003-1138-3361АмбатьеллоЛ. Г.AmbatielloL. G.

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

Москва

Lali G. Ambatiello, Cand. Of Sci. (Med.), Senior Researcher, Hypertension Department, A.L. Myasnikov Institute of Clinical Cardiology

Moscow 

https://orcid.org/0000-0001-8011-2798БалановаЮ. А.BalanovaYu. A.

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

Москва

Yulia A. Balanova, Dr. Sci. (Med.), Leading Researcher, Department of Epidemiology of Chronic Non-Communicable Diseases

Moscow 

https://orcid.org/0000-0002-2699-1610БрагинаА. Е.BraginaA. E.

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

Москва

Anna E. Bragina, Dr. Sci. (Med.), Professor of the Department of Faculty Therapy No 2 

Moscow 

https://orcid.org/0000-0001-9853-9087ДаниловН. М.DanilovN. M.

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

Москва

Nikolay M. Danilov, Dr. of Sc. (Med.), Leading Researcher, Department of Hypertension 

Moscow 

https://orcid.org/0000-0003-0323-2635ДрапкинаО. М.DrapkinaO. M.

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

Москва

Oksana M. Drapkina, Academician of RAS, Professor Dr. of Sci. (Med.), Director 

Moscow 

https://orcid.org/0000-0002-4529-3308ДроздоваЛ. Ю.DrozdovaL. Yu.

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

Москва

Lyubov Yu. Drozdova, Cand. of Sc. (Med.), Head of the Laboratory of Outpatient Therapy

Moscow 

https://orcid.org/0000-0002-1518-6552ЕжовМ. В.EzhovM. V.

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

Москва

Marat V. Yezhov, Dr. of Sci. (Med.), Professor, Chief Researcher, Head of the Laboratory of Lipid Metabolism Disorders, Department of Atherosclerosis Problems

Moscow 

https://orcid.org/0000-0002-3140-5030ЕлфимоваЕ. М.ElfimovaE. M.

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

Москва

Evgeniya M. Elfimova (Deputy Chairman), Cand. of Sc. (Med.), Senior Researcher, Sleep Apnea Laboratory, Hypertension Department

Moscow 

https://orcid.org/0000-0001-7895-9068ЖернаковаЮ. В.ZhernakovaYu. V.

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

Москва

Yuliya V. Zhernakova, Dr. of Sci. (Med.), Professor, scientific secretary 

Moscow 

https://orcid.org/0000-0002-4066-2661ЖировИ. В.ZhirovI. V.

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

Москва

Igor V. Zhirov, Dr. of Sci. (Med.), Leading researcher, the Department of myocardial diseases and heart failure

Moscow 

https://orcid.org/0000-0002-2028-8748КислякО. А.KislyakO. A.

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

Москва

Oxana A. Kislyak, Dr. of Sci. (Med.), Professor, Professor of the Department of Faculty Therapy Institute of Clinical Medicine

Moscow 

https://orcid.org/0000-0001-5918-9969ЛитвинА. Ю.LitvinA. Yu.

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

Москва

Alexander Yu. Litvin, Dr. of Sc. (Med.), Head of the Sleep Apnea Laboratory, Chief Researcher, Hypertension Department; Professor, Department of Outpatient Therapy, Faculty of Medicine

Moscow 

https://orcid.org/0000-0002-5265-3164НебиеридзеД. В.NebieridzeD. V.

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

Москва

David V. Nebieridze, Dr. of Sci. (Med.), professor, Head of the Department of Prevention of Metabolic Disorders

Moscow 

https://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

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

Москва

Olga D. Ostroumova, Dr. of Sci. (Med.), professor, Head of the Department of Therapy and Polymorbid Pathology named after Academician M.S. Vovsi

Moscow 

https://orcid.org/0000-0002-0758-5609ПодзолковВ. И.PodzolkovV. I.

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

Москва

Valery I. Podzolkov, Dr. of Sci. (Med.), Professor, Head of the Faculty Therapy Department No. 2 

Moscow 

https://orcid.org/0000-0003-1534-3965СергиенкоИ. В.SergienkoI. V.

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

Москва

Igor V. Sergienko, Dr. of Sci. (Med.), Associate Professor, Chief Researcher, Head of the Laboratory of Atherosclerosis Phenotypes, Department of Atherosclerosis Problems

Moscow 

https://orcid.org/0000-0002-0060-095XСиваковаО. А.SivakovaO. A.

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

Москва

Olga A. Sivakova, Cand. Sci. (Med.), Head of the 5th Cardiology Department 

Moscow 

https://orcid.org/0000-0001-9262-9233СтародубоваА. В.StarodubovaA. V.

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

Москва

Antonina V. Starodubova, Dr. of Sci. (Med.), Associate Professor, Deputy Director for Scientific and Medical Work; Head of the Department of Faculty Therapy, Institute of Clinical Medicine

Moscow 

https://orcid.org/0000-0002-2848-046XСтрюкР. И.StryukR. I.

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

Москва

Raisa I. Stryuk, Dr. of Sci. (Med.), professor, Head of the Department of Internal Medicine 

Moscow 

https://orcid.org/0000-0001-9234-6129ТерещенкоС. Н.TereshchenkoS. N.

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

Москва

Sergey N. Tereshchenko, Dr. of Sci. (Med.), professor, chief scientific officer, the Department of myocardial diseases and heart failure

Moscow 

https://orcid.org/0000-0002-5820-1759ТрушинаО. Ю.TrushinaO. Yu.

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

Москва

Olga Iu. Trushina, Dr. Sci. (Med.), Professor, the Department of Faculty Therapy No 1 

Moscow 

https://orcid.org/0000-0002-9053-6030ЩелковаГ. В.ShchelkovaG. V.

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

Москва

Galina V. Schelkova, Cand. of Sci. (Med.), Scientific expert Department 

Moscow 

Институт клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова»РоссияA.L. Myasnikov Research Institute of Cardiology, E.I. Chazov National Medical Research Center of CardiologyRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Research Institute of Cardiology, E.I. Chazov National Medical Research Center of CardiologyRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова»РоссияA.L. Myasnikov Institute of Clinical Cardiology ; E.I. Chazov National Medical Research Center of CardiologyRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова»РоссияA.L. Myasnikov Institute of Clinical Cardiology, E.I. Chazov National Medical Research Center of CardiologyRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава РоссииРоссияE.I. Chazov National Medical Research Center of CardiologyRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian FederationФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. акад. Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Institute of Clinical Cardiology, E.I. Chazov National Medical Research Center of CardiologyRussian FederationФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian FederationФГАОУ ВО РНИМУ им. Н.И. Пирогова, Москва, Российская ФедерацияРоссияPirogov Russian Federationn National Research Medical UniversityRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦ кардиологии им. ак. Е.И. Чазова» Минздрава России ; ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»РоссияA.L. Myasnikov Institute of Clinical Cardiology, E.I. Chazov National Medical Research Center of Cardiology ; N.I. Pirogov Russian Federationn National Research Medical UniversityRussian FederationФГБОУ ДПО РМАНПОРоссияRussian Federationn Medical Academy of Continuous Professional EducationRussian FederationИнститут клинической медицины им. Н.В. Склифосовского, ФГАОУ Первый МГМУ им. И.М. Сеченова (Сеченовский Университет) Минздрава РоссииРоссияN.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Institute of Clinical Cardiology, E.I. Chazov National Medical Research Center of CardiologyRussian FederationФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Institute of Clinical Cardiology, E.I. Chazov National Medical Research Center of CardiologyRussian FederationФГБУН «Федеральный исследовательский центр питания и биотехнологии» ; ФГАОУ ВО РНИМУ им. Н.И. ПироговаРоссияFederal Research Center for Nutrition Biotechnology and Food Safety ; Pirogov Russian Federationn National Research Medical UniversityRussian FederationМосковский Государственный Медико-Стоматологический Университет имени А.И. ЕвдокимоваРоссияA.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава РоссииРоссияE.I. Chazov National Medical Research Center of CardiologyRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. акад. Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiologyRussian Federation2024261220242145109Copyright © 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., 20242024Чазова 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.Chazova I.E., Chikhladze N.M., Blinova N.V., Aksenova A.V., Alekseeva T.A., Ambatiello L.G., Balanova Y.A., Bragina A.E., Danilov N.M., Drapkina O.M., Drozdova L.Y., Ezhov M.V., Elfimova E.M., Zhernakova Y.V., Zhirov I.V., Kislyak O.A., Litvin A.Y., 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.Y., Shchelkova G.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/832

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.

The сlinical guidelines present the main approaches to the management of patients with arterial hypertension (aH) using the principles of evidence-based medicine. The guidelines include sections containing expanded and updated information on the main aspects of diagnosis, treatment, prevention methods and follow-up patients with hypertension, taking into account the phenotypes of disease and various clinical situations, as well as secondary forms of hypertension of various origins.

артериальная гипертонияартериальная гипертензияартериальное давлениеантигипертензивная терапиядиагностиканаблюдениефенотипы АГрезистентная АГсердечно-сосудистые заболеваниявторичные АГрекомендацииarterial hypertensionblood pressureantihypertensive therapydiagnosispatient’s follow-uphypertension phenotypesresistant hypertensioncardiovascular diseasesecondary hypertensionguidelinesСОСТАВ 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.........................................................................................131. Общая информация по заболеванию...................................... 141.1 Определение артериальной гипертонии.......................... 141.2 Эпидемиология артериальной гипертонии........................1.3 Этиология и патогенез артериальной гипертонии.......151.4 Классификация артериальной гипертонии....................151.5 Кодирование по Международной классификацииболезней 10 пересмотра................................................................ 162. Диагностика артериальной гипертонии................................ 162.1 Измерение артериального давления.................................. 162.1.1 Клиническое (офисное) измерениеартериального давления.........................................................172.1.2 Суточное мониторирование артериальногодавления.......................................................................................172.1.3 Самоконтроль артериального давления..................202.1.4 Приборы для измерения клиническогоартериального давления ........................................................212.2 Общеклиническое обследование........................................212.2.1 Анамнез..............................................................................222.2.2 Физикальное обследование.........................................222.3 Лабораторные и инструментальные методыисследования...................................................................................232.3.1 Исследование органов-мишеней................................232.3.2 Лабораторные методы исследования.......................242.3.3 Инструментальные методы исследования.............252.4 Оценка общего (суммарного)сердечно-сосудистого риска.......................................................272.5 Формулировка диагноза ....................................................... 313. Вторичные (симптоматические) артериальныегипертонии ......................................................................................... 313.1 Общие подходы к диагностике и лечению....................... 313.2 Вторичные почечные АГ........................................................323.3 Реноваскулярная АГ...............................................................343.4 Первичный гиперальдостеронизм.....................................363.5 Эндогенный гиперкортицизм.Болезнь и синдром Иценко-Кушинга......................................383.6 Феохромоцитома/ параганглиома......................................394. Лечение артериальной гипертонии..........................................404.1 Показания к назначению антигипертензивнойтерапии .........................................................................................404.2 Целевые уровни артериального давления.......................424.3 Немедикаментозные методы лечения ..............................434.4 Медикаментозная антигипертензивная терапия.........454.4.1 Основные принципы медикаментознойтерапии артериальной гипертонии....................................454.4.2 Классы антигипертензивных препаратовдля лечения артериальной гипертонии............................464.4.2.1 Основные классы антигипертензивных препаратов..............................................................................464.4.2.2 Дополнительные классыантигипертензивных препаратов...................................474.4.3 Тактика антигипертензивной терапии....................474.5 Терапия для коррекции факторов рискаи сопутствующих заболеваний..................................................484.6 Инструментальное лечение артериальнойгипертонии.......................................................................................505. Резистентная и рефрактерная артериальнаягипертония .........................................................................................516. Фенотипы артериальной гипертонии.....................................546.1 Артериальная гипертония «белого халата»....................546.2 «Маскированная» артериальная гипертония................546.3 Неконтролируемая артериальная гипертония«белого халата» и неконтролируемая маскированнаяартериальная гипертония...........................................................556.4 Изолированная систолическая артериальнаягипертония.......................................................................................556.5 Изолированная диастолическая артериальнаягипертония.......................................................................................567. Артериальная гипертония в отдельныхдемографических группах...............................................................567.1 Артериальная гипертония у детей и подростков..........567.2 Артериальная гипертония у лиц молодоговозраста (моложе 50 лет) .............................................................577.3 Артериальная гипертония у лиц пожилогои старческого возраста..................................................................587.4 Артериальная гипертония у женщин................................587.4.1 Артериальная гипертония при беременностии лактации...................................................................................587.4.2 Лечение АГ у женщин в послеродовомпериоде и при лактации..........................................................617.4.3 Пероральные контрацептивы и АГ ..........................617.4.4 Менопаузальная гормональная терапия ................617.4.5 Вспомогательные репродуктивныетехнологии..................................................................................618. Артериальная гипертонияв отдельных клинических ситуациях..........................................618.1 Артериальная гипертония у пациентовс ожирением.....................................................................................618.2 Артериальная гипертония у пациентовс сахарным диабетом и предиабетом ......................................638.3 Артериальная гипертония у пациентовс хронической болезнью почек..................................................648.4 Артериальная гипертония у пациентов сбессимптомной гиперурикемией и подагрой......................678.5 Артериальная гипертония при бронхиальной астмеи хронической обструктивной болезни легких....................678.6 Артериальная гипертония у пациентовс ишемической болезнью сердца...............................................698.7. Артериальная гипертония у пациентовс хронической сердечной недостаточностью........................708.8 Артериальная гипертония у пациентовс фибрилляцией предсердий......................................................728.9 Артериальная гипертония у пациентовс цереброваскулярными заболеваниями...............................758.9.1 Лечение артериальной гипертониипри остром геморрагическом инсульте ............................758.9.2 Лечение артериальной гипертониипри остром ишемическом инсульте...................................778.9.3 Лечение артериальной гипертонииу пациентов, перенесших инсультили транзиторную ишемическую атаку............................778.9.4 Ведение пациентов с когнитивныминарушениями и деменцией...................................................788.10 Артериальная гипертония у пациентовс клапанными пороками сердца................................................798.11 Артериальная гипертонияи периферическое поражение сосудов....................................798.12 Артериальная гипертонияи обструктивное апноэ сна.........................................................808.13 Артериальная гипертонияи эректильная дисфункция.........................................................828.14 Артериальная гипертонияи ревматические заболевания....................................................828.15 Артериальная гипертонияи онкологические заболевания..................................................838.16 Артериальная гипертонияи коронавирусная инфекция......................................................849. Экстренные и неотложные состояния, обусловленныеартериальной гипертонией (гипертонические кризы)..........8510. Профилактика и диспансерное наблюдение.......................88Приложения.........................................................................................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.

 

 

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