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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">cardiotomsk</journal-id><journal-title-group><journal-title xml:lang="ru">Сибирский журнал клинической и экспериментальной медицины</journal-title><trans-title-group xml:lang="en"><trans-title>Siberian Journal of Clinical and Experimental Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2713-2927</issn><issn pub-type="epub">2713-265X</issn><publisher><publisher-name>TSU publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.29001/2073-8552-2021-36-2-36-44</article-id><article-id custom-type="elpub" pub-id-type="custom">cardiotomsk-1189</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И ЛЕКЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEWS AND LECTURES</subject></subj-group></article-categories><title-group><article-title>Особенности фармакотерапии артериальной гипертензии у некоторых категорий пациентов</article-title><trans-title-group xml:lang="en"><trans-title>Features of antihypertensive pharmacotherapy in patients with metabolic syndrome and diabetes mellitus</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1312-8076</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Влюбчак</surname><given-names>О. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Vlyubchak</surname><given-names>O. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Влюбчак Оксана Вадимовна, аспирант, врач-пульмонолог</p><p>655012, Российская Федерация, Республика Хакасия, Абакан, пр. Ленина, 23</p></bio><bio xml:lang="en"><p>Oksana D. Vlyubchak, Pulmonologist, Post-Graduate Student</p><p>23, Lenin ave., Abakan, 655012, Republic of Khakassia, Russian Federation</p></bio><email xlink:type="simple">vlyubchak92@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1849-7735</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дутова</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Dutova</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дутова Светлана Вячеславовна, д-р фарм. наук, доцент, заведующий кафедрой фундаментальной медицины и гигиены</p><p>655017, Российская Федерация, Республика Хакасия, Абакан, пр. Ленина, 90</p></bio><bio xml:lang="en"><p>Svetlana V. Dutova, Dr. Sci. (Pharm.), Associate Professor, Head of Department of Fundamental Medicine and Hygiene</p><p>90, Lenin ave., Abakan, 655017, Republic of Khakassia, Russian Federation</p></bio><email xlink:type="simple">coluria@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8750-6121</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Романова</surname><given-names>И. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Romanova</surname><given-names>I. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Романова Ирина Петровна, канд. биол. наук, доцент, доцент кафедры фундаментальной медицины и гигиены</p><p>655017, Российская Федерация, Республика Хакасия, Абакан, пр. Ленина, 90</p></bio><bio xml:lang="en"><p>Irina P. Romanova, Cand. Sci. (Biol.), Associate Professor, Department of Fundamental Medicine and Hygiene</p><p>90, Lenin ave., Abakan, 655017, Republic of Khakassia, Russian Federation</p></bio><email xlink:type="simple">romirapet@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Республиканская клиническая больница имени Г.Я. Ремишевской</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Republican Clinical Hospital named after G.Ya. Remishevskaya</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Хакасский государственный университет имени Н.Ф. Катанова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Khakas State University named after N.F. Katanov</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2021</year></pub-date><pub-date pub-type="epub"><day>01</day><month>07</month><year>2021</year></pub-date><volume>36</volume><issue>2</issue><fpage>36</fpage><lpage>44</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Влюбчак О.В., Дутова С.В., Романова И.П., 2021</copyright-statement><copyright-year>2021</copyright-year><copyright-holder xml:lang="ru">Влюбчак О.В., Дутова С.В., Романова И.П.</copyright-holder><copyright-holder xml:lang="en">Vlyubchak O.V., Dutova S.V., Romanova I.P.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.sibjcem.ru/jour/article/view/1189">https://www.sibjcem.ru/jour/article/view/1189</self-uri><abstract><p>В статье описываются результаты анализа публикаций, посвященных особенностям фармакотерапии артериальной гипертензии (АГ) у пожилых пациентов, пациентов с метаболическим синдромом (МС) и сахарным диабетом (СД). Приводятся статистические данные о распространенности АГ среди пожилых пациентов, заболеваемости ожирением и СД в Российской Федерации. Выделяются особенности течения гипертонической болезни у лиц старшей возрастной группы: преобладание изолированной систолической АГ, жесткость сосудов и усиление эндотелиальной дисфункции. Подтверждается необходимость применения антигипертензивных препаратов для снижения риска развития осложнений и повышения качества жизни даже у пациентов старшей возрастной группы. Анализ данных многочисленных крупных исследований позволил авторам определить основные принципы выбора препаратов для антигипертензивной фармакотерапии (АГФТ) пожилых пациентов: в качестве препаратов первой линии следует назначать блокаторы медленных кальциевых каналов (БМКК), ингибиторы ангиотензинпревращающего фермента (иАПФ), диуретики в низких дозах. На следующем этапе лечения при неудовлетворительном результате стартовой терапии следует рассматривать добавление антагонистов минералокортикоидных рецепторов, альфа-адреноблокаторов, селективных агонистов имидазолиновых рецепторов. Описываются основные подходы к антигипертензивной терапии у пациентов с МС и СД. Авторы отмечают факт неблагоприятного воздействия МС на сердечно-сосудистую систему, в результате чего лечение АГ в таких клинических случаях должно быть агрессивным, а для достижения стойкого гипотензивного эффекта может быть использовано несколько препаратов. В качестве АГФТ первой линии у таких пациентов рекомендуется применение диуретиков, ингибиторов ангиотензинпревращающего фермента и блокаторов рецепторов ангиотензина (БРА). Приводятся доводы, что одним из эффективных путей решения проблемы приверженности к лечению у пожилых пациентов и пациентов с сопутствующими нарушениями обменных процессов является использование комбинаций антигипертензивных препаратов, объединенных в одной лекарственной форме.</p></abstract><trans-abstract xml:lang="en"><p>The article describes the results of analyzing the available literature concerning specifics of pharmacotherapy for hypertension in elderly patients and patients with metabolic syndrome and diabetes mellitus. Authors present statistical data on the prevalence of hypertension among elderly patients and the incidence of obesity and diabetes in the Russian Federation. The paper highlights the characteristics of clinical course of hypertension in the older age group including the predominance of isolated systolic hypertension, vascular stiffness, and increased endothelial dysfunction. The need for administration of antihypertensive drugs to reduce the risk of complications and improve the quality of life even in older patients is confirmed. The analysis of data from numerous large studies allowed the authors to identify the main principles for selecting antihypertensive drugs in elderly patients. Slow calcium channel blockers, angiotensin converting enzyme inhibitors, and low-dose diuretics should be prescribed as first-line drugs. At the next stage of treatment, in case of unsatisfactory results of initial therapy, the addition of mineralocorticoid receptor antagonists, alpha-blockers, and selective imidazoline receptor agonists should be considered. The main approaches to antihypertensive therapy in patients with metabolic syndrome and diabetes mellitus are described. The authors note the fact of unfavorable impact of metabolic syndrome on cardiovascular system, which provides rationale for aggressive treatment of hypertension in such clinical cases where several drugs may be used to achieve a stable antihypertensive effect. Diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers are recommended as first-line antihypertensive pharmacotherapy in these patients. The authors argue in favour of the use of antihypertensive drug combinations in one dosage form as one of the effective ways to solve the problem of adherence to treatment in elderly patients and patients with concomitant metabolic disorders.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>артериальная гипертензия</kwd><kwd>фармакотерапия</kwd><kwd>антигипертензивные препараты</kwd><kwd>пожилые пациенты</kwd><kwd>метаболический синдром</kwd></kwd-group><kwd-group xml:lang="en"><kwd>arterial hypertension</kwd><kwd>pharmacotherapy</kwd><kwd>antihypertensive drugs</kwd><kwd>elderly patients</kwd><kwd>metabolic syndrome</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Fagard R.H. Epidemiology of hypertension in the elderly. American Journal Geriatrics and Cardiology. 2002;11(1):23–28. 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