cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2024-39-3-41-50cardiotomsk-2424Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESРоль вегетативного дисбаланса в патогенезе артериальной гипертонии и терапевтической эффективности ренальной денервации (обзор литературы)The role of autonomic imbalance in the pathogenesis of hypertension and the therapeutic effectiveness of renal denervation (literature review)https://orcid.org/0000-0002-5954-1640СкомкинаИ. А.SkomkinaI. A.

Скомкина Ирина Александровна, ординатор, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Irina A. Skomkina, Medical Resident, Department of Arterial Hypertension

111a, Kievskaya str., Tomsk, 634012

sia@cardio-tomsk.ruhttps://orcid.org/0000-0002-2238-4573МордовинВ. Ф.MordovinV. F.

Мордовин Виктор Федорович, д-р мед. наук, профессор, ведущий научный сотрудник, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Victor F. Mordovin, Dr. Sci. (Med.), Professor, Leading Research Scientist, Department of Hypertension

111a, Kievskaya str., Tomsk, 634012

mordovin@cardio-tomsk.ruhttps://orcid.org/0000-0002-5638-3034ФальковскаяА. Ю.FalkovskayaA. Yu.

Фальковская Алла Юрьевна, д-р мед. наук, заведующий отделением артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Allа Yu. Falkovskaya, Dr. Sci. (Med.), Head of Department of Hypertension

111a, Kievskaya str., Tomsk, 634012

alla@cardio-tomsk.ruhttps://orcid.org/0000-0001-6995-9875ЗюбановаИ. В.ZyubanovaI. V.

Зюбанова Ирина Владимировна, канд. мед. наук, научный сотрудник, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Irina V. Zyubanova, Cand. Sci. (Med.), Research Scientist, Department of Hypertension

111a, Kievskaya str., Tomsk, 634012

ziv@cardio-tomsk.ruhttps://orcid.org/0000-0003-4066-869XЛичикакиВ. А.LichikakiV. A.

Личикаки Валерия Анатольевна, канд. мед. наук, научный сотрудник, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Valeriia A. Lichikaki, Dr. Sci. (Med.), Research Scientist, Department of Hypertension

111a, Kievskaya str., Tomsk, 634012

manankovalera@mail.ruhttps://orcid.org/0000-0003-3577-1895МанукянМ. А.ManukyanM. A.

Манукян Мушег Айкович, младший научный сотрудник, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Musheg A. Manukyan, Junior Research Scientist, Department of Hypertension

111a, Kievskaya str., Tomsk, 634012

manukyan.muscheg@yandex.ruhttps://orcid.org/0000-0001-9857-4368СолонскаяЕ. И.SolonskayaE. I.

Солонская Екатерина Игоревна, канд. мед. наук, младший научный сотрудник, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Ekaterina I. Solonskaya, Cand. Sci. (Med.), Junior Research Scientist, Department of Hypertension

111a, Kievskaya str., Tomsk, 634012

haksen_sgmu@mail.ruhttps://orcid.org/0000-0003-1192-0489ВторушинаА. А.VtorushinaA. A.

Вторушина Анастасия Анатольевна, аспирант, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Anastasiya A. Vtorushina, Graduate Student, Department of Arterial Hypertension

111a, Kievskaya str., Tomsk, 634012

vaa@cardio-tomsk.ruhttps://orcid.org/0000-0002-5000-4216ХунхиноваС. А.KhunkhinovaS. A.

Хунхинова Симжит Андреевна, аспирант, отделение артериальных гипертоний

634012, Томск, ул. Киевская, 111а

Simzhit A. Khunkhinova, Graduate Student, Department of Aterial Hypertension

111a, Kievskaya str., Tomsk, 634012

hsa@cardio-tomsk.ruАфанасьевС. А.AfanasievS. A.

Афанасьев Сергей Александрович, д-р мед. наук, заведующий лабораторией молекулярно-клеточной патологии и генодиагностики

634012, Томск, ул. Киевская, 111а

Sergej A. Afanasiev Dr. Sci. (Med.), Professor, Head of the Laboratory of Molecular-Cellular Pathology and Genetic Diagnostics

111a, Kievskaya str., Tomsk, 634012

tursky@cardio-tomsk.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наук (НИИ кардиологии Томского НИМЦ)РоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences (Cardiology Research Institute, Tomsk NRMC)Russian Federation2024011020243934150Copyright © Скомкина И.А., Мордовин В.Ф., Фальковская А.Ю., Зюбанова И.В., Личикаки В.А., Манукян М.А., Солонская Е.И., Вторушина А.А., Хунхинова С.А., Афанасьев С.А., 20242024Скомкина И.А., Мордовин В.Ф., Фальковская А.Ю., Зюбанова И.В., Личикаки В.А., Манукян М.А., Солонская Е.И., Вторушина А.А., Хунхинова С.А., Афанасьев С.А.Skomkina I.A., Mordovin V.F., Falkovskaya A.Y., Zyubanova I.V., Lichikaki V.A., Manukyan M.A., Solonskaya E.I., Vtorushina A.A., Khunkhinova S.A., Afanasiev S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/2424

Несмотря на успехи клинической фармакологии и использование современных антигипертензивных препаратов, артериальная гипертония (АГ) остается глобальной проблемой современного здравоохранения, основным фактором риска сердечно-сосудистых осложнений. Это обусловливает необходимость более углубленного изучения патогенетических механизмов данного заболевания и разработки новых патогенетически обоснованных методов его лечения. С каждым годом публикуется все больше исследований, результаты которых свидетельствуют о значительной роли вегетативного дисбаланса в патогенезе заболевания. В статье представлены основные современные данные, касающиеся изучения этой проблемы. Проведен подробный анализ работ, посвященных роли симпатической гиперактивации в устойчивом повышении уровня артериального давления (АД) и развитии резистентных к фармакотерапии форм АГ. Особое внимание уделено влиянию современных методов эндоваскулярного воздействия на изменения степени выраженности иммуновоспалительных процессов, путем активации которых реализуются гипертензивные эффекты повышенной активности симпатической нервной системы. Описаны возможные механизмы терапевтической эффективности ренальной денервации (РДН) и перспективы дальнейшего клинического применения метода.

Arterial hypertension (AH) remains a global problem of modern healthcare, since, despite advances in clinical pharmacology and the use of modern antihypertensive drugs, it continues to be a major risk factor for cardiovascular complications. This necessitates a more in-depth study of the pathogenetic mechanisms of this disease and the development of new pathogenetically based methods of its treatment. Every year more and more studies are published, the results of which indicate the significant role of autonomic imbalance in the pathogenesis of the disease. The article presents the main modern data concerning the study of this problem. A detailed analysis of works devoted to the role of sympathetic hyperactivation in a sustained increase in blood pressure (BP) and the development of pharmacotherapy-resistant forms of hypertension (RAH) was carried out. Particular attention is paid to the influence of modern endovascular methods on changes in the severity of immunoinflammatory processes, through the activation of which the hypertensive effects of increased activity of the sympathetic nervous system are realized. Possible mechanisms of the therapeutic effectiveness of renal denervation and prospects for further clinical application of the method are described.

артериальная гипертониясердечно-сосудистый рисквегетативная нервная системавегетативный дисбаланссимпатическая нервная системасимпатическая активностьадренореактивностьиммуновоспалительные процессынорадреналинренальная денервацияhypertensioncardiovascular riskautonomic nervous systemautonomic imbalancesympathetic nervous systemsympathetic activityadrenoreactivityinflammationnorepinephrinerenal denervationReferencesNguyen T.N., Chow C.K. Global and national high blood pressure burden and control. Lancet. 2021;398(10304):932–933. DOI: 10.1016/S0140-6736(21)01688-3.Nguyen T.N., Chow C.K. Global and national high blood pressure burden and control. Lancet. 2021;398(10304):932–933. DOI: 10.1016/S0140-6736(21)01688-3.NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–980. 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The authors declare that there are no conflicts of interest present.