Артериальная гипертензия при трансплантации почки – современная стратегия терапии


DOI: https://dx.doi.org/10.18565/nephrology.2023.4.53-59

Носов В.П., Королева Л.Ю., Соловьянова Е.Н.

ФГБОУ ВО «ПИМУ» Минздрава РФ, Нижний Новгород, Россия
Артериальная гипертензия (АГ) является наиболее частым фактором сердечно-сосудистого риска у реципиентов почечного трансплантата. Под посттрансплантационной АГ понимается персистирующее повышение артериального давления (АД) или нормотензивное состояние на фоне антигипертензивной терапии после успешной трансплантации почки. Посттрансплантационная АГ, являясь ведущим фактором риска ишемической болезни сердца (ИБС), инсульта и застойной сердечной недостаточности у реципиентов почечного трансплантата, сопровождается снижением выживаемости, обусловленным главным образом присоединением ИБС. Так, трансплантация почки и АГ, по данным анализа национальной базы данных во Франции, увеличивают риск развития инфаркта миокарда, главным образом без подъема сегмента ST на электрокардиограмме в течение первых 5 лет в 1,45 раза. В целом повышение систолического АД на каждые 20 мм рт.ст. свыше 140 мм рт.ст. ассоциировано с ростом частоты больших кардиоваскулярных событий на 32%. Основной целью терапии посттрансплантационной АГ является профилактика сердечно-сосудистых осложнений и гипертензивного повреждения почечного аллографта. Трудность терапии при этом сопряжена с ассоциированной множественной коморбидностью, вынужденной полипрагмазией, определенной патогенетической стадийностью, что требует осуществления полидисциплинарного подхода.

Литература


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Об авторах / Для корреспонденции


Носов Владимир Павлович – д.м.н., профессор кафедры госпитальной терапии и ОВП им. В.Г. Вогралика ФГБОУ ВО «ПИМУ» Минздрава РФ. Адрес: 603950 Нижний Новгород, БОКС-470, пл. Минина и Пожарского, 10/1
Королева Любовь Юрьевна – д.м.н., профессор кафедры госпитальной терапии и ОВП им. В.Г. Вогралика ФГБОУ ВО «ПИМУ» Минздрава РФ. Адрес: 603950 Нижний Новгород, БОКС-470, пл. Минина и Пожарского, 10/1
Соловьянова Елена Николаевна – к.м.н., доцент кафедры госпитальной терапии и ОВП им. В.Г. Вогралика ФГБОУ ВО «ПИМУ» Минздрава РФ. Адрес: 603950 Нижний Новгород, БОКС-470, пл Минина и Пожарского, e-mail: elenas-nn@mail.ru


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