Лечение артериальной гипотензии

DOI: https://doi.org/10.29296/25877305-2023-05-04
Номер журнала: 
5
Год издания: 
2023

К.Р. Амлаев, доктор медицинских наук, профессор,
И.А. Знаменская, кандидат медицинских наук, доцент,
Х.Т. Дахкильгова, кандидат медицинских наук, доцент
Ставропольский государственный медицинский университет Минздрава России
E-mail: kum672002@mail.ru

Лечение артериальной гипотензии – комплексная проблема, требующая коррекции гемодинамических параметров пациента и, если это возможно, воздействия на причину снижения АД. Необходимо уделять внимание коррекции факторов, отягчающих течение гипотензии. Немаловажно применение немедикаментозных методов коррекции сниженного АД, таких как ношение компрессионного белья, увеличение потребления жидкости и соли, физические упражнения. Фармакологическая терапия гипотонии включает использование ряда препаратов с разным механизмом действия, таких как мидодрин, флудкортизон, дроксидопа, ингибиторы мембранного транспортера норэпинефрина. Особое внимание уделяется лечению ортостатической гипотензии, постпрандиальной гипотензии.
Ключевые слова: 
кардиология
артериальная гипотензия
ортостатическая гипотензия
антигипотензивное лечение
Для цитирования
Амлаев К.Р., Знаменская И.А., Дахкильгова Х.Т. Лечение артериальной гипотензии . Врач, 2023; (5): 26-31 https://doi.org/10.29296/25877305-2023-05-04

Список литературы: 
  1. Meng L. Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review. Br J Anaesth. 2021; 127 (6): 845–61. DOI: 10.1016/j.bja.2021.06.048
  2. Mascha E.J., Yang D., Weiss S. et al. Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery. Anesthesiology. 2015; 123 (1): 79–91. DOI: 10.1097/ALN.0000000000000686
  3. Hsieh J.K., Dalton J.E., Yang D. et al. The Association Between Mild Intraoperative Hypotension and Stroke in General Surgery Patients. Anesth Analg. 2016; 123 (4): 933–9. DOI: 10.1213/ANE.0000000000001526
  4. Hirsch J., DePalma G., Tsai T.T. et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth. 2015; 115 (3): 418–26. DOI: 10.1093/bja/aeu458
  5. Babazade R., Yilmaz H.O., Zimmerman N.M. et al. Association Between Intraoperative Low Blood Pressure and Development of Surgical Site Infection After Colorectal Surgery: A Retrospective Cohort Study. Ann Surg. 2016; 264 (6): 1058–64. DOI: 10.1097/SLA.0000000000001607
  6. Momodu I.I., Okafor C.N. Orthostatic Syncope. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2022.
  7. Magkas N., Tsioufis C., Thomopoulos C. et al. Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich). 2019; 21 (3): 426–33. DOI: 10.1111/jch.13491
  8. Fumagalli U., Melis A., Balazova J. et al. Intra-operative hypotensive episodes may be associated with post-operative esophageal anastomotic leak. Updates Surg. 2016; 68 (2): 185–90. DOI: 10.1007/s13304-016-0369-9
  9. Magny E., Donadio C., Maronnat F. et al. Hypotensions in the elderly: Clinical and therapeutic features. Presse Med. 2019; 48 (2): 134–42. DOI: 10.1016/j.lpm.2018.11.008
  10. Bocti C., Pépin F., Tétreault M. et al. Orthostatic hypotension associated with executive dysfunction in mild cognitive impairment. J Neurol Sci. 2017; 382: 79–83. DOI: 10.1016/j.jns.2017.09.028
  11. Palma J.A., Kaufmann H. Management of Orthostatic Hypotension. Continuum (Minneap Minn). 2020; 26 (1): 154–77. DOI: 10.1212/CON.0000000000000816
  12. Newton J.L., Frith J. The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging. Neurology. 2018; 91 (7): e652–e656. DOI: 10.1212/WNL.0000000000005994
  13. Fanciulli A., Goebel G., Metzler B. et al. Elastic Abdominal Binders Attenuate Orthostatic Hypotension in Parkinson's Disease. Mov Disord Clin Pract. 2015; 3 (2): 156–60. DOI: 10.1002/mdc3.12270
  14. Okamoto L.E., Diedrich A., Baudenbacher F.J. et al. Efficacy of Servo-Controlled Splanchnic Venous Compression in the Treatment of Orthostatic Hypotension: A Randomized Comparison With Midodrine. Hypertension. 2016; 68 (2): 418–26. DOI: 10.1161/HYPERTENSIONAHA.116.07199
  15. Fanciulli A., Jordan J., Biaggioni I. et al. Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS): Endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH). Clin Auton Res. 2018; 28 (4): 355–62. DOI: 10.1007/s10286-018-0529-8
  16. Di Stefano C., Maule S. Treatment of supine hypertension in autonomic failure: a case series. Clin Auton Res. 2018; 28 (2): 245–6. DOI: 10.1007/s10286-017-0479-6
  17. Gibbons C.H., Schmidt P., Biaggioni I. et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017; 264 (8): 1567–82. DOI: 10.1007/s00415-016-8375-x
  18. Grijalva C.G., Biaggioni I., Griffin M.R. et al. Fludrocortisone Is Associated With a Higher Risk of All-Cause Hospitalizations Compared With Midodrine in Patients With Orthostatic Hypotension. J Am Heart Assoc. 2017; 6 (10): e006848. DOI: 10.1161/JAHA.117.006848
  19. Lamotte G., Holmes C., Sullivan P. et al. Substantial renal conversion of L-threo-3,4-dihydroxyphenylserine (droxidopa) to norepinephrine in patients with neurogenic orthostatic hypotension. Clin Auton Res. 2019; 29 (1): 113–7. DOI: 10.1007/s10286-018-0564-5
  20. Hauser R.A., Biaggioni I., Hewitt L.A. et al. Integrated Analysis of Droxidopa for the Treatment of Neurogenic Orthostatic Hypotension in Patients with Parkinson Disease. Mov Disord Clin Pract. 2018; 5 (6): 627–34. DOI: 10.1002/mdc3.12695
  21. Palma J.A., Norcliffe-Kaufmann L., Martinez J. et al. Supine plasma NE predicts the pressor response to droxidopa in neurogenic orthostatic hypotension. Neurology. 2018; 91 (16): e1539–e1544. DOI:10.1212/WNL.0000000000006369
  22. Biaggioni I., Arthur Hewitt L., Rowse G.J. et al. Integrated analysis of droxidopa trials for neurogenic orthostatic hypotension. BMC Neurol. 2017; 17 (1): 90. DOI: 10.1186/s12883-017-0867-5
  23. Kaufmann H. Droxidopa for symptomatic neurogenic orthostatic hypotension: what can we learn? Clin Auton Res. 2017; 27 (Suppl 1): 1–3. DOI: 10.1007/s10286-017-0426-6
  24. Shibao C.A., Palma J.A., Celedonio J.E. et al. Predictors of the Pressor Response to the Norepinephrine Transporter Inhibitor, Atomoxetine, in Neurogenic Orthostatic Hypotension. Hypertension. 2021; 78 (2): 525–31. DOI: 10.1161/HYPERTENSIONAHA.119.14483
  25. Okamoto L.E., Shibao C.A., Gamboa A. et al. Synergistic Pressor Effect of Atomoxetine and Pyridostigmine in Patients With Neurogenic Orthostatic Hypotension. Hypertension. 2019; 73 (1): 235–41. DOI: 10.1161/HYPERTENSIONAHA.118.11790
  26. Pavelić A., Krbot Skorić M., Crnošija L. et al. Postprandial hypotension in neurological disorders: systematic review and meta-analysis. Clin Auton Res. 2017; 27 (4): 263–71. DOI: 10.1007/s10286-017-0440-8
  27. Abbas R., Tanguy A., Bonnet-Zamponi D. et al. New Simplified Screening Method for Postprandial Hypotension in Older People. J Frailty Aging. 2018; 7 (1): 28–33. DOI: 10.14283/jfa.2018.2
  28. Borg M.J., Xie C., Rayner C.K. et al. Potential for Gut Peptide-Based Therapy in Postprandial Hypotension. Nutrients. 2021; 13 (8): 2826. DOI: 10.3390/nu13082826
  29. Fedorowski A., Ricci F., Hamrefors V. et al. Orthostatic Hypotension: Management of a Complex, But Common, Medical Problem. Circ Arrhythm Electrophysiol. 2022; 15 (3): e010573. DOI: 10.1161/CIRCEP.121.010573
  30. Kaufmann H., Palma J.A. Neurogenic orthostatic hypotension: the very basics. Clin Auton Res. 2017; 27 (Suppl 1): 39–43. DOI: 10.1007/s10286-017-0437-3
  31. Dasgupta I., Thomas G.N., Clarke J. et al. Associations between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes. Clin J Am Soc Nephrol. 2019; 14 (3): 385–93. DOI: 10.2215/CJN.08240718
  32. Strutt J., Flood A., Kharbanda A.B. Shock Index as a Predictor of Morbidity and Mortality in Pediatric Trauma Patients. Pediatr Emerg Care. 2019; 35 (2): 132–7. DOI: 10.1097/PEC.0000000000001733