Bulletin of the Russian Military Medical AcademyBulletin of the Russian Military Medical AcademyВестник Российской военно-медицинской академии1682-73922687-1424Eco-Vector7131410.17816/brmma71314ReviewsОбзорыReview ArticleApproaches to antihypertensive therapy in patients predisposed to symptomatic hypotension and syncopeПодходы к антигипертензивной терапии у пациентов, предрасположенных к развитию симптомной гипотензии и синкопальных состоянийBarsukovAnton V.БарсуковАнтон Владимирович
Russian Federation

doctor of medical sciences, professor

доктор медицинских наук, профессор

avbarsukov@yandex.ruGlukhovskoyDmitry V.ГлуховскойДмитрий Владимирович
Russian Federation

candidate of medical sciences

кандидат медицинских наук

gluhovskoi@inbox.ruEmelyanovaKristina E.ЕмельяноваКристина Евгеньевна
Russian Federation

therapist

врач-терапевт

air-kristina@mail.ruVasilyevaIrina A.ВасильеваИрина Алексеевна
Russian Federation

candidate of medical sciences

кандидат медицинских наук

vasilyeva-ia@yandex.ruMilitary Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian FederationВоенно-медицинская академия имени С.М. Кирова МО РФ150620212322072180406202104062021Copyright ©; 2021, Barsukov A.V., Glukhovskoy D.V., Emelyanova K.E., Vasilyeva I.A.Copyright ©; 2021, Барсуков А.В., Глуховской Д.В., Емельянова К.Е., Васильева И.А.2021Barsukov A.V., Glukhovskoy D.V., Emelyanova K.E., Vasilyeva I.A.Барсуков А.В., Глуховской Д.В., Емельянова К.Е., Васильева И.А.http://creativecommons.org/licenses/by-nc-nd/4.0https://journals.eco-vector.com/1682-7392/article/view/71314

The management of a hypertensive patient with a history of syncope is aimed at maintaining a balance between cardiovascular and hypotensive (syncope) risks. The article presents an analysis of the literature data regarding the relationship between these clinical problems, and also draws practical conclusions that allow to ensure the optimal reduction in blood pressure in the interests of preventing cardiovascular diseases without the threat of drug-related hypotension (fainting). Variants of syncope in patients with arterial hypertension are summarized, depending on the association with antihypertensive therapy. There presented an expert opinion on the recommended target level of systolic blood pressure (120 mm Hg) in hypertensive patients under 70 years of age with a low syncope but high cardiovascular risk, as well as the target level of systolic blood pressure (140 mm Hg) in patients with high syncope and low cardiovascular risk or in elderly and / or frail individuals with hypertension. There noted the admissibility of bringing the systolic blood pressure to the target value up to 160 mm Hg in persons with severe frailty or disability. Examples of normal and pathological (hypotensive) patterns of hemodynamic response in persons with hypertension to long-term passive orthostasis obtained during the tilt test and influencing the decision-making on the activity of antihypertensive therapy are given. The importance of an interdisciplinary team approach with the participation of experts in regulatory circulatory disorders and geriatrics, which can significantly improve the quality of management of patients with a combination of hypertension and syncope, is stated.

Ведение пациента, страдающего артериальной гипертензией, имеющего в анамнезе клинически значимую гипотензию или синкопальные состояния, нацелено на поддержание баланса между кардиоваскулярными и гипотензивными (синкопальными) рисками. Представлен анализ данных литературы, касающийся взаимоотношений между этими клиническими проблемами, а также сделаны практические выводы, позволяющие обеспечить оптимальное снижение артериального давления в интересах профилактики сердечно-сосудистых заболеваний без угрозы возникновения лекарственно обусловленной гипотензии (обморока). Суммированы варианты синкопальных состояний у пациентов, страдающих артериальной гипертензией, в зависимости от ассоциации с антигипертензивной терапией. Приведено экспертное мнение о рекомендуемом целевом уровне систолического артериального давления (120 мм рт. ст.) у больных артериальной гипертензией в возрасте до 70 лет с низким синкопальным, но высоким кардиоваскулярном риском, а также целевом уровне систолического артериального давления (140 мм рт. ст.) у пациентов с высоким синкопальным и низким кардиоваскулярным риском или у пожилых и/или хрупких субъектов, страдающих артериальной гипертензией. Отмечена допустимость приведения систолического артериального давления к целевому значению до 160 мм рт. ст. у лиц с выраженной хрупкостью или недееспособностью. Приведены примеры нормального и патологического (гипотензивного) паттернов гемодинамического ответа у лиц, страдающих артериальной гипертензией, на длительный пассивный ортостаз, полученных в ходе пассивной ортостатической пробы и влияющих на принятие решения об активности антигипертензивной терапии. Констатирована важность командного междисциплинарного подхода с участием экспертов в вопросах регуляторных расстройств кровообращения, гериатрии, который может существенно улучшить качество ведения пациентов с сочетанием артериальной гипертензии и синкопальных состояний.

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