cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2011-6-11-17cardiovascular-1952Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТОНИЯARTERIAL HYPERTENSIONСкрытая неэффективность лечения артериальной гипертонии: частота и предикторыMasked inefficacy of arterial hypertension treatment: prevalence and predictorsСмирноваМ. И.SmirnovaM. I.

с.н.с. лаборатории применения амбулаторных диагностических методов в профилактике хронических неинфекционных заболеваний

Москва, тел. 8 (495) 627 03 42

msmirnova@gnicpm.ruОгановР. Г.OganovR. G.ГорбуновВ. М.GorbunovM. V.

руководитель лаборатории

Москва

ДеевА. Д.DeevA. D.

руководитель лаборатории биостатистики

Москва

АндрееваГ. Ф.AndreevaG. F.

с.н.с. лаборатории применения амбулаторных диагностических методов в профилактике хронических неинфекционных заболеваний

Москва

ФГУ “Государственный научно-исследовательский центр профилактической медицины Минздравсоцразвития РоссииState Research Centre for Preventive Medicine2011201220111061117Copyright © Смирнова М.И., Оганов Р.Г., Горбунов В.М., Деев А.Д., Андреева Г.Ф., 20112011Смирнова М.И., Оганов Р.Г., Горбунов В.М., Деев А.Д., Андреева Г.Ф.Smirnova M.I., Oganov R.G., Gorbunov M.V., Deev A.D., Andreeva G.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1952

Цель. Определить частоту скрытой неэффективности лечения артериальной гипертонии (СНЛ АГ) и ее предикторы в разных группах (гр.) больных при различных подходах к контролю артериального давления (АД) для оценки эффективности антигипертензивной терапии (АГТ). Материал и методы. Изучена эффективность АГТ в 2 гр. больных (n=219 и n=39) с АГ 1-2 степеней, I-II стадий путем оценки соотношения показателей клинического (кл) и амбулаторного (а) АД. СНЛ АГ определяли как повышенный уровень аАД на фоне АГТ при достигнутых целевых показателях клАД. В качестве предикторов СНЛ АГ рассматривались пол, возраст, индекс массы тела (ИМТ), анамнестические сведения, частота визитов в клинику для контроля АД, показатели качества жизни (КЖ) по опроснику GWBQ, суточного профиля АД, АД, измеренного в ортостазе, ЭКГ-признаки гипертрофии левого желудочка (ГЛЖ). Результаты. Частота СНЛ АГ в I гр. составила 11,0-15,7 %, во II — 22,6-58,1 % в зависимости от определения. Гр. достоверно различались по возрасту, ИМТ, шкале III и VI опросника КЖ. СНЛ АГ ассоциировалась в I гр. в модели регрессионного анализа со II, V и VI шкалами опросника КЖ; исходными данными СМАД: 24ч вариабельностью систолического АД (САД), значением минимума среднего АД днем; приемом метопролола и амлодипина. Во II гр. в корреляционном анализе предикторами СНЛ АГ оказались возраст, ИМТ, предшествующая АГТ, употребление алкоголя, уровень САД в ортостазе, индекс Соколова-Лайона, Корнельский вольтажный индекс и Корнельское произведение, индекс Gubner, шкалы I, IV и VI опросника КЖ. Заключение. Частота СНЛ АГ зависит от ряда исходных характеристик больных, используемой АГТ. Частота СНЛ АГ может существенно возрастать при частом контроле параметров клАД вследствие регрессии к среднему.

Aim. To assess the prevalence of masked inefficacy of arterial hypertension treatment (AH MTI) and its predictors in various clinical groups and for various blood pressure (BP) control strategies, in order to evaluate the true effectiveness of antihypertensive therapy (AHT). Material and methods. AHT effectiveness was assessed in two groups of the patients with Stage I-II AH (n=219 and n=39), by comparing the ratios of clinical (cl) to ambulatory (a) BP parameters. AH MTI was defined as elevated aBP and target clBP levels during AHT. The potential predictors of AH MTI included gender, age, body mass index (BMI), anamnestic data, frequency of the clinical visits to measure BP, quality of life (QoL) parameters (GWBQ questionnaire), circadian BP profile, orthostatic BP, and ECG signs of left ventricular hypertrophy (LVH). Results. AH MTI prevalence in Groups I and II was 11,0-15,7 % and 22,6-58,1 %, respectively, depending on the definition used. The groups were significantly different in terms of age, BMI, and QoL questionnaire III and VI domains. According to the regression analysis results, in Group I AH MTI was associated with QoL questionnaire II, V, and VI domains, baseline parameters of 24-hour BP monitoring, 24-hour systolic BP (SBP) variability, minimal daytime levels of mean BP, and metoprolol and atenolol therapy. In Group II, AH MTI was predicted by age, BMI, previously administered AHT, alcohol consumption, orthostatic SBP levels, Sokolow-Lyon index, Cornell voltage and Cornell product, Gubner index, and QoL questionnaire I, IV, and VI domains. Conclusion. AH MTI prevalence is associated with some baseline characteristics of the patients and the character of AHT. Due to regression to the mean, AH MTI prevalence could increase substantially when clBP parameters are measured more often.

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The authors declare that there are no conflicts of interest present.