Current hypertension treatment possibilities and tactics in patients with comorbidities. The role of selective imidazoline receptor agonists. Expert opinion
T. V. Pecherina,
G. A. Chumakova,
Yu. I. Grinshtein,
O. Yu. Donirova,
N. V. Zakharchuk,
V. V. Kashtalap,
T. A. Petrichko,
L. I. Syromyatnikova,
O. V. Fedorishina,
S. М. Cherepenin https://doi.org/10.15829/1728-8800-2025-4609
EDN: GCPTWX
Abstract
Hypertension (HTN) is a serious public health problem. Despite advances in diagnosis and public awareness, the percentage of controlled cases remains low, especially among men and the elderly. The main challenges are related to comorbidities such as obesity, diabetes, chronic kidney disease, and obstructive sleep apnea, which worsen the prognosis and increase the risk of cardiovascular events.
The approach to HTN treatment should be individualized and take into account specific disease phenotypes and comorbidities. It is important to identify patients with increased sympathetic nervous system activity, as this group experiences the greatest difficulties in blood pressure control. Moxonidine, a centrally acting agent, selectively stimulates imidazoline receptors in the brain, causing a decrease in sympathetic activity and effective reduction in blood pressure.
The need for a personalized approach to HTN therapy is driven by the growing number of patients with multiple comorbidities and complex pathogenesis. New approaches, including early initiation of combination therapy and targeted management of metabolic risk factors, will reduce cardiovascular morbidity and mortality. Moxonidine plays a key role within antihypertensive medications due to its unique mechanism of action and ability to positively impact a wide range of HTN-related pathologies
About the Authors
T. V. Pecherina
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Academician L. S. Barbarash boulevard, building 6, Kemerovo, 650002
G. A. Chumakova
Altai State Medical University
Russian Federation
Russian Federation
Lenin Avenue, 40, Barnaul, Altai Territory, 656038
Yu. I. Grinshtein
Voyno-Yasenetsky Krasnoyarsk State Medical University
Russian Federation
Russian Federation
Partizan Zheleznyak St., 1, Krasnoyarsk, Krasnoyarsk Territory, 660022
O. Yu. Donirova
Semashko Republican Clinical Hospital
Russian Federation
Russian Federation
Pavlova St., 12, Ulan-Ude, Republic of Buryatia, 670031
N. V. Zakharchuk
Pacific State Medical University
Russian Federation
Russian Federation
Ostryakova Avenue, 2, Vladivostok, Primorsky Krai, 690002
V. V. Kashtalap
Research Institute for Complex Issues of Cardiovascular Diseases;
Kemerovo State Medical University
Russian Federation
Russian Federation
Academician L. S. Barbarash boulevard, building 6, Kemerovo, 650002;
Voroshilova St., 22A, Kemerovo, 650070
T. A. Petrichko
Institute for Advanced Training of Healthcare Specialists
Russian Federation
Russian Federation
Krasnodarskaya St., 9, Khabarovsk, 680009
L. I. Syromyatnikova
Wagner Perm State Medical University
Russian Federation
Russian Federation
Petropavlovsk St., 26, Perm, 614000
O. V. Fedorishina
Irkutsk State Medical Academy of Postgraduate Education — Branch of the Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Yubileyny microdistrict, 100, Irkutsk, 664049
S. М. Cherepenin
Chelyabinsk Regional Clinical Hospital
Russian Federation
Russian Federation
Vorovskiy St., 70, Chelyabinsk, 454000
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Supplementary files
What is already known about the subject?
- The growing number of patients with multimorbidity and complex pathogenesis of hypertension (HTN) requires a personalized approach to treatment taking into account the etiology, clinical phenotype, and comorbidities.
What might this study add?
- The authors' consensus on personalized therapy for HTN in patients with comorbidities is substantiated. A new term, "acute blood pressure increase without target organ damage" or "uncontrolled hypertension," is proposed.
- Early initiation of combination therapy using an imidazoline receptor agonist (moxonidine), which improves a wide range of HTN-related pathologies, makes an important contribution to cardiovascular risk reduction.
Review
For citations:
Pecherina T.V., Chumakova G.A., Grinshtein Yu.I., Donirova O.Yu., Zakharchuk N.V., Kashtalap V.V., Petrichko T.A., Syromyatnikova L.I., Fedorishina O.V., Cherepenin S.М. Current hypertension treatment possibilities and tactics in patients with comorbidities. The role of selective imidazoline receptor agonists. Expert opinion. Cardiovascular Therapy and Prevention. 2025;24(9):4609. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4609. EDN: GCPTWX
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