arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2019-25-4-389-406arthyper-1833Research ArticleОбзоры и лекцииReviewПовышенная частота сердечных сокращений у пациентов с артериальной гипертонией и ишемической болезнью сердца: маркер тяжести заболевания или корригируемый фактор риска при сохраненной фракции выброса левого желудочкаElevated heart rate in hypertension and coronary artery disease: risk factor or risk marker in patients with preserved left ventricular ejection fractionhttps://orcid.org/0000-0002-5556-7106КоханЕ. В.KokhanE. V.

Кохан Елизавета Васильевна — клинический ординатор кафедры внутренних болезней с курсом кардиологии и функ­циональной диагностики имени академика В. С. Моисеева

ул. Вавилова, д. 61, Москва,  117292

SPIN-код: 1307-6750

Elizaveta V. Kokhan, MD, Resident, Department of Internal Medicine with Course of Cardiology and Functional Diagnostics named after V. S. Moiseev

61 Vavilov street, Moscow, 117292

kokhhan@gmail.comhttps://orcid.org/0000-0002-8532-1270КиякбаевГ. К.KiyakbaevG. K.

Киякбаев Гайрат Калуевич — доктор медицинских наук, профессор, профессор кафедры внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева

Москва

SPIN-код: 3192-2303

Gayrat K. Kiyakbaev, MD, PhD, DSc, Professor, Department of Internal Medicine with Course of Cardiology and Functional Diagnostics named after V. S. Moiseev

Moscow

gayratkk@gmail.comhttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZ. D.

Кобалава Жанна Давидовна — доктор медицинских на­ук, профессор, заведующая кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева

Москва

SPIN-код: 9828-5409

Zhanna D. Kobalava, MD, PhD, DSc, Professor, Head, Department of Internal Medicine with Course of Cardiology and Functional Diagnostics named after V. S. Moiseev

Moscow

zkobalava@mail.ruФедеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»РоссияPeoples’ Friendship University of Russia (RUDN University)Russian Federation201920092019254389406Copyright © Кохан Е.В., Киякбаев Г.К., Кобалава Ж.Д., 20192019Кохан Е.В., Киякбаев Г.К., Кобалава Ж.Д.Kokhan E.V., Kiyakbaev G.K., Kobalava Z.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1833

Многочисленные исследования демонстрируют негативное прогностическое значение тахикардии, как в общей популяции, так и в отдельных подгруппах больных, в том числе имеющих ишемическую болезнь сердца (ИБС), артериальную гипертензию (АГ) и хроническую сердечную недостаточность с со­храненной фракцией выброса (СНсФВ). В последней редакции Европейских рекомендаций по ведению больных АГ уровень частоты сердечных сокращений (ЧСС), превышающий 80 уд/мин, выделен как от­дельный независимый предиктор неблагоприятных исходов. Однако эффективность фармакологического урежения ЧСС при синусовом ритме не определена, и поэтому возможность назначения пульсурежаю­щих препаратов следует рассматривать на любом этапе лечения АГ, если немедикаментозные методы коррекции ЧСС с доказанным влиянием на прогноз оказались недостаточными. В отличие от пациентов со сниженной фракцией выброса (ФВ) левого желудочка (ЛЖ), у которых прослежены положительные эффекты пульсурежающей терапии, данные о влиянии медикаментозного снижения ЧСС на прогноз больных АГ, ИБС и/или СНсФВ не столь однозначны. При этом обсуждаются и некоторые неблагопри­ятные последствия фармакологической коррекции ЧСС у таких пациентов, которые могут быть следстви­ем изменения контура давления в аорте с его повышением в позднюю систолу в условиях имеющейся диастолической дисфункции ЛЖ. В обзоре представлены данные, отражающие многообразие проблемы клинико-прогностической значимости повышенной ЧСС и ее коррекции у пациентов с АГ, стабильной ИБС и/или СНсФВ.

Numerous studies have demonstrated the negative prognostic value of tachycardia, both in the general population and in specific subgroups, including patients with coronary artery disease (CAD), arterial hypertension (HTN) and heart failure with preserved ejection fraction (HFpEF). In the latest edition of the European guidlines for the treatment of HTN the level of heart rate (HR) exceeding 80 beats per minute is highlighted as a separate independent predictor of adverse outcomes. However, the feasibility of pharmacological reduction of HR in patients with sinus rhythm is unclear. Unlike patients with reduced ejection fraction, in whom the positive effects of HR reduction are well established, the data on the effect of pharmacological HR reduction on the prognosis of patients with HTN, CAD and/or HFpEF are not so unambiguous. Some adverse effects of pharmacological correction of HR in such patients, which may be caused by a change in the aortic pressure waveform with its increase in late systole in the presence of left ventricular diastolic dysfunction, are discussed. The reviewed data underline the complexity of the problem of clinical and prognostic significance of increased HR and its correction in patients with HTN, stable CAD and/or HFpEF.

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