arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2022-28-5-600-608arthyper-2159Research ArticleОБЗОРREVIEWРефрактерная артериальная гипертензия: гиперактивность симпатической нервной системы, почка и подходы к повышению клинической эффективности антигипертензивной лекарственной терапииRefractory arterial hypertension: hyperactivity of the sympathetic nervous system, kidney and approaches to antihypertensive drug therapyhttps://orcid.org/0000-0003-3730-3665КузьминО. Б.KuzminO. B.

Кузьмин Олег Борисович — доктор медицинских наук, профессор, заведующий кафедрой фармакологии

Парковый пр., д.7, Оренбург, 460000

Oleg B. Kuzmin, MD, PhD, Professor, Head, Department of Pharmacology

7 Park Avenue, Orenburg, 460000

kuzmin.orgma@mail.ruhttps://orcid.org/0000-0003-1321-2101ЖежаВ. В.ZhezhaV. V.

Жежа Владислав Викторович — кандидат медицинских наук, доцент кафедры фармакологии

Оренбург

Vladislav V. Zhezha, MD, PhD, Associate Professor, Department of Pharmacology

Orenburg

zhezha56@mail.ruhttps://orcid.org/0000-0002-4431-9641БучневаН. В.BuchnevaN. V.

Бучнева Наталья Викторовна — кандидат медицинских наук, доцент кафедры фармакологии

Оренбург

Nataliya N. Buchneva, MD, PhD, Associate Professor, Department of Pharmacology

Orenburg

buzap01@yandex.ruhttps://orcid.org/0000-0001-5021-5964ЛандарьЛ. Н.LandarL. N.

Ландарь Лариса Николаевна — кандидат медицинских наук, доцент кафедры фармакологии

Оренбург

Larisa N. Landar, MD, PhD, Associate Professor, Department of Pharmacology

Orenburg

landar@mail.ruГосударственное бюджетное образовательное учреждение высшего образования «Оренбургский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияOrenburg State Medical UniversityRussian Federation202208072022285600608Copyright © Кузьмин О.Б., Жежа В.В., Бучнева Н.В., Ландарь Л.Н., 20222022Кузьмин О.Б., Жежа В.В., Бучнева Н.В., Ландарь Л.Н.Kuzmin O.B., Zhezha V.V., Buchneva N.V., Landar L.N.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/2159

Улучшение контроля артериального давления (АД) и снижение рисков развития неблагоприятных сердечно-сосудистых и почечных исходов у пациентов с рефрактерной артериальной гипертензией (АГ) является актуальной проблемой кардиологии. По данным клинических исследований, больные рефрактерной АГ, получающие интенсивную диуретическую терапию хлорталидоном и антагонистом минералкортикоидных рецепторов, отличаются от пациентов с резистентной АГ более высокой активностью симпатической нервной системы (СНС). Гиперактивность симпатических нервов может быть одним из ключевых патогенетических факторов, который вовлекается в почках в механизм формирования рефрактерной АГ, оказывая прямое стимулирующее влияние на активность Na+ /H+ -обменника 3-го типа (NHE3) и натрий-глюкозного котранспортера 2-го типа (SGLT2), участвующих в контроле АД в организме с помощью механизма прессорного натрийуреза. В обзоре представлены данные об особенностях симпатической регуляции транспорта натрия в канальцах почек и результаты исследований, посвященных выяснению у пациентов с резистентной и рефрактерной АГ клинической эффективности ингибиторов SGLT2 глифлозинов, симпатолитика резерпина и ингибитора аминопептидазы А головного мозга фирибастата, подавляющего активность центральных структур СНС.

Improving blood pressure (BP) control and reducing the risk of developing unfavorable cardiovascular and renal outcomes in patients with refractory hypertension (HTN) is an urgent problem of cardiology. According to clinical studies, patients with refractory HTN receiving intensive diuretic therapy with chlorthalidone and a mineralcorticoid receptor antagonist differ from patients with refractory HTN by a higher sympathetic nervous system (SNS) activity. Overactivity of sympathetic nerves may be one of the key pathogenetic factors that is involved in the kidney in the formation of refractory HTN, exerting a direct stimulating effect on the type 3 Na+ / H+ exchanger (NHE3) and type 2 sodium glucose cotransporter (SGLT2), which are involved in BP control by mechanism of pressure natriuresis. The review presents data on the peculiarities of sympathetic regulation of sodium tubular transport and the results of studies devoted the elucidating in the patients with resistant and refractory HTN the clinical efficacy of SGLT2 inhibitors glyflozins, sympatholytic reserpine and brain aminopeptidase A inhibitor firibastat, which suppresses the activity of central structures of SNS.

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