arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2023-29-2-246-252arthyper-2324Research ArticleСтатьиArticlesСтарческая астения и артериальная гипертония: вопросы клинической практикиFrailty and arterial hypertension: clinical practice issueshttps://orcid.org/0000-0002-1628-5093КотовскаяЮ. В.KotovskayaYu. V.

Котовская Юлия Викторовна - доктор медицинских наук, профессор, заместитель директора по научной работе

ул. 1-я Леонова, д. 16, Москва, 129226

Yulia V. Kotovskaya, MD, PhD, DSc, Professor, Deputy Director for Scientific Work

16 1th Leonova str., Moscow, 129226

kotovskaya@bk.ruhttps://orcid.org/0000-0002-4193-688XТкачеваО. Н.TkachevaO. N.

Ткачева Ольга Николаевна - доктор медицинских наук, профессор, член-корреспондент

ул. 1-я Леонова, д. 16, Москва, 129226

Olga N. Tkacheva, MD, PhD, DSc, Professor, Corresponding member of the Russian Academy of Sciences, Director

16 1th Leonova str., Moscow, 129226

tkacheva@rgnkc.ruФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Министерства здравоохранения Российской Федерации - обособленное структурное подразделение «Российский геронтологический научно-клинический центр»РоссияPirogov’s Russian National Research Medical University of the Ministry of Health of the Russian Federation — Russian Clinical and Research Center of GerontologyRussian Federation202317042023293246252Copyright © Котовская Ю.В., Ткачева О.Н., 20232023Котовская Ю.В., Ткачева О.Н.Kotovskaya Y.V., Tkacheva O.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/2324

Старческая астения — состояние повышенной уязвимости к воздействию эндо- и экзогенных стрессовых факторов вследствие возраст-ассоциированного снижения физиологического резерва организма. Развитие старческой астении ставит сложные клинические вопросы ведения артериальной гипертонии (АГ) и других хронических сердечно-сосудистых и несердечно-сосудистых заболеваний у пожилого пациента. Несмотря на то, что российские и международные клинические рекомендации по АГ отмечают необходимость учета старческой астении при принятии решения о тактике антигипертензивной терапии, оптимальные инструменты и критерии выбора того или иного решения остаются неопределенными. АГ часто встречается у пациентов со старческой астенией, однако прямая роль АГ в ее развитии окончательно не установлена. Контроль артериального давления (АД) является важнейшим фактором для снижения риска сердечно-сосудистых событий и сохранения качества жизни у пациентов с АГ и старческой астенией. АД снижается в позднем периоде жизни у пациентов, полностью зависимых от посторонней помощи. Смертность у пациентов со старческой астенией и низким АД выше, чем при высоком АД, что ставит вопрос об оптимальном уровне АД у этой уязвимой категории пациентов. Когнитивное снижение — один из доменов старческой астении, тесно ассоциированный с утратой автономности, способности к самообслуживанию и снижением качества жизни. Остается спорным, оказывает ли антигипертензивная терапия положительные эффекты на когнитивные функции у пациентов очень пожилого возраста.

Frailty is a state of increased vulnerability to endo- and exogenous stress factors when the physiological reserve is decreased due to ageing. Frailty poses challenges for the management of arterial hypertension (HTN) and other chronic cardiovascular and non-cardiovascular diseases in older adultst. Although many Russian and international clinical guidelines on HTN frailty recommended to consider it in decision making process on antihypertensive therapy tactics, the optimal criteria and instruments are still uncertain. HTN is common in patients with frailty, but the direct impact of HTN on frailty development has not been fully established. Blood pressure (BP) control is important for reducing the risk of cardiovascular events and maintaining quality of life in patients with HTN and frailty. BP decreases in later life and in patients who are completely dependent in daily activity. Mortality in patients with frailty and low BP is higher than in patients with high BP, which raises the question of the optimal BP level in this vulnerable category of patients. Cognitive decline is one of the domains of frailty that is closely associated with loss of autonomy, self-care ability, and reduced quality of life. It remains controversial whether antihypertensive therapy has beneficial effects on cognition in very old patients.

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