arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2016-22-2-128-143arthyper-419Research ArticleЛЕКЦИЯLECTUREПатогенетические механизмы формирования стойкой артериальной гипертензии при хроническом психоэмоциональном напряженииPathogenic mechanisms of arterial hypertension in patients with chronic psychoemotional stressУшаковА. В.UshakovA. V.

доктор медицинских наук, профессор, заведующий кафедрой внутренней медицины № 1 с курсом клинической фармакологии Медицинской академии имени С. И. Георгиевского ФГАОУ ВО «КФУ им. В. И. Вернадского»

MD, PhD, DSc, Professor, Head, Department of Internal Medicine № 1 with the Clinical Pharmacology Course, Medical Academy n. a. S. I. Georgievsky, V. I. Vernadsky Crimean Federal University

ИванченкоВ. С.IvanchenkoV. S.

аспирант кафедры внутренней медицины № 1 с курсом клинической фармакологии Медицинской академии имени С. И. Георгиевского ФГАОУ ВО «КФУ им. В. И. Вернадского»

MD, PhD, PhD Student, Department of Internal Medicine № 1 with the Clinical Pharmacology Сourse, Medical Academy n. a. S. I. Georgievsky, V. I. Vernadsky Crimean Federal University

ГагаринаА. А.GagarinaA. A.

кандидат медицинских наук, доцент кафедры внутренней медицины № 1 с курсом клинической фармакологии Медицинской академии имени С. И. Георгиевского ФГАОУ ВО «КФУ им. В. И. Вернадского»

MD, PhD, Associate Professor, Department of Internal Medicine № 1 with the Clinical Pharmacology Course, Medical Academy n. a. S. I. Georgievsky, V. I. Vernadsky Crimean Federal University

Медицинская академия имени С. И. Георгиевского Федерального государственного автономного образовательного учреждения высшего образования «Крымский федеральный университет имени В. И. Вернадского», Симферополь, Россия кафедра внутренней медицины № 1 с курсом клинической фармакологии, пр. Академика Вернадского, д. 4, Симферополь, Россия, 295007. Тел.: +7(3652)54– 50–36РоссияMedical Academy named after S. I. Georgievsky, V. I. Vernadsky Crimean Federal University, Department of Internal Medicine No.1 with the Clinical Pharmacology course, 4 Academician Vernadsky avenue, Simferopol, 295007 Russia. Phone: +7(3652)54–50–36.Russian FederationМедицинская академия имени С. И. Георгиевского Федерального государственного автономного образовательного учреждения высшего образования «Крымский федеральный университет имени В. И. Вернадского», Симферополь, РоссияРоссияMedical Academy named after S. I. Georgievsky, V. I. Vernadsky Crimean Federal University, Simferopol, RussiaRussian Federation201622082016222128143Copyright © Ушаков А.В., Иванченко В.С., Гагарина А.А., 20162016Ушаков А.В., Иванченко В.С., Гагарина А.А.Ushakov A.V., Ivanchenko V.S., Gagarina A.A.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/419

Статья представляет собой обзор литературы, в котором обсуждается значимость психоэмоциональных факторов в формировании стойкой артериальной гипертензии (АГ). АГ и ассоциированные с ней сердечно-сосудистые заболевания занимают лидирующее место среди причин высокой смертности и ранней инвалидизации взрослого населения. Как известно, повышенное артериальное давление (АД) является основным модифицируемым фактором риска преждевременной смерти, инфаркта миокарда, мозгового инсульта и других сердечно-сосудистых осложнений. Патогенез АГ является сложным и многофакторным с существенной вариабельностью задействуемых механизмов у каждого конкретного больного. В этой связи определение конкретных патогенетических механизмов, лежащих в основе развития стойкого повышения АД у отдельного пациента, позволит существенно индивидуализировать терапевтические подходы, а следовательно, и повысить эффективность лечения. Среди факторов, способствующих становлению АГ, в последнее время вновь стало широко обсуждаться влияние психоэмоционального стресса. Глобальная урбанизация, малоподвижный образ жизни, ежедневный стресс на рабочем месте и отсутствие социальной поддержки приводят к повышенной тревожности, неуверенности и, наконец, к хроническому психоэмоциональному напряжению. В данном обзоре проанализированы основные психофизиологические маркеры хронического стресса, а также нейроэндокринные и иммунологические механизмы, лежащие в основе формирования АГ. Обсуждается роль эндотелиальной дисфункции в качестве связывающего звена между хроническим стрессом и стабильным повышением АД.

The article is based on literature review and describes the implication of psycho-emotional factors in the development of arterial hypertension (HTN). HTN and its cardiovascular complications take a leading place among the causes of high mortality and disability in the adult population. High blood pressure (BP) is known to be a major modifiable risk factor for premature death, myocardial infarction, stroke and other cardiovascular diseases. The pathogenesis of HTN is complex and multifactorial with a significant variability of the involved mechanisms in individual patients. In this regard, the determination of specific pathogenic mechanisms underlying stable BP elevation would substantially individualize therapeutic approaches, and hence increase the effectiveness of treatment. The role of psycho-emotional stress has been recently reassessed and it is widely discussed as a factor contributing to the HTN formation. Global urbanization, sedentary lifestyle, daily work-related stress, lack of physical activity and social support lead to increased anxiety, uncertainty, and finally to chronic mental and emotional stress. This review analyzes the main physiological markers of chronic stress, neuroendocrine and immunological mechanisms underlying the development of HTN. The role of endothelial dysfunction as a binding link between chronic stress and high BP is also discussed.

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