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Артериальная гипертензия

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Повышенная частота сердечных сокращений у пациентов с артериальной гипертонией и ишемической болезнью сердца: маркер тяжести заболевания или корригируемый фактор риска при сохраненной фракции выброса левого желудочка

https://doi.org/10.18705/1607-419X-2019-25-4-389-406

Полный текст:

Аннотация

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.

Об авторах

Е. В. Кохан
Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»
Россия

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



Г. К. Киякбаев
Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»
Россия

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



Ж. Д. Кобалава
Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»
Россия

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



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Для цитирования:


Кохан Е.В., Киякбаев Г.К., Кобалава Ж.Д. Повышенная частота сердечных сокращений у пациентов с артериальной гипертонией и ишемической болезнью сердца: маркер тяжести заболевания или корригируемый фактор риска при сохраненной фракции выброса левого желудочка. Артериальная гипертензия. 2019;25(4):389-406. https://doi.org/10.18705/1607-419X-2019-25-4-389-406

For citation:


Kokhan E.V., Kiyakbaev G.K., Kobalava Z.D. Elevated heart rate in hypertension and coronary artery disease: risk factor or risk marker in patients with preserved left ventricular ejection fraction. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2019;25(4):389-406. (In Russ.) https://doi.org/10.18705/1607-419X-2019-25-4-389-406

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