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Артериальная гипертензия

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Артериальная гипертония у пациентов старших возрастных групп: когда и кому нужен гериатрический подход?

https://doi.org/10.18705/1607-419X-2019-25-4-357-375

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Аннотация

Повышенное артериальное давление (АД) является важным фактором риска не только сердечно-сосудистой заболеваемости и смертности, но и снижения когнитивных функций и утраты автономности в более позднем периоде жизни. Рандомизированные клинические исследования (РКИ) в популяциях пациентов старшего возраста, проживающих дома, с невысокой коморбидностью и сохранной автономностью указывают на пользу снижения повышенного АД у пациентов старше 80 лет. Пациенты старшего возраста со старческой астенией, с утратой автономности и рядом других гериатрических проблем систематически исключались из РКИ, а наблюдательные исследования у этих групп пациентов указывают на повышение заболеваемости и смертности при более низком уровне АД и на фоне антигипертензивной терапии.  Очевидно, что у очень пожилых пациентов не может применяться универсальная стратегия лечения АГ в виду значительной гетерогенности их функционального статуса. В обзоре обсуждается подход с позиции гериатрической медицины, который предполагает оценку функционального статуса пациента, наличия старческой астении и степени сохранности автономности для выбора тактики антигипертензивной терапии.

Об авторах

Ю. В. Котовская
Обособленное структурное подразделение «Российский геронтологический научно-клинический центр» Федерального государственного автономного образовательного учреждения высшего образования «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России

Котовская Юлия Викторовна — профессор, заместитель директора по научной работе

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



О. Н. Ткачева
Обособленное структурное подразделение «Российский геронтологический научно-клинический центр» Федерального государственного автономного образовательного учреждения высшего образования «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России
Россия

Ткачёва Ольга Николаевна — доктор медицинских наук, профессор, директор ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пи­рогова» Минздрава России, Российский геронтологический научно-клинический центр

Москва



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Для цитирования:


Котовская Ю.В., Ткачева О.Н. Артериальная гипертония у пациентов старших возрастных групп: когда и кому нужен гериатрический подход? Артериальная гипертензия. 2019;25(4):357-375. https://doi.org/10.18705/1607-419X-2019-25-4-357-375

For citation:


Kotovskaya Y.V., Tkacheva O.N. Arterial hypertension in older adults: who needs geriatric approach? "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2019;25(4):357-375. (In Russ.) https://doi.org/10.18705/1607-419X-2019-25-4-357-375

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