The new 2018 European guidelines for the management of arterial hypertension: the most important aspects of use in real-life clinical practice

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Aim. To present the fundamental standpoints of renewed 2018 European guidelines for the management of arterial hypertension and to discuss aspects of its use in real-life clinical practice with due consideration of Russian experts opinions. Materials and methods. 2018 European guidelines for the management of arterial hypertension and Russian Society of Cardiology Memorandum on these guidelines are discussed. Results and conclusion. Fundamental standpoints of 2018 European guidelines for the management of arterial hypertension as well as essential and important in context of real-life clinical practice changes in comparison with the previous revision are presented. Much attention is given to risk factors and associated with hypertension organ damage detection. Special focus is made on the main principle of blood pressure pharmacological control - “one pill strategy”. A step to step regimen for prescription of combined antihypertensive therapy where renin angiotensin aldosterone system (RAAS) inhibitors are first line medications is presented. At the first stage the choice combination includes angiotensin-converting-enzyme inhibitor or angiotensin II receptor blocker and dihydropyridine calcium channel blocker or diuretic. It is outlined that for the first time in the guidelines the use of 3-component antihypertensive therapy in the form of “one pill” is emphasized and its actual components are specified (RAAS inhibitor, calcium channel blocker and diuretic). Also a small subset of patients in whom it is possible to use antihypertensive medications in monotherapy is described. The management of elderly and very elderly patients and patients with senile asthenia syndrome is described. Target blood pressure levels depending on comorbid disorders existence such as diabetes mellitus, chronic kidney disease, ischemic kidney disease, stroke and/or transient ischemic attack as well as patient age are discussed. All standpoints of European guidelines for the management of arterial hypertension are discussed from the point of view of Russian experts that is presented in Russian Society of Cardiology Memorandum. The second part of the article presents possibilities of one pill strategy use in combined antihypertensive therapy based of valsartan and discusses the importance of patients’ compliance to blood pressure pharmacological control and ways of improving this compliance.

About the authors

Olga D. Ostroumova

N.I.Pirogov National Medical and Surgical Center of the Ministry of Health of the Russian Federation - Russian Clinical and Research Center of Gerontology

Email: ostroumova.olga@mail.ru
D. Sci. (Med.), Prof., Head of Laboratory of Clinical Pharmacology and Pharmacotherapy 16, 1-ia Leonova st., Moscow, 129226, Russian Federation

Aleksei I. Kochetkov

N.I.Pirogov National Medical and Surgical Center of the Ministry of Health of the Russian Federation - Russian Clinical and Research Center of Gerontology

Email: ak_info@list.ru
Cand. Sci. (Med.), Research Assistant in Laboratory of Clinical Pharmacology and Pharmacotherapy 16, 1-ia Leonova st., Moscow, 129226, Russian Federation

References

  1. Williams B, Mancia G, Spiering W et al; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018; 39 (33): 3021-104. doi: 10.1093/eurheartj/ehy339
  2. Кобалава Ж.Д., Конради А.О., Недогода С.В. и др. Меморандум экспертов Российского кардиологического общества по рекомендациям Европейского общества кардиологов/Европейского общества по артериальной гипертензии по лечению артериальной гипертензии 2018 г. Рос. кардиол. журн. 2018; 23 (12): 131-42. doi: 10.15829/1560-4071-2018-12-131-14
  3. Weber K.T, Brilla C.G, Janicki J.S. Myocardial fibrosis: functional significance and regulatory factors. Cardiovasc Res 1993; 27: 341-8.
  4. Fisher J.P, Paton J.F. The sympathetic nervous system and blood pressure in humans: implications for hypertension. J Hum Hypertens 2012; 26 (8): 463-75.
  5. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281-357. doi: 10.1097/01.hjh.0000431740.32696.cc
  6. Van Sloten T.T, Stehouwer C.D. Carotid Stiffness: A Novel Cerebrovascular Disease Risk Factor. Pulse (Basel) 2016; 4 (1): 24-7. doi: 10.1159/000445354
  7. Laurent S, Katsahian S, Fassot C et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003; 34 (5): 1203-6. doi: 10.1161/01.STR.0000065428.03209.64
  8. Laurent S, Boutouyrie P, Asmar R et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37: 1236-41.
  9. Kullo I.J, Bielak L.F, Turner S.T et al. Aortic pulse wave velocity is associated with the presence and quantity of coronary artery calcium: a community-based study. Hypertension 2006; 47 (2): 174-9. doi: 10.1161/01.HYP.0000199605.35173.14
  10. Corrao G, Mazzola P, Monzio Compagnoni M et al. Antihypertensive medications, loop diuretics, and risk of hip fracture in the elderly: a population-based cohort study of 81.617 Italian patients newly treated between 2005 and 2009. Drugs Aging 2015; 32: 927-36.
  11. Kjeldsen S.E, Stenehjem A, Os I et al. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press 2016; 25: 333-6.
  12. Galzerano D, Capogrosso C, Di Michele S et al. New standards in hypertension and cardiovascular risk management: focus on telmisartan. Vasc Health Risk Manag 2010; 6: 113-33.
  13. Максимов М.Л., Ермолаева А.С., Дралова О.В. Когда назначать валсартан? Применение блокатора рецепторов ангиотензина валсартана в фармакотерапии сердечно-сосудистых заболеваний. Артериальная гипертензия. 2013; 19 (5): 458-71.
  14. Остроумова О.Д., Гусева Т.Ф., Шорикова Е.Г. Применение препарата Вальсакор® при артериальной гипертонии: результаты словенского многоцентрового исследования. Рус. мед. журн. 2010; 18 (2): 642.
  15. Yusuf S, Hawken S, Ounpuu S et al; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364 (9438): 937-52. doi: 10.1016/S0140-6736(04)17018-9
  16. Rapsomaniki E, Timmis A, George J et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet 2014; 383 (9932): 1899-911. doi: 10.1016/S0140-6736(14)60685-1
  17. Ettehad D, Emdin C.A, Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387 (10022): 957-67. doi: 10.1016/S0140-6736(15)01225-8
  18. McMurray J, Solomon S, Pieper K et al. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol 2006; 47 (4): 726-33.
  19. Maggioni A.P, Latini R, Carson P.E et al; Val-HeFT Investigators. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J 2005; 149 (3): 548-57.
  20. Cohn J.N, Tognoni G; Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001; 345 (23): 1667-75.
  21. Чазова И.Е., Мартынюк Т.В., Accetto R и др. Итоги международного клинического исследования VICTORY: эффективность и безопасность антигипертензивной монотерапии валсартаном (Вальсакор®) и его фиксированной комбинации с гидрохлоротиазидом (Вальсакор® Н) у пациентов с артериальной гипертонией 1-2-й степени. Системные гипертензии. 2017; 14 (2): 80-9. doi: 10.26442/2075-082X_14.2.80-89
  22. Чазова И.Е., Мартынюк Т.В., Accetto R. и др. Влияние антигипертензивной терапии валсартаном и его фиксированной комбинации с гидрохлоротиазидом на скорость пульсовой волны и центральное артериальное давление у пациентов с артериальной гипертонией 1-2-й степени по результатам международного клинического исследования VICTORY. Системные гипертензии. 2018; 15 (2): 6-13. doi: 10.26442/2075-082X_2018.2.6-13.
  23. Борисова Е.В., Кочетков А.И., Остроумова О.Д. Влияние фиксированной комбинации валсартан/амлодипин на уровень артериального давления и параметры жесткости сосудов у пациентов с эссенциальной гипертонией 1-2 степени. Рациональная фармакотерапия в кардиологии. 2018; 14 (6): 831-9. doi: 10.20996/1819-6446-2018-14-6-831-839
  24. Assaad-Khalil S.H, Najem R, Sison J et al. Real-world effectiveness of amlodipine/valsartan and amlodipine/valsartan/hydrochlorothiazide in high-risk patients and other subgroups. Vasc Health Risk Management 2015; 11: 71-8. doi: 10.2147/VHRM.S76599
  25. Hagendorff A, Kurz I, Müller A, Klebs S. Evaluation of effectiveness and safety of amlodipine/valsartan/hydrochlorothiazide single-pill combination therapy in hypertensive patients: an observational study. J Drug Assess 2014; 3 (1): 1-9. doi: 10.3109/21556660.2014.884506

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