Updating approaches to patient management in the light of new European guidelines on arterial hypertension: analytical review

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Abstract

Data from epidemiological studies show a high prevalence of cardiovascular diseases, including arterial hypertension (AH) and the risk of complications, with changes in AH control and treatment techniques. The review article summarizes the main directions of the new European guidelines on hypertension, which help implement different patient groups in outpatient practice. Secondary risk factors for cardiovascular disease are revised in the new clinical guidelines. The recommendation outlines a diagnostic and therapeutic approach for resistant arterial hypertension, its associated phenotypes, and night-time hypertension. The use and position of renal denervation for antihypertensive treatment have been updated compared with previous recommendations. The new European clinical guidelines reflect a differentiated approach to target indicators of ambulatory blood pressure in different age groups, with functional levels of aging, comorbidity, and AH phenotypes, which is of great clinical importance for a primary care physician and can significantly reduce the risk of heart disease vascular complications.

About the authors

Vera N. Larina

Pirogov Russian National Research Medical University

Author for correspondence.
Email: larinav@mail.ru
ORCID iD: 0000-0001-7825-5597
SPIN-code: 3674-9620

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Elena A. Vartanyan

Pirogov Russian National Research Medical University

Email: mediportmail@gmail.com
ORCID iD: 0000-0002-7714-0832
SPIN-code: 1367-0097

MD, Cand. Sci. (Med.), associate professor

Russian Federation, Moscow

Ekaterina V. Fedorova

Pirogov Russian National Research Medical University

Email: evfedorova91@mail.ru
ORCID iD: 0000-0002-7623-7376
SPIN-code: 4014-4245

MD, Cand. Sci. (Med.), assistant

Russian Federation, Moscow

Marina P. Mikhaylusova

Pirogov Russian National Research Medical University

Email: mikhailusova@yandex.ru
ORCID iD: 0000-0003-0271-6726
SPIN-code: 3428-4959

MD, Cand. Sci. (Med.), associate professor

Russian Federation, Moscow

Olga V. Sayno

Pirogov Russian National Research Medical University

Email: OlgaSayno33@gmail.com
ORCID iD: 0000-0002-1841-5066
SPIN-code: 6168-7137

MD, Cand. Sci. (Med.), associate professor

Russian Federation, Moscow

Tatiyana N. Mironova

Pirogov Russian National Research Medical University

Email: mironova.tanya.90@yandex.ru
ORCID iD: 0000-0002-6430-7111
SPIN-code: 1089-3342

MD, Cand. Sci. (Med.), assistant

Russian Federation, Moscow

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2. Fig. 1. Factors determining cardiovascular risk in patients with arterial hypertension. Note. SCORE 2 (Systematic Coronary Risk Evaluation 2) and SCORE 2-OP predict the 10-year risk of fatal and nonfatal cardiovascular events in people aged 40–69 (SCORE2) and 70 years and older (SCORE 2-OP). ЧСС — heart rate, ЛП (а) — lipoprotein (a), НАЖБП — non-alcoholic fatty liver disease, ХВЗ — chronic inflammatory diseases, ЭД — erectile dysfunction, ХОБЛ — chronic obstructive pulmonary disease.

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3. Fig. 2. Phenotypes of arterial hypertension (European Society of Hypertension, 2023). Note. ГБХ — white coat hypertension, АГ — arterial hypertension, ИСАГ — isolated systolic arterial hypertension.

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4. Fig. 3. Definition of truly resistant arterial hypertension and principles of antihypertensive therapy. Note. САД — systolic blood pressure, ДАД — diastolic blood pressure, ИАПФ — angiotensin-converting enzyme inhibitors, БРА — angiotensin II receptor blockers, АК — calcium antagonists, Т/ТП — thiazide and thiazide-like diuretics, ПОМ — target organ damage, СМАД — 24-hour blood pressure monitoring, ССЗ — cardiovascular diseases.

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