Цель: исследовать особенности поражения органов-мишеней, нейрогуморального и противовоспалительного статуса у пациентов с резистентной артериальной гипертензией (РАГ). Материалы и методы. В исследование включены 257 пациентов с предварительным диагнозом РАГ. Вторичная АГ диагностирована у 8,5 % больных. На фоне 3-месячного лечения трехкомпонентной фиксированной комбинацией антигипертензивных препаратов в максимальных дозах выделены пациенты с истинной РАГ (n = 103) и больные с псевдорезистентной АГ (ПРАГ) (n = 132). Проведен сравнительный анализ клинических характеристик, степени поражения органов-мишеней, особенностей нейрогуморального (альдостерон, активный ренин в плазме, метанефрини в моче) и противовоспалительного (С-реактивный протеин (СРП), интерлейкин-6 (ИЛ-6), фактор некроза опухоли α (ФНО-α) в плазме) статуса между группами. Результаты. Пациенты с РАГ характеризуются высоким уровнем офисного и амбулаторного артериального давления (АД), наличием до 14 % нарушений суточного ритма АД по типу nigh-peaker, высоким утренним приростом АД. Пациенты с РАГ имели в 95 % случаев концентрическую гипертрофию левого желудочка и в 80 % — атеросклеротические бляшки в сонных артериях, существенное снижение расчетной скорости клубочковой фильтрации и увеличение экскреции альбумина с мочой. Более высокое содержание СРП на 17,3 % (р = 0,02), ИЛ-6 на 21,8 % (р = 0,01), ФНО-α на 13 % (р = 0,003) установлено в группе РАГ по сравнению с группой ПРАГ. Выводы. Пациенты с РАГ имеют высокий уровень АД, поражение органов-мишеней, более выражены признаки активации системного воспаления низкой градации и активность симпатоадреналовой и ренин-альдостерон-ангиотензиновой систем.

The aim – to study the activity of low-grade inflammation and determine an interaction of its parameters with characteristics of humoral systems of blood pressure regulation, hypertensive heart and kidney damage in patients with resistant arterial hypertension (AH).Material and methods. The results of examination of 129 patients with AH (72 patients with controlled AH, 57 persons with resistant AH) were included into the analysis. All patients, besides routine clinical examination, underwent 24-hours’ blood pressure monitoring, evaluation of systemiс inflammation markers (C-reactive protein, fibrinogen, IL-6, TNF-α), MMP-12 activity, cystatin C, renin, aldosterone, citrulline blood concentration; 24-hours’ excretion of albumin and metanephrine. Results. In the resistant AH, compared to the patients with controlled arterial hypertension, higher levels of inflammation active phase proteins (C-reactive proteins – by 17.3 %, fibrinogen – by 10.6 %) and proinflammatory cytokines (IL-6 by 21.8 % TNF-α by 13 %) were detected. The activation of low-grade inflammation in patients with resistant AH has been associated with higher renin-angiotensin-aldosterone system activity: the concentration of plasma aldosterone correlated with IL-6 level (r=0.334; Р=0.03) and matrix metalloproteinase 12 activity (r=0.326; Р=0.02); active renin blood contents – with IL-6 (r=0.416; Р=0.01) and TNF-α (r=0.323; Р=0.03) levels). In patients with resistant AH the increase of left ventricle myocardial mass index was accompanied by elevation of plasma IL-6, and decrease of glomerular filtration rate was associated with growth of plasma TNF-α blood level (r=0.318; Р=0.04). Correlation of MMP-12 activity with renal impairment markers – cystatin С (r=0.405; Р=0.01) and citrulline (r=0.338; Р=0.03) was detected. In resistant AH pts increase of LVMI was accompanied by elevation of IL-6.Conclusions. Resistant AH was characterized by more expressed activation of low – grade inflammation, compared to controlled AH, which is associated with renin-angiotensin-aldosterone system activation and hypertensive injury of heart and kidneys.

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The aim – to evaluate the features of the target organs damage, neurohumoral and proinflammatory status and to determine the predictors of the effectiveness of antihypertensive therapy in patients with resistant arterial hypertension (RAH). Materials and methods. The study included 257 patients with apparent RAH. The secondary hypertension was revealed in 8.5 % of patients. After 3 months therapy with triple fixed-dose combination (FDC) of antihypertensive drugs in maximum tolerated doses, patients were distributed into two groups – true RAH (n=103) and patients with pseudo resistant AH (PRAH) (n=132). We performed the comparative analysis of clinical characteristics, target organ damage degree, features of neurohumoral (plasma concentration of aldosterone and active renin, 24 – hour urinary metanephrines) and proinflammatory (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor – α (TNF-α) in plasma) status among groups. The predictors of effectiveness of the 4th antihypertensive drug addition (spironolactone, eplerenone, nebivоlol, moxonidine) to triple FDC in patients with RAH were studied. Results and discussion. Higher levels of office and ambulatory blood pressure (BP), frequent (up to 14 %) disturbance of BP rhythm as night-peaker type, high BP morning surge are typical for RAH patients. 95 % of RAH patients had concentric left ventricular hypertrophy and 80 % – carotid atherosclerosis, a lower glomerular filtration rate and higher level of urinary albumin excretion rate (UAER). RAH patients had higher level of CRP – by 17.3 % (p=0.02), IL-6 – by 21.8 % (p=0.01), TNF-α – by 13 % (p=0.003) in comparison with PRAH patients. The predictors of spironolactone and eplerenone efficacy are plasma aldosterone concentration (β=0.653; p=0.002), aldosterone-renin ratio (β=0.542; p=0.003), UAE (β=–0.362; p=0.01) and the level of CRP (β=–0.315; p=0.03). Conclusions. Higher level of BP, target organ damage, more expressed activation of low – grade inflammation, sympathetic and renin-aldosterone-angiotensin systems activity are typical for RAH patients. The most effective drugs in addition to three – component FDC are MRA – spironolactone and eplerenone, which lead to the achievement of target BP at 48.5 % and 46.9 % (according to office and ambulatory testing) RAH patients. Nebivolol application contributed to BP normalization at 39.7 % and moxonidine – at 41.2 % RAH patients.