Evidence, Guidelines and Treatment Algorithms for Patients with Arterial Hypertension and Dyslipidemia: the Need for Compromise and Optimization of Tactics in Practical Healthcare
https://doi.org/10.20996/1819-6446-2019-15-4-578-585
Abstract
The scientific basis of the selection algorithms for the management of patients with hypertension and hypercholesterolemia is presented in article. The advantages and limitations of current recommendations on the management of patients with hypercholesterolemia, which were presented by American and European experts, are discussed. Data on the narrow-mindedness of use of risk assessment scales for the development of cardiovascular complications for primary prevention in a wide population are presented. The question of the ratio of proven facts and expert opinions in clinical recommendations, as well as the validity of a flexible approach to the choice of tactics for a specific patient, considering the most acceptable approaches presented in different clinical recommendations, is being considered. The validity of recommendations for achieving lower concentrations of lowdensity lipoprotein cholesterol in patients with high and very high cardiovascular risk is discussed. The difficult problem of choosing target blood pressure levels in patients with hypertension and with some characteristics or concomitant diseases and/or risk factors is discussed. The evidence base of modern drugs for preventing the development of cardiovascular complications and/or treating patients with such complications is discussed, including new data on the benefits of longer treatment with atorvastatin for the primary prevention of cardiovascular complications in patients with hypertension are discussed. Data on the problems of the choice of drugs used for the primary or secondary prevention of cardiovascular complications in patients with hypertension and hypercholesterolemia are presented.
About the Authors
O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Oxana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director
Petroverigsky per. 10, Moscow, 101990 Russia
M. V. Ezhov
National Medical Research Centre of Cardiology
Russian Federation
Russian Federation
Marat V. Ezhov – MD, PhD, Professor, Chief Researcher, Department of Atherosclerosis
Tretya Cherepkovskaya ul. 15А, Moscow, 121552 Russia
S. R. Gilyarevsky
Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Sergey R. Gilyarevsky – MD, PhD, Professor, Chair of Clinical Pharmacology and Therapy
Barrikadnaya ul. 2, Moscow, 123242 Russia
R. N Shepel
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Ruslan N. Shepel – Researcher, Department of Fundamental and Applied Aspects of Obesity; Head of Department of organizational and methodological management and analysis of the quality of medical care; Assistant Director for Regional Development, National Medical Research Center for Preventive Medicine
Barrikadnaya ul. 2, Moscow, 123242 Russia
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Review
For citations:
Drapkina O.M., Ezhov M.V., Gilyarevsky S.R., Shepel R.N. Evidence, Guidelines and Treatment Algorithms for Patients with Arterial Hypertension and Dyslipidemia: the Need for Compromise and Optimization of Tactics in Practical Healthcare. Rational Pharmacotherapy in Cardiology. 2019;15(4):578-585. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-4-578-585
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