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АНЕСТЕЗІОЛОГИ, ХІРУРГИ

"Hypertension" Том 14, №6, 2021

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Weight-Loss Strategies for Prevention and Treatment of Hypertension. A Scientific Statement From the American Heart Association

Authors: Michael E. Hall, MD, MS, FAHA, голова, Jordana B. Cohen, MD, MSCE, заступник голови; Jamy D. Ard, MD, Brent M. Egan, MD, FAHA, John E. Hall, PhD, FAHA, Carl J. Lavie, MD, Jun Ma, MD, PhD, FAHA, Chiadi E. Ndumele, MD, MHS, Philip R. Schauer, MD, Daichi Shimbo, MD
від імені Комітету Американської асоціації серця із гіпертензії; Комітету з атеросклерозу, тромбозу та судинної біології; Комітету зі способу життя та кардіометаболічного здоров’я та Комітету із інсульт

Categories: Cardiology

Sections: Specialist manual

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Summary

Артеріальна гіпертензія є основним фактором ризику серцево-судинних та ниркових захворювань у США та в усьому світі. Ожиріння становить значну частину ризику щодо розвитку первинної гіпертензії через декілька механізмів, включаючи нейрогормональну активацію, запалення та дисфункцію нирок. Оскільки поширеність ожиріння продовжує зростати, частота гіпертензії та пов’язаних із нею серцево-ниркових захворювань також буде зростати, якщо не будуть розроблені більш ефективні стратегії запобігання ожирінню та його лікування. Хворим на ожиріння, як правило, рекомендується зміна способу життя, включаючи дієту, зменшення малорухливого життя та підвищення фізичної активності; однак довгостроковий успіх цих стратегій для зменшення ожиріння, підтримки втрати маси тіла та зниження артеріального тиску був обмеженим. Ефективні фармакотерапевтичні та процедурні стратегії, включаючи метаболічні операції, є додатковими можливостями для лікування ожиріння та запобігання або ослаблення гіпертензії при ожирінні, пошкодження органів-мішеней та розвитку наступних ускладнень. Ліки можуть бути корисними для короткочасного та тривалого лікування ожиріння; однак призначення цих ліків є обмеженим. Метаболічна хірургія ефективна для досягнення стійкої втрати ваги та для лікування гіпертензії та метаболічних розладів у багатьох пацієнтів із тяжким ожирінням. Залишаються без відповіді питання щодо механізмів розвитку захворювань, пов’язаних з ожирінням, довгострокової ефективності різних стратегій лікування та профілактики, а також термінів цих втручань для запобігання ожирінню та опосередкованому гіпертензією ураженню органів-мішеней. Подальші дослідження, включаючи рандомізовані контрольовані дослідження, мають важливе значення для вирішення цих питань, і акцент слід зробити на профілактиці ожиріння, щоб зменшити тягар асоційованих із гіпертензією серцево-судинних і ниркових захворювань і подальшої смертності.

Hypertension is a major risk factor for cardiovascular and renal diseases in the United States and worldwide. Obesity accounts for much of the risk for primary hypertension through several mechanisms, including neurohormonal activation, inflammation, and kidney dysfunction. As the prevalence of obesity continues to increase, hypertension and associated cardiorenal diseases will also increase unless more effective strategies to prevent and treat obesity are developed. Lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited. Effective pharmacotherapeutic and procedural strategies, including metabolic surgeries, are additional options to treat obesity and prevent or attenuate obesity hypertension, target organ damage, and subsequent disease. Medications can be useful for short- and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity. Unanswered questions remain related to the mechanisms of obesity-related diseases, long-term efficacy of different treatment and prevention strategies, and timing of these interventions to prevent obesity and hypertension-mediated target organ damage. Further investigation, including randomized controlled trials, is essential to addressing these questions, and emphasis should be placed on the prevention of obesity to reduce the burden of hypertensive cardiovascular and kidney diseases and subsequent mortality.


Keywords

наукова заява Американської асоціації серця; артеріальний тиск; метаблічні операції; ожиріння

AHA Scientific Statements; blood pressure; metabolic surgery; obesity


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