Лекарственно-индуцированная ортостатическая гипотензия

Ортостатическая гипотензия (ОГ) является одним из значимых симптомов в клинической практике. С развитием ОГ в краткосрочной перспективе связаны такие последствия, как падения, снижение приверженности лечению, в долгосрочной перспективе ОГ ассоциируется с деменцией и повышением общей смертности. Одним из ведущих факторов развития ОГ являются лекарственные средства, в таком случае используется термин «лекарственно-индуцированная» (ЛИ) ОГ. К ведущим препаратам – индукторам данного симптома относятся антигипертензивные препараты, вазодилататоры, а также альфа-адреноблокаторы и антидепрессанты. Факторами риска ЛИ ОГ являются пожилой возраст, сопутствующие заболевания, в особенности артериальная гипертензия (АГ). Сложным является вопрос ЛИ ОГ у пациентов с АГ: с одной стороны, АГ является фактором риска ОГ, кроме того, антигипертензивные препараты являются индукторами ОГ и увеличение количества антигипертензивных препаратов может приводить к увеличению риска развития ОГ, а с другой стороны, оптимальная комбинированная терапия АГ, напротив, приводит к снижению выраженности ОГ. Основа лечения ЛИ ОГ – коррекция терапии с отменой либо заменой препарата. Ведущими методами профилактики и лечения являются нефармакологические, требующие активного участия пациента – определенный алгоритм принятия вертикального положения, изменение пищевого поведения и контрманевры. Методы фармакологической терапии играют второстепенную роль. Информирование врачей, а также самих пациентов о проблеме ЛИ ОГ играет важную роль в профилактике ее последствий.

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