avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2026-16-1-5-11APSOHTavk-2162Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESСтратегия депрескрайбинга антигипертензивных препаратов у очень пожилых и ослабленных пациентов: обзор современных данныхStrategy for Depressing Antihypertensive Drugs in Very Elderly and Fragile Patients: A Review of Contemporary Datahttps://orcid.org/0000-0002-6233-7202АнтроповаО. Н.AntropovaO. N.

Антропова Оксана Николаевна — д.м.н., профессор

Барнаул 

Oksana N. Antropova — MD, PhD, Professor 

Barnaul 

antropovaon@mail.ruhttps://orcid.org/0000-0002-6845-6173ОсиповаИ. В.OsipovaI. V.

Осипова Ирина Владимировна — д.м.н., заведующий кафедрой 

Барнаул 

Irina V. Osipova — MD, PhD, Head of the Department 

Barnaul 

i.v.osipova@gmail.comhttps://orcid.org/0000-0003-4387-7737ПыриковаН. В.PyrikovaN. V.

Пырикова Наталья Викторовна — д.м.н., профессор кафедры 

Барнаул 

Natalya V. Pyrikova — MD, PhD, Professor 

Barnaul 

allinatali@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Алтайский государственный медицинский университет» Министерства здравоохранения Российской Федерации, кафедра факультетской терапии и гериатрииРоссияFederal State Budgetary Educational Institution of Higher Education «Altai State Medical University» of the Ministry of Health of the Russian Federation, Department of Faculty Therapy and GeriatricsRussian Federation202605022026161511Copyright © Антропова О.Н., Осипова И.В., Пырикова Н.В., 20262026Антропова О.Н., Осипова И.В., Пырикова Н.В.Antropova O.N., Osipova I.V., Pyrikova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/2162

Антигипертензивные препараты снижают риск инсульта и сердечно-сосудистых заболеваний во всех возрастных группах. Однако, у пожилых и ослабленных пациентов антигипертензивное лечение связано с повышенным риском гипотонии, обморока, острого повреждения почек и гиперкалиемии, у таких пациентов риск нежелательных явлений может превышать пользу от антигипертензивного лечения, и для снижения этого риска предлагается отмена назначения препарата. Концепция депрескрайбинга антигипертензивных препаратов новая и многие практические аспекты требуют дальнейшего изучения в рандомизированных контролируемых исследованиях для определения долгосрочных эффектов, определяющих важные клинические результаты и качество жизни пожилых пациентов. Необходимо признать, что отмена антигипертензивных препаратов является областью с ограниченными доказательствами, с очень небольшим количеством клинических испытаний, оценивающих долгосрочные клинические эффекты. В данном обзоре рассмотрены обоснование и возможные препятствия к внедрению в клиническую практику контролируемой отмены антигипертензивных препаратов у лиц пожилого и старческого возраста. Приведены рекомендации по идентификации пациентов с высоким риском нежелательных явлений и алгоритму депрескрайбинга.

Antihypertensive drugs reduce the risk of stroke and cardiovascular disease in all age groups. However, in elderly and frail patients, antihypertensive treatment is associated with an increased risk of hypotension, syncope, acute kidney injury and hyperkalemia; in these patients, the risk of AEs may outweigh the benefits of antihypertensive treatment, and drug withdrawal is proposed to reduce this risk. The concept of controlled withdrawal of antihypertensive drugs is new and many practical aspects require further study in randomized controlled trials to determine the longterm effects on important clinical outcomes and quality of life in elderly patients. Given the limited evidence on long-term outcomes of controlled withdrawal of antihypertensive drugs, it must be recognized that withdrawal of antihypertensive drugs is an area of limited evidence, with very few clinical trials assessing long-term clinical effects. This review examines the rationale and potential barriers to the implementation of controlled withdrawal of antihypertensive drugs in the elderly. Recommendations for identifying patients at high risk of adverse events and a deprescribing algorithm are provided.

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The authors declare that there are no conflicts of interest present.