Ïîëåçíîå:
Êàê ñäåëàòü ðàçãîâîð ïîëåçíûì è ïðèÿòíûì
Êàê ñäåëàòü îáúåìíóþ çâåçäó ñâîèìè ðóêàìè
Êàê ñäåëàòü òî, ÷òî äåëàòü íå õî÷åòñÿ?
Êàê ñäåëàòü ïîãðåìóøêó
Êàê ñäåëàòü òàê ÷òîáû æåíùèíû ñàìè çíàêîìèëèñü ñ âàìè
Êàê ñäåëàòü èäåþ êîììåð÷åñêîé
Êàê ñäåëàòü õîðîøóþ ðàñòÿæêó íîã?
Êàê ñäåëàòü íàø ðàçóì çäîðîâûì?
Êàê ñäåëàòü, ÷òîáû ëþäè îáìàíûâàëè ìåíüøå
Âîïðîñ 4. Êàê ñäåëàòü òàê, ÷òîáû âàñ óâàæàëè è öåíèëè?
Êàê ñäåëàòü ëó÷øå ñåáå è äðóãèì ëþäÿì
Êàê ñäåëàòü ñâèäàíèå èíòåðåñíûì?
Êàòåãîðèè:
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Ïðîáåëû â äîêàçàòåëüíûõ äàííûõ è íåîáõîäèìîñòü äàëüíåéøèõ èññëåäîâàíèé⇐ ÏðåäûäóùàÿÑòð 76 èç 76
Åñëè ïðîàíàëèçèðîâàòü äîêàçàòåëüíûå äàííûå, íà îñíîâå êîòîðûõ ñîçäàâàëèñü ðåêîìåíäàöèè 2013 ã. ïî ÀÃ, ñòàíîâèòñÿ î÷åâèäíûì, ÷òî íåñêîëüêî òåðàïåâòè÷åñêèõ ïðîáëåì ïðîäîëæàþòñÿ îñòàâàòüñÿ îòêðûòûìè è íóæäàþòñÿ â äàëüíåéøåì èçó÷åíèè: 1. Íóæíî ëè íàçíà÷àòü ìåäèêàìåíòîçíóþ àíòèãèïåðòåíçèâíóþ òåðàïèþ âñåì áîëüíûì ñ Àà 1 ñòåïåíè è íèçêèì è ñðåäíèì ñåðäå÷íî-ñîñóäèñòûì ðèñêîì? 2. Íóæíî ëè íàçíà÷àòü ìåäèêàìåíòîçíóþ àíòèãèïåðòåíçèâíóþ òåðàïèþ áîëüíûì ñòàð÷åñêîãî âîçðàñòà ñ óðîâíåì ÑÀÄ îò 140 äî 160 ìì ðò.ñò.? 3. Íóæíî ëè íàçíà÷àòü ìåäèêàìåíòîçíóþ òåðàïèþ ïàöèåíòàì ñ «ãèïåðòîíèåé áåëîãî õàëàòà»? Ìîæíî ëè äèôôåðåíöèðîâàòü ïàöèåíòîâ ñ ýòèì ñîñòîÿíèåì, íóæäàþùèõñÿ è íå íóæäàþùèõñÿ â ëå÷åíèè? 4. Íóæíî ëè íà÷èíàòü ìåäèêàìåíòîçíóþ àíòèãèïåðòåíçèâíóþ òåðàïèþ â äèàïàçîíå âûñîêîãî íîðìàëüíîãî ÀÄ è åñëè äà, òî êàêèì áîëüíûì? 5. Êàêîâû îïòèìàëüíûå îôèñíûå çíà÷åíèÿ ÀÄ (ò.å., íàèáîëåå áåçîïàñíûå è îáåñïå÷èâàþùèå íàèëó÷øóþ ïðîòåêöèþ), êîòîðûõ íóæíî äîñòèãàòü íà ôîíå ëå÷åíèÿ ó ïàöèåíòîâ ñ ðàçëè÷íûìè äåìîãðàôè÷åñêèìè è êëèíè÷åñêèìè õàðàêòåðèñòèêàìè? 6. Èìåþò ëè ïîäõîäû ê ëå÷åíèþ, îñíîâàííûå íà êîíòðîëå âíåîôèñíîãî ÀÄ, ïðåèìóùåñòâî (â âèäå ñíèæåíèÿ êëèíè÷åñêîé çàáîëåâàåìîñòè è ñìåðòíîñòè, ïðèìåíåíèÿ ìåíüøåãî ÷èñëà ïðåïàðàòîâ, ìåíüøåãî ÷èñëà ïîáî÷íûõ ýôôåêòîâ) ïåðåä ïîäõîäàìè, îñíîâàííûìè íà òðàäèöèîííîì îôèñíîì êîíòðîëå ÀÄ? 7. Êàêîâû îïòèìàëüíûå çíà÷åíèÿ âíåîôèñíîãî (äîìàøíåãî è àìáóëàòîðíîãî) ÀÄ, êîòîðûõ íóæíî äîñòèãàòü íà ôîíå ëå÷åíèÿ, è äîëæíû ëè öåëåâûå çíà÷åíèÿ ó áîëüíûõ Àà âûñîêîãî ðèñêà áûòü âûøå èëè íèæå? 8. Ìîæåò ëè ó÷åò çíà÷åíèé öåíòðàëüíîãî ÀÄ óëó÷øèòü ïðîãíîçèðîâàíèå ñåðäå÷íî-ñîñóäèñòûõ ñîáûòèé ó íåëå÷åíûõ è ëå÷åíûõ áîëüíûõ ÀÃ? 9. Èìåþò ëè èíâàçèâíûå ïðîöåäóðû äëÿ ëå÷åíèÿ ðåçèñòåíòíîé Àà ïðåèìóùåñòâà ïåðåä íàèëó÷øåé ìåäèêàìåíòîçíîé òåðàïèåé è îáåñïå÷èâàþò ëè îíè äëèòåëüíûé êîíòðîëü ÀÄ è ñíèæåíèå çàáîëåâàåìîñòè è ñìåðòíîñòè? 10. ßâëÿåòñÿ ëè äèíàìèêà áåññèìïòîìíîãî ïîðàæåíèÿ îðãàíîâ-ìèøåíåé, îáóñëîâëåííàÿ ëå÷åíèåì, ïðåäèêòîðîì èñõîäîâ? Êàêèå ïàðàìåòðû èëè êàêàÿ êîìáèíàöèÿ ïàðàìåòðîâ íàèáîëåå öåííû? 11. Ìîãóò ëè èçìåíåíèÿ îáðàçà æèçíè, êîòîðûå ñíèæàþò ÀÄ, óìåíüøèòü òàêæå ÷èñëî îñëîæíåíèé è ñìåðòíîñòü ó áîëüíûõ ÀÃ? 12. Ñïîñîáñòâóåò ëè óìåíüøåíèå ñóòî÷íîé âàðèàáåëüíîñòè ÀÄ íà ôîíå ëå÷åíèÿ ëó÷øåìó ïðîòåêòèâíîìó äåéñòâèþ àíòèãèïåðòåíçèâíîé òåðàïèè íà ñåðäå÷íî-ñîñóäèñòóþ ñèñòåìó? 13. Ìîæåò ëè ñíèæåíèå ÀÄ ñóùåñòâåííî óìåíüøèòü ñåðäå÷íî-ñîñóäèñòûé ðèñê ïðè ðåçèñòåíòíîé ÀÃ? Õîòÿ «çîëîòûì ñòàíäàðòîì» ðàçðåøåíèÿ òåðàïåâòè÷åñêèõ ïðîáëåì îñòàþòñÿ ÐÊÈ, òî÷íî òàêæå ÿñíî, ÷òî áûëî áû íåðàçóìíî îæèäàòü, ÷òî íà âñå ýòè âîïðîñû ìîæíî â ïðåäâèäèìîì áóäóùåì äåéñòâèòåëüíî ïîëó÷èòü îòâåò ñ ïîìîùüþ ÐÊÈ. Ðåøåíèå íåêîòîðûõ èç ýòèõ âîïðîñîâ, íàïðèìåð, îá óìåíüøåíèè ñåðäå÷íî-ñîñóäèñòîé çàáîëåâàåìîñòè è ñìåðòíîñòè ïðè ëå÷åíèè áîëüíûõ Àà 1 ñòåïåíè ñ íèçêèì ðèñêîì ñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèé èëè î ñíèæåíèè ÷èñëà ñåðäå÷íî-ñîñóäèñòûõ ñîáûòèé ïðè èçìåíåíèè îáðàçà æèçíè, ïîòðåáîâàëî áû èññëåäîâàíèé íà ìíîãèõ òûñÿ÷àõ ïàöèåíòîâ â òå÷åíèå î÷åíü äëèòåëüíîãî âðåìåíè; êðîìå òîãî, òàêèå èññëåäîâàíèÿ âûçâàëè áû ðÿä ýòè÷åñêèõ ïðîáëåì. Äðóãèå âîïðîñû, òàêèå êàê ïîëüçà ëåêàðñòâåííîé òåðàïèè ïðè «ãèïåðòîíèè áåëîãî õàëàòà» èëè äîïîëíèòåëüíàÿ ïðîãíîñòè÷åñêàÿ ñèëà öåíòðàëüíîãî ÀÄ, ïî ñðàâíåíèþ ñ ïåðèôåðè÷åñêèì, ìîãóò ïîòðåáîâàòü áîëüøèõ óñèëèé îò èññëåäîâàíèé ïðè ñêðîìíîé îæèäàåìîé ïîëüçå. Ïðåäñòàâëÿåòñÿ öåëåñîîáðàçíûì, ïî êðàéíåé ìåðå, â áëèæàéøèå ãîäû, ôîêóñèðîâàòü ÐÊÈ íà âàæíûõ è ëåã÷å ðåøàåìûõ âîïðîñàõ, òàêèõ êàê îïòèìàëüíûå öåëåâûå çíà÷åíèÿ ÀÄ íà ôîíå ëå÷åíèÿ; çíà÷åíèÿ ÀÄ, ïðè êîòîðûõ íóæíî íàçíà÷àòü òåðàïèþ è öåëåâûå çíà÷åíèÿ ó áîëüíûõ Àà ïîæèëîãî è ñòàð÷åñêîãî âîçðàñòà; ñíèæåíèå çàáîëåâàåìîñòè è ñìåðòíîñòè ïðè èñïîëüçîâàíèè íîâûõ ïîäõîäîâ ê ëå÷åíèþ ðåçèñòåíòíîé Àà è âîçìîæíàÿ ïîëüçà îò ëå÷åíèÿ ïàöèåíòîâ èç ãðóïïû âûñîêîãî ðèñêà, íî ñ âûñîêèì íîðìàëüíûì ÀÄ. Ê ðåøåíèþ äðóãèõ âàæíûõ âîïðîñîâ, íàïðèìåð, î ïðîãíîñòè÷åñêîì çíà÷åíèè âíåîôèñíîãî ÀÄ è ïîðàæåíèÿ îðãàíîâ-ìèøåíåé, áîëåå ðåàëüíî ìîæíî ïîäîéòè, åñëè äîáàâèòü îöåíêó ýòèõ ïîêàçàòåëåé â äèçàéí íåêîòîðûõ ÐÊÈ, êîòîðûå ïëàíèðóþòñÿ â áëèæàéøåì áóäóùåì. Ëèòåðàòóðà 1. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21:1011–1053. 2. 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