Petrova M M, Moskaleva P V, Shnayder N A, Nasyrova R F
Voino-Yasenetsky V.F. Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Voino-Yasenetsky V.F. Krasnoyarsk State Medical University, Krasnoyarsk, Russia Bekhterev V.M. National Medical Research Center for Psychiatry and Neurology, Saint-Petersburg, Russia.
Kardiologiia. 2020 Nov 12;60(10):132-140. doi: 10.18087/cardio.2020.10.n1363.
Arterial hypertension (AH) and exertional headache (EHA) are comorbidities. The article presents a nonsystematic review focused on studying the AH+EHA phenotype. The authors addressed the history of studying the phenotype, several theories about its pathophysiological causes (psychosomatic, neuroanatomical, and baroreflector). The protective "hypertension-associated hypoalgesia" phenotype, a mechanism of its change in AH chronization, and difficulties of differential diagnosis are described. The AH+EHA phenotype requires further study since its incidence is quite high. This will allow developing an individualized approach in prevention and treatment of EHA attacks, decreasing the risk of life-threatening cardiovascular complications, and avoiding iatrogenic complications in patients with AH. The main way to prevent the development of AH+EHA phenotype is patient's compliance, which can be provided by using combination hypotensive drugs to reduce the number of pills and dosing. It is important to take into account possible adverse reactions of the nervous system (medication-overuse headache or EHA aggravation). Considering these conditions, the drug Triplixam can be used for prevention of complications in the AH+EHA phenotype. Triplixam is a fixed triple combination of amlodipine/indapamide/perindopril, and its individual components have low and medium risk for development of headache.
动脉高血压（AH）与劳力性头痛（EHA）是共病。本文献呈现了一项聚焦于研究AH+EHA表型的非系统性综述。作者阐述了该表型的研究历史、关于其病理生理原因的几种理论（心身、神经解剖和压力感受器反射）。描述了保护性的“高血压相关痛觉减退”表型、其在AH病程中变化的机制以及鉴别诊断的难点。AH+EHA表型因其发病率相当高，需要进一步研究。这将有助于制定个性化方法来预防和治疗EHA发作、降低危及生命的心血管并发症风险，并避免AH患者出现医源性并发症。预防AH+EHA表型发展的主要方法是患者依从性，可通过使用联合降压药物减少药片数量和给药次数来实现。重要的是要考虑到可能的神经系统不良反应（药物过度使用性头痛或EHA加重）。考虑到这些情况，Triplixam药物可用于预防AH+EHA表型的并发症。Triplixam是氨氯地平/吲达帕胺/培哚普利的固定三联组合，其各成分发生头痛的风险较低和中等。
