Summary of "КАК лечат гипертонию в 2026: ЭТИ ТАБЛЕТКИ уходят в прошлое?"

Core message

Modern hypertension (HTN) treatment in 2026 favors starting most patients on a rational two‑drug combination rather than the traditional stepwise approach (start one drug → uptitrate → add a second only if needed). Combination therapy:

Achieves blood pressure (BP) targets faster and more reliably.
Often causes fewer side effects than high‑dose monotherapy.
Should be individualized based on patient physiology and comorbidities (coronary disease, COPD, gout, salt‑sensitivity, resistant HTN, chronic kidney disease, heart failure).

Evidence highlights

Large trial (~11,000 patients): two‑drug combination lowered BP much more effectively than increasing the dose of a single drug.
Combination therapy reached target BP roughly 20% faster than usual stepwise practice.
ARB (sartan) vs ACE inhibitor (pril): some ARBs provide better 24‑hour BP control than losartan. A cited trial showed candesartan reduced BP by ~13–15 mmHg versus ~7–8 mmHg with losartan in similar patients.
Azilsartan + amlodipine (Edarbi AM) study (~600 patients): after 6 weeks the combination reduced systolic/diastolic BP by ~25/15 mmHg versus ~14.8 mmHg reduction with amlodipine + placebo (monotherapy). Edema incidence was lower with ARB+amlodipine (~3%) versus amlodipine alone (~8%).
Two‑year study in ~2,000 patients with coronary atherosclerosis (average BP ≈130/80): amlodipine reduced cardiovascular events versus placebo (≈110/700 vs ≈150/700); an ACE inhibitor group had intermediate results. This supports amlodipine’s protective effect in atherosclerotic disease.
Chlorthalidone (a thiazide‑like diuretic) is highlighted as highly effective — useful in salt‑sensitive patients, resistant HTN, and some patients with advanced chronic kidney disease.

Key concepts and physiology reminders

Hypertension commonly results from multiple failing regulatory systems: renin–angiotensin–aldosterone, sympathetic/adrenal, volume/salt handling, plus behavioral contributors (obesity, excess salt).
Because multiple mechanisms are often involved, single‑mechanism treatment frequently fails to control BP.
Target BP for most hypertensive patients was presented as approximately <130/80 mmHg.
The primary goal of BP control is to reduce target‑organ risk (heart, vessels, brain, kidneys) and prevent events (myocardial infarction, stroke), not merely to normalize tonometer numbers.

Practical recommendations / methodology

Initial strategy

Start most patients on a two‑drug combination from the outset rather than monotherapy escalation.
Choose rational combinations that target complementary mechanisms (for example, renin–angiotensin blocker + calcium channel blocker, or renin–angiotensin blocker + thiazide‑like diuretic).

Drug‑class choices and when to prefer them

Prefer ARBs (sartans) in many patients — they often give better BP control and have fewer cough side effects than ACE inhibitors. ACE inhibitors still have roles where specifically indicated (e.g., certain CKD indications, heart failure with reduced ejection fraction).
When to choose ARB + amlodipine (ARB + CCB):
- Ischemic heart disease/angina (amlodipine has coronary vasodilatory and antianginal benefits).
- COPD or asthma where beta‑blockers are undesirable (amlodipine does not provoke bronchospasm).
- Metabolic concerns (amlodipine is metabolically neutral and does not raise uric acid — useful in gout).
- Atherosclerotic disease (amlodipine associated with fewer CV events in the cited study).
- Combination reduces common CCB side effect (ankle edema) compared with CCB alone.
When to choose ARB + chlorthalidone (ARB + thiazide‑like diuretic):
- Salt‑sensitive individuals or those with high salt intake.
- Resistant (treatment‑resistant) hypertension.
- Chronic kidney disease — chlorthalidone shown effective even in advanced stages and is relatively kidney‑friendly in context.
- Volume‑dependent HTN (e.g., fluid retention in post‑menopausal women).

Practical prescribing tips

Use 24‑hour ambulatory BP monitoring and reliable home BP measurements to judge control rather than relying solely on office readings.
If a patient on one pill doesn’t reach target, don’t reflexively double the dose — adding a second drug that targets another mechanism is often superior.
Combination formulations (fixed‑dose combinations or co‑packs) can improve adherence. Some options provide flexibility (e.g., separate pills packaged together so dosing can be adjusted easily).

Avoidances and cautions

The worst long‑term strategy is any regimen that persistently fails to achieve BP targets. Avoid chronic reliance on short‑acting emergency agents (e.g., repeated use of captopril or other fast‑acting drugs) as a substitute for a structured regimen.
Do not self‑medicate based on videos or general advice; seek specialist consultation for individualized therapy and monitoring.

Follow‑up and goals

Monitor BP control and target‑organ protection (heart, kidneys, brain). Adjust therapy based on comorbidities, tolerability, and objective ambulatory/home BP data.
Aim for guideline targets and use combination therapy to reach them safely and more quickly.

Practical examples / branded combinations mentioned

Edarbi AM (azilsartan + amlodipine) — effective 24‑hour ARB + CCB combination with lower edema rates and strong BP lowering.
Edarbiclo (azilsartan + chlorthalidone) — ARB + chlorthalidone option for salt‑sensitive and resistant HTN, and CKD support.
Other names mentioned: losartan (referred to as “lazartan”), perindopril (ACE inhibitor), candesartan (referred to as “condosartan”), azilsartan, chlorthalidone, amlodipine.

Takeaway (practical rule‑of‑thumb)

Start with a rational two‑drug combination targeting complementary mechanisms, and choose the combination to match the patient’s comorbidities and likely side‑effect profile. Use ambulatory/home BP data to guide therapy rather than stepwise dose escalation of a single agent.

Speakers and sources featured

Primary speaker: cardiologist Dmitry Liskov.
Guideline sources referenced: modern Russian, American and European cardiology/hypertension guidelines (general references; no specific documents cited).
Clinical studies cited in the video (titles/authors not provided in subtitles):
- Large study (~11,000 people) comparing single‑drug escalation versus combination therapy.
- Head‑to‑head trial: candesartan 16 mg vs losartan 50 mg (greater BP reduction with candesartan).
- Azilsartan + amlodipine (Edarbi AM) randomized trial (~600 participants).
- Two‑year trial in ~2,000 patients with coronary atherosclerosis comparing amlodipine, an ACE inhibitor, and placebo.
- Evidence supporting chlorthalidone’s effectiveness (including use in advanced CKD).
Note: subtitles used transliterated and brand forms of drug names; exact study references were not provided.