Personalized approach to the treatment of patients with arterial hypertension: focus on imidazoline receptor agonists. Opinion on the problem

Hypertension (HTN) remains one of the most pressing problems of modern healthcare. Morbidity and mortality associated with HTN continue to increase, despite a wide range of available antihypertensive agents and regular updates of related clinical guidelines. In October 2024, an annual forum was held to discuss the optimization of approaches to the treatment of HTN. During the discussion, special attention was paid to personalized therapy of patients, which should be based on modern concepts of the disease pathogenesis and individual risk factors. In addition, the validity of prescribing imidazoline receptor agonists, which are additional agents that lower blood pressure, in certain clinical situations was discussed, along with the main five classes of antihypertensive drugs. In routine practice, it is recommended to consider the use of centrally acting drugs, in particular moxonidine, to control hypertension as part of combination therapy. A central sympathetic inhibition with moxonidine therapy ensures control of blood pressure and has pleiotropic effects, among which the most important is an increase in tissue sensitivity to insulin. This is especially important for the treatment of hypertension in patients with obesity, metabolic syndrome, prediabetes, type 2 diabetes, in patients with various metabolic disorders (hyperglycemia, dyslipidemia, hyperuricemia) and in women in the peri- and postmenopausal period.